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NATIONAL CHILD SURVIVAL
AND SAFE MOTHERHOOD PROGRAMME
I
EVALUATE SERVICE
COVERAGE
Ministry of Health and Family Welfare
Government of India
New Delhi
1992
02275
GOALS AND COMPONENTS OF
NATIONAL CHILD SURVIVAL AND SAFE MOTHERHOOD PROGRAMME
GOALS
o
o
o
o
o
o
o
o
Infant mortality rate reduced from 81 to 75 by 1995 and 50 by 2000.
Child (1-4 years) mortality rate reduced from 41.2 to < 10 by 2000.
Maternal mortality rate reduced from 400 to 200/100,000 by 2000.
Polio eradication by 2000.
Neonatal tetani>c ",™:—— 1—
90% cases by 1995.
Measles - previ
’'5% cases by 2000.
Diarrhoea - pre
% deaths by 2000.
Acute respiratc
Components of this p:
Children
Newborn care at home
Primary immunizatioi
Vitamin A prophylaxis
Pneumonia - Correct c
Diarrhoea - Correct ca
Pregnant Women
^Immunization against
Anaemia prophylaxis a
Antenatal check-up - a
Referral of those with complications
Care at birth - promotion of clean delivery
Birth timing and spacing
ery village.
EVALUATE SERVICE COVERAGE
ADAPTED FROM WHO MODULE
EVALUATE SERVICE COVERAGE
Published by :
Ministry of Health & Family Welfare
Government of India
Nirman Bhawan
New Delhi.
First Published
Revised
Revised
Revised
Revised
Revised
Revised
1985
1986
1987
1988
1989
CHlOl
COMMUNITY HEALTH CELL
326, V Mnin, I Slock
Korambrig; l.i
Bangalore-560034
India
1990
1992
This publication is available in English only
EVAT.UATE SERVICE COVERAGE
CONTENTS
INTRODUCTION
1
COMPONENTS OF COVERAGE SERVICE
2
1.0 Preliminary Activities
1.1 Identify clusters
1.2 Organize details and logistics
Exercise A
6
6
13
8
16
2.0 Field Work
2.1 Selection of first household
2.2 Visit to household
2.3 Next household
2.4 Other clusters
2.5 Selection of household in densely populated urban areas
2.6 Check data collected
Exercise B
Exercise C
16
16
27
27
27
33
28
34
36
3.0 Tabulate Data
Exercise D
Exercise E
37
43
4.0 Evaluate programme
4.1 Evaluation with reference to programme objectives
4.2 Comparison between reported & evaluated coverage
4.3 Comparison between successive surveys
4.4 Dropout rates
Exercise F
Exercise G
44
45
47
48
49
45
50
5.0 Plan revisions in mother-child care activities
52
6.0 Evaluation of Diarrhoeal diseases control
53
54
Exercise II
7.0 Policy on pneumonia control
8.0 Provide feedback
56
57
9.0 Summary
Annexure-I
Annexure-ll
Annexure-III
Annexure-IV
Annexure-V
55
Forms 1 to 11
Lameness Survey
Neonatal tetanus mortality survey
Local Events Calendar
Survey findings on Polio/NNT
58
72
74
77
78
EVALUATE SERVICE COVERAGE
INTRODUCTION
Under the Child Survival and Safe Motherhood Programme, various services are provided
to mothers and children. Every mother must have a safe pregnancy and delivery and every
baby must be assured of a trouble-free birth and survival through the risky early childhood.
This module aims at providing you with skills
o
to conduct a coverage evaluation survey, and
o
to interpret results of the survey for programme management.
It is important to know whether various services planned and instituted are actually reaching
all mothers and children; it is also important to know the quality of services given.
The coverage surveys for Child Survival and Safe Motherhood services help to:
give a true picture of the coverage with select services to the target population;
cross-check results with your routine reporting system;
identify areas with good and poor coverage;
determine whether preventive services are being given at the right age;
identify positive and negative factors affecting the programme and modify the action
plan accordingly; and
identify the extent to which other non-governmental agencies are participating in the
programme to improve coordination in the future.
1
COMPONENTS OF COVERAGE SURVEYS FOR CHILD SURVIVAL AND SAFE
MOTHERHOOD PROGRAMME
1.
Coverage of primary immunization of infants.
2.
Coverage with first dose of Vitamin A, to prevent Vitamin A deficiency.
3.
Correct case management for children suffering from diarrhoea and access for ORS
packets in the village.
4.
Ability of mothers to recognize critical symptoms during acute respiratory infections
in young children, and seek appropriate care.
5.
Coverage with tetanus toxoid immunization and iron and folic acid supplementation
to all pregnant women; proportion of pregnant women receiving antenatal care.
6.
Proportion of pregnant women delivered at institutions and attended to by trained
personnel.
7.
Coverage with services for timing, spacing and limiting births.
Done on a periodic basis (for example, once a year) a coverage evaluation survey will
provide you with reliable information which you can use to make changes, if necessary, in
your programme activities. You will specifically learn, whether you are meeting your
immunization and other programme coverage objectives or not.
IMMUNIZATION
Organizing immunization activity in communities by itself does not guarantee a reduction in
disease morbidity and mortality. The full course of vaccines must be given at the right age,
at the right interval and vaccines used must be potent.
As a programme manager, you will be interested in accurate information on immunization
coverage and the reasons when coverage levels are below your expectations. Low coverage
is mainly due to:
o
Poor attendance
o
High drop outs
2
If there is poor attendance in the immunization sessions or beneficiaries do not return for
the subsequent doses, then you should know the reasons for this. Only then you will be able
to take corrective action. This supplementary information is also collected during surveys.
In the absence of surveys, you have to rely on health centre records only, which may provide
inaccurate or misleading information. For example, health centre records may indicate that
80% of children in a community are being immunized. A coverage evaluation survey may
show that 30% of these children have been immunized at the wrong age. You must conduct
a field survey to have an accurate idea of how many people are being immunized. This can
be done in a systematic way so that only a sample of the population will need to be surveyed
to obtain valid results.
Immunization as an activity is not an end in itself. It should lead to immunity against the
disease and reduction in morbidity and mortality.
I:
CONTROL OF DIARRHOEAL DISEASES
The mainstay of diarrhoeal diseases control programme is correct case management. This
has two major components - ability to diagnose dehydration early and ORAL
REHYDRATION THERAPY (ORT). ORT is the major strategy to control deaths due to
diarrhoea during epidemics also. Thus, as a programme manager, you need to know the
commonly available fluids in your area which can be given for diarrhoea as Home Available
Fluids.
The coverage surveys will provide answers on:
o
Do family members give increased amounts of fluids to a child with diarrhoea?
o
Do mothers/family members continue feeding a child during diarrhoea?
o
Do they have adequate knowledge to recognize dehydration in order to seek expert
help?
o
Do they get ORS packets whenever required within the village?
o
Do they get ORS packets whenever required from a health facility?
The answers to the above questions should lead to a better understanding of the status of
the programme at the community level. Based on such an understanding, action can be
initiated for improvement.
3
CONTROL OF ACUTE RESPIRATORY INFECTIONS
The major cause of death in children with acute respiratory infection (ARI) is pneumonia.
Mortality in ARI can be significantly reduced by early detection and treatment of
pneumonia.
The key strategy is:
o
Early recognition of pneumonia by members of the family and health workers
o
Initiating therapy by health workers with cotrimoxazole.
From the coverage survey, we assess the capacity of family members to recognize the danger
signs in a case of acute respiratory infection. This would give us information on the
effectiveness of our communication, for seeking appropriate therapy in time.
CONTROL OF VITAMIN A DEFICIENCY
Every child in the age group 9 months to 3 years should receive five mega doses of Vitamin
A at 6 monthly intervals to prevent deficiency. Every infant coming for measles vaccine
should receive the first dose of 100,000 LU. of Vitamin A. During the second and third year
of life, the child should receive four additional doses of 200,000 LU. of Vitamin A at 6
monthly intervals. As a programme manager, you will be interested in determining whether
all children below 3 years in your area are receiving the Vitamin A doses in time. Routine
monthly reports provide this information. However, it is important to have an additional
source of data for programme management. The coverage survey provides information on
the proportion of children who receive the first dose of Vitamin A.
CONTROL OF ANAEMIA IN PREGNANT WOMEN
Anaemia is responsible for deaths in pregnant women. Pregnant women are the most
important group that require prophylaxis and treatment with iron and folic acid tablets
(IFA). We must ensure that every pregnant woman consumes 100 tablets of iron and folic
acid as prophylaxis; and all women with anaemia diagnosed clinically should consume 200
tablets of iron and folic acid (one tablet of IFA twice a day). The coverage survey provides
information on the proportion of pregnant women who have received prophylactic as well
as therapeutic iron and folic acid tablets.
4
T*
CARE OF PREGNANT WOMEN
Every pregnant woman will have at least three ante-natal check-ups. This information is
available from routine monthly reports; coverage surveys will also provide data on this for
programme managers.
The coverage evaluation surveys provide information on the proportion of women delivered
at different places and the proportion delivered by trained birth attendants/personnel.
TIMING, SPACING AND LIMITING BIRTHS
Delaying first pregnancy upto 20 years of age and spacing of births at a minimum of 3 years
interval increases child survival and promotes safe motherhood. Under the programme you
will promote a two-child norm.
The coverage survey provides information on the proportion of mothers or couples practising
any of the methods for spacing or limiting births.
The service coverage survey also provides information on the age of the immediately elder
sibling of the child being assessed for immunization. In case the child being assessed has a
younger sibling, you will obtain that information instead. This gives information on the trends
of birth spacing in the population. The age of the mother at first pregnancy is also noted.
A note on exercises:
Exercises in this module are organized differently. They are sometimes long, and have not
been separated from the text of the module. Answers may be provided for some exercises
to save time. Ask your facilitator for help whenever you are unsure about what you are
supposed to do.
Additional information can be collected during the survey, which is not part of the service
coverage evaluation, but can still provide information for you as a manager of the Child
Survival and Safe Motherhood programme. In this module,, surveys for (i) the neonatal
tetanus and (ii) lame children under 5 years have been included as Annexures II and III.
5
1.0
PRELIMINARY ACTIVITIES
1.1
IDENTIFY CLUSTERS
The first step for any evaluation process is the systematic collection of data. For an
evaluation of immunization coverage as well as coverage with other services, data need to
be systematically collected on the number of children and pregnant women immunized (a)
by vaccine and select services and (b) by age. The assessment should be done by people who
did not perform the immunizations. The method used is the cluster sampling technique. A
cluster is a randomly selected group. In this case it is a group which has at least 7 children
in the age group of 12 to 23 months. The minimum age of children should not be less than
one year. For mothers, a group of 7 mothers, each of whom delivered a baby in the last one
year, forms a cluster.
The cluster sampling technique allows a small number of the target population to be
sampled and provides data which are statistically valid.
A survey containing 30 clusters of 7 children will give you information on what proportion
of eligibles are being properly immunized. Statistically it will meet the following standards
of reliability:
♦
The data obtained from the survey will have a level of accuracy of plus or minus
10%. For example, if the survey shows
immunization coverage of 70% in the
sample, the actual coverage in the target population will be between 60% and 80%.
*
19 out of 20 times the result of the survey will be within the stated level of accuracy.
The level of confidence is 95%, which means there is a 95% probability that the
survey results will fall within the range listed above (plus or minus 10% of the
coverage in the target population).
*
The survey data will reflect coverage of a period of 1 year prior to the date of survey
*
The results will reflect coverage in the area as a whole. Comparisons between clusters
are not valid.
Data will be valid only when the thirty clusters are randomly selected. A randomly selected
cluster or group is one which is chosen by chance. You will learn from this module how to
choose such groups. To do this, you must know how to select a random number. A random
number is a number chosen from many numbers, each of which has as much chance of being
selected as the number finally chosen. Choosing numbers from memory is not a satisfactory
method for selecting random numbers because unconscious biases occur. Certain numbers
tend to be selected more frequently than others by certain individuals. If you do not have
a table of random numbers you could use the numbers on currency notes. To identify a
random number from a currency note, start with the last digit of the serial number.
6
Under the direction of the course facilitator, work through the following examples using the
serial numbers on currency notes to select random numbers:
1.
Choose a one-digit random number between 1 and 9, both numbers included.
2.
Choose a two-digit1 random number between 01 and 87, both numbers included.
3.
Choose a three-digit2 random number between 001 and 345, both numbers included.
4.
Choose a four-digit random number between 0001 and 9,053, both numbers included.
5.
Choose a five-digit random number between 0001 and 48,321, both numbers included.
If the random number you select from a currency note is larger than the highest acceptable
number, you will have to select another number. You can do this by taking the next 3 digits
from the right to left. For instance, in number 3, if you select a number which is more than
345, you will need to choose another random number. For example, if the currency note
number was 362515, the first random number would be 515. This number is higher than 345.
So you select the next 3 digits - 251, which is within 345.
