Regional Health Integration to Enhance Services-North, Lango
LQAS Survey Report
May 2019
The Lango sub-region 2019 Lot Quality Assurance Sampling (LQAS) Survey was conducted by the district government teams with technical and financial support from the Regional Health Integration to Enhance Services (RHITES-N, Lango), a five-year program funded by USAID, and the SITES Project.
Disclaimer
This report is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents of this report are the responsibility of John Snow, Inc. (JSI) and do not necessarily reflect the views of USAID or the United States Government.
Contact Address:
Additional information about the survey may be obtained from SITES; Telephone: +256 312264872/3; Email: [email protected]; [email protected].
Additional information about the survey may also be obtained from RHITES-N, Lango Email: [email protected]; [email protected].
Regional Health Integration to Enhance Services-North, Lango | 2019 LQAS STUDY SURVEY REPORT 1
TABLE OF CONTENTS FORWORD ...... 5 1. INTRODUCTION ...... 6 1.1 Background Information ...... 6 1.2 Objectives of the 2019 Lango sub-region LQAS Survey ...... 7 1.3 Methodology ...... 7 1.3.1 Survey Design and Implementation...... 7 1.3.2 Survey questionnaires ...... 8 1.3.9 Survey Response Rates and Data Processing ...... 10 2. SURVEY RESULTS ...... 11 2.1 HIV SERVICES ...... 19 2.1.1 HIV Testing Services ...... 19 2.1.2 Prevention of Mother to Child Transmission (PMTCT) Program...... 20 2.1.3 Voluntary Medical Male Circumcision...... 22 2.1.4 Comprehensive HIV Knowledge ...... 22 2.1.5 Sexual Behavior: Multiple Sexual Partners and Condom Use ...... 23 2.1.6 Early Initiation of Sexual Behavior ...... 25 2.1.7 Stigma for HIV ...... 26 TB Knowledge ...... 26 Knowledge of Viral Load (VL) Testing and benefits ...... 27 2.1.8 Family Planning ...... 28 2.1.9 Water, Sanitation, and Hygiene (WASH) ...... 31 2.1.10 Malaria ...... 34 2.1.11 Child Health ...... 38 2.1.12 Maternal Health ...... 42 2.1.13 Nutrition...... 45 3. CONCLUSION AND RECOMMENDATIONS...... 47 APPENDICES ...... 50 Appendix 1: Knowledge and HIV Practices by Region, District and Year of LQAS survey ...... 50 Appendix 2: Lango Sub-Region LQAS Survey 2018 Results (disaggregated by districts and sex) ... 53
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TABLE OF FIGURES Figure 1: HTS coverage in the Lango sub-region ------20 Figure 2: Percentage of individuals who were tested for HIV and received their result as a couple -- 20 Figure 3: Percentage of mothers of children (0-11 months) who were counseled and received an HIV test during the last pregnancy and know their results. ------21 Figure 4: Percentage of mothers of children 0-11 months who were counselled for PMTCT services during the last pregnancy ------21 Figure 5: Percentage of the male youth 15-24 years who are circumcised ------22 Figure 6: Percentage of individuals who both correctly identify ways of preventing the sexual transmission of HIV and reject major misconceptions about HIV transmission ------23 Figure 7: Percentage of individuals who had sex with more than one sexual partner in the last 12 months ------23 Figure 8: Percentage of adults aged 15-49 who had more than one sexual partner in the past 12 months who report the use of a condom during their last intercourse ------24 Figure 9: Percentage of individuals who had sexual intercourse with a non-marital or non-cohabiting sexual partner in last 12 months and used a condom at last higher risk sex------24 Figure 10: Percentage of youth who have had sexual intercourse before the age of 15 ------25 Figure 11: Proportion of youth 15-49 years who have had sexual intercourse before the age of 15 --- 25 Figure 12: Percentage of women and men aged 15-49 who report discriminatory attitudes towards people living with HIV ------26 Figure 13: Percentage of individuals who know how TB is transmitted ------26 Figure 14: Percentage of individuals who know the risk of not completing TB treatment ------27 Figure 15: Knowledge about Viral Load Testing by district. ------28 Figure 16: Viral Load Testing Knowledge by sex ------28 Figure 17: Percentage of sexually active women age 15-49 years who are using any modern method of family planning------29 Figure 18: Percentage of sexually active women age 15-49 years who are using any modern method of family planning------29 Figure 19: Percentage of women 15-49 years who want to use a FP method in the last 12 months but cannot access it ------30 Figure 20: Percentage of men and women 15-49 years who are satisfied with family planning services ------30 Figure 21: Percentage households with latrine or toilet ------31 Figure 22: Percentage of individuals who wash their hands with soap after visiting the toilet ------32 Figure 23: percentage of individuals who wash their hands with soap after visiting the toilet, LQAS Survey 2019. ------32 Figure 24: Percentage of households with safe water supply ------33 Figure 25: Percentage of households with soap and water at a handwashing station commonly used by family members ------33 Figure 26: percentage of households with soap and water at a hand washing station commonly used by family members in 2019 ------34 Figure 27: Percent of households in target areas practicing correct use of recommended household water treatment technologies ------34 Figure 28: Percentage of mothers of children 0-59 months who know two or more ways to prevent malaria ------35 Figure 29: Percentage of mothers of children under five years who know two or more signs and symptoms of malaria ------35
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Figure 30: Percentage of mothers of children under five years who know how malaria is transmitted ------36 Figure 31: Percentage of households with at least one ITN ------36 Figure 32: Percentage of children 0-59 months who slept under an ITN the night preceding the survey in 2019 ------37 Figure 33: Percentage of children 0-23 months who had fever in the two weeks preceding the survey and received treatment with ACTs within 24 hours of onset of fever ------37 Figure 34: Percentage of children 0-23 months who had fever in the two weeks preceding the survey and blood sample was taken for testing and was given ACT ------38 Figure 35: Percentage of children 0-11 months with diarrhea in the last two weeks receiving ORT - 38 Figure 36: percentage of children 0-11 months with diarrhea in the last two weeks receiving ORT, LQAS 2019 survey ------39 Figure 37: Percentage of children 0-23 months who had fever in the two weeks preceding the survey and received treatment with ACTs within 24 hours of onset of fever ------39 Figure 38: Percentage of children 0-23 months who had fever in the two weeks preceding the survey and received treatment with ACTs within 24 hours of onset of fever in 2019 ------40 Figure 39: Percent of children 12-23 months who are fully vaccinated ------40 Figure 40: Percentage of mothers of children 0-23 months who received two or more doses of IPT2 during their last pregnancy in 2019 ------41 Figure 41: Measles vaccination coverage ------41 Figure 42: Percentage of mothers who went for ANC 1 within the first trimester ------42 Figure 43: Percentage of mothers of children 0-11 months who attended ANC at least 4 times during last pregnancy ------42 Figure 44: percentage of mothers of children 0-11 months who attended ANC at least 4 times during last pregnancy, LQAS Survey, 2019. ------43 Figure 45: Percentage of mothers of children 0-11 months who delivered their last baby in a health facility ------43 Figure 46: percentage of mothers of children 0-11 months who delivered their last baby in a health facility LQAS Survey 2019 ------44 Figure 47: Percentage of mothers of children 0-11 months who were assisted by a trained health worker during delivery ------44 Figure 48: percentage of mothers of children 0-11 months who were assisted by a trained health worker during delivery ------45 Figure 49: Exclusive breastfeeding ------45 Figure 50: Percentage of children aged under five years who have received a 2nd dose for deworming ------46
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FORWORD
Lot Quality Assurance Surveys (LQAS) were adopted by Uganda in 2007, and USAID-funded implementing partners (IPs) have been implementing them annually in the Lango region since 2013. Regional Health Integration to Enhance Services (RHITES) IPs have undertaken the administrative and financial responsibilities to conduct LQAS. The USAID Regional Health Integration to Enhance Services- North, Lango (RHITES-N, Lango) activity assumed the responsibilities for coordinating the implementation of the LQAS in 2018. The Lango Region 2019 LQAS survey is the second LQAS survey supported RHITES-N, Lango, and is a collaborative effort between USAID SITES, Lango district teams and USAID RHITES-N, Lango. Financial support for the 2019 LQAS came from United States Agency for International Development (USAID) Uganda through RHITES-N, Lango Activity.
LQAS Survey data is complementary to the routine health services data reported in the online District Health Information System (DHIS2), and the Uganda Demographic Health Survey and it provides evidence for additional indicators that are not contained in the DHIS2. These data support the Government of Uganda (GoU) and USAID Uganda and IPs to identify, plan and deliver services and to track progress towards attaining priority program objectives.
The 2019 Survey report contains comparative analysis using the 2018 results as baseline. The analysis has been made for regional and district level performances. The technical program areas contained in the survey are HIV/AIDS and viral load (VL) testing, tuberculosis (TB), reproductive health and family planning, water, sanitation and hygiene (WASH), malaria, infant and child health, maternal health, child and adult nutrition.
The number of districts covered in the survey has grown from eight to nine between the 2018 and 2019 LQAS, due to the creation of Kwania District. Geographically, Kwania District was carved out of Apac District through the actions of Local Government and was approved by the Parliament of Uganda. Due to the large size of some of the Supervision Areas (SAs) in Amolatar district, an additional supervision area (SA) was created to minimize the burden of data collection in the district.
The Lango region LQAS 2019 indicates mixed program performance. While some indicators showed declines, others showed improvements. Either way, the data collected for the LQAS offer a vital resource for program teams and the districts to target interventions based on reliable information, particularly where performances have remained low or even declined. Where performances have improved, successful strategies can be identified and scaled or adapted to low performing program areas. The same analysis needs to drill down at the SA (sub-county), level at the time of district level dissemination to increase micro-planning. RHITES-N, Lango will extend support to the districts to deepen this level of analysis.
Overall, RHITES-N, Lango appreciates the various district teams (DHOS, LQAS Focal Persons, LQAS Survey Supervisors, Data Collectors and Community Guides) without whom the results contained in this report would not have been realized. We remain grateful and indebted to USAID Uganda and the generous tax payers in America who funded the LQAS Survey. Please enjoy reading the report!
Med Makumbi CoP, RHITES-N, Lango
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1. INTRODUCTION
1.1 Background Information
The USAID-funded Regional Health Integration to Enhance Services-North, Lango (USAID RHITES- N, Lango) is a district and community-focused project committed to working with the Government of Uganda and local institutions and networks to increase the effective use of sustainable health services in the nine districts of the Lango sub-region. John Snow, Inc. (JSI) leads the project with sub- partners African Medical and Research Foundation, Doctors with Africa, The Medical Concierge Group, and Another Option.
The project contributes to measurable improvements in key Ugandan national health indicators and promotes the adoption of healthy behaviors by raising awareness at the individual, provider, and community levels, with the goals of increasing access to services, reducing delays in seeking care, and lowering barriers to service usage. The project ensures the provision of high-quality services by health workers whose skills are supported through clinical training and mentorship. The project works with Ugandan stakeholders to design and implement health system strengthening strategies to scale up high- impact, evidence-based interventions at the national, sub-regional, district, and community levels in the nine districts of the Lango Sub-region in Northern Uganda. With its life-cycle perspective, the project helps improve key population-based national health indicators.
For better planning and implementation of interventions that can lead to improved service delivery, the use of strategic information is crucial. Local governments and other service providers need routine management information for planning and program design. The Lot Quality Assurance Sample (LQAS) survey provides valuable information that complements routine management information system data and national level population-based surveys such as Uganda Demographic and Health Surveys (UDHS). In Uganda, many districts have been implementing annual LQAS surveys since 2009 with support from development partners, notably USAID. These surveys have provided district level planners with accurate local information to enable data driven decisions, and allows program managers to take corrective action during implementation. By classifying the sub-counties or group of sub-counties (supervision areas) into performance categories, the LQAS survey results have helped prioritize the allocation of resources based on the outcomes of sub-counties at district level.
While the Lango region LQAS 2018 was conducted in eight districts, the LQAS 2019, conducted in March 2019, was implemented in 9 districts, after the creation of Kwania district that was carved out of Apac district. The 2019 Lango sub-region LQAS Survey was conducted in the following nine districts: of Amolatar, Dokolo, Lira, Apac, Kole, Kwania, Oyam, Alebtong and Otuke, with leadership from the Strategic Information, Technical Support (SITES), and in collaboration with the Regional Health Integration to Enhance Services-N, Lango (USAID RHITES-N, Lango) project and the targeted nine district health offices. It was a follow-on to the LQAS 2018 conducted in July 2018 in the same sub- region. While USAID RHITES-N, Lango provided financial support, including transport, stationary and financial facilitation during the training and data collection exercise, the districts provided the training venues, and data collection personnel. SITES support focused on:
• Provision of technical guidance and tools on survey planning and budgeting; • Technical guidance on implementation elements of the survey; • Leading the development process of all the data collection tools; • Conducting the refresher training and supportive supervision of data collection; • Providing survey materials (tablets, training manuals and questionnaire check lists); • Data analysis.
