Liberia Multiple Indicator Cluster Survey 1995

Publication date: 1996

• • LIBERIA MULTIPLE-INDICATOR CLUSTER SURVEY 1995 FINAL I REPORT \5 I < ~ ?-- I t ~I! ~ ' 1 ~ ~ l f.- ? \.-, J 1-- ' . ~ . <t ~ I ,\-- '"'' \J) I --v ! Min\stry of Planning and Economic Mfai.:S Ministry of Health and Social Welfare United Nation Children's Fund August 1995 JFO JPffiW OJIID In 1990, at the World Summit for Children, Heads of State and Governments from countries around the world pledged themselves to a Declaration and Plan of Action for Children. The Summit set clear goals to be achieved by the end of the centucy'. Based on the commitments, many countries, including Liberia, have developed their own Niitional Programme of Action. The Mid-Decade Goals emerged from the first two years of experience, beginning in 1990. In 1992 the International Conference on Assistance to African Children adopted a set of 13 Mid- Decade Goals which have come to form the milestone that all countries need to achieve by the ·· end of 1995 as stepping stones to the goals for the year 2000. In Liberia, due to the emergency, the programme focus was on immediate life saving interventions while at the same time supporting rehabilitation efforts. Though emergency in nature, the various programmes implemented by different agencies, and above all the individual efforts made by Liberian families, have a long lasting impact on the situation of children. The Multiple Indicator Cluster Survey (MICS) is designed to collect data on the well being of children. It helps to look into our progress towards the achievement of the Mid-Decade goals and to estimate the impact of our programmes. The data also provide some information which can be useful for planning purposes. ~nfortunately, the information provided in this report covers only three counties (Montserrado,part of Margibi, and Bassa)and-does--I1ot -Ciaiin~therefore~ io te1lect the situatx~lJh~-~hqJ~_§ouiit_ij~~H:owever,- about 60 percent of the poputation.-reSiaes in [his arcil.We plan to conduct a similar survey in 1996 covering, hopefully, a larger part of the country and population. It is our hope that this report will lead to a better understanding of the situation of children in Liberia and fill part of the enormous information gap, so helping all of us to identify areas where we can assist the survival and development of children. Alan Everest Representative UNICEF !Liberia ACCKNOWLJEJDGEMJENT The Liberia Multiple-Indicator Cluster Survey (MICS) was conducted as part of the worldwide survey designed to measure progress toward the Mid-Decade Goals. The survey was carried out for the first time in Liberia and it is expected to be conducted each year i~ order to establish data bank covering health, education, water and sanitation and mo~ty of children of Liberia. To be specific, the main objectives of the MICS are: a) to produce a body of data for monitoring progress toward Mid-Decade Goals of the World Summit for Children; b) to narrow the information gaps for specific areas critical to the survival and development of each Liberian child; c) to add to the international body of data which could be used for comparative purposes; d) to produce body of data which could be useful to policy makers, for public advocacy and socio-economic planning for the survival and development of children in Liberia; and e) to build the institutional capacity of the Bureau of Statistics of the Ministry of Planning and Economic Affairs and to enhance the ability of Liberian staff to conduct MICS in the future. At the time of the survey, the country was going through a civil crisis which compelled the survey organizers to restrict the field activities in those areas that were under the effective control of the Economic Community of West African States (ECOWAS) Peace Keeping and Monitoring Force (ECOMOG). These areas, included among others, Montserrado County; Harbel and its evirons, Margibi County; and Buchanan City andits environs, Grand Bassa County. This implies that only part of the country was covered by the survey. It is our hope, however, that the 1996 MICS will cover the entire country. Fieldwork for the Liberia Multiple-Indicator Cluster Survey was conducted from 20 March to 3 April 1995 by the personnel of the Ministries of Planning and Economic Affairs and Health and Social Welfare. Financial Assistance was provided by UNICEF while technical and adnfi~istrative services for the survey were jointly provided by Ministry of Planning and Economic Affairs, the Ministry of Health and Social Welfare and UNICEF. The successful implementation of the MICS would not