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Of Vitamin a Supplementation in Chhattisgarh, India

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Of Vitamin a Supplementation in Chhattisgarh, India POST EVENT COVERAGE SURVEY (PECS) OF VITAMIN A SUPPLEMENTATION IN CHHATTISGARH, INDIA UNICEF Office for Chhattisgarh, Raipur Post Event Coverage Survey (PECS) of Vitamin A in Chhattisgarh, India © United Nations Children’s Fund (UNICEF) Chhattisgarh, India 2017 Cover photo: ©UNICEF India/2014/Altaf Qadri UNICEF Office 503, Civil Lines Raipur 492001 www.unicef.in August 2017 Suggested citation: United Nations Children’s Fund (UNICEF), ‘Post Event Coverage Survey (PECS) of Vitamin A in Chhattisgarh, India’, UNICEF, Chhattisgarh, India, 2017. POST EVENT COVERAGE SURVEY (PECS) OF VITAMIN A SUPPLEMENTATION IN CHHATTISGARH, INDIA August, 2017 Disclaimer: This is a working document. It has been prepared to facilitate the exchange of knowledge and to stimulate discussion. The text has not been edited to official publication standards and UNICEF accepts no responsibility for errors. The designations in this publication do not imply an opinion or legal status of any country or territory, or of its authorities, or the delimitation of frontiers. CONTENTS FOREWORD .................................................................7 PREFACE ......................................................................8 ACRONYMS ................................................................9 EXECUTIVE SUMMARY...........................................11 INTRODUCTION .......................................................15 METHODOLOGY ......................................................21 STUDY FINDINGS ....................................................27 RECOMMENDATIONS AND WAY FORWARD.....41 ANNEXURES Annexure 1: Statistical table ..........................................44 Annexure 2: List of Clusters ..........................................45 Annexure 3: List of Enumerators and Team Leaders ....46 Annexure 4: Copy of consent letter ...............................47 ACKNOWLEDGEMENTS .........................................48 Post Event Coverage Survey (PECS) of Vitamin A in Chhattisgarh, India 3 LIST OF FIGURES Figure 1: Coverage of VAS in Chhattisgarh through bi-annual campaigns 17 Figure 2: Comparison of VAS coverage across health surveys in Chhattisgarh 18 Figure 3: Comparison of Measles and Full immunization coverage in Chhattisgarh 19 Figure 4: Clusters covered in the PEC Survey in Chhattisgarh 24 Figure 5: Sampling and final enrollment 28 Figure 6: Percent coverage of Vitamin A 31 Figure 7: Children received Vitamin A in VAS campaign VS Wealth quartiles 31 Figure 8: Deworming coverage 36 Figure 9: Antigen wise immunization coverage 39 Figure 10: Reasons of failure of full immunization 40 Post Event Coverage Survey (PECS) of Vitamin A in Chhattisgarh, India 5 LIST OF TABLES Table 1: Survey indicators for coverage of VAS in Chhattisgarh 17 Table 2: Characteristics of Child 29 Table 3: Characteristics of Caregiver 29 Table 4: Community Leader surveyed 30 Table 5: Health workers covered 30 Table 6: Quartile table 30 Table 7: Vitamin A coverage 30 Table 8: Coverage of VAS by gender 31 Table 9: Coverage of VAS by wealth quartile 31 Table 10: Location from which Vitamin A received 32 Table 11: Knowledge of caregiver about Vitamin A 32 Table 12: Knowledge of caregiver about benefits of Vitamin A 32 Table 13: Reasons for failure of VAS 33 Table 14: Knowledge of health worker on benefits of VAS 33 Table 15: Knowledge of health worker on dosage of Vitamin A 34 Table 16: Knowledge of health worker on various methods to combat Vitamin A deficiency 34 Table 17: Knowledge of community leader of SSM campaign 35 Table 18: Coverage of Albendazole 35 Table 19: Knowledge of caregiver on benefits of Deworming 36 Table 20: Reasons for not receiving Deworming tablet 37 Table 21: Knowledge of health worker on dosage of Albendazole 37 Table 22: Coverage of IFA 38 Table 23: IFA Coverage by gender 38 Table 24: Knowledge of health worker on dosage of IFA 38 Table 25: Antigen wise coverage 39 6 Post Event Coverage Survey (PECS) of Vitamin A in Chhattisgarh, India FOREWORD Post Event Coverage Survey (PECS) of Vitamin A in Chhattisgarh, India 7 PREFACE As part of UNICEF’s partnership with Government of Chhattisgarh, a Post Event Coverage Survey on the implementation of Shishu Sanrakshan Maah was conducted with the support of Helen Keller International, an internationally renowned organisation for Post Event Coverage Surveys. Shishu Sanrakshan Maah is a flagship campaign of the State government which focuses on Vitamin A Supplementation and other services aimed to better child health in the State. The survey has collected data on the coverage of Vitamin A, IFA, deworming and immunization and also attempted to find out the barriers for achieving universal coverage of all