Please note that the survey methods described in this module will allow you to draw
conclusions about the area surveyed as a whole and they will not permit you to make
comparisons between different sub-sections of the total area. Therefore, if you want to
compare, for example, urban with rural areas, or areas using one strategy with areas using
some other strategy, you will have to do a separate survey in each area. For the evaluation
of Child Survival and Safe Motherhood programme, the district as a whole is taken including
the urban and rural areas. While, each individual survey, irrespective of population has the
same methodology, the minimum population of the area should be over 50,000. This will
allow adequacy of Sample size and be cost-effective.
All 30 clusters must be surveyed within a short and defined period of time, ideally within one
week. This is necessary to ensure that they accurately represent the same population.
The theories behind cluster sampling are statistically valid but complex. What you need to
know is how to use the technique and the fact that statisticians agree that it produces useful
results.
i
01 is a two digit number
2
001 is a three digit number
7
EXERCISE A
The following guidelines describe the steps for identifying clusters. Refer to the example
provided on pages 9 to 13 as you read. You will note that some information is missing from
this example (for example, the sampling interval number). In this exercise you will be asked
to supply the missing information. Using the instructions given below for completing a cluster
identification form, you will identify clusters 1-7 (clusters 8-30 have already been identified).
1.
List all villages and sectors/wards of cities and towns included in the area for which
service coverage is to be evaluated. This step has already been completed for you.
In this exercise the area to be evaluated is district ’A” under child survival and safe
motherhood programme. All towns and villages of this district have been listed on
cluster identification form on pages 10 to 13.
2.
Against the name of each village or ward, write the individual population of this
village or ward. This has been completed for you.
3.
Calculate and write in the cumulative population of each village or ward. This is done
in the serial order in which the villages or wards are listed. This has already been
completed. The total cumulative population of the district is 8,00,000.
4.
Determine the sampling interval. Use the formula provided below. Round all
decimals off to the nearest whole number.
Total cumulative population
30 clusters
=
Sampling Interval
Using the above formula, calculate the sampling interval in District ’A’: Enter the
number in the space provided at (A) on the bottom of the Form on Page 13.
5.
Select a random number which is less than or equal to the sampling interval. The
number you select must have the same number of digits as the sampling interval. As
your sampling interval in the exercise turns out to be five-digit number, the random
number selected must also be a five digit number that is, between 00001 and the
sampling interval.
For the purpose of this module, the random number, 12,762 has already been
selected. Enter this number at (B) on the bottom of the Form on page 13.
6.
8
Identify the community in which Cluster 1 is located. This is done by locating the first
village on the Form on page 10 in which the cumulative population equals or exceeds
the random number. Write "1” beside this village.
T-
7.
Identify the community in which Cluster 2 is located. Use the formula provided
below.
Random No. -+- Sampling Interval
Note that the cumulative population listed for that village will equal or exceed the
number you obtain by addition.
8.
Identify Clusters 3, 4, 5, 6 and 7 (Clusters 8-30 have already been identified). Use the
formula provided below:
Number which
identifies the
location of the
previous cluster
)
) + Sampling Interval =
)
)
Using the data provided in the Form write the number of each cluster lf 2, 3, 4, 5, 6 and 7
besides the appropriate villages on the Form at page 10. A single village or town may contain
more than one cluster.
If you have completed step 8,
discuss with your course facilitator.
9
CLUSTER IDENTIFICATION FORM
(SAMPLE FORMAT)
CITIES, TOWNS AND VILLAGES OF DISTRICT ’A’
SI.
No.
Name of the
Village
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
Rampur
Nankheri
Chopal
Lal Path
Tiara
Nagrota
Chadar
Shapur
Haripur
Nurpur
Paragpur
Sidhbari
Sadwar
Indore
Jwalapur
Gopalpur
Hathnikund
Manpur
Deora
Bhagani
Taruwala
Bheriwala
Majra
Sataun
Shilla
Jataun
Mahakaal
Lalru
Viratpur
Pipli
Udaypur
Kalibari
Fatehpur
10
Jagatpur
Mewa
Aut
Shamshi
Population
12,888
3,488
6,826
4,339
2,203
4,341
1,544
885
2,962
4,234
1,520
3,767
3,053
60,000
2,207
1,355
833
4,118
2,782
3,285
4,416
3,188
1,179
612
3,193
17,808
3,914
15,006
9,584
4,225
2,652
35,000
3,954
2,115
507
3,516
14,402
Cumulative Cluster
Population No.
12,888
16,376
23,202
27,541
29,744
34,085
35,629
36,514
39,476
43,710
45,230
48,997
52,050
112,050
114,257
115,612
116,445
120,563
123,345
126,630
131,046
134,234
135,413
136,025
139,218
157,026
160,940
175,946
185,530
189,755
192,407
227,407
231,361
233,476
233,983
237,499
251,901
8,9
SI.
No.
Name of the
Village
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
Andheri
Mohkampur
Dinajpur
Kandaghat
Banjar
Rohini
Tori Devi
Durgapur
Bagipal
Berthin
Sheshnag
Aam Wala
Varun
Bouli
Babri
Darpan
Ompura
Gangath
Nagwaih
Wazirpur
Onam
Kamirao
Paonta
Naggar
Patti
Anand
Pali
Nangal
Hazira
Yol
Chalana
Laksar
Rambasti
Angadpur
Ransiha
Phulpur
Dugana
Bakhtari
Wajiba
Tanda
Sapnera
Population
2,575
3,105
4,176
4,176
3,261
4,270
3,301
3,250
4,670
757
12,037
2,155
3,702
2,262
791
3,468
4,338
3,930
2,112
3,953
,198
9,891
3,154
2,548
1,034
2,415
4,325
13,233
511
2,313
3,108
4,163
4,250
784
3,423
4,098
4,540
2,322
3,987
4,211
2,541
Cumulative
Population
254,476
257,581
261,757
265,933
269,194
273,464
276,765
280,015
284,685
285,442
297,479
299,634
303,336
305,598
306,389
309,857
314,195
318,125
320,237
324,190
326,388
336,279
339,433
341,981
343,015
345,430
349,755
362,988
363,499
365,812
368,920
373,083
377,333
378,117
381,540
385,638
390,178
392,500
396,487
400,698
403,239
Cluster
No.
10
1
2
11
SI.
No.
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
12
Name of the
Village
o
Nerwa
Nagarjun
Kiarada
Vareli
Rakhani
Jaipur
Throach
Yashpur
Mahilpur
Pallavi
Agrakhan
Tadu
Jubbal
Paintai
Larji
Lalkudi
Champa
Dhakon
Birla
Hidimba
Badabagh
Lalpani
Tejpur
Lana
Jhandu
Gogna
Agre
Eknath
Sawra
Lalmani
Doaba
Sagar
Garli
Mahua
Mehla
Tatpur
Ekgran
Pamposh
Oonchagram
Tissa
Sangam
Population
848
1,281
3,310
4,313
4,762
3,647
2,530
16,983
2,730
4,869
3,300
4,150
3,760
1,587
16,699
2,703
747
4,451
4,425
3,860
2,835
1,725
3,988
4,124
4,389
1,126
2,166
3,393
4,787
3,447
3,689
4,696
60,000
3,990
4,754
4,121
3,214
16,008
4,732
2,769
532
Cumulative Cluster
Population No.
404,087
405,368
408,678
412,991
417,753
421,400
423,930
440,913
443,643
448,512
451,812
455,962
459,722
461,309
478,008
480,711
481,458
485,909
490,334
494,194
497,029
498,754
502,742
506,866
511,255
512,381
514,547
517,940
522,727
526,174
529,863
534,559
594,559
598,549
603,303
607,424
610,638
626,646
631,378
634,147
634,679
6
7
20
21,22
23
24
2.0
FIELD WORK
2.1
SELECTION OF THE FIRST HOUSEHOLD
When you reach the selected cluster, you should go to the centre of the village and select
the first house by the following random selection procedure. Number the paths leading from
the centre. Use a currency note and look at the last digit of the serial number. Select the
path you will take. Next, count or estimate as accurately as possible the number of houses
from the centre of the village to the boundary along that path. Then, select a random
number between 1 and the total number of houses. This number represents the first house
from which you will start the survey. The first house and the direction the investigator
identifies for the survey should be at random.
Before beginning the survey in the field, complete the appropriate space for cluster number,
date of survey, locality and surveyor’s name on the forms.
2.2
VISIT TO HOUSEHOLD
As you will be visiting a small percentage of the households only, it is important that you ask
every question carefully and that you visit the households according to the following
procedure.
When you reach the first household enter the time begun on Form 3 (Child Coverage
Form).
Before you commence the interview, you should explain the purpose of the visit to the
mother, family head or other responsible member of the family. If there is no responsible
member present who can answer questions and a Mother-infant immunization card is also
not available then skip the household and make no entry on the form.
2.2.1
Recording on "Household tally marking form" (Form 1)
You should first ask if there are any children under 5 years of age (children who have not
completed 5 years) in the household. If there are no children under 5 years of age in the
household, put a ’O’ in the appropriate space on Form 1 and then proceed to the next
household. If there are children under 5 years of age, enter the number of children in the
appropriate space on Form 1. Ask questions 3, 4 and 5.
Next ask question number 6 if the answer is ‘yes’, administer questions 7, 8, 9 and 10. The
response for items 7 and 8 will be as per codes indicated and for 9 and 10 it will be ‘yes’ or
‘no’. Similarly administer items 12 and 13 and mark ‘Y’ for ‘yes’, ‘N’ for ‘no’ and ‘DK’ for
‘don’t know’ (item 12).
16
Optional:
List of Lame Children (Form 2)
Additional Questions for the Cluster Survey Form
(Form 6)
Forms for analysis :
Cluster Summary Forms for the four essential forms
mentioned earlier (Forms 7a,7b,8,9). Form 10 & 11 are
the cluster summary forms for the optional forms - 2
and 6.
(ii)
Pencil, rubber
(iii)
File board
(iv)
Vitamin A dispensing spoon and syrup.
1.2.2
Children included in the survey
The survey is conducted for children of 12 to 23 months of age. To determine the earliest
acceptable date of birth you will subtract exactly 24 months from the date of interview. To
determine the latest acceptable date of birth, you will subtract exactly 12 months from the
date of interview. For example, if the survey is starting on 23 April 1992 then the earliest
date of birth would be 23 April 1990 and the latest 23 April 1991.
In addition, during the household tally marking you will investigate for episodes of diarrhoea
and acute respiratory infections in children below 5 years and the practices adopted to
prevent or treat dehydration.
1.2.3
Household
A household is defined as a group of people sharing the same kitchen. You may find many
households in a single building, specially in the urban areas.
Tenants and servants living in the same building but maintaining separate kitchens are
counted as different households. On the other hand, families of, say, two brothers living in
the same house and sharing the same kitchen are counted as one household.
1.2.4
Resident child
A child residing for last 6 months or more in the area is considered resident Records of all
children in the correct age group must be taken. If there is a child who is from outside the
area but residing in the household for 6 months or more, that child should also be
considered a resident.
15
1.2
ORGANIZE TEAMS AND LOGISTICS
Once the clusters have been identified, it will now be necessary to take action for field work.
For this you will do the following:
1.
Make a list of people who will help you in the survey. They should not be those who
are directly involved in the immunization programme in the area under survey.
2.
Explain carefully to this group exactly how the work is to be done in the field. (This
is discussed in the next chapter). Make sure that every member of the team has
understood the directions. Each member should practise filling the forms so that they
know exactly how it should be done.
3.
If the distances of the clusters from the district headquarters and between the clusters
is large (as it is likely to be in a district) make travel arrangements in time. The
routes should be chalked out in advance. It may be possible for one vehicle to drop
several teams to their clusters. Transport facilities are particularly important if every
team is expected to visit two clusters a day. The distances should be such that there
is no problem in completing the survey.
4.
Ensure that adequate copies of printed forms for survey are available.
5.
Assign responsibility for checking individual household/coverage forms as soon as the
team returns from survey. Ideally, all forms should be checked by an experience^
supervisor at a location not far from the cluster to allow for return to the cluster .to
correct any errors.
6.
Assign responsibility for compilation and analysis of data and preparing a report.
Analysis of data should be done immediately on receipt of data from all clusters. The
formal report should be completed within one week of the survey.
CHECKLIST OF ITEMS REQUIRED FOR FIELD WORK AND ANALYSIS
(i)
Forms:
Essential
Optional
-4
-2
For field work
Essential:
14
Household Tally Marking Form (Form 1)
Child Coverage Form (Form 3)
Reasons for Coverage Failure (Form 4)
Mother Coverage Form (Form 5)
SI.
No.
Name of the
Village
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
Bassi
Okhla
Dadosiba
Sarin
Rakkar
Chakra
Wachal
Math
Basti
Hastina
Thana
Kalsi
Charak
Korga
Angana
Lohgarh
Kartik
Lepoh
Deogarh
Oddi
Ulta
Shergil
Akola
Tattapani
Parvati
Mashobra
Hansa
Hathras
Rupam
Alampur
Kollipara
A
Sampling interval
Population
1,143
3,394
8,147
4,555
695
3,634
2,115
4,507
3,516
2,402
3,575
14,005
676
45,000
4,261
4,919
17,270
3,837
2,149
3,702
1,927
4,971
2,468
3,383
3,930
3,585
1,355
4,285
3,177
1,420
1,318
Cumulative
Population
Cluster
No.