have been possible without relentless effort and dedication of the Ministries of Planning and Economic Affairs and Health and Social Welfare, UNICEF and others who made the successful implementation of this program possible. It is in this light, I wish to extend my gratitude to the following individuals and institutions for their immense contribution to the success of the MICS Project; i a) the UNICEF Resident Representative and his able staff who provided both fmancial, technical and administrative assistance; , ' b) the Minister of Health and Social Welfare and his dedicated personnel who were seconded to the project; . ' . ··~.;t')r ·:t. c) the Minister of Planning and Economic Affairs and li"t- able staff of the Bureau of Statistics who were seconded to the project; d) the Minister of Internal Affairs and Officials of the counties where the survey was conducted for their kind support and cooperation with the field staff during the MICS fieldwork; e) the High Command ofECOMOG and ECOMOG Officers in the counties where the MICS was implemented for their cooperation and support; · f) the press and electronic media, particularly EL W A and LBS, for the vital role they played by promoting and educating the public about the objectives and importance of the survey; .and g) finally, all those who in one way or another contributed to the successful implementation of this very important survey. Amelia Ward, Minister Ministry of Planning and Economic Affairs ii • CONTENTS • ! ACKNOWLEDGEMENT CONTENTS lll CONTENTS OF TABLES v 1.0 BACKGROUND 1.1 Introduction 1 1.2 Sample and Methodology 2 1.2a Coverage 2 1.2b Sample Frame 2 1.2c Sample Size 3 1.2d Selection of Sample Households 6 • 1.3 The Collection and Processing of Data 6 1.3a Estimated Budget for Multiple-Indicator Cluster Survey (MICS) 6 1.3b MISC Personnel 6 1.3c Training of Field Personnel 7 1.3d Interviewer Manuel 7 1.3e Questionnaire 7 1.3f Field Work 8 1.3g Data Processing 9 1.4 Major Problems 10 2-.0 RESULTS 2.1 Immunization of Children 10 2.2 Diarrhea 17 iii 2.3 Timely Complementary Feeding and Breast Feeding 18 2.4 Acute Respiratory Infections .t! 19 2.5 Water and Sanitation 20 ·j~'-. . 2.6 Nutrition "' . lt;. 21 "\. 2.7 Primary Education 25 - 3.0 APPENDICES 3.1 Confidence Intervals for selected immunization indicators 27 3.2 List of Selected Blocks/Neighborhood or Clusters 28 3.3 Sample MICS Questionnaire 34 3.4 List of Survey Personnel 46 • iv TABLES OF CONTENTS :< ·-·. ;;f '; , .; ·l~f ,~ . r' ~~~~ ·-: . ~ .' i(f{t'!"i~ !;l~~~!!lft, :; :~. ~~~?~:~~~r;~-~ Table Title Page 'i ?- . . ~It,. ' 1 Computation of Sample Size 5 2A Valid Immunization of Children Aged 12 - 23 Months by Region 12 2B Card + History Immunization of Children Aged 12 - 23 Months by Region 13 3A Card Only Immunization of Children Less Than Sixty Months by Region and Sex 14 3B Card + History Immunization of Children Less Than Sixty Months by Region and Sex 16 4 Proportion of Children Less Than Sixty • Months with Diarrhea Cases Given ORT by Region 18 5 Timely Complementary and Continued Feedings of Children Aged 6 - 23 Months by Region 19 / 6 Proportion of Mothers/Caretakers of Under Five Children Who Know the Signs of ARI by Region 20 7 Proportion of the Population with Adequate Access to Water Supply and Sanitation Facilities by Region 21 81\ Prevalence of Weight-For-Height Malnutrition Among Under-Fives by Region and Sex 23 8B Prevalence of Height-for-Age Malnutrition Among Under-Fives by Region and Sex 24 9 Primary Education Inqicators for Children Aged 5 - 14 Years by Region and Sex 26 v 1.0 BACKGROUND .& ·' 1.1 Introduction The Liberia Multiple-Indicator Cluster Survey (MICS) 'tWVering'health, education, water and sanitation and mortality of children was conducted iii March, 1995 by the Bureau of Statistics of the Ministry of Planning and Economic Affairs, Ministry of Heath and Social Welfare and UNICEF. The survey which was conducted for the first time in the country, collected data from about 2,520 households that were selected from three distinct regions - Montserrado County; Harbel and its environs, Margibi County; and Buchanan City and its environs, Grand Bassa County. The MICS was restricted to these three regions because, at the time of the survey, the country was going through a civil war and only the above mentioned regions which were under the control of the Economic Community of West African States (ECOWAS) Peace Keeping and Monitoring Force (ECOMOG) were considered safe and accessible. Technical assistance for the survey was provided by the Bureau of Statistics, Ministry of Planning and Economic Affairs, Ministry