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SITES will provide detailed district reports, and a national report comparing Lango sub-region results with other regions, and trends of indicator values over time. These reports will be updated routinely and shared over the course of the project.
1.2 Objectives of the 2019 Lango sub-region LQAS Survey The specific objectives of the 2019 Lango sub-region LQAS survey was to provide information on: • Progress on district level coverage of the various services provided once the LQAS 2018; • Baseline values for new indicators introduced and measured by the regional IP, USAID RHITES-N, Lango project.
The 2019 Lango sub-region LQAS survey provides data on the coverage of services at the district level and on the performance of different sub-counties or group of sub-counties within each district, specifically estimating changes in values of indicators over the period of seven months (completion of 2018 LQAS survey) undertaken by USAID RHITES-N, Lango project. The comparison is made in several areas of service delivery, including HIV/AIDS services, sexually transmitted infections, tuberculosis, malaria, reproductive health and family planning, child health, education, nutrition, water and sanitation, services.
1.3 Methodology 1.3.1 Survey Design and Implementation The Lango sub-region 2019 LQAS Survey was household-based and conducted in nine districts where the USAID RHITES-N, Lango projected is being implemented. The study assessed levels of knowledge, behaviors and access to services, particularly focusing on HTS, PMTCT, respondents’ behavior, STI, TB, knowledge about ARVs, the stigma for HIV/AIDS, malaria, reproductive health, family planning, maternal and child health, education, nutrition, water, sanitation and hygiene.
Table 1: Supervision Areas by Region and Service Areas Covered in the 2018 Lango sub-region LQAS Survey
Number of District Supervision Service Areas Covered Areas Alebtong 5 • HIV/AIDS (HCT, PMTCT) Amolator 7 • HIV/AIDS Knowledge and Sexual Behaviors • HIV (Viral Load knowledge) Apac 6 • Tuberculosis Dokolo 6 • Malaria • Sexually Transmitted Infections (STIs) Kole 6 • Reproductive Health & Family Planning Kwania 4 • Child Health Lira 6 • Water & Sanitation Otuke 6 • Nutrition
Oyam 8 Total 52
Each district consists of 5-8 supervision areas (SAs), each of which consists of one or two administrative sub-counties. At the first stage, 19 villages (or 24 villages in some districts) were
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selected from each SA using probability proportional to the number of individuals in the SA according to the Uganda National Household and Population Census, 2014. At the second stage, within each selected village, a household was randomly identified as the starting point or the reference household. The interviewer then proceeded to the household directly to the left of this reference to list eligible respondents.
A household member was eligible for the survey if he or she belonged to one of the following seven categories:
1. Youth 15-24 years 2. OVC 5-17 years 3. Mothers of children 0-11 months 4. Mothers of children 12-23 months 5. Mothers of children 24-59 months 6. Women 15-49 years 7. Men 15-54 years
At the third stage of sampling, in each selected household only one eligible member in one specific category was selected based on a random number table. Overall, in each village, seven eligible members, one in each of the seven categories, from seven households were interviewed. In each district, at least 650 households and 90 villages were visited.
The number of households and respondents reached are presented in Table 2. Overall, 99% (7,228 of 7,296) of the intended households was reached, and data on 1,813 males, 1,807 females, 2,136 youth (15-24 years), 2,701 children (0-59 months), and 907 orphans and vulnerable children (OVC) were collected.
Table 2: Sampling Summary for 2018 Lango sub-region LQAS Survey
No. of Total No. No. of No. of No. of No. of District SAs sampled men women mothers youth Otuke 6 910 114 113 342 227 Oyam 8 1214 152 152 456 302 Alebtong 5 760 95 95 285 190 Amolatar 7 1061 132 133 399 264 Apac 5 759 94 95 285 190 Dokolo 6 913 115 115 342 227 Kole 5 761 95 95 285 191 Kwania 4 766 95 96 288 191 Lira 6 911 113 114 342 228
Total 8,055 1,005 1,008 3,024 2,010
1.3.2 Survey questionnaires
All districts used the same standard questionnaire that was used in the previous years of LQAS survey applications. Separate questionnaires were developed for each of the seven categories of respondents. Each district team translated key terms and phrases in the questionnaires, with support from the SITES technical team into the districts’ primary local language(s). This was done to ensure that meanings of
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key terms and phrases were not lost in individual interviewer’s ad-hoc translations during data collection. This practice has been found to be efficient and enhances consistency of the data collected across the different regions. Mobile Data Collection (MDC) devices were used for data collection in all the districts surveyed.
1.3.3 Selection of Supervision Areas (SAs) Supervision areas (SAs) that were demarcated in 2013 and 2014 were used. In addition, four supervision areas were created in the new districts of Kwania, and an additional supervision area added in the district of Amolatar because of the very long distances to the last supervision area in the district, that rendered a difference in service access by the people living in that area. Each SA was established as a “true” supervision area in a programmatic sense, so that the survey results for an SA would guide and strengthen the programmatic and managerial responsibilities established within targeted geographical areas. 1.3.4 Sampling of Interview Villages An updated list of villages with corresponding household numbers was obtained from planning units or from the office of the local district Biostatistician. These lists were then organized according to SA definitions and a set of 19 villages were randomly selected from each SA using the Probability Proportional to Size (PPS) sampling technique. 1.3.5 District Survey Teams
The district team for each SA consisted of one supervisor and two data collectors. Participants were drawn from the departments of health and community services. These teams were formed several years back, and have been conducting the annual LQAS in the sub-region. In total, each SA was assigned three team members: two data collectors, and a supervisor. An additional two district staff participated as overall district LQAS supervision team (DLST).
1.3.6 Implementation Process
Implementation of the 2019 LQAS survey lasted for 10 days in each district. Three days were spent on a refresher training on LQAS concepts and principles and seven days on data collection. A team from SITES and USAID RHITES-N, Lango supported the process.
1.3.7 Training During the first three days, participants were refreshed on the theory and methodological aspects of LQAS application. Facilitators guided participants on the purpose of the workshop in relation to their expectations, relating them to the overall goal and the role of each stakeholder in the current LQAS survey as defined by their mandates. In the new district of Kwania, the training lasted five days. 1.3.8 Data Collection The data collection exercise took seven days in each district. During data collection, the supervision area team moved together to each sampled village, in order to enable effective supervision and ensure timely data quality check by the SA supervisors. The SA supervisor had the responsibility of identifying respondents; the SITES team gave technical support to data collectors in the field, ensuring adherence to LQAS principles, and monitoring to ensure interviews were being conducted correctly in all the sampled villages.
Eligible respondents were selected using a simple random sampling method. Two procedures for household selection for the 19 sets of interviews per supervision area were followed. The first
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procedure considered a scenario where the village household list (LC 1 Register, VHT register) is available and up to date, the data collector then numbered the households consecutively from start to finish with no missing numbers. They then identified a random sampling range taking into consideration the end number and chose a random number. The randomly selected number, then became the reference household. As a principle, interviews are conducted at the next nearest household (walking distance). If the household had suitable respondents only one respondent category was interviewed and the team proceeded to the nearest next household to identify another category.
In cases where the village household list was not available and it was not possible to update the list accurately, the data collector then drew a village sketch map with guidance from the community leader indicating the major physical features and landmarks in the village, subdivided the village into 2-5 sections with approximately the same number of households (<30 households) in each section. The team then selected one section at random, created a household list for the selected portion with the assistance of the community leader, and then randomly selected the reference household.
The following sections provide insight into the process of data collection, and not the findings from the survey itself. They have implications for future LQAS surveys in the sub-region over the life of the USAID RHITES-N, Lango project.
Lessons Learned • Rigorous supervision and spot checks on data collection teams provides support to the teams in addition to improving their morale towards the survey. • Availability of village registers in some villages made the exercise of identifying reference households and starting households very easy. • Members of the community were willing to be interviewed. • Involvement of community leaders, household heads and respondents in the random sampling made the exercise very interesting and attracted more cooperation from the community. • Data collectors moving and working in villages as a team with the SA supervisor quickened the data collection exercise. • With every subsequent day of the survey, the teams gained more confidence and the time spent on a respondent during the interview reduced.
1.3.9 Survey Response Rates and Data Processing Owing to the small sample size within each SA and data collected by the community based community workers, health or social workers, the survey achieved a 98% response rate. Electronic databases from various projects/partners were submitted to SITES for data processing.
1.3.10 Data Analysis
The analyses and reports to meet the objective of this study have been summarized in district level reports that will be shared with districts.
In this report, estimates of district level coverage of services were based on data aggregated at district level through pooling across the SAs, with each SA treated as a “stratum”. The district level coverages were also pooled within the region to form regional level estimates of coverage, with each district considered as a “cluster”. Since all the districts were surveyed, the results represent the entire sub-region.
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2. SURVEY RESULTS
The Lango sub-region 2019 LQAS reveals slight changes in the region’s health sector over the past seven months. However, the seven-month period between the two surveys, was very short and many changes in the indicators between 2018 and 2019 2018 are not statistically significant. For example, many indicators have increases of less than 5 percent points (not percentage), and it is likely that the new 2019 values may fall within the confidence interval of the 2018 values. A few indicators have reductions, but again the differences are less than 5 percent points. There are, however, indicators like knowledge of transmission of malaria from mothers that increased from below 60% to over 90%, that reveal effective interventions and approaches for some program areas. Table 3 summarizes 2018 and 2019 values of these indicators as estimated through the two surveys.
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Table 3 RHITES-N, Lango LQAS Indicator Summary 2019
Baseline 2019 Indicator Performance Indicator definition and unit of Data Disaggregated Baseline Value Value Comment measurement Source by Year Source Indicators -2018 Goal: Effective Use of Sustainable Health Services in The Lango Sub-Region of Northern Uganda Prevalence of Exclusive breastfeeding refers to feeding a exclusive child only o breast milk, giving no other breastfeeding liquids or semi-solids or water except 84.90% 72.70% of children prescribed drops or syrups consisting of under six vitamins and mineral supplements or months of age medicine and expressed breast milk. Context Statistically (LQAS (LQAS & FTF LQAS District 2018 significant 2018) 2019) HL.9.1-b decrease Numerator: Number of children under 6 months of age who received only breast milk since birth.
Denominator: Total number of children
aged 0-5 months surveyed. Result 1: Increased Availability and Accessibility of Health Services Numerator: Number of sexually active Contraceptive Increase women aged 15-49 years who are using Context Prevalence LQAS District 2018 26.90% 29.30% but may any modern contraceptive method of Rate (CPR) not be family planning.
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(LQAS (LQAS statistically
2018) 2019) significant Denominator: Number of sexually active women aged 15-49 years in the survey. Percentage of Numerator: Number of women ages 15 women who to 49 with live births who attended ANC 64.50% 69.00% used antenatal four or more times during most recent care provided pregnancy. by skilled health Increase Standard, personnel for but may LQAS, reasons LQAS, District 2018 not be FHT related to Denominator: Total number of women statistically (USAID) (LQAS (LQAS pregnancy at with live births within the reference significant 2018) 2019) least 4 times period. during pregnancy (ANC 4th visit coverage) Numerator: Total number of individuals who could sleep under an ITN if each ITN 92.70% Proportion of 88.20% Decrease population in the household is used. LQAS / Context, but may with access to Malaria (LQAS (LQAS Standard District 2018 not be an ITN within indicator 2018) 2019) LQAS statistically their survey Denominator: Total number of significant household individuals who spent the previous night in surveyed households. Numerator: Number of women Percent of No currently married or in union who are Context women with LQAS District, Age 2018 6.80% 6.60% significant fecund and who desire to either unmet need difference terminate or postpone childbearing, but
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for family who are not currently using a planning contraceptive method.
(LQAS (LQAS
2018) 2019) Denominator: number or percent of women currently married or in union
who are fecund and who desire to either terminate or postpone childbearing.