635,822
639,216
647,363
651,918
652,613
656,247
658,362
662,869
666,385
668,787
672,362
686,367
687,043
732,043
736,304
741,223
758,493
762,330
764,479
768,181
770,108
775,079
777,547
780,930
784,860
788,445
789,800
794,085
797,262
798,682
25
26
27
28
9
30
800,000
Total cumulative population
(800,000)
Total No. of clusters (30)
B
Random Number
13
A
Form No. 1
HOUSEHOLD TALLY MARKING FORM
District
Cluster No.
Cluster Name
i.
Household No.
2.
No. of children
under 5 years
Range of dates of birth
From
Till
1
2
3
4
5
6
7 8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31-75
M
F
3.
No. of live births
within last 1 year
M
F
4.
5.
No. of deaths
within 4 weeks of
birth in last 1 yr
M
No. of deaths
within 1 year of
age in last 1 yr.
M
F
F
6.
No. of deaths
M
in 0-5 yrs., of old
in last 1 year
F
7.
In the past two
weeks did any
child under 5 yrs.
have diarrhoea
M
F
8.
If yes, what did
you give the child
9.
Did you give more, less
or same amount of food
as diarrhoea started, or
did you stop feeding
during diarrhoea
10. Did you receive ORS from
within your village
11. If you sought help from
any health facility,
did you get ORS?
12. During the past two M
weeks did any child
under 5 years have
F
cough or cold
13. Did your child have fast
breathing, difficult
breathing or chest
indrawing
14. If yes, did you seek help
from a health facility
For question Nos. 7, 10, 12 and 14, mark *¥’ for Yes and 'N' for No for appropriate answers.
For question No. 13, mark
for Yes, 'N' for No and 'DK' for do not know.
For question No. 8, Mark (1) for 'no fluids’ (2) for home available fluids (3) for ORS and (4) for other options.
For question No. 9 mark 'M' for more, 'S' for same, 'L' for less, 'W for stopped and ’DK' for do not know.
Date :
INVESTIGATOR'S NAME AND SIGNATURE
17
Age of the child
You can calculate the earliest acceptable date of birth by subtracting exactly 5 years from
the date of survey. For example, if the survey is being done on 23 April 1992, the earliest
acceptable date of birth would be 23 April 1987. All children born after this date should be
included in the survey (Form 1). If the mother/family member finds it difficult to assess the
age of the child, you may help her to remember by referring to local festivals/events. A
sample of a calendar with local events is given in Annexure-IV.
Infant and neonatal deaths
Enquire about any birth or death of an infant in the family during the past one year. The
death of a baby within the first four weeks of life must be specifically asked for and the
information entered separately under item 4. The infant death under item 5 includes all
deaths below one year of age including the deaths entered under item 4.
Diarrhoea
When stools contain more water than normal, it is called diarrhoea. For question No. 6 on
diarrhoea, please indicate ’Y’ for Yes and ’N’ for No. In case, more than one child have
suffered diarrhoea in the last two weeks, the response should be ’Y’. However, for questions
7 to 10 the responses for the youngest child who suffered diarrhoea should be entered as per
legend at the bottom of the form.
Pneumonia (ARI)
When you are filling up the questions (11 to 13) on cough and cold, you will obtain data on
the morbidity level of the same among under fives in the community. It also tells us the
proportion of mothers who can recognize fast breathing and chest-indrawing and the
treatment seeking behaviour of mothers/care-givers.
Poliomyelitis
You should then ask if any child less than 5 years of age is lame. List the names of such
children in the Form 2. This will be done as an optional part of evaluation of service
coverage. Please note that the sample size will have to be much larger. More details are
included under Annexure II.
Child Immunization Status
Once the data regarding children under 5 years of age in the household have been entered
on the Household tally marking and Lameness form (optional), you should determine if
there are any children under 2 years of age in the household. Complete the child coverage
form for children of 12-23 months, Reasons for coverage failure form, Mother coverage form
(Forms 3, 4 and 5) and Additional questions for Coverage failure (Form 6).
18
2.2.2
Recording on "Child Coverage Form" (Form 3)
The child coverage form is for children from 12 to 23 months of age. The earliest and latest
acceptable date of birth are calculated by subtracting exactly 24 months and 12 months from
the date of interview. If the coverage survey is done on 23 April 1992, the date of births of
children to be surveyed must fall between: 23 April 1990 and 23 April 1991.
If there is no child aged 12-23 months, make no entry on the Child Coverage Form.
If there is a child of the particular age, request the mother or a responsible person to
produce the following documents (if available):
1.
2.
Child’s birth registration certificate (Janma Pramana Patra) and
Mother-infant immunization card or record.
These documents should as far as possible be produced for every child. You should
complete the survey form as follows:
Range of date of birth
23 April 1990 to 23 April 1991
Time begun
Enter time when survey is begun in the cluster
Time completed
Enter time when the survey form is completed in the cluster
Name, address and sex
Enter name of the child. Next enter name of child’s father or
mother and address. Also record the sex of the child.
Child number
The child’s number ranges from 1 to 10. The child numbers 8,
9 and 10 have also been included. Please remember that eligible
children in excess of 7 should be included only if they are also
living in the same household as the 7th child.
Sibling interval in months Ask if the index child has a younger sibling. If so, ask the age of
the immediately elder sibling. Record the difference in age (in
months) between the index child and the younger (in the
absence of younger, the older) sibling. If the index child has no
sibling record ‘O’.
Date of birth
Enter date of birth, e.g. 24/2/91 or 2/91. If possible verify with
any available record produced by mother, whether the date falls
between 23 April 1990 and 23 April 1991 (both dates inclusive).
Immunization Card
If a card or any record is present, documenting the immuniza
tion mark ( + ) in box. If no record is available, mark (-) in box.
19
Form-3
CHILD COVERAGE FORM
District
Range of dates of birth
From
Cluster No.
Cluster Name
Till
CHILD NUMBER IN CLUSTER
1
2
3
4
5
6
7
8
9
10
Total
Name
Father's Name & Address
Sex : M/F
Sibling interval in mnths
Date of Birth
IMMUNIZATION
CARD
Yes
No
DPT 1
Date
Source
DPT 2
Date
Source
DPT 3
Date
Source
POLIO 1
Date
Source
POLIO 2
Date
Source
POLIO 3
Date
Source
MEASLES
Date
Source
BCG
Date
Scar +/0
Source
VIT A Dose 1
Date
Source
Whether fully immunized
HOS - Hospital, HC-Health Centre, SC - Sub-Centre, OUT - Outreach or
village and PRV - Non-Governmental or Private Sector facilities.
Indicate against the column total the dose totals for each vaccine/Vitamin A under the same five
sub-headings i.e. HOS/HC/SC/OUT/PRIV.
Source (Place of Immunization) :
Time Begun
Time completed
20
Investigator's Name and Signature
For boxes DPT 1, 2, 3; Polio 1, 2, 3; Measles; BCG and Vitamin A*
Enter date of every dose of immunization and the first dose of
Vitamin A e.g. 18/8/90 or 8/90. Verify date with immunization
card or record if available.
Date
If the card is not available, enquire from mother if the child has
been immunized or has been given the first dose of Vitamin A.
If the answer is Yes, enter the month and year in the box for
the relevant dose.
If a child has not received a dose, put "O" in the box for the
relevant dose.
BCG Scar
Examine child’s upper arm and enter "+" if scar is present. If
there is no scar enter "O". If the child is not available for
examination, enter "A”.
Source
Fill in source of immunization/lst dose of Vitamin A. Put HOS
for government hospital, HC for government health centre or
sub-center and other fixed centres providing immunization
services. OUT for outreach and PRV for non-governmental or
private hospitals, clinics or practitioners.
♦
In order to familiarize the mother with Vitamin A, the syrup in the standard plastic
spoon administered usually must be shown to her. This is necessary if the card is not
available for verification.
0^27^
C ///Of
c
COMMUNITY HEALTH CEU
326, V Main, I Block
Korambngnfa
Bangalore-56 0034
India
21
2.2.3
Recording on "Reasons for Coverage Failure Form" (Form 4)
Once the Form 3 (Child coverage form) is completed, determine whether the child is fully
immunized. The immunization status of the child is entered as FULLY, PARTIALLY OR
NOT IMMUNIZED by placing a mark
in the relevant box of Form 4.
FULLY
BCG (1), DPT (3), OPV (3), Measles (1).
PARTIALLY
Some doses of vaccine have
immunization is not complete.
NOT IMMUNIZED
Not even a single dose of any vaccine has been administered.
been
administered
but
For a PARTIALLY IMMUNIZED CHILD or a NOT IMMUNIZED CHILD, ask the
responsible person to give the most important reason why immunizations were incomplete
or not done. This is an open ended question. Wait till the respondent answers in her or his
own words. Do not read out the list of possible answers. Put a mark
in the box(es) for
the relevant reason(s): If a reason given is not on the list, use the blank space provided.
The
should be marked in the same column as the number of the child. For example, if
the children Nos. 3 and 5 were partially immunized, mark the given responses in columns
3 and 5 only. Other columns will be left blank.
For a child who was not given Vitamin A prophylaxis - ask whether it was available. Write
Y for YES, N for NO and DK for DO NOT KNOW.
Next, ask the mother, would she give her child Vitamin A prophylaxis if it is made available.
Write Y for YES, N for NO.
22
FORM NO. 4
REASONS FOR COVERAGE FAILURE FORM
Range of dates of birth
From
Till
District
Cluster No.
Cluster Name
Child number In cluster
Immuni
zation
status
Lack of
infor
mation
1.
Fully immunized
2.
Partially immunized
3.
Not immunized
1.
Unaware of need for immunization
2.
Unaware of need to return for 2nd or
3rd dose
3.
Place and/or time of immunization
unknown
4.
Fear of adverse reactions
5.
Wrong notions on contraindications
1
2
3
4
5
6
7
8
9
10
Total
6.
Lack of
moti
vation
Obstacles
1.
Postponed till another time
2.
No faith in immunization
3.
Rumours
1.
Place too far
2.
Time inconvenient
3.
Vaccinator absent
4.
Vaccine not available
5.
Mother too busy
6.
Family problem, mother ill
7.
Child ill, not brought
8.
Child ill brought, not given
9.
Long waiting time
10.
Vitamin
A
Prophyla
xis
Note :
1.
Prophylaxis given
2.
Prophylaxis not given
3.
Availability
Y/N / DK
4.
Acceptability
Y/N
Ask only one question i.e.
Why was the child not immunized? or
Why was the child not fully immunized?
Mark (/) the most relevant rcason(s) according to your judgement.
Date :
Invcstigntor’s Name and Signature
23
2.2.4
Recording on the "Mother Coverage Form" (Form 5)
The information entered on the Mother coverage form (Form 5) should be for mothers who
had delivered in the last 12 months. If the survey is conducted on 23 April 1992, all mothers
delivered after 23 April 1991 would be included.
Age at the time of first pregnancy
Ask the mother her age at the time of her
becoming pregnant for the first time. You will
determine if the first pregnancy was either too
soon or too late through this question.
Date of last delivery/abortion
Ask the mother if she had either a delivery or
abortion before the one on which you are
collecting information. If yes, record the month
and year of the delivery/abortion. You will
determine whether the birth interval between
successive pregnancies is adequate or not, by the
answer.
Range of dates of birth
Between 15 April 1991 - 15 April 1992
Date of birth of Child
As we are assessing only the mothers who had
delivered in the last 12 months the date of birth
of the Child should be within one year of the date
of survey.
Immunization card3
Ask for immunization card or any other record of
immunization of the mother.
TH, TT2/Booster
Determine if any dose of TT was. given prior to
this delivery. Enter the date of the first dose of
TT in the box for "TT1". Record the date of the
second dose or booster in the box for
TT2/Booster.
3
24
If an immunization record is not available, ask the mother if she has ever been immunized.
Try to determine if the immunization was for tetanus. If you are convinced that the mother
received TT then enter dose in the box for TT. If the month and year is not known ascertain
the same by asking in which month of pregnancy it was given and when she delivered or how
old the baby is now. If the mother has received more than 1 dose of TT and the most recent
dose was during pregnancy enter month and year for TT2 or booster. If possible try and verify
the immunizations reported with records at the Health Centre.
FORM NO. 5
MOTHER COVERAGE FORM
Range of dates of birth
From
Till
District
Cluster No.
Cluster Name
Mother number In cluster
Your age
at first
pregnancy
1
2
3
4
5
6
7
8
10
9
Total
< 20 years
20 - 30 years
> 30 years
Date of last delivery/abortion
Date of birth of Child
Immunization Card
Yes
Other records
Date
TIT
Source
TT2 / Booster
Date
Source
Iron and Folic acid
tablets
Given (mention numbers)
Consumed Y/N
Source*
Antenatal care
Yes/No
Govt, or private
HC/Hospital
Place of delivery
Home
Other
I
Health staff
Trained Dai
Attended by
Untrained Dai
Other
Family Planning Method**
Source (Place of immunization): Govt. Hospital - HQs; Govt. Sub-centre - SC
Outreach - OUT; Govt. Health Centre - HC; Non-Govt. Hospital/Private Clinic - PRIV
FP method - 1 None, 2 temporary - Condom/IUD/Oral pill, 3 permanent tubectomy/vascctomy and 4 natural.
