14th - 18th May 2012 REPORT HOUSEHOLD SURVEY OF BILASPUR DISTRICT (Chhattisgarh 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 India, 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 Mungeli district 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 Takhatpur 269480 229058 180010 78.6 10 Bilha 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.