The total number of women with an unmet need for family planning (FP) consists of two groups of women: (a) those with an unmet need for limiting, and (b) those with an unmet need for spacing. 1.2 Increased availability of quality high impact community-based health services Technology type: Chlorination or Percent of Flocculent/Disinfectant (chemical households in disinfection), Filtration (physical removal), 30.40% 26.80% target areas Solar disinfection (UV/heat disinfection, Decrease Standard practicing Boiling (disinfection via heat) District, but may 3.1.6.8-2, correct use of Numerator: Number of households in LQAS residence, 2018 not be FHT recommended target areas practicing correct use of (LQAS (LQAS technology type statistically (USAID) household recommended household water 2018) 2019) significant water treatment technologies treatment technologies Denominator: Total number of
households in the target areas Standard Percent of Numerator: Number of people with District, sex, LQAS 2018 32.80% 25.50% 3.1.8-32 population access to improved sanitation facility age
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with access to (LQAS (LQAS Statistically improved 2018) 2019) sanitation significant facility Denominator: Total population decrease 1.3 Strengthen referral network/linkages across all levels, including non-public health providers Proportion of Numerator: Number of children (0-59) children (0-59) months who had a fever in the last two 67.50% 79.10% months who weeks and were tested for malaria Statistically FHT had a fever in LQAS District 2018 (LQAS (LQAS significant (USAID) the last two 2018) 2019) increase weeks and were tested Denominator: Number of children (0-
for malaria 59) months surveyed Percentage of Numerator: Number of households households with soap and water at a hand washing 13.50% 14.10% with soap and station commonly used by family Standard Increase water at a members 3.1.6.8-2, District, but not hand washing LQAS 2018 FHT residence statistically station (USAID) Total number of (LQAS significant commonly Denominator: (LQAS households 2018) used by family 2019) members. Result 3: Increased Adoption of Healthy Behaviors Percent of Numerator: Number of individuals who women and were counseled and received an HIV test 60.70% 62.30% men aged 15 – in last 12 months and know their results. Increase 49 years who Standard District, Sex, but not tested for HIV LQAS 2018 LQAS Age group statistically in the last 12 Number of women in (LQAS Denominator: (LQAS significant months and the survey aged 15 – 49 years 2018) 2019) received results
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Percent of 88.60% 79.20% children 0-59 Numerator: Number of children 0-59 months who months who slept under an ITN the night Statistically Custom slept under an preceding the survey Denominator: LQAS District 2018 (LQAS (LQAS significant ITN the night Number of children 0-59 months in the 2018) 2019) decrease before the survey survey Numerator: Number of deliveries that FHT Percentage of 72.60% 74.60% take place in a health facility Increase (USAID), institutional LQAS, (LQAS (LQAS but not RMNCH deliveries District, age 2018 HMIS 2018) 2019) statistically Score (Health unit significant card delivery rate) Denominator: Expected deliveries in a
catchment population Percentage of Numerator: Number of of children, children, ages ages 12–23 months, who received measles 75.40% 73.00% 12–23 months, vaccine at the time of the survey who received (LQAS (LQAS Decrease measles FHT 2018) 2019) but not vaccine at the LQAS Age, district 2018 (USAID) statistically time of the significant survey Denominator: Total number of of (Measles children, ages 12–23 months. vaccination coverage) Percentage of Numerator: Number of children aged Num: children aged under five years who have received a 2nd 11.90% 10.70% HMIS Decrease under five dose for deworming FHT but not years who Age, district 2018 (USAID) statistically have received Den: (LQAS (LQAS significant a 2nd dose for Calculated 2018) 2019) deworming
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Denominator: Estimated population of LQAS children aged under 5 years.
3.1 Increased awareness of health seeking behaviors and commitment to addressing high priority health risks by the individual, providers, and community levels. Numerator: Number of women and men age 15 years and above with 27.40% comprehensive knowledge of HIV. (LQAS 25.50% 2019)
Percent of Denominator: Total number of women (LQAS
women and and men interviewed during the survey. 2018) men age 15 Increase Standard years and District, age, but not LQAS 2018 LQAS above with Comprehensive knowledge means Sex statistically comprehensive knowing that the risk of getting HIV can significant knowledge of be reduced by using condoms and limiting HIV sex to one uninfected partner, knowing that a healthy-looking person can have
HIV, and rejecting the two most common local misconceptions about HIV prevention and transmission: that HIV can be transmitted by mosquito bites or by sharing food with a person who has HIV. Percentage of Numerator: Number of women in women in the reproductive age group 15 – 49 who 47.80% 51.00% Statistically Standard reproductive know at least 3 methods of family LQAS District, age 2018 significant LQAS age group 15- planning and have used the methods increase 49 who known (LQAS (LQAS
at least 3 2018) 2019)
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methods of Denominator: Number of women in the
family planning reproductive age group 15-49. Percentage of Numerator: Number of mother of Mothers of Children who know at least 3 ways how 55.20% 91.90% Children 0-59 malaria is transmitted and prevented months who at Statistically Standard (LQAS (LQAS least know 3 LQAS District, age 2018 significant LQAS 2018) 2019) ways how increase Malaria is Denominator: Number of mother of transmitted Children in the survey. and prevented 3.2 Reduced delays in seeking appropriate care Percentage Numerator: Number of pregnant pregnant Women attending 1st ANC visit within HMIS, 42.80% 47.20% women 1st trimester national Statistically RMNCH District, health attending 1st Population 2018 (LQAS (LQAS significant Scorecard Denominator: All expected pregnancies facility level, Age ANC visit data, 2018) 2019) increase within the 1st LQAS trimester Proportion of Numerator: Number of all women who HMIS, RMNCH Mothers have received PNC at 6 days after national 76.60% 71.50% Statistically Score receiving PNC delivery Population District, age 2018 significant card checks within Denominator: All expected deliveries in data, (LQAS (LQAS decrease 6 days a given population LQAS 2018) 2019) Percent of Numerator: Number of mothers who HMIS, mothers who attended PNC visit within 6 weeks 69.80% 73.60% Increase national FHT attended PNC postpartum but not Population District, age 2018 (USAID) visit within 6 statistically All expected pregnancies data, (LQAS (LQAS weeks Denominator: significant in a catchment LQAS 2018) 2019) postpartum
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2.1 HIV SERVICES 2.1.1 HIV Testing Services
HIV testing services (HTS) are an essential first step towards receiving HIV care and treatment among HIV-infected persons and plays an important role in reducing HIV transmission through improved risk reduction behavior. HTS leads to the achievement of the first of the global 95/95/95 goals: at least 95% of HIV-positive individuals know their status.
To assess coverage of prior HIV testing behavior, respondents were asked if they have ever tested for HIV and whether they know where to get an HIV test. They were also asked if they tested and received their HIV results within the last 12 months. The proportions of respondents (15-49 years), disaggregated by sex and district, who tested and received HIV results in the past 12 months for the two surveys (2018 and 2019), are summarized in Table 4.
HTS coverage is still low in the Lango sub-region. The 2019 general coverage for HTS in the last 12 months was estimated at 62.3%, just 1.6 percentage points above the value in 2018 (LQAS 2018). The pattern is the same in all districts, with only two districts registering likely significant increases. HTS coverage was low (below 60%) in three districts (Amolatar, Kwania, and Kole). Otuke district returned the highest HTS coverage (above 70%). Kole district had lowest HTS coverage even in 2018. Results show that women are tested for HIV more than men in all districts.
Table 4: HIV Testing Services
Percentage of individuals who were counselled and received an HIV test in last 12 months and know their results Coverage Sub- Total Male Female FY 2018 FY 2019 FY 2018 FY 2019 FY 2018 FY 2019 Lango sub- 60.7 62.3 59.0 58.6 53.4 65.9 region Districts Alebtong 63.0 61.9 43.8 62.5 35.2 61.3 Amolatar 57.9 59.0 54.7 52.1 51.1 66.0 Apac 61.0 62.0 63.8 57.1 65.6 67.0 Dokolo 65.1 63.2 63.2 60.7 56.8 65.6 Kole 51.2 57.0 58.0 54.7 53.4 59.2 Kwania 61.0 58.1 63.8 53.9 65.6 62.3 Lira 67.0 64.5 59.1 56.5 43.4 72.8 Otuke 66.8 74.3 54.8 72.9 45.0 75.8 Oyam 52.2 60.4 70.0 57.4 64.1 63.3
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Figure 1: HTS coverage in the Lango sub-region
2018 2019
Figure 2 below illustrates HTS uptake in couples. Regionally, there was no change in the proportion of people taking HIV test and receiving the results as couples (84.7% in 2018, against 84.5% in 2019). However, Significant differences in couple testing are observed in three districts: Alebtong (from 85.5% to 91.0%), Kole from (70.7% to 78.3%), and Oyam (from 73.8% to 79.6%). Five districts returned almost same values, while Apac district significantly dropped from 88.5% to 78.5% for couple testing. To improve partner HIV Counselling and Testing, the project will intensify couple HIV counselling and testing intervention in Antenatal Care and DREAMS program focusing mainly on Districts with the lowest results.
Figure 2: Percentage of individuals who were tested for HIV and received their result as a couple
Percentage of individuals who were tested for HIV and received their result as a couple 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional FY 2018 85.5% 88.5% 88.5% 88.3% 70.7% 88.5% 84.8% 89.3% 73.8% 84.7% FY 2019 91.0% 90.1% 78.5% 86.7% 78.3% 82.5% 82.9% 88.3% 79.6% 84.5%
2.1.2 Prevention of Mother to Child Transmission (PMTCT) Program With support from the USAID RHITES-N, Lango, the region continues to focus on effectively treating HIV positive pregnant mothers to reduce HIV transmission risk from an infected mother to her baby. This includes testing for
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HIV during antenatal care (ANC) or during delivery. The Lango sub-region LQAS 2019 results show that testing of HIV among pregnant women has slightly increased from 92.2% in the 2018 study to 93.5% of pregnant women being tested and being given their results (see table 4). Three districts registered higher increases, Kole- 86.3% to 92.6%, Apac- 89.4% to 94.7%, and Kwania 89.4% to 95.8%; while Lira and Otuke districts registered slight decreases. All districts scored above 90%. This result implies that counseling of pregnant HIV mothers to take up PMTCT services has been improved, and is steadily moving closer to 95% of pregnant mothers knowing their HIV status. It also means that fewer HIV positive children may be born, thereby decreasing the burden of HIV in the sub-region.
Figure 3: Percentage of mothers of children (0-11 months) who were counseled and received an HIV test during the last pregnancy and know their results.
Percentage of mothers of children (0-11 months) who were counseled and received an HIV test during the last pregnancy and know their results 100 98 96 94 92
% 90 88 86 84 82 80 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 93.3 92.9 89.4 94.7 86.3 93 98 87.1 92.2 2019 94.7 95.2 94.7 94.7 92.6 95.8 91.2 93.9 90.3 93.5
Overall, the survey reveals that counseling of pregnant mothers for HIV testing services (HTS) has slightly improved from about 92% in 2018 to 94% in 2019. Most districts remained almost at the same level of performance for this indicator. Kole and Apac districts registered the biggest increases from about 86% to about 93%. However, Kwania (about 96%) performed much higher than the results of the two districts of Kwania and Apac in 2018. Lira and Otuke districts declined in 2019. RHITES-N, Lango will utilize the results for this indicator to conduct targeted SBCC campaigns in the districts and leveraging existing programs such as DREAMS to offer HIV testing for segments of pregnant and lactating mothers and their partners.
Figure 4: Percentage of mothers of children 0-11 months who were counselled for PMTCT services during the last pregnancy
Percentage of mothers of children 0-11 months who were counselled for PMTCT services during the last pregnancy 100 80 60 % 40 20 0 Alebton Amolata Apac Dokolo Kole Kwania Lira Otuke Oyam Regional g r 2018 92.2 65.2 80.5 76.1 60 87.7 75.7 75 76.6 2019 85.3 58.9 86.3 86.0 64.2 74.0 77.0 72.8 81.8 76.2
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Mothers of children aged 0-11 mothers who were counseled and tested for HIV during their last pregnancy were counseled for PMTCT if positive. In 2019, there was no difference with the proportion of mothers counselled for PMTCT remaining at 76% across the region. However, Lira Alebtong and Otuke districts registered slightly lower levels of performance for this indicator. On the other hand, Dokolo, Oyam and Apac districts registered increases.
2.1.3 Voluntary Medical Male Circumcision Comparing 2018 and 2019, the region has registered improvements in male circumcision as evidenced by results of the LQAS Survey 2019. Although the overall coverage of SMC is still low, all districts have shifted upwards by 5 percentage points (see Figure 5 below). This result agrees with the project performance for VMMC in the first two quarters of FY 2019.
Figure 5: Percentage of the male youth 15-24 years who are circumcised
Percentage of the male youth 15-24yrs who are circumcised 35 30 25 20 % 15 10 5 0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 15.2 22 22.6 26.5 24.6 23.8 18.9 21.7 21.9 2019 19.6 25.8 32.5 28.4 27.9 27.9 20.9 19.9 29.0 25.8
The biggest improvement across the districts since the 2018 survey occurred in Apac (approximately 10%) and Oyam (approximately 8%). Improvements in the number of male youth who were circumcised could be attributable to improved mobilization and awareness creation on the benefits of circumcision. The Voluntary Medical Male Circumcision (VMMC) teams also conducted outreach camps in Apac and Oyam districts. Lira and Otuke districts, however, had small declines. Overall, there is still room to provide more circumcision services in the region.
2.1.4 Comprehensive HIV Knowledge
Proper knowledge about HIV transmission and prevention is key to empowering individuals to fight the HIV epidemic. Common misconceptions include the idea that all HIV-positive individuals appear ill and the belief that the virus can be transmitted through mosquito bites, by sharing food with someone who is infected, or by witchcraft or other supernatural means. In this report, we define comprehensive knowledge about HIV prevention as knowing that both condom use and limiting sexual intercourse to one uninfected partner are HIV prevention methods, knowing that a healthy-looking person can have HIV, and rejecting all the local misconceptions about HIV transmission.