these services. The comprehensive survey was done using android-based phone technology for data collection which substantially reduced processing time, with minimal errors and enabled geo-spatial analysis to identify barriers to high and equitable coverage. The survey findings have highlighted the pivotal role of community mobilisation in improving access to services. It also calls for the need to continue to build capacities of frontline workers. I am confident that the findings of the survey will further strengthen government’s efforts to increase demand generation and improve service delivery and the methodology and tools used in the survey will have greater scope of replication to evaluate other nutrition and health interventions in Chhattisgarh as well as other states in India. UNICEF sincerely acknowledges the contribution of Department of Health and Family Welfare, Government of Chhattisgarh in conducting this study and I believe that the department will find the recommendations of the study useful. On behalf of the UNICEF team, I appreciate the efforts of Helen Keller International and the team of CF SHORE (Christian Fellowship Society for Health Opportunity Rehabilitation and Empowerment) for the timely and successful completion of the survey. Prasanta Dash Chief Field Office UNICEF Office for Chhattisgarh 8 Post Event Coverage Survey (PECS) of Vitamin A in Chhattisgarh, India ACRONYMS AHS Annual Health Survey ANM Auxiliary Nurse Midwife ASHA Accredited Social Health Activist AWW Anganwadi Worker CES Coverage Evaluation Survey CF SHORE Christian Fellowship Society for Health, Opportunity, Rehabilitation and Empowerment CG Chhattisgarh CM&HO Chief Medical and Health Officer DLHS District Level Household and Facility Survey HKI Helen Keller International HMIS Health Management Information System HW Health Worker IFA Iron and Folic Acid MPW Multi-Purpose Worker (Male) NDD National Deworming Day NFHS National Family Health Survey PECS Post Event Coverage Survey PPS Probability Proportion to Size RSOC Rapid Survey on Children SSM Shishu Sanrakshan Maah (VAS bi-annual round) UNICEF United Nations Children’s Fund VAS Vitamin A Supplementation VAD Vitamin A deficiency VHSND Village Health Sanitation and Nutrition Day Post Event Coverage Survey (PECS) of Vitamin A in Chhattisgarh, India 9 EXECUTIVE SUMMARY INTRODUCTION METHODOLOGY Vitamin A deficiency (VAD) is considered as one A cross-sectional randomised 30 x 30 clusters of the most prevalent micronutrient deficiencies survey was conducted between 21st February 2017 worldwide, mainly affecting the children in and 1st March 2017 where sampling was done as developing countries. It is estimated that Vitamin per probability proportion to size (PPS). The primary A deficiency is affecting 190 million children under objective of the study is to obtain and validate the five years of age. VAD predisposes children to coverage of VAS and deworming in Chhattisgarh. increased risk of a range of problems, including The study also aimed to characterise children respiratory diseases, diarrhoea, measles, and vision missed from such services as a basis to plan better problems, and it can lead to death. The recent strategies to reach them in future. Cochrane review of 2017 highlights that Vitamin A reduces overall risk of death and death due to A total of 1068 persons were interviewed which diarrhoea by 12% specifically by reducing new includes 978 caregivers of children aged 9-59 occurrences of diarrhoea and measles. Vitamin months, 60 health workers and 30 Community A supplementation is associated with a clinically leaders. Households with children between 9 and 59 meaningful reduction in morbidity and mortality in months of age as on December 2016 was considered children (Cochrane, 2017) which has been strongly as the inclusion criteria for the household. corroborated WHO as well. RESULTS Since 2006, Government of Chhattisgarh, following the national policy, is implementing the The evaluated coverage of VAS was 71.9% for the supplementation of Vitamin A to children under five age group of 9-59 months against the reported years of age through a bi-annual campaign called coverage of 88.9% indicating a 19.12% decrease Shishu Sanrakshan Maah (SSM) which has led to in the validated coverage against the reported a progressively increasing reported coverage of coverage. The figure went up to 75.2% for children Vitamin A supplementation (VAS) in Chhattisgarh. provided with Vitamin A in last six months which is However, population based survey shows that very close to the NFHS-4 figure of 70.2%. Two main the coverage of VAS is not optimal and below the reasons for children not receiving Vitamin A are the universal coverage limit. Evidences have shown family not aware about the session and place and that effect of vitamin A supplementation may be time of the session
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