Semi Quantitative Evaluation of Access and Coverage (SQUEAC) of Outpatient Therapeutic program Bungudu, Bakura & Shinkafi LGAs, Zamfara State, Nigeria 25th January – 12th March 2014 ACF international & Save the Children International TABLE OF CONTENTS .I. Acknowledgements ...................................................................................................................... 5 .II. Acronyms ..................................................................................................................................... 6 .III. EXECUTIVE SUMMARY ................................................................................................................ 7 .IV. INTRODUCTION ........................................................................................................................ 10 .V. METHODOLOGY ......................................................................................................................... 12 .V.1. SQUEAC approach and screening model ............................................................................ 12 .V.2. SQUEAC investigation in Zamfara State LGAs. ................................................................... 14 .VI. RESULTS .................................................................................................................................... 16 .VI.1. Stage 1 investigation-Routine program data ....................................................................... 16 .VI.1.1. Plot of admission over time - Bungudu, Bakura & Shinkafi LGAs ...................... 17 .VI.1.2. Bugundu LGA –Analysis of routine data ........................................................... 19 .VI.1.3. Bakura LGA-Analysis of routine data ................................................................ 24 .VI.1.4. Shinkafi LGA-Analysis of routine data .............................................................. 28 .VI.1.5. Summary of quantitative data analysis ............................................................ 32 .VI.2. Stage 1: investigation-qualitative data analysis ................................................................... 32 .VI.2.1. Bungudu LGA ................................................................................................... 33 .VI.2.2. Bakura LGA ...................................................................................................... 35 .VI.2.3. Shinkafi LGA .................................................................................................... 37 .VI.3. Stage 2: Confirmation of high and low coverage areas using small area survey and small studies......................................................................................................................... 41 .VI.3.1. Bungudu LGA ................................................................................................... 42 .VI.3.2. Bakura LGA ...................................................................................................... 45 .VI.3.3. Shinkafi LGA .................................................................................................... 47 .VI.4. Forming the prior ................................................................................................................ 50 .VI.5. Stage 3: Wide area survey - overall estimate of program coverage ..................................... 52 .VI.5.1. Bungudu LGA ................................................................................................... 55 .VI.5.2. Bakura LGA ...................................................................................................... 57 .VI.5.3. Shinkafi LGA .................................................................................................... 59 .VII. DISCUSSIONS ........................................................................................................................... 61 .VII.1.1. Bungudu LGA .................................................................................................. 61 .VII.1.2. Bakura LGA ..................................................................................................... 62 .VII.1.3. Shinkafi LGA.................................................................................................... 63 .VIII. RECOMMENDATIONS ............................................................................................................. 64 .IX. ANNEXES................................................................................................................................... 68 .IX.1.1. Parameters used in the report ......................................................................... 68 .IX.1.2. Survey Questionnaire for caretakers with cases NOT in the programme ................................................................................................................. 69 .IX.1.3. Case study with CV from Fulani community ..................................................... 70 .IX.1.4. Active and adaptive case finding procedure ..................................................... 72 .IX.1.5. Mind map-Bungudu LGA .................................................................................. 73 .IX.1.6. Mind map-Bakura LGA ..................................................................................... 73 .IX.1.7. Mind map-Shinkafi LGA ................................................................................... 73 .IX.1.8. List of the participants-Zamfara SQUEAC ......................................................... 74 2 .IX.1.9. Weighted and un-weighted barriers and boosters-Bungudu LGA ................. - 75 - .IX.1.10. Weighted and un-weighted barriers and boosters-Bakura LGA .................. - 77 - .IX.1.11. Weighted and un-weighted barriers and boosters-Shinkafi LGA................. - 80 - .IX.1.12. Concept map-Bungudu LGA ....................................................................... - 83 - .IX.1.13. Concept map-Bakura LGA .......................................................................... - 84 - .IX.1.14. Concept map-Shinkafi LGA ......................................................................... - 85 - LIST OF TABLES TABLE 1: SUMMARY OF BARRIERS AND BOOSTERS - ZAMFARA STATE LGAS ......................................................... 7 TABLE 2: THE WIDE AREA SURVEY COVERAGE ESTIMATES PRESENTED FOR ZAMFARA STATE AND ITS 3 LGAS ......... 8 TABLE 3: STABILIZATION CENTRE AND CMAM SITES PER LGA ................................................................................ 11 TABLE 4: THE LIMITATIONS IN THE SQUEAC ASSESSMENT AND POSSIBLE MITIGATION MEASURES ........................ 16 TABLE5: BARRIERS AND BOOSTERS-BUNGUDU LGA .............................................................................................. 33 TABLE6: BARRIERS AND BOOSTER-BAKURA LGA .................................................................................................... 35 TABLE7: BARRIERS AND BOOSTERS-SHINKAFI LGA ................................................................................................ 37 TABLE 8: SOURCES AND METHODS FOR BARRIERS AND BOOSTERS ....................................................................... 39 TABLE9: FINDINGS OF THE SMALL AREA SURVEY IN BUNGUDU LGA ...................................................................... 43 TABLE10: RESULTS OF THE SMALL ARE SURVEY ANALYSIS-BAKURA LGA ................................................................ 46 TABLE11: FINDINGS OF THE SMALL AREA SURVEY IN SHINKAFI LGA ...................................................................... 48 TABLE 12: MODE PRIORS ...................................................................................................................................... 51 TABLE13: SUMMARY OF THE SAMPLE SIZES FOR EACH LGA .................................................................................. 53 TABLE14: PARAMETERS USED IN CALCULATION OF COVERAGE-BUNGUDU LGA .................................................... 55 TABLE15: PARAMETERS USED IN CALCULATION OF COVERAGE IN BAKURA LGA .................................................... 57 TABLE16: PARAMETERS USED IN CALCULATION OF COVERAGE IN SHINKAFI LGA .................................................. 59 TABLE 17: COMMON RECOMMENDATIONS FOR THE CMAM PROGRAM IN BUNGUDU, BAKURA AND SHINKAFI LGAS ................................................................................................................................................................... 65 TABLE18: PARAMETERS USED IN PRIOR SETTING, SAMPLE SIZE CALCULATION AND CONJUGATE ANALYSES .......... 68 TABLE 19: LIST OF PARTICIPANTS IN THE ZAMFARA SQUEAC STUDY ...................................................................... 74 TABLE20: BARRIERS AND BOOSTERS-BUNGUDU LGA ........................................................................................ - 75 - TABLE21: BARRIERS AND BOOSTER-BAKURA LGA .............................................................................................. - 77 - TABLE22: BARRIERS AND BOOSTERS-SHINKAFI LGA........................................................................................... - 80 - List of figures FIGURE 1: ZAMFARA STATE MAP SHOWING COLOURED LGAS WHERE SQUEAC WAS CONDUCTED ........................ 10 FIGURE2: PLOT OF ADMISSIONS OVER TIME-BUNGUDU, BAKURA & SHINKAFI LGA ............................................... 17 FIGURE3: EXITS OVER TIME-BUNGUDU CMAM PROGRAM .................................................................................... 19 FIGURE 4: PLOT OF TIME TO