of Health and Social Welfare and UNICEF. However, in addition to technical assistance, UNICEF provided funding for the survey. The MI CS was particularly important in Liberia as the routine data collection system has virtually collapsed due to the war. Even pre war ( 1989) data are not available since the offices of most government agencies were physically damaged and looted. The latest available comprehensive data are the 1984 census and the 1986 DHS survey. Not only that the census and DHS data are outdated, the situation in the Country has totally changed, making meaningful projections impossible. The objectives of the MICS were: a) b) to produce a body of data for monitoring progress toward Mid-Decade Goals of the World Summit for Children; . · ·· to narrow the information. g~p~ 'for sp~cific ,areas critical to the survival and development of each Liberian child: the right J to be protected against the immunizable diseases, to be treated when sick with diarrhoea, to be breastfed, to be well nourished, to be protected against the disorders of iodine and vitamin A deficiencies, to go to school and to have access to water as well as sanitation facilities1; 1 . United Nations Centre for Human Rights, Geneva, 1990; Human Rights Fact Sheet No. 10, Convention on the Rights of the Child, Article 24. 1 c) to add to the international body of data which could be used for comparative purposes; . ' d) to produce body of data which could be useful to policy makers, for public advocacy and socio-economic planning for the survival and development of children in Liberia; and ·<:~ , ., e) to build the institutional capacity of the Bureau of Statistics of the Ministry of Planning and Economic Affairs and to enhance the ability of Liberian staff to conduct MICS in the future. 1.2 Sample and Methodolo&Y 1.2a Coveraa:e: At the time of this Multiple-Indicator Cluster Survey (MICS), Liberia was going through a senseless civil war. Thus, except those areas that were under the control of the Economic Community of West African States (ECOWAS) Peace keeping and Monitoring Force (ECOMOG), most areas of the country were inaccessible to the survey personnel. As a result, it was decided that the survey be conducted in three major areas that were under the effective control of ECOMOG. These selected areas were Montserrado County (Montserrado)- Region I, .Harbel and its environs, Margibi County (Harbel) - Region II and Buchanan and its environs, Grand Bassa County (Bassa) - Region III. Nonetheless, at the time of the survey, about 60 percent of the total population lives in these three regions2• It is also worth to note that the children covered in this survey do not represent all the children of Liberia, but only those who are living in the three selected regions. 1.2b Sample Frame: The Special Emergency Life Food Program (SELF) demarcated Montserrado County - Region I into zones, communities and blocks in 1991 for the purpose of delivering relief services to the thousands of starving people and for conducting surveys and censuses. A total of about 21 zones, 212 communities and 83 7 blocks/neighborhoods. were established in Monrovia and its surroundings. Since the Bureau of Statistics (BOS) of the Ministry of Planning and Economic Affairs (MPEA), which is the National Statistical Office of Liberia, had earlier worked closely with SELF to verify the boundaries of these demarcated areas, the Multiple-Indicator Cluster Survey Project Coordinating Committee decided to use the SELF structure as the sample frame for Montserrado County. ~- Total estimated population in the country at the time of this survey was 2,000,000. 2. Total estimated population covered by this survey was 1,200,000. a) Total estimated population covered by the survey in Region I was 960,000. b) _Total estimated population covered by the survey in Region II was 96,000 . c) Total estimated population covered by the survey in Reg i on III was ~44 , 000. 2 Similarly SELF, BOS and the Catholic Relief Service (CRS) demarcated Region II - Harbel (Harbel, Dolo Town and Smell-No-Taste or Unification Town) and Region III- Bassa (Buchanan and its environs) into z6nes, communities and blocks/neighborhoods. As a result of the demarcation exercise, Region II has l zone, 3 communities and 38 blocks/neighborhoods and Region III comprises of 1 zone, 17 communities and 120 blocks/neighborhoods. These structures were also used·:~ the sample frames for the two '"\. regions. The number of occupied structures in the three zones is constantly updated for the purpose of relief food distribution. It is believed that the total number of people living in these areas could be overestimated as families tend to inflate the number of their members to get increased ration of relief food. This, however, has little, if any, impact on our sample frame as our smallest sampling unit is the "household" and not the individuals in the household. 