The 2019 LQAS returned slight increases for this indicator, with the sub-region scoring 27.4% compared to 25.5% obtained in 2018. This finding was largely contributed to by Oyam which increased from 27.8% to 38.2%, Otuke from 28.8% to 39.5%, and Apac from 23.7% to 31.9%. On the other hand, Lira district registered a decrease from 38.2% to only 27.5%. Similar to 2018 findings, Alebtong district scored the lowest with only 15.1%, a slight decrease from 16.1%. Figure 6 shows the results for this indicator. These results call for more interventions to increase awareness of HIV transmission in the general population.
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Figure 6: Percentage of individuals who both correctly identify ways of preventing the sexual transmission of HIV and reject major misconceptions about HIV transmission
Percentage of individuals who both correctly identify ways of preventing the sexual transmission of HIV and reject major misconceptions about HIV transmission 45.0 40.0 35.0 30.0 25.0 % 20.0 15.0 10.0 5.0 0.0 Lango Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Region 2018 16.1 22.6 23.7 22.6 21.1 23.7 38.2 28.8 27.8 25.5 2019 15.1 23.1 31.9 20.0 23.4 21.9 27.5 39.5 38.2 27.4
2.1.5 Sexual Behavior: Multiple Sexual Partners and Condom Use The 2019 LQAS revealed that sex with multiple partners over the last 12 months has increased compared to 2018 findings, and was reported at 15.2%. This finding is slightly higher than respondents in 2018 who reported 13.5% had sex with multiple partners. This proportion was reportedly higher among men across all districts, (see data tables in the appendices). Of those respondents who reported sex with more than one partner, a higher proportion of respondents reported having sex with non-marital or non-cohabiting partners (28.5% compared to 26.0%) (figure 7).
Figure 7: Percentage of individuals who had sex with more than one sexual partner in the last 12 months
Percentage of individuals who had sex with a non marital or non cohabiting sexual partner in the last 12 months 40.0 35.0 30.0 25.0
% 20.0 15.0 10.0 5.0 - Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Lango Region 2019 28.9 21.0 25.2 27.4 35.7 35.0 32.4 16.2 36.0 28.5 2018 27.7 27.2 28.3 28.7 23.8 28.3 23.0 18.9 30.6 26.0
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Condom use among those who reported more than one sexual partner in the last 12 months was 72.0% compared to 70.3% in 2018 overall in the Lango sub-region. Significant increases in reported condom use were found in Amolatar, Kwania and Oyam. Significant declines occurred in Dokolo and Otuke.
Figure 8: Percentage of adults aged 15-49 who had more than one sexual partner in the past 12 months who report the use of a condom during their last intercourse
Percentage of individuals who had sex with a non marital or non cohabiting sexual partner in the last 12 months and used a condom at last higher risk sex 90.0 80.0 70.0 60.0 50.0 % 40.0 30.0 20.0 10.0 0.0 Lango Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Region 2019 78.6 77.6 58.8 60.0 68.3 70.0 65.0 64.5 81.3 72.0 2018 78.7 63.9 61.7 66.2 72.7 61.7 68.9 75.6 76.8 70.3
Exploring the barriers to use of condoms and messaging needs to be strengthened; in parallel condoms must be made widely available since it is clear that over 20% of residents in the region have sex with multiple partners and not all of them are using condoms consistently. Further disaggregated results can be found in the tables in the appendices. The maps below (figure 9), shows that condom use messages have to be emphasized in Apac, Dokolo, and Kole. Except for Kwania, results indicate that messages and availability of condoms have to be emphasized in all other districts.
Figure 9: Percentage of individuals who had sexual intercourse with a non-marital or non-cohabiting sexual partner in last 12 months and used a condom at last higher risk sex
2018 2019
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2.1.6 Early Initiation of Sexual Behavior The Lango sub-region LQAS 2019 reveald that youth still perceive themselves as having a low risk of acquiring HIV. Among youth (15-24 years) surveyed, 78.5% (compared to just over 70 percent in 2018), perceive that they have a low or no risk of getting HIV infection. This was highest in Otuke (88.2%) and lowest in Oyam (72.3%). Districts with the highest and lowest values in 2018 and with almost same numbers were Alebtong (which is still high at 84.5%, and Amolatar which has gone higher to 78.9%.
This perception may not be consistent with their behaviors which may put them at elevated risk for acquiring HIV. The Lango sub-region LQAS 2019 estimated that about 28% of youth 15 – 24 years had had sexual intercourse before the age of 15, similar to the 2018 survey. But there were significant variations across between male and female youth in almost all the districts. More female youth than male youth male youth reporting having had sexual intercourse before the age of 15 years. This result points to a likelihood of young girls involved in transactional sex with older men. Moreover, this trend is more pronounced in all the four DREAMS districts (Lira, Oyam, Apac and Kwania; See Figure 10, below). It is therefore that current programme focuses on this emerging trend in order to reverse the escalating early sex among female youth.
Figure 10: Percentage of youth who have had sexual intercourse before the age of 15
Percentage of youth who have had sexual intercourse before the age of 15 40.0 35.0 30.0 25.0
% 20.0 15.0 10.0 5.0 0.0 Fema Fema Fema Fema Fema Fema Fema Fema Fema Regio Male Male Male Male Male Male Male Male Male le le le le le le le le le nal Alebtong Amolatar Apac Dokolo Kwania Kole Lira Otuke Oyam 2018 34.2 29.2 37.2 31.0 36.9 20.8 34.4 21.6 36.9 20.8 34.2 27.6 21.8 17.6 27.1 24.8 33.0 25.4 28.2 2019 30.0 35.1 37.7 37.9 23.5 31.8 25.4 32.6 26.8 35.7 28.6 26.6 22.1 29.6 27.6 32.7 31.3 34.6 28.8
Figure 11: Proportion of youth 15-49 years who have had sexual intercourse before the age of 15
2018 2019
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2.1.7 Stigma for HIV
Overall, HIV stigma and discrimination has slightly decreased from 32% to 29%. Except for Amolatar and Lira districts that where results show increases (29% to 34% and 36% to 39%, respectively), all districts registered decrease in HIV stigma prevalence. The biggest proportionate decrease was in Otuke district. These results show concerted efforts by the SBC team to raise awareness disputing misconceptions about HIV/AIDS. However, with a general stigma prevalence of over 29%, the need to continue with awareness campaigns still exists. More effort will be needed in the two districts of Lira and Amolatar where increases in stigma were registered.
Figure 12: Percentage of women and men aged 15-49 who report discriminatory attitudes towards people living with HIV
Percentage of women and men aged 15-49 who report discriminatory attitudes towards people living with HIV 50.0 40.0 30.0 20.0 10.0 0.0 Lango Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Region 2018 39.0 28.9 30.8 35.6 27.7 30.8 36.2 24.5 33.1 31.8 2019 36.6 33.5 27.2 32.5 22.3 28.4 39.2 17.1 27.2 29.4
2018 2019
TB Knowledge
The 2019 LQAS Survey results reveal no significant changes in levels of TB knowledge in the region with the overall proportion of respondents who know how TB is transmitted decreasing slightly from 86% in 2018 to 84% in 2019 (See figure 13 below). Only four of the nine districts (Amolatar, Apac, Dokolo and Oyam) registered small improvements in knowledge of TB transmission.
Figure 13: Percentage of individuals who know how TB is transmitted
Percentage of individuals who know how TB is transmitted 100
80
60 % 40
20
0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 88.7 79.6 85.6 80.7 85.2 92.4 88.1 86.2 85.8 2019 85.1 81.8 93.7 83.6 75.9 84.1 80.8 87.3 87.4 84.4
2018 2019
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Whereas the knowledge is still seemingly high, program data over the last six months before the 2019 LQAS Survey (March 2019) show increasing cases of TB morbidity especially drug resistant TB. This could be linked to the over 20% gap in community knowledge about TB transmission. There is decrease, albeit small, in knowing the risks of not completing TB treatment within the region. These decreases are consistent in the districts which had decreased knowledge of TB transmission (See figures 14 and 13).
Figure 14: Percentage of individuals who know the risk of not completing TB treatment
Percentage of individuals who know the risk of not completing TB treatment 100
95
90
85
80
75 Men Women AlebtongAmolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 96.4 94.1 94.4 95.6 97.3 93.2 97.2 95.2 96 93.2 95.3 2019 94.9 92.5 93.2 96.1 97.1 82.7 94.2 97.9 94.7 97.4 90.4 93.5
2018 2019
Knowledge of Viral Load (VL) Testing and benefits The World Health Organization recommends Viral Load Testing as the strategy for monitoring of Patients on ART. Since 2014, patient response to ART in Uganda is being monitored through viral load as contained in MoH revised HIV treatment guideline 2014. RHITES-N, Lango analysis of the regional performance of viral load testing shows an underwhelming performance in the October-December (Q1 2019) and January – March (Q2 2019). Given the Centrality of the Viral Load Testing articulated in the WHO strategy to contain HIV epidemic and its subsequent adoption by the Ministry of Health, Viral Load Testing had a few knowledge, attitude and practice (KAP) indicators adopted in LQAS Survey 2019. Data on the indicators were collected from six districts (Figure 15).
Results show dismal levels of knowledge on viral load testing in the community and is even worse for knowledge of the benefits of viral load testing at <28% and 9%, respectively). These results may explain the low levels of viral load testing coverage and suppression rates observed in the region. Whereas the project has enhanced its approaches (e.g. VL Camps) to improving VL coverage and suppression, it is apparent that low knowledge levels in the community might be contributing to the low uptake of VL services. Results further show a lopsided gender perspective with more men (about 30%) as opposed to about 25% women who have ever heard of viral load testing. Equally so, more men (slightly more than 13% as opposed to about 10.5% women who know at least two benefits of Viral Load Testing. No results for 2018 exist and in future the 2019 assessment results of the viral load indicators will be used as baseline.
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Figure 15: Knowledge about Viral Load Testing by district.
Viral Load Testing 35.0 30.0 25.0 20.0 % 15.0 10.0 5.0 0.0 Amolatar Kole Kwania Lira Otuke Oyam Regional Percentage that ever heard of viral load 28.2 31.9 31.0 26.9 15.7 31.0 27.5 testing Percentage that know at least two 12.8 10.2 18.0 11.2 3.5 15.5 8.4 benefits of VL testing
Figure 16: Viral Load Testing Knowledge by sex
With these findings, the Viral Load Testing project has already embarked on awareness-raising on VL 40.0 29.5 25.4 27.5 through collaborative radio
% 13.3 20.0 10.4 8.4 talk shows and SBC campaigns. RHITES-N, Lango 0.0 will intensify these Men Women Regional awareness-raising efforts, Percentage that ever heard of viral load testing client tracking and intensive adherence counselling to Percentage that know at least two benefits of VL testing clients with non-suppressed VL.
2.1.8 Family Planning
Similar to 2018, the LQAS 2019 survey covered FP knowledge and practices. Respondents eligible to use FP services were also asked if they currently have access to these services. • Modern family planning use among women 15-49 years increased from 26.9% to 29.3% across the sub-region. FP knowledge, including method options, among sexually active women 15 to 49 years of age remained low in 2019; • In 2019, there is a slightly lower number of women aged 15-49 years (6.6%) who want to use a family planning method in the last 12 months but cannot access it as compared to 6.8% in 2018; • Only 57.7% of respondents have heard about FP on mass media in the last three months; this is far below the 2018 score (67.9%) that had heard about FP on mass media; • While 47.8% of respondents (only female), knew at least three methods of FP in 2018, this increased to 51.0% in 2019; • In 2019, just 37.4% of sexually active (married) women 15 to 45 years of age report using any FP method as opposed to 31.3% who reported using it in 2018; • About the same number of respondents 89.7% as compared to 86.7% in 2018 are satisfied with FP services provided at the health facilities.
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Figure 17: Percentage of sexually active women age 15-49 years who are using any modern method of family planning
Percentage of sexually active women aged 15-49 years who are using any modern method of family planning 40 35 30 25
% 20 15 10 5 0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 17.9 27.5 29.6 31.7 29 26.2 22 29.2 26.9 2019 28.3 32.2 36.8 32.2 23.7 25.5 25.0 20.0 35.4 29.3
Overall, use of modern Family Planning Methods slightly increased in the region from about 27% to about 29%. Five of the nine districts registered increases in the use of modern family planning methods. Relatively higher increases were registered in Alebtong and Apac district. Otuke district has the least overall percentage (20% in 2019). Lira has slightly dropped from above 26% in 2018 to 25% in 2019. Results for this indicator mirror the routinely reported data in the DHIS2. The map (Fig 18) below shows changes in in FP use among sexually active women age 15-49 years since the last LQAS Survey in 2018. Clearly, Otuke district remains challenged as far as this indicator is concerned.
