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Lashkar Gah District of Helmand Province, Afghanistan from 10Th to 29Th March 2018

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Lashkar Gah District of Helmand Province, Afghanistan from 10Th to 29Th March 2018 Semi Quantitative Evaluation of Access and Coverage (SQUEAC) for OPD-SAM Programme Final Report Lashkar Gah District of Helmand Province, Afghanistan From 10th to 29th March 2018 AFGHANISTAN Funded by: SQUEAC Manager: Sayed Rahim RASTKAR Authors: Sayed Rahim RASTKAR, Celine Soulier & Bijoy Sarker Action Against Hunger | Action Contre La Faim A non-governmental, non-political and non-religious organization Acknowledgements Action Against Hunger (AAH) would like to thank all the parties who were involved either directly or indirectly in the success of the SQUEAC assessment. ACF Helmand provincial office through the project manager for providing logistical support in addition to materials used in training and data collection . The SQUEAC assessment team for a high level of commitment and professionalism throughout the assessment period . All the key informants interviewed during the various stages of the assessment . All the communities residing in the districts surveyed for providing consent and taking part in the assessment . GAC for providing financial support to undertake the assessment. Abbreviations ACF Action Contre la Faim | Action Against Hunger AYSO Afghan Youth Services Organization BHC Basic Health Center BBQ Booster, Barrier and Questions BPHS Basic package of health services BRAC Building Resources Across Communities (NGO) CHC Comprehensive health center CHS Community health supervisor CHW Community health worker IMAM Integrated management of acute malnutrition DH District Hospital DoPH Directorate of Public Health EPI Expanded Program on Immunization EPHS Emergency package of health services FGD Focused Group Discussion GAM Global Acute Malnutrition HMIS Health Management Information System MAM Moderate Acute Malnutrition MoPH Ministry of Public Health MUAC Mid-upper arm circumference OTP Out Patient Therapeutic Program PLW Pregnant and Lactating Women PNO Provincial Nutrition Officer PPHD Provincial Public Health Directorate RUTF Ready-to-use therapeutic food SAM Severe Acute Malnutrition SMART Standardized Monitoring and Assessment of Relief and Transitions WHO World Health Organization WFP World Food Program SQUEAC Semi-Quantitative Evaluation of Access and Coverage Table of Contents Acknowledgements .................................................................................................................................... 2 Abbreviations .............................................................................................................................................. 3 1.0 Introduction ................................................................................................................................... 10 1.1. Objectives .................................................................................................................................. 10 1.2. Methodology ............................................................................................................................. 10 1.3. SQUEAC investigation team ................................................................................................... 11 1.5 Context .......................................................................................................................................... 12 1.5.1 Nutritional Situation ....................................................................................................................... 14 * The new IMAM guideline with revised admission and discharge criteria’s is currently in the process of finalization till this report is being written .......................................................................... 16 2.0. The SQUEAC Survey - STAGE ONE .......................................................................................... 16 2.1. Introduction ........................................................................................................................... 16 2.2. Identification of areas with low and high coverage ............................................................. 17 2.3. Quantitative data collection and analysis .............................................................................. 17 2.3.1 Admissions over time ................................................................................................................. 17 1.3 Admissions per health facility ................................................................................................... 20 2.3.3 Discharge outcomes ................................................................................................................... 21 2.3.4 Length of stay before cure ........................................................................................................ 24 2.3.5 Defaulting over time ................................................................................................................... 25 2.3.6 Time to default ............................................................................................................................ 26 2.4 Qualitative data collection and analysis ...................................................................................... 27 2.4.1 Introduction ............................................................................................................................. 27 2.4.2 Data compilation and analysis ............................................................................................... 34 Introduction ........................................................................................................................................... 39 Hypothesis setting and testing: .......................................................................................................... 39 3.2 Prior building .................................................................................................................................. 42 3.2.1 Introduction ............................................................................................................................. 42 3.2.2 Weighted scores ..................................................................................................................... 45 3.2.3 Simple scores ........................................................................................................................... 45 3.2.4 Histogram prior ....................................................................................................................... 45 3.2.5 Concept Map ........................................................................................................................... 46 3.2.6 Mind Map ................................................................................................................................. 47 3.2.7 Prior mode ............................................................................................................................... 48 4. STAGE THREE: WIDE AREA SURVEY ........................................................................................... 49 4.1. Minimum sample size of villages for the wide area survey ..................................................... 49 4.2. Wide area survey Methodology .................................................................................................. 50 4.3. Coverage estimations ................................................................................................................... 50 3.2 Results of the wide-area survey ............................................................................................. 52 4.4. Measurement data of wide area survey ..................................................................................... 53 4.5. Reasons for un-covered SAM cases ........................................................................................... 53 5. Conclusions ....................................................................................................................................... 54 6. Recommendation and Joint Action Plan ........................................................................................ 55 7. Annexes ............................................................................................................................................. 58 Table of Figures Figure 1: Admissions over time at 5 HFs and 2 Mobile clinics from February, 2017 to January, 2018 ........................................................................................................................................................... 18 Figure 2: Total admissions per OPD-SAM site (5 HFs & 2 Mobile clinics) Lashkar Gah district, Helmand province .................................................................................................................................... 20 Figure 3: MUAC at admission of 5HFs and 2Mobile clinic_ Lashkar Gah district, Helmand province ..................................................................................................................................................... 21 Figure 4: Discharges over time –from treatment follow up cards of 5 HFs and 2 Mobile clinics from February, 2017 to January, 2018 .................................................................................................. 22 Figure 5: Discharges over time –from the nutrition report (IMAM database) of 5 HFs and 2 Mobile clinics from February, 2017 to January, 2018_ Lashkar Gah district, Helmand province . 23 Figure 6: Discharge outcomes per OPD-SAM site- 5 HFs and 2 Mobile Clinics_ Lashkar Gah district, Helmand
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