1.2c Sample Size: The sample size was primarily designed to get separate data for the three distinct regions to generate information for both programme and reporting purposes. The only difference from the methodology of the national sample design is that, in this case, a higher margin of error (ten percent rather than five) was selected. After the computation of the data, however, the margin of error for most of the indicators was in fact below ten percent (see Annex 3.3). It should be noted that the sample size for each region was made to be large enough to get statistically valid results for each district within the above mentioned level of margin of error. The sample size was designed to obtain data for the three specific regions within 10 percents of margin of error. A weighted average was then computed taking the relative population size of the three regions.3 Technically, therefore, the weighted average will have a margin of error less that 10 percent. Hence, a sample size of 840 households for each of the three regions was estimated using the spreadsheet SAMPGOAL.WK.l 4• 3 Based on their relative population size, Region I (Montserado), Region II (Harbel and environs), and Region III (Bassa), have weights of 0.80, 0.08~ and 0.12 respectively. 4A Practical Handbook for Multiple-Indicator Surveys - United Nations Children ' s Fund , New York, J anuary 1 995 3 I, ' 4 The sample size was determined by entering the below basic assumptions, estimated prevalence and margin of errors. Besides the spreadsheet, the following formulae could be used to manually tabulate the target sample size, and the required number of households for each indicator: 1. n = (4*p*(l - p)*d)/e"2 Where n = target sample size p = estimated prevalence d = design effect e =margin of error, and 2. NHHs = n/(APH*PP) Where NHHs n APH pp =required number of households = target sample size = average number of persons per household = proportion of population made up of target group J I I ' ~ ,,., TABLE 1 COMPUTATION OF SAMPLE SIZE BASIC ASSUMPTIONS Design effect Persons per household Pet of population <5 years Prevalence of diarrhea 15 days Target Indicator Pop. DPT3 Coverage 12-23 mo Measles Coverage 12-23 mo OPV3 Coverage 12-23 mo BCG Coverage 12-23 mo TT2 Coverage 0-11 mo (pregnancy) Vitamin A Coverage 0-23 mo Iodized Salt Households Consumption Use of ORT(l) in Diarrhea <5 Diarrhea Years Use of ORT(2) in Diarrhea <5 Diarrhea Years Percent Low All <5 Years Weight/Age School Enrollment 5-9 Years Safe Water Population Sanitation Population Required Number of Households . ' Est. Prev. 0.4 0.4 0.4 0.8 0.3 0.0 0.0 0.4 0.5 0.4 0.6 0.5 0.5 2 7 0.17 0.25 Margin of Error 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.05 0.1 0.1 Required Target Sample 192 192 192 128 168 0 0 192 200 192 746 1000 1000 Required Number of HH's 807 807 807 538 706 • ' · · . 0 0 645 672 161 627 143 143 807 (840) 5 Entering the above assumptions onto the spreadsheet, a maximum required number of households of about 807, which was rounded off to 840, was obtained and used for each region. Note that, from the table above, tlie total required number of households is the highest required number of households among the number of households for each indicator. Selecting the highest required number of households enables the interviewers to find the target sample size (the required number of~~hildfen~ for each indicator. 1.2d Selection of Sample Households: For the purpose of this survey a household was defined as groups of persons who regularly live under the same roof and cook and eat together. To minimize the design effect, it was decided to have 40 randomly selected clusters which contain 21 households each. In this light a two stage sampling methodology was applied to select the sample households in each region. At the first stage, the primary units, 40 blocks/neighborhoods, were selected using systematic random sampling technique with probability proportional to size, while at the second stage, the first household was selected randomly from a list of households in the block. The twenty subsequent households were selected using the revised EPI technique for choosing the nearest household until 21 householdswere selected in each block/neighborhood to form one cluster (See Annex l:.L for the list of the selected primary units.) 