14th - 18th May 2012

REPORT HOUSEHOLD SURVEY OF BILASPUR DISTRICT ( state) ON MDA EVALUATION

Date of MDA 2012 – 9th to 11 May 2012 in rural area - 22th to 24th April 2012 in urban area

Regional Office of Health and Family Welfare and Regional Leprosy Training and Research Institute, Ministry of Health and Family Welfare, Govt of , Raipur, Chhattisgarh state

Regional Office of Health and Family Welfare and Regional Leprosy TrainingEvaluation and Team1 Research Institute, Govt of India, MoHFWDr Sunil ,Raipur Gitte, Chhattisgarh M.D. (PSM) state, Deputy Director Dr Ravi Rao, Medical officer, S.Dhruw, I Maisih, PMW,

INDEX PAGE No.

 BACKGROUND 03

 OBJECTIVES 03

 METHOD OF SURVEY 05

 OBSERVATIONS 08

 SUMMARY 13

 CONCLUSION/RECOMMENDATION 15

 FORMAT I- BILASPUR DISTRICT 17

 PHOTOS 19

Regional Office of Health and Family Welfare and Regional Leprosy Training and 2 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state BACKGROUND OF MDA EVALUATION

A Post MDA evaluation survey was conducted with the objective to review the progress of the single dose of diethyl-carbamazine (DEC) and Albendazole, administration and to understand the functioning of the programme to recommend mid-term amendment.

It has been observed in the past that the actual drug consumption was lower than the reported coverage by peripheral health workers or / volunteers. As per the norms, the drug is to be consumed by the eligible population in the presence of drug distributor but on many occasion, the drug was handed over to the family members for consumption later on. It has been observed that a substantial proportion of community members do not consume the drug. Therefore, it is important that the mid term assessment should be conducted by the independent team members who are not directly connected with the MDA programme in the selected area. The assessment shall be completed within three weeks of MDA so that the community will be able to recall the events without memory lapse. The purpose of the MDA evaluation in the BILASPUR district is the mid-course corrections and to suggest necessary steps for further course of action.

Objective: i) To review the progress of activities of single dose DEC mass administration in the selected district. ii) To make an independent assessment of the programme implementation with respect to process and outcome indicators. iii) To recommend mid-course corrections and to suggest necessary steps for further course of action.

Regional Office of Health and Family Welfare and Regional Leprosy Training and 3 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state MAP District Bilaspur

As of 2011 India census, Bilaspur had a population of 26, 62,077. Males constitute 51% of the population and females 49%. Bilaspur has an average literacy rate of 72%, lower than the national average of 74%; with male literacy of 83% and female literacy of 60%.

15% of the population is under 6 years of age.

In the year 2011, new carved from Bilaspur district. But MDA was carried out by Bilaspur District Health administration. MDA 2012 was carried out into two phases due to Gram Swaraj Abhiyan

Regional Office of Health and Family Welfare and Regional Leprosy Training and 4 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state

METHODS:

Survey area: Bilaspur District

The teams of ROHFW visited the study district and tried to collect data by desk review, in-depth interviews, on site observations, and from the community. A) Selection of households: The PHC should be stratified in to 3 groups depending upon MDA 2012 coverage as given below: Sr. Category MDA Coverage % No 1 PHC with coverage below 50 2 PHC with coverage between 50-80 3 PHC with coverage above 80

 In case there is no PHC in a particular category, two blocks from the next category may be selected.  In each category, PHC should be selected randomly  From each of the selected PHC, one village should be selected randomly for household survey.  In each village, 30 households should be covered. The detailed questionnaire is enclosed at Annex. 1  Similarly, in urban areas one ward should be selected randomly for the evaluation of the programme.  In each selected ward, 30 households should be covered.  In this way, in each district, 120 households will be surveyed for the purpose of MDA evaluation.