Time started
Time finished
Date
Investigator’s name and signature
25
TT1, TT2/Booster (contd.)
The code for the source of Tetanus immunization must
be entered below the date of the corresponding dose.
The code is the same as in the child coverage form
(Form No. 3).
Iron and folic acid tablets
Record the number of iron and folic acid (IFA) tablets
given by the health worker in the box provided, if that
information is available from card or if the mother
remembers the number. If some IFA tablets were given
but the mother is not sure of the quantity enter ',+” only.
If no tablets were given mark ”O".
Ante-natal care
If the mother had at least three ante-natal contacts
during the current pregnancy, mark ‘YES’ in the box.
Otherwise, mark ‘NO’ in the box.
Deliveiy
Enter a mark "+" in the relevant box for place of
delivery of the child.
Attended by
Enter a mark
in the relevant box for ‘who attended
the delivery of this child’.
If the mother is not present, enter "A" in the boxes.
Family planning
Mark the appropriate code for family planning method
used:
1. if no family planning practice is adopted,
2. in case of temporary methods such as condom, IUD,
Oral pill,
3. for the permanent methods - tubectomy or
vasectomy, and
4. for natural methods such as rhythm methods, safe
period etc.
26
2.3
NEXT HOUSEHOLD
After completing the first household, move to the next household whose front door is
nearest to the front door of the household just visited by you. Keep moving to the nearest
household till you have completed survey of 7 children/mothers. If there is more than one
child of the right age group in the last household then record the particulars of all the
children and do not stop when you complete the particulars of the seventh child. You will
adopt the same procedure while filling up the "Mother coverage form".
Excluded from the survey are:
(i)
(ii)
(iii)
(iv)
households already visited;
households outside the survey area;
households that are locked;
military establishments, hostels, orphanages, schools, mosques, temples, hospitals,
maternity homes etc.
2.4
OTHER CLUSTERS
The survey would be completed by using the same process for the remaining 29 clusters.
2.5
SELECTION OF HOUSEHOLDS IN DENSELY
AREAS AND IN MULTI-STOREY BUILDINGS
POPULATED
URBAN
Urban areas are divided into wards and sub-divisions of wards. After selection of a cluster
in a particular ward, go to a central space of the ward and select the direction as given
earlier in section 2.1.
Selection of the first household: Select the first household in the same manner as for
villages. If it is not possible to count or to estimate the number of buildings along a
particular road, then it may be necessary to determine the first household in another
manner. It is suggested that the distance may be measured or estimated, for example, by the
time taken to walk to the end of the road. Then a random number between 1 and the
maximum distance can be chosen by using a currency note, for example, if it takes 15
minutes to walk to the end of the road, then a number between 1 and 15 can be randomly
chosen. Say if 7 is chosen then walk for 7 minutes and go to the nearest building to start.
In case your 1st household falls in a multi-storey building, select the floor and then the
household at random.
In a double storey building, even digit indicates the ground floor and odd digit, the first floor.
27
EXERCISE B
Complete the Child Coverage Form (Form No.3) given on page 29
1.
Record the name of the district.
2.
Identify the cluster number. For this you may assume you are doing your survey in
District "A". Record the correct cluster number on the Child Coverage Form. Refer
to Form on page 10 to identify the number of cluster in the district.
3.
Record the date of interview. For this exercise record 7 March 1992 as the date of
evaluation.
4.
Identify the age group to be evaluated. (The age group to be evaluated is children
in the 12-23 months of age at the time of the survey).
Identify the dates of birth of children in the age group. These dates will be based on
the date of interview.
To determine the earliest acceptable date of birth, you will need to subtract exactly 24
months from the date of interview. (You subtract 24 months instead of 23 months because
you wish to include all children who are even one day less than 24 months of age). By
subtracting 24 months, you will also include children who are exactly 24 months of age,
which is acceptable. To determine the latest acceptable date of birth, you will need to
subtract exactly 12 months from the date of interview.
Example
1.
Assume the interview date to be 7 March 1992.
2.
Count back from the date of interview exactly 24 months to determine the earliest
acceptable date of birth.
3.
Count back from the date of interview exactly 12 months to determine the latest
acceptable date of birth.
4.
Using the date of interview of 7 March 1992, calculate and record the dates of birth
of children in the age group to be included in the survey.
5.
If no immunization cards or birth records are available, you may need to use months
of birth instead of specific dates.
6.
Identify the city or town or village of the cluster by referring to the Cluster
Identification Form on page 10 to 13.
7.
Write your name as the interviewer.
28
Form-3
CHILD COVERAGE FORM
District
Cluster No.
Cluster Name
Range of dates of birth
From
Till
CHILD NUMBER IN CLUSTER
i
2
3
4
5
6
7
8
9
10
Total
Name
Father's Name & Address
Sex : M/F
Sibling interval in mnths
Date of Birth
IMMUNIZATION
CARD
Yes
No
DPT 1
Date
Source
DPT 2
Date
Source
DPT 3
Date
Source
POLIO 1
Date
Source
POLIO 2
Date
Source
POLIO 3
Date
Source
MEASLES
Date
Source
BCG
Date
Scar +/0
Source
VIT A Dose 1
Date
Source
Whether fully immunized
Source (Place of Immunization) :
HOS - Hospital, HC-Health Centre, SC - Sub-Centre, OUT - Outreach or
village and PRV - Non-Governmental or Private Sector facilities.
Indicate against the column total the dose totals for each vaccine/Vitamin A under the same five
sub-headings i.e. HOS/HC/SC/OUT/PRIV.
Time Begun
Time completed
Investigator's Name and Signature
29
-------- RECORD OF A.N.C. AND_____
IMMUNIZATION_DURING PREGNANCY
INFANT IMMUNIZATION RECORD.!__
I. DURING THE FIRST YEAR (0-12 MONTHS): ■
fWTHER-INFANTIMMUNIZATION.CARD
mW?4!'
DATE
DATE-
A.N.C.-II
A.N.C.-2
I
DATE'
DATE
S.C.G.
A.N.C.-3 •
—
I
date
[
DATE
off
1R0N
I
iron
I
DATET.T.—i;
1^4-71
DATE
IRON
DATE ,
O.P.T.-I
DATE1 I
T.T.-2 (Soosterf
0. Remember, it is important to get 2 T.T. injections or
■ I T.T. booster injection, and to lake 100 iron tablets in
3 months, during pregnancy.
I
:
Governmeni al incia'
1
Serial number.
p
i I
DATE
O.P.V.-l
DATE
0.P.V.-2
*'DATE
307-9/
3O-7-7I
date'
DATE!
Vitamin A .f
ano
11
LILA
Husband’s name]
RAHU
Expected date of deliver/1
|g. |2.-?0
n
~j i
0.P.V.-3
Housa number') ©OS’VillageAVard |
l i...................
.
—.
, r
P.H.C/Townl
R AMPU R
;Sub-€entfe/Clinicl
MlLAp
Name of the infant '
U HA
Sex of the infant F
Date of birth'
11-.
TT
i i
! |
13-IZ-90
Heailir wfxer's signalu/e
■ ■ ■ t *-i ■ r
/;y
z
18^
□ Get all the mieclwns/doses at the scheduled lime and gel ihem
recorded here.
! □ Remember, there must be a gap of one month beriveen every
!
injection/doseojDZTjQZy._ _
t-
naTjChal ;;.imunizat:cn mission
16.3-9/
Measles
' Remember that T.T.-2 (Booster) should be given at least
.. I J
,lh® ^peeled dale of delivery.
I
DATE'
O.P.7.-3
Name of the pregnant woman |
□. The pregnant woman should regularly meet the health
worker Io gel ante-nalal check-ups (AM.) dene.
I
DATE
0.P.T.-2!
_ IJ? IlJ
NAT’CNAl i.mmunizadcn .mission
Gov-rni.iem of Inoia
national iMMUNjZAjiON Mission l
Government of India'’
— .RECORD Or A.N.C. AND____
IMMUNIZATiONJURING PREGNANCY
— INFANT IMMUNIZATION RECORD!
I. DURING THE FIRST YEAR (0-12 MONTHS/.
nnn
L PATS
J
I
DATE- I
|
S.ll’W
DATE' j
A.N.C.-1,'
A.N.C.-2
AKC.-3.
IRON
IRON
IRON.
I DATE
I
i DATE I
date'
T.T.—1;
MOTHER-INFANT IMMUNIZATION CARD
I
DATE I
I DATE' |
oafpf
I
DATE?
T.T. -2 (Boosterp
DATE I
I
DATE | JDATE |
O.P.V.-l y> O.P.V.-2
O.P.V.-3
ii
Name ofthe pregnant woman j
1
11
-
Expected date of delivery!
DATE'
Measles
date:
ANO Vitamin A -T
ii
r ffl ’
:□ Gel ail the mfeclions/dases at the scheduled lime and gei ihem
recorded here.
Remember, there musl be a gap ci one month between every
inject:on/dose of D.P.TJQf.V.
,
NATIONAL IMMUNIZATION MISSION
Governmenl of Incia
j-<
J
Heailtr worxers signature.
*1
____ k-lU-LJi
* I • I
(3) i
i
L -jXJL-j
^■tih
< 11. ?Q
P.H.C Aownl
RA H PU R,
'
fSub-centre/Clinicl
MILAQ
NATIONAL IMMUNIZATION MISSION
Govermnenl of India'
M ILAD
i11
Name of the infant •'
!______________
ii
Sex of the infant
zw
~~
SOH U
Husband’s name |
House number) 8*60 Village/Ward!
;
;
%
SUMAN
11
□. The pregnant woman should regularty meet the health
worker to gel anie-nalal check-ups (A.N.C.) done.
° i Remember, it is important Io get 2 T.T. injections or
|
• I T.T. booster injection, and to lake 100 iron tablets in !
3 months, during pregnancy.
} Remember that T.T.-2 (Booster) should be given al least
I 1
tefcfe to* expected date of delivery.
Serial number.
i i
Date of birth
___________
___ ml
6- 11-?O
□T
NATIONAL IMMUNIZATION MISSION I
’Government of India''
In order to identify age errors on the mother-infant immunization card/record(s), it is best
if the child whose record(s) is being reviewed, is physically present at the time of review. If
there appears to be an age discrepancy, you should attempt to verify the listed date of birth
by asking to see the child’s birth certificate (if available) or through questioning. If the card
is presented for a child who is not present, but who falls in the age range to be evaluated,
record the information on the form.
Use the information on the sample mother-infant immunization card on pages 30-31 to
complete the ’’Child coverage form" for the first household.
After listing information on all the children in the household whose ages fall in the
acceptable range, check the date recorded for any obvious errors. (Are there blank spaces?
Are there immunization dates which occurred prior to the date of others in the same family
eg. twins?) Then proceed to the next household, which will be one nearest to the initial
household. Use information on the sample card, to complete the same "Child coverage form"
in the second household. When you have recorded all relevant information for the second
household, review your form with a course facilitator.
In a real survey situation you would continue the process until the seventh child in the age
range to be surveyed has been located. Other children in this age range who are residents
in the same household where the seventh child is identified should also be listed.
32
2.6
CHECK DATA COLLECTED
The data collected from the survey teams must be checked to ensure that the survey
contains the correct number and locations of clusters and the correct number of children in
each cluster.
You will need to ensure that:
o
30 clusters have been surveyed. To do this, you must review the forms submitted by
each team member to see if there are forms for 30 clusters. When fewer than 30
clusters have been surveyed, the missing cluster(s) will need to be identified and
surveyed.
o
Seven children in the age range to be surveyed have been listed for each cluster. To
do this, you must review every "Child coverage form" to determine if at least seven
children in the range of ages to be included have been listed for every cluster.
o
If a "Child coverage form" or "Mother coverage form" is missing or incomplete, the
cluster must be resurveyed. If any discrepancies are noted in the information, the
child must be visited again.
33
EXERCISE C
As mentioned earlier recording errors may occur and need to be checked and corrected
before leaving every household. On the facing page is a ’’Child coverage form” which was not
carefully reviewed. Review this form and circle all obvious errors and or omissions. Review
your work with a course facilitator and correct the form according to the information
provided by the course facilitator.
Complete the Child Coverage Form (Form 3)
The fact that the immunization was given does not ensure that it was valid. To be effective
vaccines must be given at appropriate ages and if the immunization is either DPT or OPV,
it must be given after the appropriate interval.
Measles - As soon after 9 months as possible (9 months completed)
BCG - any time after birth.
Polio/DPT - First dose any time after 6 weeks of birth. Subsequent doses spaced at least one
month or 28 days apart.
A person immunized at the wrong age should be considered not immunized. A second or
third DPT or polio dose which is given less than one month after the preceding dose should
be considered invalid. There is no limit for maximum interval between first and second dose
and second and the third dose. You would, however, check to see that the doses were
completed before 12 months of age. Measles vaccine given before 9 months of age (2.70
days) is not valid.