1.3 The Collection and Processing of Data 1.3a MICS Personnel: The Assistant Minister for Statistics from the Ministry of Planning and Economic Affairs was seconded to the project to serve as the Coordinator for three months, while the Senior Epidemiologist from the Ministry of Health and the Director of Industrial Statistics from the Ministry of Planning were seconded for two months and one month respectively to serve as Assistant Coordinators. These three personnel from the Government and the UNICEF Monitoring and Evaluation Officer managed the planning, design and implementation of the survey. They reviewed the questionnaire modules and instructional manuals from the Practical Handbook for Multiple-Indicator Cluster Survey, prepared the sample frame, recruited and trained the field staff, and supervised the collection and processing of the data. 1.3b Field Staff: Sixty-eight field personnel were seconded from the Ministry of Planning and Economic Affairs and Ministry of Health and Social Welfare to the MICS project for a period of twenty days. The sixty-eight field staff who have had considerable experience with censuses and surveys like the 1974 and 1984 Population and Housing Censuses, the Liberian Demographic and Health Survey, etc., consisted of eight supervisors (among whom four were assigned to Region I - Montserrado and two each to Region II - Harbel and Region III - Bassa) and sixty interviewers with 20 persons assigned to each of the three regions. 6 1.3c Trainine of Field Personnel:- The field staff were trained from 13 to 17 March, 1995 by the MI CS personnel. ·The training included, among others, lectures, role module or practice interviewing both in the classroom and "n the field, etc. Since the questionnaires were printed in English, the training and interviews were conducted in English. However, the interviewers were instructed to translate, if necessary, any question into local dialects. The field testing gave us an idea on the amoun~of tim~ required to complete a questionnaire for an average household. About one hour was required to complete one questionnaire by a team. of two interviewers due to the inclusion of the anthropometry module, particularly the · measurement of height/length. 1.3d Interviewer Manual: The instructions for interviewers in the Practical Handbook for Multiple-Indicator Surveys were also slightly modified so as to enable the interviewers to comprehend and interpret the survey questionnaires. 1.3e Questionnaire: The following questionnaire modules from the Practical Handbook for Multiple-Indicator Surveys were slightly modified and used as the questionnaire for the survey: 1. Mortality: Except incomplete epidemiological reports from few health facilities, there is no estimate on the level of under five mortality in Liberia since 1986. Due to the significant changes, caused by the civil war, it is believed that the mortality rate would be higher. The MICS Coordinating Committee decided to include the module on mortality on the hope of getting some rough estimate on the level of under five mortality. Unfortunately, however, we cannot compute the data with existing programmes. Attempts are being made to use other programmes like "Mortpak" to analyze the data. The report on mortality would, therefore, be prepared· later as an addendum to this report. 2. Water and Sanitation: The module on water and sanitation was used without much modification to get estimates on water and sanitation coverage, which otherwise are notavailable from other routinesources. However, the data collected from the two-regions (Region II and III) were later on discarded as most of the residents in the two regions are displaced people and the questionnaire did not capture their situation. In areas where most displaced people live, existing water and sanitation facilities are being used by too many people which makes the facilities extremely unhygienic. There was no question to capture this reality, and the results obtained could be misleading. After discussions with professionals in the sector, it was decided that the results from the two regions will not be reported. 3. Education: The module was ~sed as it is without revision. At the analysis stage, definitions appropriate to the Country were adopted (the definitions are discussed under "Findings" on education). 7 4. For Mothers: The Tetanus Toxoid and the Care of Acute Respiratory Infection (ARI) modules were included in the questionnaire. Mothers' knowledge of ARI is important for design of health program;nes since ARI is one of the three major causes of morbidity and mortality in Liberia. 