Regional Office of Health and Family Welfare and Regional Leprosy Training and 5 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state

 Reported coverage of district Bilaspur by BMO Total Eligible Population % sr No Name of Block@ Population population Covered MDA coverage 1 Bilaspur Urban 353198 300218 238359 79.4 2 Marwahi 131709 111953 110222 98.5 3 Gourella 124636 105941 85202 80.4 4 Pendra 91190 77512 75169 97.0 5 Kota 218058 185349 169827 91.6 6 Lormi 230461 195892 196432 100.3 7 Mungeli 247955 210762 187615 89.0 8 Patharia 168188 142960 122923 86.0 9 269480 229058 180010 78.6 10 326303 277358 240733 86.8 11 Masturi 275264 233974 215120 91.9 Total 2436442 2070977 1821612 88.0 @ Source by DMO office B) Modified Sampling  The BLOCK was stratified into 3 groups depending upon MDA 2012 coverage of BILASPUR as given below A) Fixed and Random sites based on above coverage Fixed AND Random Sr. District MDA Category sites no COVERAGE BILASPUR BLOCK with coverage 1 50 00 below BLOCK with coverage 2 50-80 02 between

BLOCK with coverage 3 >80 09 above

(* The readymade data of the PHC Coverage/village are not available at district or Block)

Regional Office of Health and Family Welfare and Regional Leprosy Training and 6 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state

b) The Blocks was stratified into 3 groups depending upon MDA 2012 coverage –

BILASPUR district MDA Sr Category Coverag Name of no No of e village/ PHC/URBAN ward Block with coverage 1 50% NO PHC NO VILLAGE below Ward no Block with coverage Bilaspur urban 2 50-80% 40,41 between Belpan PHC Podikala Ratanpur Urban Karhaiyapara Block with coverage 3 >80% above Nawagaon PHC Lalpur Amadand PHC Amadand

*From above category, 3 Block was selected randomly.

*From each of selected block, one village was selected randomly for survey.

*In each village, 30 household should covered.

**One urban area was selected randomly and from selected urban area ,one ward

was selected randomly. The 30 households were surveyed in selected ward.

Data analysis: Data was analyzed on the same day and entered in Microsoft Excel

sheet and results were shared with Chief Medical officer (CMO) cum Joint Director

and District Malaria Officer. The VBD consultant was not available during

discussion.

Funds: The IEC funds were not analyzed due to lack of availability of document

during survey.

Regional Office of Health and Family Welfare and Regional Leprosy Training and 7 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state

RESULTS:

Table-1 –Age and sex distribution of surveyed eligible population

Particulars Male Female Total

Adult 296 (32.5) 264 (28.9) 560(61.4)

Children 184 (20.1) 168 (18.3) 352(38.6) (<14 year) Total 480 (52.6) 432 (47.4) 912 (100%)

In surveyed population, 53% were male while 47% were female. 39% were children less than 14years of age.

Table-2 -Coverage of MDA in the eligible population

No Sr no Profile

150 1 Total Houses surveyed

912 2 Total survey population

3 Total eligible Surveyed population 807

5 Person consume DEC tablets 509

6 Person not taken DEC on MDA 2012 298

% of actual DEC taken 63%

Regional Office of Health and Family Welfare and Regional Leprosy Training and 8 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state

Table -3. Area wise coverage of MDA in Urban and Rural area of Bilaspur

Bilaspur Pendra Takhatpur Kota Block Kota Block Block Block Block Sr PARTICULARS Bilaspur Nawagaon no Ratanpur Amadan Podikala (URBAN) Lalpur (URBAN) d(Rural) (Rural) (RURAL) Total Houses 1 30 30 30 30 30 surveyed Total eligible 213 3 179 161 117 137 population Person not taken 55 5 DEC on MDA 119 115 0 9 2012 % of actual DEC 74% 6 33.5% 28.5% 100% 93% taken

The urban area coverage was significantly low as compare to rural area. The

overall drug consumed coverage was 64% in surveyed houses. This district

reported coverage is very high which needs to review the activity by state.

The population of the district as per census 2011 is 26, 62,077 but total

population of district taken by DMO is 24, 36,442 which need to be updated.

Graph 1 showing the beneficiary who actual swallowed the DEC tablets in presence of Drug distributor

Regional Office of Health and Family Welfare and Regional Leprosy Training and 9 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state Out of 807 beneficiaries, none of the interviewed beneficiaries had consumed the DEC+ Alb tablets in the presence of the drug distributors.