Figure 18: Percentage of sexually active women age 15-49 years who are using any modern method of family planning
2018 2019
Districts that had increases have established integrated outreach programs and social mobilization through the SBC teams and district leaderships. Service uptake of sexual and reproductive health services is particularly poor in Otuke, Lira and Kole districts. This is partly due to the prevailing myths and misconceptions on FP and Sexual and Reproductive Health Services. RHITES-N, Lango has started to address this problem through social mobilization involving men to promote uptake of SRH services in these districts. It is also planned that DREAMS Peer Leaders in Lira district will be involved to carry out community FP Services to adolescent girls and young women.
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Across the region, there was a slight reduction in unmet need for FP Services among women aged 15-49 years. Dokolo, Alebtong and Kole had the most reduction in the unmet need for modern FP services. Kwania district had the least unmet need for modern FP services. Three districts Amolatar, Apac and Lira had higher number of women with unmet FP need. These three districts need focus to meet service needs.
It is observed that there is a correlation between the unmet need and the modern FP use. Districts with high use of modern FPs have lower unmet need and the reverse is true.
Figure 19: Percentage of women 15-49 years who want to use a FP method in the last 12 months but cannot access it
Percentage of women 15-49 years who desire to use a family planning method in the last 12 months but cannot access it 18 16 14 12 10 % 8 6 4 2 0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 8.9 5.1 2.9 16.3 5.4 4.2 6.7 5.7 6.8 2019 7.5 12.1 3.8 6.8 3.6 1.8 9.7 6.5 5.4 6.6
RHITES-N, Lango will work towards reducing the unmet need in the districts of Amolatar and Lira where unmet need has increased in the last one year. The project will also focus on districts such as Alebtong, Otuke and Oyam that seem to have attained very limited reductions of unmet modern FP needs in order to reduce the high unmet needs for modern FP methods in the region. This will be through integrated community outreaches and community dialogues as well as engaging community structures such as women’s groups, religious and cultural groups, VHTS, among others, to promote FP services in the communities.
Figure 20: Percentage of men and women 15-49 years who are satisfied with family planning services
Percentage of men and women 15-49 years who are satisfied with FP services provided at the health facilities 100.0 95.0 90.0
% 85.0 80.0 75.0 70.0 Amolata Alebtong Apac Dokolo Kole Kwania Lira Otuke Oyam Regional r 2018 97.8 91.5 90.6 82.2 85.5 86.7 90.6 94.8 89.7 2019 88.5 88.5 94.9 87.6 89.6 93.1 81.5 90.4 91.5 89.6
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Satisfaction with the FP services remained the same among men at 89.4% and women at 90% across the two years. Decline in satisfaction was, however, reported in four districts (Alebtong, Amolatar, Lira and Oyam) and minimally in Otuke. On the other hand, Apac, Dokolo reported increases in satisfaction with FP services provided at health facilities. Overall, there is no change in the level of FP Services’ client satisfaction. Through the ongoing collaboration, learning and adopting initiatives, the Project will ensure best performing districts (Apac, Dokolo and Kole) where satisfaction increased to share their experiences with the low performing districts by mainly applying continuous quality improvement approaches within the health facilities.
2.1.9 Water, Sanitation, and Hygiene (WASH)
WASH indicators returned mixed values (high and low). While the overall proportion of respondents who reported access to a latrine or toilet, and safe water supply were high, (94% and 88%, respectively), the proportion practicing hand washing with soap after visiting a toilet was lower at only 73%. The trend is similar across districts (Figure 21). Unfortunately, the study did not investigate factors leading to low hygienic practices. The RHITES-N, Lango team will need to examine the underlying factors that contribute to these practices (e.g., the burden of fetching water).
Other WASH indicators demonstrated poor findings. • The percentage of households with soap and water at a handwashing station commonly used by family members was only 14.6%; • Percent of households in target areas practicing correct use of recommended household water treatment technologies was 27%; • Percent of the population using an improved sanitation facility was 33%. Great variation is observed in access to latrines between the two years but this is a consistent trend across the districts. Witnessed variation could probably be explained by the application of the “improved” definition of a latrine in 2019 as opposed to 2018.
The Lango region 2019 LQAS results of 26% of latrine coverage is consistent with the national average results of 37% using the “improved” definition. However, this performance is far below the National Development Plan 2015-2020 target for improved sanitation coverage of 80%. It is known that contributing factors to low coverage of improved latrines in the districts supported by the Uganda Sanitation Fund include: late and inconsistent disbursement of funds to the districts, geological challenges, mobile communities, scarcity of construction materials. The project may need to investigate further to establish the underlying factor to support the districts to address the challenge of very low latrine/toilet coverage in the region.
Figure 21: Percentage households with latrine or toilet
120.0
100.0
80.0
% 60.0
40.0
20.0
0.0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 93.5 91.7 92.9 92.3 96.0 98.5 90.7 97.2 94.0 2019 20.1 35.2 23.2 32.9 20.7 18.8 35.0 26.3 15.8 25.5
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Use of soap to wash hands after a visit to the toilet / latrine is considered basic sanitary hygiene practices. In 2019, results show that hand washing using soap after visiting the toilet / latrine, however, dropped by more than 6 percent across the Lango region. The drop was highest in Oyam (18%), Dokolo (14%) followed by Lira and Otuke that had a drop of an average of 5%. Alebtong district continued having the lowest performance in handwashing with soap after toilet / latrine visit. The new district of Kwania had the second lowest performance in hand washing.
The 2019 LQAS Survey result for handwashing with soap after visiting the toilet is about 67%, could be attributed to increased awareness created by the Uganda Sanitation Fund that support 8 out of the 9 districts in the region.
Figure 22: Percentage of individuals who wash their hands with soap after visiting the toilet
100
80
60 % 40
20
0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 37.3 82.2 56.1 92.3 65.2 80.3 77.7 84.1 73.2 2019 33.4 85.0 64.1 77.6 78.0 40.1 74.7 72.8 65.4 66.9
The map below (Figure 23) shows the district-level performance in handwashing using soap after toilet visit. While all districts scored above 60%, Alebtong and Kwania lagged behind at about 40% and below. It is evident that more efforts are required to improve the performance of handwashing with soap after latrine visit in the two districts. RHITES-N, Lango will share the LQAS Survey results with active WASH IPs in the region to facilitate their focused planning and interventions in the region.
Figure 23: percentage of individuals who wash their hands with soap after visiting the toilet, LQAS Survey 2019.
Availability of safe water supply to households had a 1.2% higher performance than in 2018 but is not significant. Amolatar and Kwania districts reported the highest district scores for this indicator. Five districts had improved performance while three districts had drops in performance in safe water availability for households. Generally, findings mirror the results of the 2018 survey. The regional coverage of 88.3% is higher than the national coverage at 79.5% as at July 2019. However, the unchanged results from the 2018 survey could be attributed to the low operation and
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maintenance (measured by functionality at 85%) of water points, limitation of the main technology (borehole) used to improve rural water supply.
Figure 24: Percentage of households with safe water supply
120
100
80
% 60
40
20
0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 77.7 99.1 98 88.4 86.8 89.1 87.3 77.9 88.3 2019 84.3 99.8 98.4 84.4 84.8 99.0 89.6 85.7 81.4 89.5
Similarly, the percentage of households with soap and water at a handwashing station commonly used by family members had results mirroring the 2018 findings. Almost all the districts showed increases in soap and water at handwashing stations between 2018 and 2019, with the exception of two districts (Dokolo and Otuke). The district of Kwania had the lowest score in this indicator and shows there is need to continue to improve public health awareness on the benefits of handwashing with soap.
Figure 25: Percentage of households with soap and water at a handwashing station commonly used by family members
35
30
25
20 % 15
10
5
0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 8.6 13.2 10.2 9.1 7.4 25.1 16.3 15.4 13.5 2019 12.1 18.8 14.8 6.6 9.8 5.7 28.8 14.9 16.5 14.6
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Figure 26: percentage of households with soap and water at a hand washing station commonly used by family members in 2019
The correct use of recommended technologies for household water treatment dropped slightly from over 30% in 2018 to below 27% in 2019. Although this drop is not huge and given the low percentages of the technologies usage, it is a pointer that promotion of technologies for water treatment in the region is still a huge opportunity to exploit.
Figure 27: Percent of households in target areas practicing correct use of recommended household water treatment technologies
50 45 40 35 30
% 25 20 15 10 5 0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 44.4 17.3 23.7 41.8 20.6 29 31.2 36.5 30.4 2019 19.8 21.1 25.9 38.4 17.8 19.0 35.7 37.1 24.6 26.8
2.1.10 Malaria
The LQAS indicators for malaria focus on mother’s knowledge and management of malaria in children 0 – 59 months (under 5 years), access to, and use of ITNs. Results show a general decline in knowledge of malaria prevention among mothers of children under 5 years of age across the region. Only Alebtong district had an increase in knowledge by about 4%.
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Figure 28: Percentage of mothers of children 0-59 months who know two or more ways to prevent malaria
70
60
50
40 % 30
20
10
0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 50.2 59.5 64.2 63.1 38 53.4 65 54.8 55.2 2019 54.0 55.3 55.9 38.3 35.1 46.5 36.6 54.7 60.0 48.4
From figure 29 below, results indicate low levels of knowledge of signs and symptoms of malaria. However, Alebtong and Amolatar districts registered increases in the values of this indicator, comparing the performances of the two years (from 38% to 42% and from 44% to 53%, respectively). Lira and Dokolo districts registered significant decreases (54% to 36% and 65% to 56%, respectively), while the rest of the districts returned almost same results for this indicator for the two consecutive surveys. These results are surprising, given that mothers always receive health education during antenatal care visits. Apparently, not much effort has been put to raising awareness in the communities about malaria. Whereas RHITES-N, Lango provides mentorships at facilities, it is apparent that the communities are not constantly reminded of the symptoms and signs of malaria. The project SBC component should use this information to implement continuous targeted malaria awareness programs in the communities.
Figure 29: Percentage of mothers of children under five years who know two or more signs and symptoms of malaria
80
70
60
50
% 40
30
20
10
0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 38 43.7 68 65.2 44 54 55.7 65.3 53.3 2019 43.5 55.3 66.8 56.1 44.3 59.4 35.7 57.9 65.1 53.5
Figure 30 below, shows that knowledge of transmission of malaria among mothers increased slightly from 90% to 92% comparing results of 2018 to those of 2019. Oyam District returned the highest increase in the percentage of mothers who knew how malaria is transmitted to 98%, from the 2018 knowledge level of about 93%. Other districts in the region that registered increases for this indicator were Alebtong and Amolatar; while the rest of the districts showed slight reductions. It is surprising that knowledge of transmission among mothers is high while the same mothers do
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not know the signs and symptoms of malaria. This may point to the quality of messaging during the education talks. The project should study these results carefully and design appropriate messages to address these gaps.
Figure 30: Percentage of mothers of children under five years who know how malaria is transmitted
100 98 96 94 92
% 90 88 86 84 82 80 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 91.6 89.1 93.8 95.1 90.1 95.3 94.2 93.5 90.2 2019 92.3 92.7 92.3 93.3 86.9 93.4 93.5 93.6 98.3 91.9
Across the region, about 88% of households had a mosquito net, compared to 93% in 2018. This was a significant reduction from the 2018 levels of ITN available in households. This could be attributed to stock out of nets in the region between November 2018 to Feb 2019. Distribution resumed by Mar 2019, meaning that some households may not have received the nets by the time of the survey. This is a temporary problem, however, working with partners in the region, the project should ensure constant supply of ITNs.
Figure 31: Percentage of households with at least one ITN
100 98 96 94 92 90 % 88 86 84 82 80 78 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 91.3 96.8 94.4 96.6 95.1 97.1 97.2 94.9 92.7 2019 84.6 95.3 88.1 92.7 90.8 88.2 85.8 89.5 88.6 88.2
In addition to the drop in availability of ITN at household level (figure 31), ITN utilization also dropped. In five of the 9 districts 80% or less of children below five years slept under a mosquito net the night preceding the survey. Three districts had between 80.1% - 85% of the children who had slept under an ITN the night preceding the survey. Only one district (Amolatar) had more than 85.1% of under five years old children who had slept under a mosquito net the night preceding the survey. Given the endemic nature of malaria in the region and high susceptibility to malaria among children, this finding points to a high risk for children to contract malaria.
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Figure 32: Percentage of children 0-59 months who slept under an ITN the night preceding the survey in 2019
Results also show that malaria treatment with ACTs within 24 hours improved across the region (Figure 33) by about 5 percent. However, this percentage increment is still within a possible margin of error.