5. For Children under Five Years of Age: 411 the modules for children, i.e. Diarrhoea, Breast-feeding, Immunization, and Ahthropometry were included in the questionnaire since all of them were extremely relevant for the situation in Liberia. In fact, in the anthropometry module, we included the measurement of height/length to be able to compute acute malnutrition, despite its heavy implication on costs. Since Liberia is an emergency country, more accurate data on the nutritional status of children are very important for programme purposes. In addition, available nutrition data, though scattered, in the emergency period are based on Weight for Height and we want this survey to generate data which can be compared to previous studies. These modules were selected with the consent of the epidemiologist from the Ministry of Health and Social Welfare and UNICEF experts in the areas of health, education and water and sanitation (see Annex 3.2 .for sample questionnaire). The Vit. A module was not included as there is no general Vit. A supplementation programme in the Country. Vit. A supplement, with measles vaccination, is given only for selected groups - primarily for children in newly accessible areas (these are areas which become accessible after being isolated for many months due to fighting). Normally, Vit. A deficiency was not a significant health problem before the war due to the availability of .Vit. A rich local food. We are planning to conduct a clinical survey to know the extent of the problem after the war. The module on salt iodization was also not included in the survey. In 1994 a market survey was done in six counties to test the presence of iodine in all brands of salt. That test showed that all brands of salt in the Liberian market do not contain iodine. Since all Liberian householdS-Consume one or another of the brands tested, we believe that testing at a household level is unnecessary. 1.:3f Field Work:- The sixty interviewers were organized into teams of two members. The teams, on 19 March 1995, were given their assignments and field materials which included questionnaires, weighing scales, height measuring board, pens, pencils, erasers and staple machines and pins. A work load of about 84 households were assigned to each team for a period of fifteen days. Immediately after the teams received their assignments and supplies on 19 March 1995, those interviewers who were assigned to Regions II and III were dispatched. Interviews in the three regions began the next day, 20 March 1995 and ended on 3 April 1995 with the collection of all completed and uncompleted questionnaires and returnable supplies. 8 The experience of the interviewers indicates that the mothers or caretakers of the children highly cooperated during the interviews. However, it was reported by the field supervisors that for the first two days of tlie survey' interviewers had difficulty completing the Pregnancy History Form, Child Listing Form, Tetanus Toxoid (TT) Questionnaire, Care of Acute Respiratory Illness (ARI) Questionnaire and Anthropometry Questionnaire. For example, in the first two days, interviewers t~k at' rrlost forty five minutes to measure the weights and heights of some of the children between the ages of one and three years. The children were simply afraid of the interviewers and the measuring equipment. This problem was overcome by the interviewers offering sweets and soliciting the help of the children's mothers or caretakers. As for the other forms and questionnaires, the enumerators did not just understand how to complete them. But this was resolved by frequent visits of the field supervisors and the MICS personnel. Besides, all completed questionnaires were carefully field edited by the field supervisors and, where need be, corrections were made on the field by the supervisors and/or interviewers. Additionally, the MICS personnel edited the returned completed questionnaires before the data were entered. L3g Data Processin~: Data from MICS questionnaires were entered into and processed on two microcomputers at the UNICEF office in Monrovia by the data processing personnel of the Ministry of Health and Social Welfare. With the exception of the mortality information (including the Mother Listing and Pregnancy History Forms), all data were entered, checked for range, skip and consistency errors and analyzed using both the EPI Info Package for Mid-Decade Goal Surveys and the EPI Info 6 software. The mortality Information have not been entered and processed because, during the entry of the MICS data, it was discovered that the EPI