This Distribution drive depends only on anganwadi workers and volunteers at urban area and ASHA in Rural area. There is minimal involvement of Peripheral workers at rural area in the present drive. Most of the distributors distributed the Drugs without giving any information to the beneficiary.

Graph 2- In Urban and Rural area opinion of beneficiaries as who should be the Drug distributor

In Urban area Anganwadi worker was preferred more as the drug distributor.

Regional Office of Health and Family Welfare and Regional Leprosy Training and 10 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state In rural area the ASHA workers are preferred more than the other workers, this might be due to following reasons– a) Local community workers b) She can spend more time in village c) She is close to the villagers than any other worker In urban area Anganwadi workers are more preferred. Graph 3 Reasons of non-consumed drugs by beneficiary

 Various sources of the health information regarding the MDA

None of the interviewed members had any information about MDA. IEC is very poor in both urban and rural areas and it is restricted to only banners on the wall of Health institute. However, the level of awareness about the morbidity management in the community was low. Very few subjects with LF, who were interviewed, could answer the proper method of care. The training on morbidity management was not given to the identified cases.

Regional Office of Health and Family Welfare and Regional Leprosy Training and 11 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state  Drug distributor persuaded swallowing of the drug in his presence

None of the drug distributor had persuaded the beneficiary to swallow the Dec tablets in his/her presence. This drive was focused only on the distribution instead of persuaded swallowing of drug in his/her presence.

 The interviewed person helps the drug distributor for drug

compliance in his village or mohallah

None of the interviewed persons helps the drug distributor for drug compliance in his village or mohallah. There is lot of scope for involvement of the community members in MDA activities. DMO and VBDs should call meetings of the community leaders at block and urban settings. Most of the community members are not aware of the MDA activities in their area.

 Side effects of DEC +Alb in surveyed population:

Out of the surveyed beneficiaries, none had experienced any side effects. None of them were informed regarding side effects and if occur, where to report

 Comments of Action Plan:

The action plan had good micro plans with detailed information on how to

proceed for an activity and could easily serve as a model for the programme,

while no such plan were available in District , where, the work was coordinated

from PHC level, without much input from district malaria office and without

proper planning.

The VBD consultant should involve on the preparation of detailed micro plan, which was not provided to evaluation team.

Regional Office of Health and Family Welfare and Regional Leprosy Training and 12 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state

SUMMARY

 The MDA activities in the surveyed districts are going through the stage of

planning and implementation and appear to be weak. In none of this

surveyed area of districts, the local authorities sought the active help or

cooperation of the community members for the implementation of MDA

activities. There is need of intensive health education campaign to make

the community aware about LF and, increase their participation in the

programme. None of the drug distributor explained to interview person

and family members regarding DEC intake on elimination of Lymphatic

Filariasis and details of transmission of the disease.

 Fear of drug, lack of information of tablets and absence from home due to

travel/Marriage season was the main reason for not taking drug (DEC) on

MDA 2012. The children were not allowed to consume the tablets by their

parents due to fear of drugs.

 None of beneficiary swallowed the tablets in presence of Drug distributor;

the consumption of drug is very low in urban area and good in rural area.

In area where there was prophylactic drive of tab chingumsulf, the

consumption is very good. Some of people assumed and consumed these

tab as malaria prevention tablets

Regional Office of Health and Family Welfare and Regional Leprosy Training and 13 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state  Drug distributor visited all surveyed houses and distributed the drugs in

rural area but in urban area, some of the houses were missing due to lack

of coordination of two workers and also due to unclear demarcation of

wards.

 None of the drug distributor had persuaded swallow of the DEC in his or

her presence in 150 houses.

 None of the surveyed population has helped the drug distributor for drug

compliance in village/urban area. None of the beneficiaries have prior

information regarding MDA.

 The local volunteer/agencies were not actively participated in MDA

activity in urban area.

 None of the beneficiary had experienced side effects.