34
Form-3
CHILD COVERAGE FORM
District
Custer No.
Cluster Name
Range of dates of birth
From IS'- 7- ?0
Till
3- 3’9/
CHILD NUMBER IN CLUSTER
Father's Name & Address
15; z
4
5
6
7
8
ME
2, g.
Hnclcl
Tcufrv
csai
p
p
Ifc
IS
7.T-
-F
■f
-F
|3?
ICA*ny
T0fcf»v___
lonnv
5ipu>\
F
p
M
p
72-
3)
4g
3
Sibling interval in mnths
Date of Birth
17-12*71
Yes
+
-V
No
Date
grz-e
FJodd Hcdd -----hccUJ- - HocM____
Sex : M/F
i—
■DPT 1
3
9
10
Total
Czxd/A| SefcxJ MeVAm
Name
IMMUNIZATION
CARD
2
1
Z ?}j£
Touftv
-V
1^431 17^1 2s>-^\ 7
12
Source
OPT 2
Date
5^ Il
p«y
2 IO.^i
Source
OPT 3
Date
o
o
3-8-Tl
He
Source
POLIO 1
>*4^1
Date
)2-^i
Source
POLIO 2
5
210^1
Date
Source
POLIO 3
Date
o
7
0
35?1
Source
MEASLES
Date
IW
PRV
OUT
13 8-7
0
3-8-7 O X-IZ7)
1^71 O
7.i2-8i
1-127 ly??) 71231
1 I 3-7| 14-1 -71 UI-7I
Source
:bcg
VIT a Dose 1
Date
Scar +/0
+
Source
OUT
Date
Source
5-lo?|l 3 47/
cur
cmT
whether fully immunized
cuT
OUT
+
Ajrce (Place of Immunization) :
HOS - Hospital, HC-Health Centre, SC - Sub-Centre, OUT - Outreach or
village and PRV - Non-Governmental or Private Sector facilities.
Ind; ate against the column total the dose totals for each vaccine/Vitamin A under the same five
sub readings i.e. HOS/HC/SC/OUT/PRIV.
Time Begun
T- ne completed
Investigator's Name and Signature
35
3.0
TABULATE DATA
Any data collected is useless unless it is analyzed. Coverage evaluation information must
not only be analyzed, but it must also be analyzed quickly in order to serve useful purpose.
When coverage evaluation team has finished collecting data from its 30 assigned clusters, the
forms should be handed over immediately to the supervisor of the coverage evaluation(s).
(S)he will check to see whether the forms are complete and accurate and (s)he will review
the forms to determine which immunizations are valid (given at the correct age and at the
correct interval). (S)he will then complete the "fully immunized" section of the forms 3 and
4. The information should then be transferred to the cluster summary forms (Forms 7a, 7b,
8 and 9). The calculations of sub-totals and totals on the Cluster summary form are part
of the analysis of collected data.
(S)he will check that all the other information has been noted including the reason for
partial or no immunization in the form 4.
36
EXERCISE D
1.
Using the corrected child coverage form which you completed in Exercise C, circle
all shots which are not valid according to the schedule listed above.
2.
If a child has received the complete immunization (there are no blank spaces and no
circled boxes), record a "+" in the column titled "fully immunized" in Form No. 4.
3.
If a child has not received all doses (there are blank spaces or circled boxes) record
a ”0" in the column titled "fully immunized" in Form No. 4.
4.
After you have reviewed all boxes on the child coverage form, add the number of
"+"s recorded in the "fully immunized" column and find out "total fully immunized".
5.
Check your answers and discuss any differences you have with a course facilitator.
37
00
FORM 7 b
CHILD COVERAGE - CLUSTER SUMMARY FORM
NAME OF DISTRICT:
Cluster No.
Period of survey
1
2
4
5
Card Test
6
6
DPT 1
5
5
3
7
6
8
9
10
11
12
14
15
5
G
7
G
G
7 7S 3 5~
Q
S
G
3
s
13
16
17
18
5
4
6
4
4 6
3 3
3
I
19
20
22
23
S 3
7G
4
I
4
3
21
26
27
5 *
G S
3 5" 5
3 3
1
24
25
28
29
3<
Total
No. of children
Sibling
<2yr
interval
2-3 yr
> 3 yr
N.A
G
6
6
5
43
4^
S 4 3 3
3 4
3
OPVl
5
5
OPV2
4 4 5 7 5
4 4 4 x 5'
DPT 2
DPT 3
Source :
5~
4 3
3 3
2
I
5 G
S
5
5
4
5- G
4 5 4
3
3
£ G
S’
3
5 2.
/ 0
4
G
G
t7S
4 4
G 4 S
3 5 4
14°?
G
3
3
12^
HOS
HC
OUT
PRIV
OPV3
Source :
G
4
5
3
X 3
5 6' 6" 5 3 4
5 3 4
6 4 4
5 3 5 3 3 4 4
3 &
3 3
2.
HOS
3
£
4 6 ^5
3>
4 -4 4 4
3 4 3. 4
I5~l
130
107
- -- -
HC
OUT
PRIV
5
Measles
Source :
HOS
HC
OUT
PRIV
5
Io
4 4 5
6
b 4 4 6
a.
4
S'
4
4
3
4 3 6 .6 4
5
3
141
•E
<3
2
I X8 o so 2
I
8X
-Q
X
I
6
E
E
JE
£
3
Z
£
X
5o >2
1
E
J '£
u
c
E
3
g
39
Form-3
CHILD COVERAGE FORM
District
Cluster No.
Ouster Name
I
CHILD NUMBER IN CLUSTER
1
Name
UMA
Father's Nana I Address
~>Qg
KuaD
Range of dates of birth
From 7- 3 • 90
TiB
^.3.^1
2
5
4
5
KUHW GOViHD JAHLS PA HI
8
9
10
Total
SURE3H RUPA
K)Shah gAKESh SATI3U
1001
»/2 y A/ H ~^O3
IOK
HUAC MHAO Ml LAP Milad kaEat KADAT
F
h
F
Sibling interval tn anths
IG
a± IB
IX
F
\+
13 I2%| 6-ll’ld6’F4D|7.||.t> 12’ n-7b|i4-i3| l-l-ll
IMMUNIZATION
CARD
Yes
±
+
+
+
±
+
No
DPT 1
Date
DPT 2
DPT 3
POLIO 1
SC
Date
16-3115-2-11
Source
SC
POLIO 3
MEASLES
SC
OUT
HC
OUT
O
R-e
PR.V
O
yioli
Source
SC
O
we
OUT
1^4^ 5-3^12 6-^1
IS-Ml
O
Re
He OUT
io-a-<f zsmpfe n.idi.s-li io-3-ii i-^i
o
SC
sc
OUT
OUT
7’4-11
16’3-71| r 211
Source
SC
Date
S-yil 5-3 11 pi Ml U-Mi
Source
SC
5C
sc
30^| 30-81/
Source
SC
Date
O
O
se
Date
Date
BCG
Se
Date
Date
POLIO 2
33^1
Source
Source
VIT A Dose 1
7
SOMupue^i JOHN
Sex : M/F
Date of Birth
6
UC
PRV
O
He
CMT
O
O
Mo-ll O
He
OUT
O
IS-11-11
O
we
O
SC
15-10-71 3 10-11
HC
P£V
Scar *70
+
O
Source
P€V
OUT
HOSP
OUT
OUT
PRy
O
o
O
o
IS-10^
o
Date
30111
Source
SC
Whether fully immunized
0
OUT
+
+
source (Piece of lenunlzation) :
HOS ■ Hospftel. HC-Heelth Centre, SC - S^-Centre, OUT - Outreach or
itU.V.f.
Village and PRV - Non-Governmental or Private Sector facilities
Indicate against the coluan total the dose totals for each vaccine/Vitamin A under the same five
st*)-headings i.e. MOS/HC/SC/OUT/PRIV.
Time Begun
;
Time completed ;
*0
Investigator's Naas and Signature
Form-3
CHILD COVERAGE FORM
District
Cluster No.
Cluster Name
X
H<
CHILD NUMBER IN CLUSTER
1
Name
Father's Name & Address
2
3
4
5
6
F
Sibling interval in ninths
12-
Yes
CARD
F
F
F
It IZ
16
18
-r
4
F
16
-b
+
4
DPT 3
POLIO 1
POLIO 2
polio 3
MEASLES
BCG
10
Total
7
4-
Date
4*3‘41
10-631 6G-3) 7-4-71 H.G.71
Source
H05 ' HOS
ue
Date
1-531 4.831 10-731 17-731
Source
kos
Date
HO
PRV
He
rtos
a-io.il IO-M
o
l-V-'il 2o.s-7i
HOS
HC
HC
Date
4-33) 1.7-31 10-63
7.4^1
Source
HOS
Date
l-S’-ll TSII 1077117-7-9/
Source
HOS
Date
7-W^ 1031110-8-31
Source
HOS
HOS
HC
Date
13-312 las t
O
Source
Pry Pry
HOS
Has
He
He PRv
He
o
He
2O-V1I O
HOS HOS HC
HOS PRV
O
l<?3| 20-831
HC
+
bi
O
HOS HOS OUT
4HC
Date
13-332 IS-S-’fe
o
Source
PRY
+
o
He
Source
pr7
o
PRV
o
O
o
PRV
O
3- 3’4)|2.33115“. 13| 2-331
Date
Whether fully immunized
He
HOS
Hos
o
10^1 O
Source
Scar +/0
VIT A Dose 1
9
4-
No
DPT 2
8
2-1230 7-331 4.231 h 12.3d I4‘13| 6-33
Date of Birth
DPT 1
7
HEMA BAtU Boe^lzuaH Roma RAM LAX NAH
MAUK SUCtSH IXAVID ASLAM Ramah LALLU RAM U
kpu£A K PUW kiM&adpa MARLET PIARKET NAPJCE1
Sex : M/F
IMMUNIZATION
Range of dates of birth
From
7. 3.70
™
3-9)
o
OUT
out
o
PRV
+
Source (Place of Immunization) :
HOS - Hospital, HC-Health Centre, SC - Sub-Centre, OUT - Outreach or
village and PRV - Non-Governmental or Private Sector facilities.
Indicate against the colunn total the dose totals for each vaccine/Vitamin A under the sane five
sub-headings i.e. HOS/HC/SC/OUT/PRIV.
Time Begun
Time completed
Investigator's Nane and Signature
41
Form-3
CHILD COVERAGE FORM
District
Cluster No.
Cluster Name
3
Range of dates of birth
From 7. 3.9 0
J.
TlU
CHILD NUMBER IN CLUSTER
1
2
3
4
5
6
? 38
7
Name
Raw I3AEU|EAEU KUHM2 5ON\A|KAejJ»4ASHoK
Father's Name & Address
Hctoiiu SfmTuX ~SK~ AO
VCM>Qm S<^
Sex : M/F
GopcA
krVSU
9
10
Total
RTF
LoA
H
F
P
n F
H
Sibling interval in mnths
17 £5
2.1
Date of Birth
2O.V3I 13 'll loa-ibs '•'ii 12-11^114.15!)
IMMUNIZATION
CARD
M
IL
+
•+
He
3 3*1
HC OUT Out
Source
He
ue
Date
O 2.10-51
Yes
+
■+
+
-f
-v
No
DPT 1
Date
Source
DPT 2
DPT 3
Date
Source
POLIO 2
Date
Source
POLIO 3
BCG
our
OUT
our
i-feftl
He CUT our
oo-tf) I-J1) I 1^531 5 3^)
He He CUT ouf
HC
OUT
H-e
O
O
13^11^/
PUT
He
O 12-5 ?| 6-C-1)
Date
cur CUT our
Our
he
O
Date
I'Z'iz
Source
our
pev
He He
' o o l|<2.‘)) iS l-HI ifc itfld 15.4^ 2-3•tll
Date
112’1)
Scar +/0
Source
VIT A Dose 1
He
to-5^ 3-87 '!>O 1-4-31 ly^l
hc He our cur
He we
Source
MEASLES
o
Date
Source
POLIO 1
751
Date
■111 IX-'il
Source
GUI
Whether fully immunized
CUT
OUT
OUT
OUT
O
o
o
4-
-r
OUT
OUT
51 oa
He
CUT
-F
+
Source (Place of Immunization) :
HOS - Hospital, HC-Health Centre, SC - Sub-Centre, OUT - Outreach or
village and PRV - Non-Governmental or Private Sector facilities.
Indicate against the column total the dose totals for each vaccine/Vitamin A under the same five
sub-headings i.e. HOS/HC/SC/OUT/PRIV.
Time Begun
Time completed
42
Investigators Naae and Signature
EXERCISE E
Complete the Cluster summary forms
To determine the number of children whose immunization doses are valid in your survey
consisting of 30 clusters, you will next transfer information from the coverage forms to the
cluster summary form.
In this exercise, you will record information on the partially-completed child coverage cluster summary form (Form 7b) on page 38-39. You will obtain information from the copies
of filled Forms provided on pages 40-42 and use it to complete the following steps:
1.
Fill in the introductory data on the cluster summary form (Form 7b). (This has been
done for you.)