Figure 33: Percentage of children 0-23 months who had fever in the two weeks preceding the survey and received treatment with ACTs within 24 hours of onset of fever
80
70
60
50
% 40
30
20
10
0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 57.6 59.6 56.6 57.5 70.8 56.3 50.4 60.3 58.5 2019 46.8 53.4 60.9 67.9 72.0 55.8 61.7 63.3 73.6 63.4
While Oyam led the sub-region with the highest improvement (13%) in use of ACT to treat fevers (figure 33), the district however was third best in blood sample testing for the fever cases before ACTs were given. Kole and Otuke performed highest in blood sample testing. Overall, there was growth in the region in terms of blood sample testing for children under two years who had fever in the two weeks preceding the survey.
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Figure 34: Percentage of children 0-23 months who had fever in the two weeks preceding the survey and blood sample was taken for testing and was given ACT
100 90 80 70 60
% 50 40 30 20 10 0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 61.9 51.7 67.3 62 80 55 51.2 79.6 65.1 2019 75.7 64.1 78.4 67.9 89.7 78.3 60.7 87.5 80.6 77.4
2.1.11 Child Health
Diarrhea
Proper management of diarrhea was assessed in both 2018 and 2019. Results show that in 2019 a higher percentage (about 58%) of children aged less than 1 year who had diarrhea were treated with ORT as compared to 50% in 2018. All the districts except Alebtong and Lira had a reported increase for this indicator. This is an encouraging trend, and the project should continue with the approaches in place to manage diarrhea.
Figure 35: Percentage of children 0-11 months with diarrhea in the last two weeks receiving ORT
80 70 60 50
% 40 30 20 10 0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 43.8 40 50 52.2 52.9 58.3 51.7 51.9 50.3 2019 38.5 53.3 72.2 62.5 58.3 42.9 50.0 60.0 67.9 57.7
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Figure 36: percentage of children 0-11 months with diarrhea in the last two weeks receiving ORT, LQAS 2019 survey
Uganda uses ACTs to treat uncomplicated malaria. Respondents affirmed more children aged 0-23 months who had fever in the two weeks preceding the survey were treated using ACTs within 24 hours than in 2018. Whereas this demonstrated an increase, the general picture in use of ACTs to treat malaria in children remains relatively the same across the region.
Figure 37: Percentage of children 0-23 months who had fever in the two weeks preceding the survey and received treatment with ACTs within 24 hours of onset of fever
80
70
60
50
% 40
30
20
10
0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 57.6 59.6 56.6 57.5 70.8 56.3 50.4 60.3 58.5 2019.0 46.8 53.4 60.9 67.9 72.0 55.8 61.7 63.3 73.6 63.4
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Figure 38: Percentage of children 0-23 months who had fever in the two weeks preceding the survey and received treatment with ACTs within 24 hours of onset of fever in 2019
Immunization
Child immunization results are similar to the 2018 LQAS survey performance levels. For example, the Lango regional proportion of fully immunized children 12-23 months was about 67% but relatively lower than the reported 71.4% finding of the same age group in 2018.
Figure 39: Percent of children 12-23 months who are fully vaccinated
90 80 70 60 50 % 40 30 20 10 0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 70.6 73 70.8 82.7 74 70.2 67.7 65.3 71.4 2019 76.8 58.2 50.5 77.2 76.8 74.0 74.6 66.7 57.2 67.3
There was a general decline of fully vaccinated children 12-23 months in the region. Specifically, a decline was witnessed in Apac, Amolatar, Oyam, Dokolo and Otuke. While this is true, some districts (Alebtong, Kole and Lira) had improvements in this indicator. Overall, the general picture for fully immunized children appears to reflect the status quo as of 2018. In 2018 OPV3 vaccination was worse, with a sub-regional average of only 58%. However, in 2019, Apac and Oyam districts had over 90% of mothers of children 0-23 months who received two or more doses of IPT2. Otuke, Alebtong and Dokolo had 80.1-90% while Kole, Lira and Kwani had 70.1-80%. Amolatar had the lowest percentage of IPT2.
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Figure 40: Percentage of mothers of children 0-23 months who received two or more doses of IPT2 during their last pregnancy in 2019
Figure 41: Measles vaccination coverage
100 90 80 70 60
% 50 40 30 20 10 0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 75.3 68.7 71.7 76.9 80.2 78.9 72.2 81 75.4 2019 71.2 63.8 61.7 92.0 90.4 71.8 85.0 64.8 58.3 73.0
Significant improvements in measles vaccination (>10%) were made in Dokolo and Kole districts. In total, three districts improved measles coverage. However, a general decline in measles vaccines coverage was seen five districts and impacted negatively on the regional coverage for measles vaccine Oyam had the biggest decline in the measles vaccination coverage. The results show that the regional lags the average measles vaccination coverage since 2012 has remained stagnent at 82%. Only two districts, Dokolo and Kole reached the minimum of at least 90% target of vaccinations coverage.
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2.1.12 Maternal Health
Antenatal Care
Although ANC 1st trimester is still below the National target of 60%, there was a general improvement in most districts with Oyam having the highest improvement. Amolatar had the least improvement. Dokolo and Lira districts had a slight decline from the last LQAS assessment. ANC 1 attendance in first trimester is still below the target due to, among others: weak community level interventions to address barriers to accessing health care, leading to inadequate follow up of pregnant women and poor referral for ANC services, negative beliefs and perceptions that affect health seeking behaviours among pregnant women.
Figure 42: Percentage of mothers who went for ANC 1 within the first trimester
70
60
50
40 % 30
20
10
0 Regional Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam 2018 42.8 45.8 36.2 32.2 51.4 29.5 50 49 44.4 2019 47.2 50.0 38.5 41.1 50.6 37.6 46.9 49.4 49.1 57.2
To turn around this indicator there is need for RHITES-N, Lango to engage the VHTs and empower them to screen for pregnancy among women of child bearing age using signs of probable pregnancy, and refer to the facility for HCG confirmation, register all pregnant women and link them to the facility for ANC services. The project must ensure all womenof child bearing age are tested for pregnancy using the HCG testing kits to rule out pregnancy during OPD consultations.
Figure 43: Percentage of mothers of children 0-11 months who attended ANC at least 4 times during last pregnancy
90 80 70 60 50 % 40 30 20 10 0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 62.2 56.3 67.3 71.7 71.7 60.5 60.5 67.2 64.5 2019 69.1 59.5 62.9 67.5 62.1 73.6 77.9 73.1 73.4 69.0
There was a general improvement in ANC 4 attendance at a sub-regional level in 2019 as compared to the previous year. Lira had the highest increase of 17.4% while Amolatar had the smallest increase of 3.2%. Overall, Kole district declined by 9.6% from the last LQAS assessment. None of the districts has attained the expected target of 85%. This
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is due to most mothers reporting late for ANC 1 and end up delivering before they attend the required 4 ANC visits. The low performance of this indicator is indicative of the need for VHTs to conduct a door to door identification of pregnant women for early initiation of ANC 1 and sensitization of communities about the importance of every ANC visit (Goal oriented ANC).
Figure 44: percentage of mothers of children 0-11 months who attended ANC at least 4 times during last pregnancy, LQAS Survey, 2019.
Deliveries.
Oyam maintained the best performance of pregnant women who had a health facility delivery at 85.2% while Kole was the worst performing district and declined from 70.7% to 60.3%. All districts are below the target of 89%of pregnant women who have deliveries at the facility. Attributing factors to this include lack of information about the importance of institutional deliveries, lack of preparedness for by pregnant women for facility deliveries. The new district of Kwania does not have 2018 results.
Figure 45: Percentage of mothers of children 0-11 months who delivered their last baby in a health facility
90 80 70 60 50 % 40 30 20 10 0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 68.9 64.3 68.1 72.6 73.7 71.1 75.7 84.5 72.6 2019 73.0 68.6 79.7 72.8 60.3 76.4 73.2 77.8 85.2 74.6
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Figure 46: percentage of mothers of children 0-11 months who delivered their last baby in a health facility LQAS Survey 2019
The project will target communities with low uptake of institutional deliveries in 2019. The population of each village in the catchment area of every health facility will be established, expected pregnant women from each parish, calculated, parishes with fewer deliveries compared to the expected pregnancies will be identified and targeted with sensitization messages and awareness and mobilization to improve institutional deliveries. VHTs will be taken through birth planning emergency preparation list items needed for birth and follow up acquisition of items for each pregnant woman.
Figure 47: Percentage of mothers of children 0-11 months who were assisted by a trained health worker during delivery
100 80 60 % 40 20 0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 66.7 65.2 75.2 85 80 78.1 73.7 87.9 76.6 2019 74.0 64.9 79.4 78.4 69.9 78.1 81.4 78.1 83.6 76.6
Most districts showed a decline in skilled birth attendances, Lira, Apac and Alebtong districts had an increase in the proportion of skilled birth attendance, while there was a general decrease of varied proportions in all other districts. Skilled birth attendance is essential for every delivery due to the obvious benefits of appropriate management of unexpected complications to both the mother and the newborn. Improving facility deliveries will automatically improve skilled birth attendance.
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Figure 48: percentage of mothers of children 0-11 months who were assisted by a trained health worker during delivery
2.1.13 Nutrition
Although exclusive breastfeeding stood at over 84% in 2018, there was a huge drop to just about 76%. Children aged 12-23 months receiving a minimum of acceptable diet was in the same range of 10-12%. Children receiving a minimum acceptable diet was below 20% across all districts in the two assessments. Regionally, Vitamin A supplementation in children in the last six months was below 56% in 2019 as opposed to about 65% in 2018.
Figure 49: Exclusive breastfeeding
Percentage of children under 6 months of age who are exclusively breastfed in the last 2 surveys
100 90 80 70 60
% 50 40 30 20 10 0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Regional 2018 75 86.5 89.6 94.7 94.1 89.4 58 94.9 84.9 2019 72.7 74.1 75.1 73.6 71.6 71.4 68.6 67.9 73.2 76.3
Exclusive breastfeeding shows a significant general decline from the results obtained in 2018 (about 85% to just about 27%). However, whereas the data shows decline, programmatically, the results appear closer to actual breastfeeding
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practices in the community. This result was obtained through proper clarification of the indicator to data collectors and nutrition interventions undertaken during the period since the last LQAS survey 2018. The project team has trained Health workers on NACS and mentored them on exclusive breastfeeding during the support supervisions. This may have impacted on their knowledge and exclusive breastfeeding among mothers.
Figure 50: Percentage of children aged under five years who have received a 2nd dose for deworming
18 16 14 12 10 % 8 6 4 2 0 Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Reional 2018 11.4 7 11.5 14.5 12 15.9 13.8 11.4 11.9 2019 11.9 7.8 11.5 14.6 8.5 9.4 12.4 11.7 10.3 10.7
At the sub-regional level, the second dose of deworming of children under five years of age had a slight drop by 1.2% in 2019. While three districts (Amolatar, Alebtong and Dokolo) had slight increases in deworming, four other districts (Kole, Lira, Otuke and Oyam) had decreases.
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3. CONCLUSION AND RECOMMENDATIONS
Results of the 2019 LQAS show mixed programme performances. While some indicators showed declines, others show improvements. However, most of these changes cannot be interpreted as they lack any statistical significance. Either way, evidence abounds in the data and offers vital resource to programme teams to make more targeted interventions, especially where performance has remained low or even declined. Where performance has improved, strategies used can be identified and adapted to low performing programme areas and districts. Viral Load Testing While results of the Viral Load Testing knowledge indicators had no baseline, the 2019 findings will provide baseline for the subsequent surveys. Generally, few respondents had heard of viral load testing and even fewer knew the benefits of viral load testing. More is required to increase knowledge about viral load testing in the population which can be translated into support towards viral load testing for community or household members living with HIV in order to walk the last mile in bringing HIV epidemic under control. Family Planning Specifically, Family Planning technical programme area showed growth in use of modern family planning methods in the subregion among sexually active women aged 15-49 years. There was a decline in the unmet need for family planning services. Two districts had outstanding growths in unmet need, indicating that there is a growing number of women who would choose to use modern family planning methods if they were available and affordable. Satisfaction with family planning services among men and women was unchanged with variations across districts. Five districts reported a drop in satisfaction and only three districts expressed increased satisfaction. WASH Similarly, water, Sanitation and hygiene (WASH) indicators had mixed results. Toilet/latrine coverage appears to be worsening but the significant decline is mainly attributable to use of new definition for a toilet or latrine according to WHO definition. Safe water availability to households remains at relatively the same levels of 2018 with the apparent 1.2% increased level falling within a possible margin of error of + or – 5 percent. Handwashing with soap after visiting the toilet or latrine declined by 6 percent and signifies an increased need for knowledge, attitude and practice changes in the population. Some 3 districts had improvement in this indicator and their experiences could be vital for sharing with the poor performing districts. The percentage of households with soap at the handwashing station commonly used by family members increased by just 1.1 percent while use of recommended technologies for water treatment slightly dropped. These variations are all within the possible margin or error that leave the region at relatively the same level as in 2018. Malaria Mothers of children under 5 years had decline in knowledge of how to prevent Malaria yet their knowledge of the signs and symptoms of malaria remained approximately the same as in 2018. A small growth of less than 2 percent on malaria transmission is only likely a random variation other than a programmatic performance change. There was a decline in availability of Insecticide treated mosquito nets (ITNs) but this decline appears to be a natural trend because of wears and tears due to frequent usage. This decline can be easily offset through net distribution. If the decline is not arrested, the region will have more household members sleeping exposed to mosquito bites that can exacerbate the malaria morbidity and mortality. The lower usage of ITNs during the night preceding the survey than in 2018 is partly contributed to by the decline in availability of ITNs at household level. While more mothers of children under five years of age know how malaria is transmitted, it was puzzling to note that results showed a decline in knowledge of how to prevent malaria. It is possible this ambiguity is due to statistical dynamics caused by random sampling. Although treatment of malaria among children under five years with ACTs within 24 hours improved in 2019 across the region, the increase is just within the margin of error and far from a result to celebrate. However, testing of blood samples significantly grew by over 11 percent that attest to improvement of service delivery in facilities following WHO and National guidelines in the treatment of malaria. This may point to the quality of messaging during the education talks. The project should study these results carefully and design appropriate messages to address these gaps.