Regional Office of Health and Family Welfare and Regional Leprosy Training and 14 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state CONCLUSIONS/RECOMMENDATIONS

1) The major focus of the staff was on the paper work. The implementation

was very poor in the district. The health education activities were not done

satisfactorily. There was limited knowledge and awareness about LF and

MDA amongst the community members. The local modes of awareness

generation were almost missing. The authorities had used TV, Posters and

newspapers for IEC activities, which had limited penetration in the rural

population. IEC activates need to improvement in rural as well as urban

area. These activities should be done timely and more frequently before

MDA.

2) The Community participation In MDA needs improvement by conducting

area wise meetings. The voluntary organization should be involved in the

activity especially in urban area where the coverage is low.

3) The tablets were distributed during the day time, when most of the

population goes to their work place, leading to insufficient coverage.

Therefore, in future, dates should be finalised after due deliberations and

input from the community. The timing for the tablet distribution should

also be made in the evening to make it convenient for the community.

There is definitive need to ensure that drug distributor meets the person.

They may go to the area in evening time or may have to pay one more visit

at the time convenient for the locals.The drug consumption in presence of

drug distributor need to be increased in urban as well as rural areas.

Regional Office of Health and Family Welfare and Regional Leprosy Training and 15 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state 4) The home-based management of a case of LF is a part of the strategy to

eliminate LF. However, the level of awareness about the morbidity

management in the community is very low. Very few subjects with LF, who

were interviewed, could not answer the proper method of care. The

training on morbidity management was not given to identified cases. IEC

activity regarding Morbidity management in-patients who are suffering

from the elphanttitis should be targeted.

5) The dates of MDA were not properly thought about. The MDA was

rescheduled in rural area.

The ROHFW, Raipur was neither informed by State Programme

Officials nor by NVBDCP division about MDA 2012 drive for elimination

of Lymphatic Filariasis in Chhattisgarh state. The coordination of these

important activity help proper planning, implementation and

evaluation.

Regional Office of Health and Family Welfare and Regional Leprosy Training and 16 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state Format I MDA Evaluation report of RD team District: Bilaspur Name of Investigator: Designation :

Particulars 1 Name of Village/GULLI selected 2 Population of selected village/ward 3 Name of PHC 4 No of beneficiaries interviewed 5 Total no of Beneficiaries in selected houses 6 No of beneficiaries consumed tablets 7 No of beneficiaries not consumed tablets 8 Percentages of consumption 9 District average consumption 10 No of House visited by the drug distributor for MDA in elected houses 11 Percentages of House visited 12 No of beneficiaries swallowed tablets in presence of drug distributors 13 Percentage of beneficiaries swallowed drug in presence of drug distributor 14 Reasons for not swallowed the drug A No information about LF/MDA/DEC B Fear of Drug C Beneficiaries on empty stomach at the time of DD visit D Side reaction of Drug E F Complication of previous year MDA G Other 15 A ANM B Health Worker ( Male) C Anganwadi worker D NGO E Volunteer F Students G Other 16 Source of Information about MDA Activity

Regional Office of Health and Family Welfare and Regional Leprosy Training and 17 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state A Health Worker ( Male) B Anganwadi worker C NGO D Volunteer E Miking F Davandi G Radio H TV I News paper J Handbills K Other 17 No of beneficiaries experienced side effects of DEC Details of side effects of DEC A Nausea B Headache C Fever D Rash E Dehydration F Fainting attack g Other 18 Whether you are aware about the nearest treatment facility center for treating side effects of DEC 19 If treated place of treatment A PHC B Rural Hospital C Private Hospital d Others 19 Information of the line listing of Elephantitis and hydrocele.

Regional Office of Health and Family Welfare and Regional Leprosy Training and 18 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state

Bilaspur Urban- Household survey

Interaction of Household and AWW

Regional Office of Health and Family Welfare and Regional Leprosy Training and 19 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state Interaction with Community Members

Person with Lymphedema Leg not consumed Drugs on special activity due to lack of Knowledge

Regional Office of Health and Family Welfare and Regional Leprosy Training and 20 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state Recovered DEC+Alb Tab after Distribution

Involvement of DM and CMO rally on MDA day

Regional Office of Health and Family Welfare and Regional Leprosy Training and 21 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state MDA Posters

Regional Office of Health and Family Welfare and Regional Leprosy Training and 22 Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state