2.
The next step is the correction of the sample "Child coverage forms" given in pages
40-42. You have already corrected one such form in Exercise ‘C’. In some instances
a child may have received 2 or 3 doses of DPT and Polio and one or more of them
may not be valid. Circle all the doses which were not given at the correct time.
Forms on pages 40 to 42 are corrected Child coverage forms.
3.
On page 40 count the number of valid doses given for each vaccine. These will be
uncircled dates. Count each dose separately (DPT1, DPT2, DPT3). On the cluster
summary form (Form 7b) record the total number of valid doses in the columns
provided for each dose besides Cluster 1. You may assume that all uncircled dates
are valid.
Count the number of Mother-infant immunization cards available. Transfer this
number to the column titled Card test in the form 7b. Check the total number
recorded for "Fully immunized" in Form 3/4 and record the number in the Fully
immunized column of the Cluster summary form.
Similarly enter the data from each cluster on the first dose of Vitamin A. Repeat this
process for Child coverage forms on pages 41 and 42; and
4.
Determine the sub-totals and total for the cluster summary form. (This has been done
for you).
When you have completed this exercise, check your answers and discuss with your course
facilitator.
43
4.0
EVALUATE PROGRAMME
The purpose of collecting and analyzing immunization and other service coverage data is to
make possible an evaluation of the extent to which the coverage objectives of the
programmes are being achieved.
*
What is the immunization coverage of the target age group?
Is the target age group being reached?
♦
Are beneficiaries outside the target age group being immunized?
*
Which are the main agencies rendering service coverage?
What are the reasons for poor attendance and high dropouts?
*
Are the children getting Vitamin A prophylaxis in time?
*
What proportion of pregnant women are protected with 2 doses of TT?
Are women receiving antenatal care?
*
Are they practicing family planning?
What are the delivery practices?
♦
Are pregnant women receiving iron and folic acid tablets regularly?
Are ORS packets available during an episode of diarrhoea within the village?
What are the practices related to rehydration and feeding during diarrhoea?
♦
Does the mother know when to take a child with acute respiratory infection to health
facility?
*
Are women conceiving for the first time after the age 20?
*
Are women practicing birth spacing?
A coverage evaluation survey pr »v:des answers to these questions.
44
4.1
EVALUATION WITH REFERENCE TO PROGRAMME OBJECTIVES
EXERCISE F
Read the guidelines below and complete the practice exercise.
Evaluate the extent to which programme objectives are met by transferring the completed
data from the cluster summary form to the appropriate space.
1.
Complete the introductory data on the form given on page 46.
2.
List every vaccine for which programme coverage is being evaluated. This has been
done.
3.
For each dose listed under Column 1, list under column 2 .(’’Objective for service
coverage in percentage") the percent coverage that was expected according to the
programme objective. This has been done.
4.
For each dose listed under Column (1), utilize the sub-totals ("+" and ”O”) from the
cluster summary form to determine the percent coverage achieved, and enter these
percents under column (3) - ’’percent coverage achieved’’. This can be determined by
using the formula:
sub-total "4-"
Total"+’’ + "O"
x 100 =
% Coverage for the dose
Use the workspace provided in the next page
For example, if the sub-total"+” for measles dose = 160 and the total of"+" and ”O”
for measles is = 210. This is 160/210 x 100 = 76%.
You should also use the data to determine the difference between the coverage
according to your health centre reports and survey data. The coverage for ’’fully
immunized" is simply the number of children fully immunized divided by the number
of children surveyed. Remember that for this exercise 30 clusters each containing at
least seven children were surveyed. In this example 214 children were surveyed.
5.
For each of the doses listed (column 1), write in the "difference" between the
objective (column 2) and the coverage achieved (column 3).
objective
achieved
=
difference
You can use the data to compare results with previous surveys.
45
Workspace for Exercise F
i
EVALUATION WITH REFERENCE TO PROGRAMME OBJECTIVES
District
State
Dates of coverage survey
DOSE (1)
PROGRAMME
OBJECTIVE (2)
TT2/Booster
100 %
BCG
100 %
DPT 3
100 %
OPV 3
100 %
Measles
100 %
Vit.A - 1
100 %
46
COVERAGE
ACHIEVED (3)
DIFFERENCE (4)
4.2
COMPARISON BETWEEN REPORTED AND EVALUATED COVERAGE
Next, you will compare the coverage figures obtained through the coverage evaluation survey
with the reported coverage from the monthly reports for the corresponding period. If a
survey is done in April 1992, you will be in a position to compare the evaluated coverage
with the reported coverage figures of April 1991. Normally, as a programme manager, you
will accept a difference of upto 10% between the reported and evaluated coverage. As the
team evaluating coverage will be different from the programme implementing team, you will
go to the district MCH officer and obtain the reported coverage figures. Use the following
format for the comparison:
DOSE (1)
Reported coverage for the
corresponding period in % (2)
TT2/Booster
100 %
BCG
100 %
DPT 3
100 %
OPV3
100 %
Measles
100 %
Vit.A - 1
100 %
Evaluated coverage
by survey in % (3)
DIFFERENCE (4)
47
4.3
COMPARISON BETWEEN SUCCESSIVE SURVEYS
As a programme manager you will be interested in having your coverage evaluated at
regular intervals. When you do regular surveys, you will compare the evaluated coverage not
only with the reported coverage for the corresponding period but also with the figures
obtained through previous evaluation surveys. You will use the following format for such
comparison:
DOSE
(1)
TT2/Booster
BCG
DPT 3
OPV 3
Measles
VitA - 1
48
Evaluation coverage from » survey done in
19(2)
19
(3)
Difference
(4)
4.4
DROPOUT RATES
(a)
A major reason for low coverage is the high dropout for the second and third doses
with the same antigen (OPV/DPT). You can calculate these from the data available
in the cluster summary form by using the following formula:
DPT 1 - DPT 3
DPT 1
X
100
DPT 1 are the number of children who received the first dose of DPT and DPT 3,
the number of children who received all 3 doses. Dropout rates for OPV are
calculated similarly.
(b)
Dropout rate for fully immunizing a set of children is calculated from the values for
the highest covered antigen dose (HCAD) minus the lowest covered antigen dose
(LCAD). The dropout rate is calculated using the formula:
HCAD - LCAD
HCAD
X
100
For example
During a village visit, the supervisor went through the immunization records and found the
following:
No. of children enumerated
42
No. given BCG
40
No. given
DPT 1 and OPV 1
37
DPT 2 and OPV 2
35
DPT 3 and OPV 3
30
Measles
25
Dropout rate for complete immunization
40-25 x 100
40
37.5%
49
EXERCISE G
Review of immunization performance for the last year in a sub-centre area having 5000
population revealed the following:
Infants alive at 1 year of age
150
BCG given
140
DPT/OPV2 given
130
DPT/OPV2 given
S3
120
DPT7OPV3 given
Measles given
1.
What is the drop out rate for DPT and OPV?
2.
What is the drop out rate for fully immunized?
50
124
s
100
What are the reasons for partial immunization?
Study the reasons for incomplete immunization carefully. These will reveal the weaknesses
in your programme on which you could take practical measures for improvement. You will
use the data from the cluster summary forms.
Source of immunization
Use of Child coverage forms to analyze the source of immunization. Are the immunizations
being provided through PHCs and sub-centres or largely through outreach operations? Are
private hospitals and voluntary organizations actively participating in the programme in your
area?
Coverage of pregnant women with TT2, antenatal care, iron and folic acid tablets and child
spacing and limiting methods.
Use cluster summary form 9. Analyze data as you did for children.
What percentage of mothers are being provided antenatal care? Are most deliveries being
conducted by untrained TBA What proportion of mothers are spacing or limiting births?
What methods for spacing or limiting births are being used? Is coverage for anaemia
prophylaxis too low? Based on survey results appropriate corrective action should be taken.
yr
/&/
COMMUNfTY RFUTR CEU
326, V Main, I Block
Koram^ng -la
/
Bangalore-560034 /
India
51
5.0
PLAN REVISIONS IN IMMUNIZATION ACTIVITIES
Knowledge gained from programme evaluation should be used in planning future
programme activities. Evaluation will help identify problems which should be corrected
through carefully planned revisions in the coverage activities. Planning should be a
continuous process and should be based on:
1.
the extent to which objectives are NOT being achieved and an analysis of the
underlying reasons for this;
2.
the extent to which objectives are being achieved and an analysis of the underlying
reasons for this; and
3.
the extent to which programme data are complete, accurate, timely or utilized.
For example, if coverage objective of 100% was established and evaluation showed 95%
coverage, we can conclude that no major modifications are needed and that a slightly
increased effort will bring the programme nearer its goal. If evaluation showed only 60%
coverage some major changes will have to be made in activities to improve performance and
step up immunization coverage.
Coverage evaluation should be reported to superiors in the health system so that staff at
those levels can help in developing improved plans.
52
6.0
EVALUATION OF DIARRHOEAL DISEASES CONTROL
While evaluating coverage for activities of Diarrhoeal Diseases control programme, you have
to select certain indicators. The programme priorities are based on indicators for which data
is normally collected through household surveys done specifically for the purpose.
An indicator suggests or indicates the extent of achievement in a programme or the level of
a condition in the population. An indicator can be a number, proportion, percentage or rate.
As a programme manager you will be interested in the following:
*
♦
♦
ORT plus feeding rate
maternal knowledge of the three rules of home management
access to ORS
An indicator may not tell you the whole story but it will give you some idea of what is
happening. It is often necessary to look at several indicators together in order to understand
the whole story.
Once you have chosen the indicators to measure, then you will have to identify the specific
data requirement. There are several important indicators that as a programme manager you
would like to obtain information regarding diarrhoeal diseases in a community. These
include, among others, the proportion of mothers who continue feeding, increase fluids,
administer ORT, correctly prepare ORS and correctly prepare home available fluids.
The coverage evaluation survey does not attempt to measure all these indicators. Rather,
it measures some of the most important, the definitions of which are outlined below:
1.
Continued feeding rate:
Proportion of cases of diarrhoea in children less than 5 years given normal or
increased amounts of food during diarrhoea.
2.
Increased fluid intake rate:
Proportion of cases of diarrhoea in children less than 5 years administered increased
amounts of fluid.
3.
ORT access rate:
Proportion of diarrhoeal episodes which had access to ORS packets within the
village/from a health facility.
53
EXERCISE H
These indicators, 1, 2 and 3 can be calculated from the data collected during this survey.
Write down the denominator data and numerator data for these three indicators below:
1.
Continued feeding rate
x 100
2.
Increased fluid intake rate
x 100
3.
ORT access rate
x 100
Consult facilitator when you have finished this exercise.
54
7.0
EVALUATION OF PNEUMONIA CONTROL ACTIVITIES
In the coverage evaluation survey, you are getting information on the following items:
♦
Two week prevalence of acute respiratory infections
Proportion of acute respiratory infections in which the mothers could identify the
signs of pneumonia and
*
Proportion of children with signs of pneumonia for which the mother/care-giver
sought help from a health facility.
This information will translate into the following indicators which can be computed by the
following formula:
1.
Prevalence of Acute respiratory infections in children less than 5 years (over a two
weeks period). This can be calculated as follows:
No. of children suffering cough or cold in last 2 weeks
x 100
Total No. of children surveyed
2.
Proportion of ARI in which the mothers identified the signs of pneumonia :
No. of children with signs of pneumonia i.e.
fast breathing/difficult breathing/chest in-drawing
x 100
No. of children suffering cough or cold
3.
Proportion of pneumonia cases seeking treatment at a health facility :
No. of children suffering cough or cold in last 2 weeks
x 100
No. of children with signs of pneumonia
You should like the information you obtain through these survey with the surveillance data
that you get both through routine and sentinel surveillance from districts, please note that
the information you obtain on diarrhoea/pneumonia through this survey cannot be used for
any statistical analysis. At best they will give information on trends.
55
)
8.0
PROVIDE FEEDBACK
Stall responsible tor immunization activities, have a right to know the results of surveys
conducted in their area. I his feedback will help them to improve the existing plans and
activities.
Meetings should not be held for the benefit of senior or middle level staff only. It is the field
level workers who are most often asked to work the hardest in difficult circumstances and
who are most affected by programme changes. These staff members in particular must be
appreciated for this very important role in the programme.
The next regular staff meeting could be utilized for a discussion on the coverage evaluation
survey results. It is ideal to have a thorough group discussion amongst health workers. This
could be done in the sectors, where the health workers, with the help of supervisors can
frankly discuss findings and all aspects of the programme. Also, this will enable health
workers assume more responsibility for remedial measures to improve coverage and commit
themselves to further changes necessary in service delivery.
The findings or reports of various sector meetings and group discussions can be summarized
and again discussed with senior staff and medical officers. Communication should not be
"one way" or "top-down" - it should be two way and continuous.
Supervisors must understand that an evaluation is not a fault finding exercise nor is it to find
scapegoats for weaknesses. It has to be more positive and creative. Supervisors must be
"problem solvers". This approach alone will instill confidence in the team and among the
team members to share rather than hide problems.