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Child Health In 2019, significantly more children aged 0-11 months with diarrhea were treated with Oral Rehydration Therapy (ORT). Results also show that more children 0-23 months who had fever in the two weeks preceding the survey were treated using ACTs. Two possible signals are borne in this result. First, it is safe to safe that nothing significant lies in this result because the regional growth falls within the margin of error of +5 percent. However, it is also possible to believe that here could be an improvement in the adherence to the national guidelines on treating uncomplicated malaria in Uganda among health workers. Immunization Fully vaccinated children declined by 4.1 percent but this is within the possible margin of error of -5 percent. Measles vaccination has remained nearly static as of 2018 levels. Two districts (Dokolo and Kole), however, had significant growths by over 10 percent each. This differential may be indicative of levels of efforts injected by district teams. The lessons from the districts of Dokolo and Kole can be shared with and adopted by the rest of the districts for scaling up performance levels. Maternal Health Although ANC 1 visit within the 1 trimester improved by over 4 percent, the achievement still keeps the region lagging behind the national target of 60% signifying that added efforts are still required to pull individual districts and the region to match or even surpass the national targets for ANC 1 visit within the first trimester. Equally so, although ANC 4 improved in in the region in 2019, this improvement still falls short of bringing the region to the national target of 85%. To improve to the national target level, late reporting for ANC 1 must be tackled and reversed. Deliveries Increases in facility deliveries were registered albeit within possible margin of error of +5 percent. Oyam district maintained its overall best performance as it did in 2018 and could share its experience with the poorer performing districts. Comparatively at district levels, performances differed. For instance, significant growth in facility deliveries in Apac district is paralleled by significant declines in Kole district. Generally, the regional performance has not changed much from the levels of 2018. Equally so, mothers of children 0-11 months who were assisted to deliver by trained health workers stagnated at the 2018 level. Nutrition Vitamin A Supplementation dropped by 9%. Data showed an alarming drop by over 57% in exclusive breastfeeding of children under 6 months of age but it is likely a possible data error. This result will be confirmed or corrected after data verification from SITES. No significant change was realized in the results of children 12-23 months who received a minimum of acceptable diet. Challenges While the survey was largely successful, it faced significant hurdles in logistical arrangements and facilitation to district teams due to district teams demanding advances towards transportation. This demand was not yielded to because it was not supported by the JSI’s organizational policies. Additionally, some of the indicators included in 2019 (especially anthropometry) attracted negative reactions from the district teams due to requirement to carry tools to execute weight and height measurements. Recommendations 1. RHITES-N, Lango should review the activity LQAS Survey 2019 to learn from the activity experience in order to improve the activity processes and results in future. This will require that RHITES-N, Lango and districts convene an action review activity involving the M&E unit and Administration to discuss and resolve district team demands and organization’s policy requirements for engaging district staff. 2. Due to the continued availability of data from the LQAS surveys across the years, data use to improve indicator performances through micro-targeting is called for. This will help to improve indicator performance within districts and supervision areas where they are generated from. RHITES-N, Lango may need to transfer data analysis skills in collaboration with USAID-SITES to ensure district teams are able to deep-dive in the LQAS
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data to analyse and to pinpoint specific supervision area level performances and to address the performance through the district development planning and programme implementation in the community and at health facilities. 3. As recommended in the 2018 LQAS Survey report, the need to sensitize and promote ownership of the LQAS activity processes and results among district leaders and LQAS Survey participants is apparent. RHITES-N, Lango needs to engage with the district teams an ensure district leaders and survey teams take up LQAS as part and parcel of Local Government Institutions for sustainability beyond Donor support. This can be tangibly measured where districts have annual work plans and budget allocation for LQAS surveys. 4. RHITES-N, Lango will need to work with districts to analyze results by Supervision Area levels to support district and Implementing Partner level efforts to address the poor results. 5. RHITES-N, Lango should disseminate the LQAS Survey results for 2019 and 2018 at district levels allowing for feedback from districts on their results and action planning to improve the weak areas.
Program-specific recommendations 1. Whereas RHITES-N, Lango provides mentorship on malaria management at health facilities, it is apparent that the communities are not as knowledgeable of the symptoms and signs of malaria. The project should use this information to implement continuous targeted malaria awareness programs in the communities including more malaria education at Antenatal Clinics. 2. The proportion of households with Insecticide Treated Mosquito Nets (ITNs) was found to have decreased. This could be attributed to stock out of nets in the region between November 2018 to Feb 2019. Whereas this was a temporary problem, the project should work with other implementing partners in the region to ensure constant supply of ITNs. 3. The need to address general HIV stigma through awareness campaigns still exists. More effort is specifically needed in the two districts of Lira and Amolatar where increases in stigma were registered in 2019. 4. The project may need to investigate further to establish the underlying factor to support the districts to address the challenge of very low latrine/toilet coverage in the region. This is in line with the finding of low improved latrine coverage in the region (25.4%). 5. Early sex before 15 was higher among female youth. It is therefore important that the RHITES-N, Lango project focuses on this emerging trend in order to reverse the escalating early sex majorly among female youth. The project should leverage on the DREAMS program since the early sex problem was predominant in the four DREASM Districts (Apac, Lira, Kwania and Oyam). 6. Although ANC 4 improved in in the region in 2019, this improvement still falls short of bringing the region to the national target of 85%. RHITES-N, Lango’s Maternal and Child health interventions should be configured to tackle and reverse late reporting for ANC 1 to improve ANC 1 and ANC 4 visits to the national target levels.
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APPENDICES
Appendix 1: Knowledge and HIV Practices by Region, District and Year of LQAS survey
Status of HIV Knowledge and Practices 2.2 Percentage of 1.5 Percentage of 1.2 Percentage of 2.1 Percentage of individuals who individuals who 1.1 Percentage of individuals who individuals who know two key were tested for individuals who were counselled know how HIV actions that HIV and received Location Year know two or and received an transmission reduce HIV their result and more benefits of HIV test in last 12 occur from an transmission from disclosed to their HCT months and know infected mother an infected Spouse in last 12 their results to her child mother to her months child
2013 62 51 77 12 58
2014 63 54 88 16 55 Lango sub- 2015 66 52 67 15 52 Region 2016 67 53 58 13 51
2018 56 61 72 47 39 2019 53.3 62.3 71.6 46.9 40.2
2013 54 46 67 8 58
2014 59 60 92 6 51
2015 71 58 61 16 53 Alebtong
2016 72 44 58 10 46
2018 40 63 77 42 32 2019 52.0 61.9 76.0 36.0 31.6
2013 68 60 78 9 53
2014 66 59 90 14 47
Amolata 2015 66 54 74 17 51 r
2016 74 60 58 24 60
2018 53 58 76 46 39
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Status of HIV Knowledge and Practices 2.2 Percentage of 1.5 Percentage of 1.2 Percentage of 2.1 Percentage of individuals who individuals who 1.1 Percentage of individuals who individuals who know two key were tested for individuals who were counselled know how HIV actions that HIV and received Location Year know two or and received an transmission reduce HIV their result and more benefits of HIV test in last 12 occur from an transmission from disclosed to their HCT months and know infected mother an infected Spouse in last 12 their results to her child mother to her months child 2019 50.4 59.0 77.9 48.5 38.7
2013 80 42 77 21 64
2014 60 53 86 13 43 Apac 2015 59 46 70 16 58
2018 65 61 69 50 42 2019 73.1 62.0 74.2 55.1 51.7
2013 69 49 78 8 72
2014 74 54 87 18 69
Dokolo 2015 78 49 66 15 60
2016 64 52 63 9 53
2018 60 65 69 42 39 2019 51.1 63.2 73.8 37.9 30.3
2013 62 55 81 15 59
2014 79 43 81 30 71
Kole 2015 77 46 78 11 53
2016 66 51 59 12 53
2018 56 51 75 39 36 2019 49.6 57.0 61.7 42.5 39.9
2013 47 56 77 9 46 Lira
2014 45 53 86 11 55
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Status of HIV Knowledge and Practices 2.2 Percentage of 1.5 Percentage of 1.2 Percentage of 2.1 Percentage of individuals who individuals who 1.1 Percentage of individuals who individuals who know two key were tested for individuals who were counselled know how HIV actions that HIV and received Location Year know two or and received an transmission reduce HIV their result and more benefits of HIV test in last 12 occur from an transmission from disclosed to their HCT months and know infected mother an infected Spouse in last 12 their results to her child mother to her months child
2015 49 65 58 8 39
2016 61 60 57 10 48
2018 51 67 74 54 35 2019 39.0 64.5 70.5 41.2 29.7
2013 51 50 82 12 56
2014 64 59 90 22 56
Otuke 2015 67 50 64 21 60
2016 64 54 59 13 48
2018 50 67 71 50 42 2019 56.1 74.3 71.9 55.9 46.5
2013 67 49 79 14 57
2014 57 52 91 14 50
Oyam 2015 63 46 67 14 43
2016 68 52 54 14 48
2018 67 52 70 50 41 2019 53.0 60.4 70.8 55.1 45.8 Kwania 2019 59.6 58.1 65.6 45.3 47.1
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Appendix 2: Lango Sub-Region LQAS Survey 2018 Results (disaggregated by districts and sex)
Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en 1.1 Percentage 52.6 51.3 50.6 50.2 73.3 72.9 55.9 46.3 46.8 52.4 56.0 63.4 35.2 42.9 61.1 51.1 58.7 47.4 of individuals who know two or more benefits of HCT 1.2 Percentage 62.5 61.3 52.1 66.0 57.1 67.0 60.7 65.6 54.7 59.2 53.9 62.3 56.5 72.8 72.9 75.8 57.4 63.3 of individuals who were counselled and received an HIV test in last 12 months and know their results Percentage 39.2 27.7 39.0 33.1 35.1 31.3 39.6 40.3 43.5 40.5 58.1 42.1 45.5 40.4 40.2 34.7 43.3 37.9 testing only once for HIV in the last 12 months 1.3 Percentage 94.7 95.2 94.7 94.7 92.6 95.8 91.2 93.9 90.3 of mothers of children (0-11 months) who were counseled and received an