Info Package did not include mortality program. As such alternative software like the Mortpak are being considered for the processing of the mortality data. Also the "lndicatr.pgm" of the EPI Info Package for Mid-Decade Goal Surveys for the tabulation of one of the. four education indicators was not functional. Reference is made to the. calculation of the retention rate, which is the proportion of children entering first grade of primary scliool who eventually reach grade 5. The computation of this indicator requires the development of conditional probabilities which was not built in the EPI Info package. It was not also possible to compute the indicator from the frequency distribution as the data collected do not contain all the required information. 5 5 Percentage of children starting grade 1 of primary school who eventually reach grade 5 = {!children starting grade 1 in year x who eventually reach grade 5)/ [all children who start grade 1 in year xl}. At the moment this cannot be computed even from school records as the records in almost all schools have been distroyed in the civil war. 9 i . • 1.4 MAJOR PROBLEMS The survey coordinating team was not familiar with the methodologies of the MICS. This required longer time to study the MICS manual and revise the questionnaire as necessary. There were no major problems in the field work ~ mo~t bf the enumerators were experienced in data collection. Logistics requirements were kept to the minimum. In future, if the Country opens up, the need for logistics will be tremendous. There were no commercial accommodations in Region II and III; we were, however, able to arrange accommodation with the help of NGOs operating in the areas. Initially though, enumerators took more time to complete a questionnaire, which improved later as they got more familiar with the questions. Completed questionnaires were checked twice - first at the field level by the supervisors and later by the coordinating team in Monrovia. Few questionnaires were returned back from Monrovia for correction. The coordinating team also visited some of the households independently to check on the accuracy of the data collected. Perhaps the major problem was at the data processing stage. We did not, at the beginning, exhaustively check the programme sent from Head Quarter. The manual does not have sufficient guideline on the use of the programme. The results from the programme were, therefore, checked against frequency distributions generated by EPINFO. Where there is some inconsistency, reference was made to the relevant formula. The mortality module still remains unsolved due to lack of appropriate guideline and theoretical consensus on the different methodologies. 2.0 RESULTS 2.1 Immunization of Children 10 During the MICS, mothers or caretakers of all children under age five years in the selected households were asked if the children had vaccination cards. If yes, the interviewers were instructed to copy the dates for each type of immunization from the card onto the questionnaire. If no date for a vaccination is recorded on the card, or if the card was not available, the interviewers were directed to use the probing questions to find out if the child received that vaccination, and if so, how many doses. The mother's or caretaker's response for each vaccine dose was recorded, but without specific information on the date the vaccine dose was administered. Note that at the time of the MICS in 1995, the country was still going through a civil war which started in 1989. As a result mothers or caretakers could not easily produce their children vaccine cards because most household members in the country, including the selected regions, have been displaced at least once. The data on Tables 2A- 2B indicate the proportion of children aged 12- 23 months old who were vaccinated before their first birthday. Table 2A presents data for children of the above mentioned age group with immunization dates for BCG, DPT3, OPV3 or Measles vaccine before the first birthday and verified by cards. The information on the table show that on the average, over 50 percent of the children have received their vaccine for each antigen. However, for Region I - Montserrado Coun~ which'includes the Capital City of the country, Monrovia, the data show that 57 percent of the children have been vaccinated against all antigens. Also 47 percent of the children in Region II - Harbel, which is located in the largest rubber plantation in the country as well as nearer to the capital city, have received full immunization. For Region III, with the exception ofBCG and Measles which had 69 percent and 31 percent coverage, respectively, the coverage rate for each of the other antigens was less than 20 percent, while, Overall coverage for Region III is only 15 percent. 