The comparisons made between (i) goals/targets and coverage, (ii) the reported and
evaluated coverage and (iii) successive surveys should be shared and discussed with other
team members of your district and PIIC level medical officers.
Finally, at the end of the meeting everyone must be provided with a copy of the points
presented during the meeting and the recommendations made.
56
9.0
SUMMARY
With this module, you have acquired skills to evaluate service coverage for various activities
for child survival and safe motherhood.
The coverage for immunization and first dose of Vitamin A was evaluated by cluster
sampling technique of 30 cluster of 7 children each. Coverage for antenatal care, IFA
supplementation and tetanus toxoid immunization as well as the age at first pregnancy and
birth spacing for pregnant mothers were also evaluated using a similar sample size.
For the assessment of service coverage on control measures on diarrhoea and pneumonia
we have used a larger sample of 750-900 children under the age of five years.
Among the skills you have acquired with this applied modular training the important ones
include:
♦
♦
*
♦
*
*
*
Identifying clusters in the population under investigation
Organizing teams and logistics of survey
Selecting first-household in a village or urban area for starting survey
Entering data accurately on various forms
Cross checking possible errors in data collection
Tabulating data in cluster summary forms
Analyzing data and evaluating the programme
Suggesting revisions or improvements based on evaluation
This training will help you understand the exact situation in your area regarding services for
Child Survival and Safe Motherhood Programme. The conclusions made by you from the
evaluation will also give directions on appropriate changes you will have to make in the
programme.
57
Form No. 1
HOUSEHOLD TALLY MARKING FORM
Range of dates of birth
From
District
Cluster No.
Cluster Name
1.
Household No.
2.
No. of children
under 5 years
Till
1
2
3
4
5
6
7 8 9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31-75
M
F
3.
No. of live births
within last 1 year
M
F
4.
5.
6.
No. of deaths
within 4 weeks of
birth in last 1 yr
M
No. of deaths
within 1 year of
age in last 1 yr.
M
F
F
M
No. of deaths
in 0-5 yrs. of old
F
in last 1 year
In the past two
weeks did any
child under 5 yrs.
have diarrhoea
M
F
8.
If yes, what did
you give the child
9.
Did you give more, less
or same amount of food
as diarrhoea started, or
did you stop feeding
during diarrhoea
10. Did you receive ORS from
within your village
11. If you sought help from
any health facility,
did you get ORS?
12. During the past two M
weeks did any child
under 5 years have
F
cough or cold
13. Did your child have fast
breathing, difficult
breathing or chest
indrawing
14. If yes, did you seek help
from a health facility
For question Nos. 7, 10, 12 and 14, mark 'Y' for Yes and 'N' for No for appropriate answers.
For question No. 13, mark ’Y' for Yes, 'N' for No and 'DK' for do not know.
For question No. 8, Mark (1) for 'no fluids' (2) for home available fluids (3) for ORS and (4) for other options.
For question No. 9 mark 'M' for more, 'S' for same, 'L' for less, 'W for stopped and 'DK' for do not know.
INVESTIGATOR'S NAME AND SIGNATURE
Date :
58
Form No. 2
LIST OF LAME CHILDREN UNDER 5 YEARS
CLUSTER NO.
DISTRICTS
CLUSTER NAME
PERIOD
SI.No.
Name of the child
Address
Age/
Date of Birth
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Probable Polio:
*
*
*
*
*
History of lebrile illness
History of abrupt onset of weakness or paralysis
No progression of paralysis after, the first three days
Paralysis not associated with trauma
Paralysis not present from birth or associated with mental retardation
Number of OPV doses prior to illness. Check immunization cards or register, if available.
Sex
Date/Month/Year
of onset of
lameness
Immunization
status**
Form-3
CHILD COVERAGE FORM
Dislrict
Cluster No.
Cluster Name
Range of dates of birth
From
Till
CHILD NUMBER IN CLUSTER
1
2
3
4
5
6
7
8
9
10
Total
Name
Father's Name & Address
Sex : M/F
Sibling interval in mnths
Date of Birth
IMMUNIZATION
CARD
Yes
No
DPT 1
Date
Source
DPT 2
Date
Source
DPT 3
Date
Source
POLIO 1
Date
Source
POLIO 2
Date
Source
POLIO 3
Date
Source
MEASLES
Date
Source
BCG
Date
Scar -»-/0
Source
VIT A Dose 1
Date
Source
Whether fully immunized
HOS - Hospital, HC-Health Centre, SC - Sub-Centre, OUT - Outreach or
village and PRV - Non-Governmental or Private Sector facilities.
Indicate against the column total the dose totals for each vaccine/Vitamin A under the same five
sub-headings i.e. HOS/HC/SC/OUT/PRIV.
Source (Place of Immunization) :
Time Begun
Time completed
60
Investigator's Name and Signature
I
FORM NO. 4
REASONS FOR COVERAGE FAILURE FORM
Range of dates of birth
From
Till
District
Cluster No.
Cluster Name
Child number in cluster
1
2
3
4
5
6
7
8
9
10
Total
1. Fully immunized
Immuni
zation
status
2. Partially immunized
3. Not immunized
1. Unaware of need for immunization
2. Unaware of need to return for 2nd or
3rd dose
Lack of
infor
mation
3. Place and/or time of immunization
unknown
4. Fear of adverse reactions
5. Wrong notions on contraindications
6.
1. Postponed till another time
Lack of
moti
vation
2. No faith in immunization
3. Rumours
1. Place too far
2. Time inconvenient
3. Vaccinator absent
4. Vaccine not available
5. Mother too busy
Obstacles
6. Family problem, mother ill
7. Child ill, not brought
8. Child ill brought, not given
9. Long waiting time
10.
1. Prophylaxis given
2. Prophylaxis not given
Vitamin
A
Prophyla
xis
Note :
3. Availability
Y/N/DK
4. Acceptability Y/N
Ask only one question Le. Why was the child not immunized? or
Why was the child not fully immunized?
Mark (/) the most relevant reason(s) according to your judgement
Date :
Investigator’s Name and Signature
61
FORM NO. 5
MO'I’I IER COVERAGE FORM
District
:
Cluster No. :
Cluster Name
Range of dates of birth
From
Till
Mother number in cluster
Your age
at first
pregnancy
1
2
3
4
5
6
7
8
9
10
Total
< 20 years
20 - 30 years
> 30 years
Date of last delivery/abortion
Date of birth of Child
Immunization Card
Yes
Other records
TH
Date
Source
1T2 / Booster
Date
Source
Iron and Folic acid
tablets
Given (mention numbers)
Consumed Y/N
Source*
Antenatal care
Yes/No
Govt, or private
HC/Hospital
Place of delivery
Home
Other
Health staff
Trained Dai
Attended by
Untrained Dai
Other
Family Planning Method**
* Source (Place of immunization) : Govt. Hospital - I IQs; Govt. Sub-centre - SC
Outreach - OUT; Govt. Health Centre - HC; Non-Govt. Hospital/Private Clinic - PRIV
FP method - 1 None, 2 temporary - Condom/IUD/Oral pill, 3 permanent tubectomy/vasectomy and 4 natural.
l ime started
lime finished
Dale
:
62
Investigator’s name and signature
Form No. 6
ADDITIONAL QUESTIONS FOR THE CLUSTER SURVEY
District
Cluster No.
CHILD
Cluster Name
NUMBER
OF
CLUSTER
1
2 3
4
5 6 7 8 9 10 Total
Does anyone in the household know the name of diseases prevented by
immunization :
1.
Diphtheria
Y/N
2.
Pertussis
Y/N
3.
Tetanus
Y/N
4.
Poliomyelitis
Y/N
5.
Measles
Y/N
6.
Tuberculosis
Y/N
Where did they receive most of their information on above :
1. Health Staff
2. Volunteer
3. Relatives
4. Neighbour
5. Radi©/Television
6. Newspapers/posters
7. Others
8. Did not receive
9. Do not know
Does anyone in the household know that :
1.
3 doses of DPT vaccine
Yes/No
2.
Birth spacing
Yes/No
3.
Need of clean delivery (5 cleans)
Yes/No
4.
Reognition of pneumonia *
Yes/No
5.
Recognition of dehydration **
Yes/No
* Recognition of pneunonia by fast breathing with or without chest indrawing in a child having cough and cold
**
Date
Signs of dehydration are thirst, sunken eyes, dry tongue and lips, and general condition - restless.
Investigator's name and signature
63
Form No. 7(a)
National Child Survival and Safe Motherhood Programme
HOUSEHOLD TALLY MARKING FORM - Cluster Summary Form
Dates of survey
Name of the district :
1
1.
No. of children
under 5 years
2
3
4
5
6
7 8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Total
Male
F emaIe
2.
No. of live births Male
within last one
Female
year
3.
No. of
deaths
during
last
one
year
Under 4
weeks of
age
Male
Female
Under one Male
year of
Female
age
Male
Under 5
years
0-5 Years Female
4.
Male
No. of children
with an episode of
F ema Ie
diarrhoea during
the last 2 weeks
5.
No fluids
No. of
chiIdren
Home Av. fluids
g i ven
fluids
dur i ng ORS
diarr
hoea
Others
6.
Feeding
dur i ng
diarr
hoea
M
more
S
same
L
less
W - stopped
DK
7.
Don't know
No. of mothers or care
givers who received ORS
from
a) source within the
viIlage
b) from a health facility
8.
No. of chiIdren
Male
with an episode of
cough/cold in the Female
last two weeks
9.
No. of children who had
fast/difficult breathing
or chest indrawing
10
No. of children for whom
help from health facility
was sought
Date :
64
Investigator's name and signature
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BCG
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Card
Scar
Source :
HOS
HC
OUT
PR1V
Fully Immunized
Partially Immunized
Not Immunized
Vitamin A 1
Source
HOS
HC
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National Child Survival and Safe Matherbaad Pratramme
MOTHER COVERAGE - Caster Sammary Farm
Survey dates :
Name of the District:
Clwster
< 20 years
20 - 30 years
> 30 years
Birt
h int
erval
< 2 yrs
2-3 yrs
> 3 yrs
N.A.
Card
Yes
No
TT1
Number
TT2/
3
Number
Sour
HOS
HC
OUT
PRIV
I FA
Proph. given
Therapy given
Consumed fully
IFA
sour
ce
HOS
SC
OUT
58
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Annexure II
LAMENESS SURVEY
One of the major aims in providing immunization coverage is to reduce incidence of vaccine
preventable diseases. You can collect information on the number of cases of these diseases
by using various methods. These are discussed in the module "Conduct Disease Surveillance”.
One of the vaccine preventable diseases which leaves a sequelae and which is easily
identifiable even by lay people, is poliomyelitis. By collecting information on the lame
children over the years you can get useful information which will help you evaluate your
programme. You already have baseline information on the incidence rate of poliomyelitis
in your State prior to the polio immunization services based on the large scale surveys on
poliomyelitis conducted in 1981 and 1982 (Annexure V).
On an average 15 to 20 children per 100,000 under fives would develop paralytic
poliomyelitis every year if there was no polio immunization programme. During a five year
period, you would thus have 75 to 100 children with poliomyelitis in the same population.
In other words, for every 10,000 children you would find at least 7 lame children if the
immunization coverage in your area was low.
While analyzing results of lameness survey you would therefore be interested in the total
number of lame children detected by you. Check the year when children developed paralysis.
If more than 2 children with poliomyelitis had developed the disease in the last two years,
this should be a warning. You must carry out a more detailed epidemiological investigation.
You should carry out a similar investigation if you find any lame child with a history of
having received OPV 3 during the last 12 months.
The numbers you have surveyed under coverage evaluation survey is, however, too small to
obtain statistically valid rates of incidence.
Using the same methodology and forms you can carry out an independent lameness survey
with a larger sample size, the total number of children under 5 years surveyed should be at
least 10,000 i.e. 334 per cluster.
You must also share your findings with the State and Central departments of health. The
data from a number of surveys could be pooled and analyzed for more details. This will help
understand the epidemiology and therefore activities for eradication of poliomyelitis can be
carried out better.
72
FORM NO. 12
CLINICAL OBSERVATION OF LAME CHILDREN
(To be completed by the Medical Officer for all lame children between 0 and 5 years of age
(a separate form for every lame child).
I.
General Information
1.
2.
3.
4.
5.
State/U.T.
District
Town (Mohalla)/PHC(Village)
Custer No.
Line List No.
H. Background Information on Lame Child
1.
3.
5.
7.
8.
Name of Child
2. Sex
Father’s Name
4. Head of Household
Date of Birth of Child
6. Address of Child
Person Interviewed
Relationship of person interviewed to child
IH. History of illness resulting in Lameness of the child
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Date of onset of lameness
________________________________
Address of child at a. Village
onset of lameness: b. District
c. Outside district surveyed YES/NO
Number of doses of polio vaccine received by child proceeding onset of lameness:
(a) one, (b) two, (c) three, (d) more, (e) none.
Medical care during illness resulting in lameness (circle correct answer):
a) Registered physician (Allopathic/Ayurvedic/Homeopathic)
b) Health Centre
c) Un-registered physician
d) Other (please specify)
Did the child have fever at the time of the onset of lameness?