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en HIV test during the last pregnancy and know their results 1.4 Percentage 91.0 90.1 78.5 86.7 78.3 82.5 82.9 88.3 79.6 of individuals who were tested for HIV and received their result as a couple 1.5 Percentage 82.6 69.4 81.3 75.5 81.9 68.5 80.6 68.5 64.7 59.2 74.1 58.4 78.2 65.6 77.6 66.7 76.7 66.0 of individuals who were tested for HIV and received their result and disclosed to their Spouse in last 12 months 2.1 Percentage 32.8 39.3 47.9 49.1 53.9 56.4 35.4 40.5 36.3 48.7 41.5 49.2 40.0 42.4 54.1 57.7 53.8 56.5 of individuals who know how HIV transmission occur from an infected mother to her child
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en 2.2 Percentage 28.6 34.6 37.5 40.0 46.1 57.4 24.0 36.6 36.3 43.5 43.5 50.8 29.6 29.9 49.3 43.6 52.8 39.0 of individuals who know two key actions that reduce HIV transmission from an infected mother to her child 2.3 Percentage 85.3 58.9 86.3 86.0 64.2 74.0 77.0 72.8 81.8 of mothers of children 0-11 months who were counselled for PMTCT services during the last pregnancy Percentage of 50.0 38.5 41.1 50.6 37.6 46.9 49.4 49.1 57.2 mothers (0-11 months children) who went for ANC1 within first trimester 3.1 Percentage 19.8 10.5 26.6 19.6 34.6 29.3 22.7 17.2 22.6 24.1 23.3 20.4 32.2 22.8 45.4 33.5 43.9 32.5 of individuals who both correctly identify ways of
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en preventing the sexual transmission of HIV and reject major misconceptions about HIV transmission 3.2 Percentage 20.2 2.4 21.4 7.4 19.2 6.9 19.5 7.0 25.4 11.7 21.1 7.0 28.0 8.0 12.4 4.2 35.3 11.6 of individuals who had sex with more than one sexual partner in the last 12 months 3.3 Percentage 34.5 23.6 29.1 13.7 33.1 18.1 33.5 21.5 42.0 29.7 46.1 24.0 40.2 23.8 16.6 15.8 46.3 26.1 of individuals who had sex with a non marital or non cohabiting sexual partner in the last 12 months 3.4 Percentage 85.7 64.3 76.2 81.3 66.7 40.0 67.5 45.0 70.0 65.0 91.1 66.7 71.4 70.6 95.2 56.3 79.5 55.2 of individuals who had sex with a non marital or non cohabiting sexual partner
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en in the last 12 months and used a condom at last higher risk sex 3.5 Percentage 85.4 83.5 85.7 72.2 72.6 65.3 76.3 78.9 92.5 83.2 87.6 72.6 69.2 73.9 90.4 85.8 73.7 70.9 of youth 15-24 years who perceive low or no risk of getting HIV/AIDS infection 3.6 Percentage 35.1 24.2 37.9 37.6 31.8 16.0 32.6 19.0 35.7 19.0 26.6 30.3 29.6 14.9 32.7 22.3 34.6 27.7 of youth who have had sexual intercourse before the age of 15 3.7 Percentage 6.3 2.1 6.7 1.5 16.8 8.5 3.1 4.2 0.5 10.4 5.2 3.9 0.4 9.6 0.9 4.3 1.6 of youth who know at least three correct steps on how to use a condom 3.8 Percentage 19.6 25.8 32.5 28.4 27.9 27.9 20.9 19.9 29.0 of the male youth 15-24yrs who are circumcised
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en Percentage of 35.4 37.7 29.2 37.7 25.7 28.7 31.4 33.5 23.2 21.5 31.1 25.7 39.1 39.3 16.2 18.1 25.9 28.6 women and men aged 15-49 who report discriminatory attitudes towards people living with HIV Percentage of 42.7 34.6 41.6 46.0 61.8 69.1 39.7 40.1 52.1 51.8 51.8 49.7 45.2 37.9 62.4 47.6 63.0 55.8 individuals who correctly identify at least two common signs/symptoms of STIs 4.1a Percentage 57.3 41.4 64.8 49.4 75.4 70.7 57.6 43.2 70.5 55.5 71.5 54.5 61.3 51.3 72.1 50.2 76.1 58.8 of individuals who correctly identify at least two common signs or symptoms of STIs in men 4.1b Percentage 49.5 42.9 46.4 55.5 62.8 75.0 44.1 56.4 55.8 65.4 56.0 71.2 48.7 46.9 65.5 56.8 65.6 66.2 of individuals who correctly identify at least two common signs/symptoms of STIs in women
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en 4.2 Percentage 32.8 32.5 40.1 43.0 62.3 61.7 34.1 36.6 52.6 49.2 57.5 60.7 27.0 24.1 55.9 49.8 52.1 39.9 of individuals who know three or more actions to take when s/he is infected has a sexually transmitted infection Percentage of 5.7 15.2 9.4 9.8 12.0 14.4 7.4 14.5 15.3 13.1 15.5 22.0 11.7 11.6 7.0 7.5 5.2 8.4 adults 15-54 years who had a genital ulcer in the past 12 months Percentage of 4.2 15.7 7.9 14.0 12.0 13.8 5.7 17.2 13.7 23.0 11.4 24.6 9.6 14.7 6.6 10.1 5.2 10.1 adults 15-54 years who had a urethral discharge in the past 12 months 5.1 Percentage 67.2 53.4 78.3 59.6 77.5 63.8 64.2 55.9 70.0 56.5 74.1 72.3 78.7 69.2 85.2 70.5 77.0 66.6 of individuals who know that TB is curable disease 5.2 Percentage 43.2 37.7 40.1 39.2 72.3 69.1 38.9 36.6 38.4 35.1 58.5 58.6 44.3 33.9 57.6 48.5 53.1 47.1 of individuals who know at least two signs
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en and symptoms of TB
5.3 Percentage 85.4 84.8 86.1 77.4 93.7 93.6 84.3 82.8 79.5 72.3 85.5 82.7 83.9 77.7 88.2 86.3 89.8 85.1 of individuals who know how TB is transmitted 5.4 Percentage 95.3 91.1 96.6 95.5 98.4 95.7 84.7 80.6 94.2 94.2 99.5 96.3 94.3 95.1 98.7 96.0 92.5 88.3 of individuals who know the risk of not completing TB treatment 6.1 Percentage 46.8 53.4 60.9 67.9 72.0 55.8 61.7 63.3 73.6 of children 0-23 months who had fever in the two weeks preceding the survey and received treatment with ACTs within 24 hours of onset of fever
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en 6.2 Percentage 87.4 63.8 93.2 83.4 79.4 74.1 77.6 81.8 90.1 of mothers of children 0-23 months who received two or more doses of IPT2 during their last pregnancy 6.3 Percentage 77.2 89.4 83.6 82.2 83.0 75.3 73.5 79.8 78.4 of children 0-59 months who slept under a ITN the night preceding the survey 6.4 Percentage 86.3 84.2 86.4 94.2 87.2 81.9 79.6 84.5 87.3 of mothers of children 0-59 months who always slept under an ITN during last pregnancy 6.5 Percentage 54.0 55.3 55.9 38.3 35.1 46.5 36.6 54.7 60.0 of mothers of children 0-59 months who know two or more ways to prevent malaria
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en 6.6 Percentage 43.5 55.3 66.8 56.1 44.3 59.4 35.7 57.9 65.1 of mothers of children under fiver years who know two or more signs and symptoms of malaria 6.7 Percentage 92.3 92.7 92.3 93.3 86.9 93.4 93.5 93.6 98.3 of mothers of children under five years who know how malaria is transmitted 6.8 Percentage 84.6 95.3 88.1 92.7 90.8 88.2 85.8 89.5 88.6 of Households with at least one ITN
7.1 Percentage 44.3 40.0 43.2 43.8 29.3 31.8 34.8 23.4 44.2 of currently married women age 15-49 years who are using any family planning method
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en 7.2 Percentage 28.3 32.2 36.8 32.2 23.7 25.5 25.0 20.0 35.4 of sexually active women age 15-49 years who are using any modern method of family planning 7.3 Percentage 69.1 59.5 62.9 67.5 62.1 73.6 77.9 73.1 73.4 of mothers of children 0-11 months who attended ANC at least 4 times during last pregnancy 7.4 Percentage 73.0 68.6 79.7 72.8 60.3 76.4 73.2 77.8 85.2 of mothers of children 0-11 months who delivered their last baby in a health facility 7.5 Percentage 74.0 64.9 79.4 78.4 69.9 78.1 81.4 78.1 83.6 of mothers of children 0-11 months who were assisted by a trained health worker during delivery
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en 7.6 Percentage 7.5 12.1 3.8 6.8 3.6 1.8 9.7 6.5 5.4 of women 15- 49 years who desire to use a family planning method in the last 12 months but cannot access it Percentage of 51.8 55.8 52.4 57.7 57.1 72.3 55.9 63.4 55.0 56.8 50.8 60.2 50.2 53.4 60.1 56.4 59.7 66.2 women who heard about family information on mass media in the past three months Percentage 88.4 88.7 91.2 86.9 93.1 96.2 85.9 89.0 92.0 87.5 95.6 91.2 82.5 80.6 82.7 96.8 93.2 90.2 satisfied with FP services provided at the health facilities Percentage who 36.5 48.2 44.6 54.3 49.2 56.9 45.4 53.3 43.2 55.0 44.0 52.9 51.3 50.0 52.0 59.9 51.5 63.0 know at least 3 methods of FP
8.2 Percentage 38.5 53.3 72.2 62.5 58.3 42.9 50.0 60.0 67.9 of children 0-11 months with diarrhea in the
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en last two weeks receiving ORT
8.3 Percentage 50.0 64.6 68.1 87.2 72.0 65.6 67.3 63.6 76.0 of children 0-23 months with any of fever, diarrhea or pneumonia seeking care from health workers within 24 hours of illness 10.1 Percentage 50.0 64.4 58.7 58.1 47.5 53.7 68.8 70.3 50.8 57.8 83.6 69.4 58.2 54.7 72.2 70.4 71.7 69.5 of children 6- 12 years who are currently in school 10.2 Percentage 45.9 40.7 39.8 53.5 34.4 50.0 46.3 33.8 30.2 32.8 32.8 41.9 48.1 54.7 41.8 56.1 37.8 38.4 of parents/ guardians who talked to their children age 6- 12 years about HIV/AIDs in the last 12 months
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en 10.3 Percentage 44.3 44.1 38.7 38.4 42.6 51.9 40.0 32.4 44.4 31.3 35.8 46.8 51.9 56.0 38.0 43.9 37.8 33.0 of parents/ guardians who had talked to their children in the last 12 months about delaying sex 11.1 Percentage 4.2 10.7 20.4 10.1 18.2 6.8 5.3 7.9 14.1 of children aged 12-23 months receiving a minimum of acceptable diet. 11.2 Percentage 25.9 24.9 26.4 28.4 28.6 31.4 32.1 26.8 23.7 of children under 6 months of age who are exclusively breastfed 11.3 Percentage 64.9 49.4 65.0 60.8 49.3 50.0 57.8 54.7 51.7 of children 12- 23 months receiving vitamin A supplementatio n in the last six months
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en 11.4 Percentage 96.8 88.6 87.1 91.2 95.4 85.8 96.5 95.3 94.3 of households using Iodized salt
11.5 Percentage 14.7 9.9 20.6 15.5 25.5 10.8 13.6 13.7 28.2 of mothers with children 12-23 months who consumed the 3 major food groups in the last 24 hours 11.6 Percentage 89.5 88.1 79.4 91.2 84.4 88.5 85.3 90.1 87.1 of mothers of children age 0- 11 months who took iron supplementary tablets for at least 90 days during the last pregnancy 11.7 Percentage 45.6 60.3 58.0 60.8 37.2 45.5 59.9 63.5 56.1 of mothers of children 0-11 months who received Vitamin A supplementatio n within 2
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en months after delivery
12.1 Percentage 32.8 34.0 84.6 85.3 63.9 64.4 78.2 77.1 77.4 78.5 37.3 42.9 73.0 76.3 72.5 73.1 66.6 64.3 of individuals who wash their hands with soap after visiting the toilet 12.2 Percentage 87.5 81.2 99.6 100.0 97.9 98.9 83.0 85.9 86.8 82.7 99.0 99.0 88.7 90.6 83.8 87.7 79.0 83.8 of households with safe water supply
12.3 Percentage 20.8 19.4 33.3 37.0 26.7 19.7 31.9 33.9 19.5 22.0 22.3 15.2 36.5 33.5 28.4 24.2 15.7 15.9 of households with latrine or toilet
Percentage of 11.5 12.8 22.4 15.2 12.5 17.2 7.8 5.3 11.3 8.3 8.3 3.1 31.9 25.7 16.7 13.2 16.3 16.6 households with soap and water at a handwashing station commonly used by family members
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en Percent of 17.7 22.0 20.2 21.9 25.7 26.1 40.6 36.1 16.3 19.4 20.2 17.8 38.3 33.0 37.6 36.6 24.9 24.4 households in target areas practicing correct use of recommended household water treatment technologies Percent of the 20.8 19.4 33.3 37.0 26.7 19.7 31.9 33.9 19.5 22.0 22.3 15.2 36.5 33.5 28.4 24.2 15.7 15.9 population using an improved sanitation facility Percentage that 29.2 27.2 35.3 28.7 34.7 27.2 28.7 25.1 16.6 14.8 32.8 29.2 ever heard of viral load testing
Percentage that 13.5 12.1 11.6 8.9 20.2 15.7 13.9 8.5 3.9 3.1 16.7 14.3 know at least two benefits of VL testing
Percentage that 73.8 71.5 51.6 45.5 50.8 40.1 49.1 40.7 57.5 49.5 69.6 67.0 53.2 46.6 68.4 60.5 55.4 56.6 believe that they were not at risk of acquiring HIV in
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Alebtong Amolatar Apac Dokolo Kole Kwania Lira Otuke Oyam Wom Wom Wom Wom Wom Wom Wom Wom Wom Indicator Men en Men en Men en Men en Men en Men en Men en Men en Men en the last 6 months
Percentage that 69.0 70.2 46.1 41.6 50.8 48.1 46.8 40.4 56.3 53.8 69.3 75.0 52.8 55.3 70.0 62.3 62.3 68.1 believes that they were not at risk of contacting TB in the last 6 months
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