BASELINE SURVEY AND NEEDS ASSESSMENT FOR CHILDREN AND MOTHERS PARTNERSHIPS (CHAMPS) PROJECT IN NZARA COUNTY, WESTERN EQUATORIA STATE- SOUTH SUDAN Submitted to CATHOLIC MEDICAL MISSION BOARD Prepared by CATHOLIC MEDICAL MISSION BOARD- SOUTH SUDAN April 2015 1 | P a g e TABLE OF CONTENTS TABLE OF CONTENTS ......................................................................................................................................... 2 ACRONYMS AND ABBREVI ATIONS ............................................................................................................. 5 ACKNOWLEDGEMENTS ..................................................................................................................................... 1 EXECUTIVE SUMMARY ..................................................................................................................................... 2 CHAPTER ONE: INTRODU CTION ................................................................................................................. 18 1.1 BACKGROUND ............................................................................................................................................ 18 1.2 CMMB SOUTH SUDAN COUNTRY PROGRAM ............................................................................... 18 1.3 MATERNAL AND CHILD HEALTH: THE GLOBAL CONTEXT ................................................. 19 1.4 MATERNAL AND CHILD HEALTH: SOUTH SUDAN COUNTRY CONTEXT ....................... 23 1.5 OBJECTIVES OF THE BASELINE AND NEEDS ASSESSMENT ................................................. 28 1.6 SCOPE OF THE ASSESSMENT ............................................................................................................... 30 CHAPTER TWO: DATA CO LLECTION METHODOLOGY ................................................................... 31 2.1 HOUSEHOLD SURVEY ............................................................................................................................. 31 2.1.1 SURVEY SAMPLING FRAME ............................................................................................................. 32 2.1.2 SAMPLE SIZE DETERMINATION ..................................................................................................... 32 2.1.3 SAMPLING DESIGN ............................................................................................................................... 34 2.1.4 SURVEY ENUMERATOR SELECTION AND TRAINING ........................................................... 35 2.1.5 SURVEY TIMEFRAME AND SUPERVISIONS ............................................................................... 36 2.1.6 SURVEY DATA ENTRY AND ANALYSIS ...................................................................................... 36 2.2 KEY INFORMANT INTERVIEWS (KII) ............................................................................................... 36 2.3 FOCUS GROUP DISCUSSIONS .............................................................................................................. 37 2.4 FACILITY ASSESSMENTS ...................................................................................................................... 38 2.5 LITERATURE REVIEW ............................................................................................................................. 39 2.6 ETHICAL ISSUES ....................................................................................................................................... 39 CHAPTER THREE: RESULTS .......................................................................................................................... 41 3.0 BACKGROUND INFORMATION............................................................................................................ 41 3.1 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS ......................................... 42 3.1.1 HOUSEHOLD COMPOSITION ................................................................................................................. 42 3.1.2 EDUCATIONAL ATTAINMENT OF THE HOUSEHOLD POPULATION ............................................ 43 3.1.3 MARITAL STATUS OF RESPONDENTS ................................................................................................ 46 3.1.4 RELIGION OF RESPONDENTS ............................................................................................................... 47 3.1.5 HOUSEHOLD ENVIRONMENT ............................................................................................................... 47 3.1.6 HOUSEHOLD POSSESSIONS .................................................................................................................. 49 3.1.7 OCCUPATION ........................................................................................................................................... 50 3.1.8 HOUSEHOLD DECISION-MAKING ........................................................................................................ 53 3.2 FERTILITY LEVELS, TRENDS, AND FAMILY PLANNING ........................................................ 54 3.2.1 BIRTH INTERVALS .................................................................................................................................. 55 3.2.2 CURRENT USE OF CONTRACEPTIVE METHODS ................................................................... 58 3.3: MATERNAL HEALTH .............................................................................................................................. 63 3.3.1 ANTENATAL CARE................................................................................................................................ 63 3.3.1.1. ANTENATAL CARE COVERAGE ....................................................................................................... 63 3.3.1.2 NUMBER OF ANTENATAL CARE VISITS ......................................................................................... 65 3.3.1.3 COMPONENTS OF ANTENATAL CARE ............................................................................................. 66 3.3.1.4 TETANUS TOXOID INJECTIONS .................................................................................................. 67 3.3.2. DELIVERY ................................................................................................................................................ 68 3.3.2.1 PLACE OF DELIVERY ........................................................................................................................... 68 3.3.2.2 DELIVERY ASSISTANCE ..................................................................................................................... 70 3.3.3. POSTNATAL CARE ............................................................................................................................... 72 3.4: GENDER-BASED VIOLENCE AND CHILD PROTECTION ......................................................... 74 3.4.1 EARLY CHILD MARRIAGE ................................................................................................................. 75 3.4.2 DOMESTIC VIOLENCE ......................................................................................................................... 76 3.4.3 SEXUAL EXPLOITATION AND ABUSE .......................................................................................... 78 3.4.4 ECONOMIC ABUSE ................................................................................................................................ 80 3.4.5 CHILD PROTECTION ............................................................................................................................. 82 3.5: CHILD HEALTH ......................................................................................................................................... 84 3.5.1 VACCINATION COVERAGE ............................................................................................................... 84 3.5.2 ACUTE RESPIRATORY INFECTION ................................................................................................ 85 3.5.3 FEVER ......................................................................................................................................................... 87 2 | P a g e 3.5.4 PREVALENCE OF DIARRHEA AMONG CHILDREN .................................................................. 88 3.5.5 KNOWLEDGE OF ORS PACKETS ..................................................................................................... 89 3.6: MATERNAL, NEWBORN AND CHILD NUTRITION ..................................................................... 89 3.6.1. NUTRITIONAL STATUS OF CHILDREN ....................................................................................... 91 3.6.2 BREASTFEEDING AND SUPPLEMENTATION ............................................................................. 93 3.6.2.1 INITIATION OF BREASTFEEDING ..................................................................................................... 93 3.6.2.2 EXCLUSIVE BREASTFEEDING FOR 6 MONTHS ............................................................................. 94 3.6.2.3 COMPLEMENTARY FEEDING IN CHILDREN .................................................................................. 95 3.6.3 MICRONUTRIENT INTAKE AMONG CHILDREN ....................................................................... 98 3.6.4 MICRONUTRIENT INTAKE AMONG MOTHERS ......................................................................... 99 3.7 MALARIA ...................................................................................................................................................