Was the onset of the lameness acute?
Did the lameness progress (increase) after onset?
For how many days did it progress?
Number:
Any history of injury (including injections) prior to the illness?
Mental retardation associated with lameness?
YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
73
IV. Physical Examination of child (Circle correct answer)
1.
2.
YES/NO
Paralysis of lower limb present
Affected limb:
Right
Left
Upper
Lower
3.
4.
5.
6.
Flaccid
Spastic
Type of paralysis present
Normal
Impaired
Sensation in affected limbs
Muscle atrophy (wasting) in affected limb
Gait-Normal/impaired/requires assistance - Unable to evaluate
Evaluation of Lameness (Circle appropriate answer)
V.
1.
Lameness not present 2. Lameness present
a) Does not require mechanical aid to walk
b) Requires mechanical aid to walk
c) Unable to walk
VI. Physician’s Diagnosis on Cause of Lameness
1.
2.
3.
4.
Poliomeylitis
Trauma (please specify)
Congenital deformity (Please specify)
Other (please specify)
Date of Investigation
74
Investigator’s Name:
Annexure III
NEONATAL TETANUS MORTALITY SURVEY
Many methods can be used to collect information on the number of cases of neonatal
tetanus. These methods have been discussed in the module ‘Conduct Disease Surveillance’.
By investigating all neo-natal deaths the mortality due to neonatal tetanus can be estimated.
The case investigation form of neonatal deaths is annexed as Form No. 13. The statewise
neonatal tetanus mortality rate per 1000 live births based on large scale surveys has been
done in 1981. The mortality rate ranged from 2.0 in Kerala to 66.7 in Uttar Pradesh per
1000 live births (see Annexure VI).
It is possible to ask about neonatal deaths in every household by asking questions on live
birth and death within 1 month of birth while filling in the household tally marking form.
However, the number you would survey while doing a service coverage as described in this
module would be too small to give statistically valid rates of incidence.
Using the 30 cluster sampling methodology you can carry out an independent neonatal
tetanus survey with a larger sample size. The sample size would depend on the past
estimates of disease incidence in the area as well as the magnitude of change in incidence
following immunization.
75
I
Form No. 13
National Child Survival & Safe Motherhood Programme
Investigation of Neonatal Deaths
To be completed by the Medical Officer on all infants who died within the 1st month of life (a separate form for each neonatal death).
I.
General Information
1.
State/U.T
2
3.
District
Town (Mohalla)/PHC (Villaage)/Ward
4.
Physician’s name
5.
Date of investigation
Background Information on Neonatal Death
11.
1.
Name of Child
2
Sex
3.
Father's Name
4.
Address of child
5.
Date of birth of child
6.
7.
Person interviewed by the Investigator
Relationship of person interviewed to child
8.
Date of death of child
III.
Mother’s Immunization History
1.
Docs the mother know about vaccination with TT7
YES
2
No of doses received during this pregnancy?
PI
3.
Date of last dose of TT
4.
PI
NO
Yl’S
Card entry verified
NO
|2|
Infants Care since Birth (please circle appropriate answer)
IV.
1 lospital/lIcalth Ccnfrc/Homc/ln the Ficlds/Other (please specify)
I.
Where was the child delivered?
2
Who delivered the child ?
Doctor/LlIV/ANM/rr.TBA/IJntr.Dai/Family mcmbcrs/Other (please specify).
3.
4.
How was the cord cut?
How was the cord drossing done?
(use code) + (a=oil. b-cowdung. c»gcntian violet, d-antibiotic, c=>none and f=other)
5.
When
the
child
became
Sterile /unstcrilc (unboiled) Instrument
ill,
who
treated
the
6.
child?
(use
code)
++
When was the child initiated on breast-milk?
1.
Was (he infant able to suck the milk after birth?
Did the infant stop sucking milk when illness began?
3.
Did the infant have a fever?
YES
YES
NO
Did the infant have convulsions?
YES
NO
5.
Was the infant noted to be stiff?
YES
NO
Other Information on Mother
1.
Is the mother alive?
2
If dead, date of death
3.
Symptoms proceeding death
VII.
1.
Cause of Neonatal Death
Cause of Mother's Death
Date of Reporting:
76
YES
NO
Medical Officer's Diagnosis
2.
NO
YES
4.
VI.
health
within 2 hrs / 2-4 hrs I 4-8 hrs / 8-24 hrs / 24-48 hrs / > 48 hrs.
V. Symptoms preceedlng Infant's death (please circle appropriate answer)
2
(a-govt.
c= unregistered physician and d-no treatment received)
(allopathic/ayurvedic/homeopathic),
Investigator's Name:
NO
centre,
b- reg
physician
LOCAL EVENTS CALENDAR
FESTIVALS & LOCAL
EVENTS
►
New Year's Day
1987
1 Jan
1988
1 Jan
1 Jan
1999
1 Jan
7 Jan
AMAVASYA (New Moon) O
Lohri
1999
13 Jan
13 Jan
13 Jan
14 Jan
Pongal
1„1
1M2
FESTIVALS A LOCAL
EVENTS
1M7
IMS
PURNIMA (Full Moon) O
11 Jun
31 May
19 Jun
8 Jun
27 Jun
11 Jun
15 Jan
4 Jan
AMAVASYA (New Moon) O
26 Jun
14 Jun
3 Jul
22 Jun
11 Ju!
30 Jun
13 Jan
13 Jan
PURNIMA (Full Moon) O
11 Jul
29 Jun
18 Jul
8 Jul
26 Jul
14 Jul
14 Jan
14 Jan
AMAVASYA (New Moon) O
25 Jul
13 Jul
1 Aug
22 Jul
10
Aug
29 Jul
29 Jul
15 Aug
4 Aug
24 Jul
25
Aug
13 Aug
24 Dec
12 Jan
Teej
26 Jan
26 Jan
26 Jan
26 Jan
26 Jan
PURNIMA (Full Moon) O
15 Jan
4 Jan
21 Jan
11 Jan
30 Jan
19 Jan
ld-ul-Zuha(Bakri Id)
AMAVASYA (New Moon) O
29 Jan
19 Jan
6 Feb
25 Jan
14 Feb
3 Feb
AMAVASYA (New Moon) O
Baaant Pancbami
3 Feb
23 Jan
10 Feb
31 Jan
21 Jan
9 Feb
Independence Day
15 Aug
13 Feb
2 Feb
20 Feb
9 Feb
28 Feb
18 Feb
Muharram
Shiv Ratri
26 Feb
16 Feb
6 Mar
24 Feb
12 Feb
3 Mar
AMAVASYA (New Moon) 0
27 Feb
17 Feb
7 Mar
25 Feb
16 Mar
Holt (PURNIMA-Full Moon)
O
15 Mar
3 Mar
21 Mar
10 Mar
Dhulendi (KOLA)
16 Mar
4 Mar
22 Mar
AMAVASYA (New Moon) O
29 Mar
18 Mar
Good Friday
17 Apr
Ram Navami
Republic Day
26 Jan
PURNIMA (Full Moon) O
1992
1 Jan
3 Jan
6 Jan/26 Dec
1991
1 Jan
14 Jan
Guru Govind Singh B'day
L9M
29 Jul
18 Jul
8 Jul
23 Jun
12 Jun
15 Aug
15 Aug
15 Aug
15
Aug
15 Aug
27 Aug
15 Aug
4 Aug
24 Jul
22 Jul
12 Jul
Naag Panchami
31 Jul
17 Aug
6 Aug
26 Jul
14
Aug
4 Mar
Rakaha Bandhan
(PURNIMA-Full Moon) O
9 Aug
27 Aug
17 Aug
6 Aug
25
Aug
13 Aug
28 Feb
18 Mar
Janam Ashtami
16 Aug
3 Sep
24 Aug
14 Aug
1 Sep
21 Aug
11 Mar
1 Mar
19 Mar
AMAVASYA (New Moon) O
24 Aug
11 Sep
31 Aug
20 Aug
8 Sep
28 Aug
6 Apr
26 Mar
14 Apr
3 Apr
Anant Chaudaai
6 Sep
24 Sep
14 Sep
4 Sep
22 Sep
1 Apr
24 Mar
13 Apr
29 Mar
17 Apr
PURNIMA (Full Moon) O
7 Sep
25 Sep
15 Sep
5 Sep
23 Sep
12 Sep
7 Apr
26 Mar
14 Apr
3 Apr
24 Mar
11 Apr
AMAVASYA (New Moon) O
23 Sep
10 Oct
29 Sep
18 Sep
7 Oct
26 Sep
Mahavir Jayanti
12 Apr
31 Mar
18 Apr
7 Apr
28 Mar
15 Apr
Gandhi Jayanti
2 Oct
2 Oct
2 Oct
2 Oct
2 Oct
2 Oct
PURNIMA (Full Moon) O
14 Apr
2 Apr
21 Apr
10 Apr
28 Apr
17 Apr
Shradh
22 Sep
10 Oct
29 Sep
18 Sep
Baiaakhi
13 Apr
13 Apr
13 Apr
13 Apr
13 Apr
13 Apr
Navratri
20 Oct
19 Sep
8 Oct
27 Sep
8 Oct
AMAVASYA (New Moon) O
28 Apr
16 Apr
5 May
25 Apr
14 May
2 May
Dussehra
2 Oct
20 Oct
10 Oct
29 Sep
17 Oct
6 Oct
BUDH PURNIMA (Full
Moon)O
13 May
1 May
20 May
9 May
28 Mar
16 May
Mahariahi Valmiki’a B’day
(PURNIMA-Full Moon) O
7 Oct
25 Oct
14 Oct
4 Oct
23 Oct
11 Oct
AMAVASYA (New Moon) O
27 May
15 May
3 Jun
24 May
, 12 Jun
1 Jun
Dtwali (AMAVASAYA-New
Moon)O
22 Oct
9 Nov
29 Oct
18 Oct
6 Nov
25 Oct
Guru Arjan Dev'a Sbahidi Din
11 May
19 May
7 Jun
28 May
15 Jun
Gobardban Pooja
23 Oct
10 Nov
30 Oct
19 Oct
7 Nov
Id-ul-Fittar (Ramzan Id)
30 May
18 May
7 May
27 Apr
16 Apr
BbaiyaDooj
24 Oct
11 Nov
31 Oct
30 Oct
8 Nov
27 Oct
Nltjala EkadaaU
8 Jun
26 Jun
Guru Nanak'a B'day
(PURNIMA-Full Moon) O
5 Nov
23 Nov
13 Nov
2 Nov
21
Nov
10 Nov
I MmwiMA fFull Moon) O
22 Jun
4 Apr
7 Aug
28 Jul
12 Aug
77
ANNEXURE-Va
ANNUAL INCIDENCE RATE OF POLIOMYELITIS
PER 1000 CHILDREN 0 TO 4 YEARS (Based on sample surveys 1981-1982)
State/UT
Incidence Rate per 1000
children
Rural
Urban
Andhra Pradesh
1.7
1.4
Gujarat
2.5
2.2
Haryana, Punjab
3.1
1.7
Karnataka, Goa
1.2
1.2
Madhya Pradesh (Bhopal
& Jabalpur Divisions)
1.9
1.7
Maharashtra
1.4
1.3
Orissa
0.8
0.7
Rajasthan (Jaipur
Division)
3.1
2.5
Tamil Nadu &
Pondicherry
1.9
2.1
Uttar Pradesh
(Allahabad Division)
2.3
1.6
West Bengal
0.8
1.0
Chandigarh
Delhi
ALL INDIA
78
1.6
1.7
1.6
ANNEXURE-Vb
I
ANNUAL NEONATAL TETANUS MORTALITY RATE
PER 1000 LIVE BIRTHS (Based on sample surveys 1981-1982)
State/UT
Incidence Rate per 1000
children
Rural
Urban
Andhra Pradesh
6.8
2.7
Bihar
11.3
5.3
Gujarat and
D & N Haveli
5.8
1.9
Chandigarh
8.4
3.1
Karnataka & Goa
5.1
1.6
Kerala
2.0
1.9
M.P. (Bhopal &
Jabalpur)
20.4
1.4
Maharashtra
4.1
4.9
Orissa
8.6
2.0
Rajasthan (Jaipur
Division)
13.5
3.4
Tamil Nadu &
Pondicherry
4.9
UP (Allahabad)
66.7
15.3
West Bengal
11.9
0.5
Haryana, Punjab
Delhi
ALL INDIA
1.0
133
3.2
79
Education is empowerment. Every girl and boy must be helped to
complete atleast primary education in school. This will facilitate attainment
of good health. In this endeavour all of us can contribute and make a
difference.
I
You can make a big difference if you
II
o
ask every family, you meet during your health work, whether their
children are in primary school;
o
persuade them to send all their children including girls, to attend
and complete primary school, if they are not in school;
o
identify the primary school teachers of the villages covered by you;
o
facilitate communication between the family and the school teacher
whenever possible;
o
encourage all functionaries working with you to actively promote
school attendance and completion of primary school; ask them
regularly, what they have done;
o
include a panel/discussion on primary education whenever you
organize a health exhibition/camp.
I
~==::==—
I
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