11 TABLE2A VALID IMMUNIZATION COVERAGE Aged 12 - 23 Months by Region March,·l995 . Region I Region III Montser- Region II -~ . , Bas~a·t t Weighted Antigen rado Co. Harbef Average Total Children 150 204 174 528 BCG% 87 91 69 85 OPT% 66 51 17 59 OPV% 63 54 17 57 Measles% 67 60 31 62 Overall% 57 47 15 51 TT Protected % 78 89 64 77 ·Region II - Harbel includes Harbel, Dolo Town and Smell-No- Taste. ··Region III - Bassa refers to Buchanan City and its environs only. 12 An EPI coverage survey conducted in 1994 in Region I indicated an overall valid immunization coverage of 32 percent: The present coverage of 57 percent for the same region shows significant progress (even taking into account the confidence intervals). There are no comparable data from the other regions. Pre war (1988) national immunization coverage was 22 percent. We believe that the coverage rate for about 40 percent of the population living in inaccessible areas, and not covered by the survey, could be extremely low; perhaps as low as zero percent in some regions. The information on Table lB present the proportion of children aged 12- 23 months old who have received BCG, DPT3, OPV3 or Measles vaccine verified by either the card or the mother's or caretaker's response. The information on this table show, on the average, 92, 64, 63 and 69 percents coverage for BCG, DPT3, OPV3 and Measles, respectively. Overall coverage based on "Card+ History" is 55 percent, with the same pattern as valid coverage based on "Cards". The table shows that Region I has the highest coverage while Region III has the lowest. ' • TABLE 2B Card + History Immunization of Children Aged 12 - 23 Months by Region Marclr, · 1995 . Region I Montser- Region II Antigen rado Co. Harber Total Children 150 204 BCG% 92 95 DPT% 69 58 OPV% 68 61 Measles% 71 71 Overall% 61 55 ·Region II - Harbel includes Harbel, Dolo Town and Smell-No- Taste. ··Region III - Bassa refers to Buchanan City and its environs only. R((gi~n III -i •~ Bassa·· , _ . ,, ' 174 87 21 21 50 19 Weighted Average 528 92 62 62 68 55 Since the immunization programme in Liberia targets all under-five children, immunization coverage for under-fives was collected and analyzed for programming purposes. The data on Table 3A indicate the proportion of children less than sixty months old who have been vaccinated against BCG, DPT3, OPV3 or Measles verified by a card entry. The information on this table show that the overall coverage rate for the regions as well as for males and females was less than 25 percent, with Region III accounting for the least. We were able to compute male/female coverage for under-fives as the sample size is large enough to allow categorical computation with out significantly compromjsing accuracy. The table shows that Region III has the least immunization coverage rates for DPT3, OPV3 and Measles. Also the table indicates that the coverage rates for these same antigens in Regions I and II are less than 35 percent. 13 • Table 3A: Card Only Immunization of for Children Less Than Sixty Months by Region and Sex March, 1995 Region I - Mont- Region II - Region III - Antigen serrado County M F T ., Total Children ·' 415 427 842 BCG% '·""" ···- 78 80 79 DPT% 28 33 30 OPV% 25 32 28 Measles% 25 29 27 Overall% 19 24 22 •Region II - Harbel includes Harbel, Dolo Town and Smell-No- Taste. ••Region III • Bassa refers to Buchanan City and its environs only. 14 Harbel* Bas sa •• M F T M F T 474 475 949 535 542 1077 87 84 86 77 75 76 26 26 26 9 9 9 26 29 28 9 9 9 29 32 32 23 23 23 21 21 21 6 8 7 Weighted Average M F T 1424 1444 2868 79 80 79 26 30 27 23 29 26 25 29 27 18 22 20 The information on Table 3B present the proportion of children less than sixty months old who have received BCG, DPT3, OPV3 or Measles vaccine verified by either the card or - the mother's or caretaker's response. j ' Immunization coverage for all under-fives based on cards is less than for those between 12 - 23 months. Two hypotheses can be forwarded - one, that parents are less likely to vaccinate their children after age one; and two, that pat,ents imiy not keep the vaccination cards of elderly children. The second hypothesis is mbre plausible considering the fact that many families have been displaced once or more in the. last couple of years. Also the card plus history response for under-fives approximates the Valid immunization for 12 - 23 months. The 1984 immunization coverage survey for under-fives shows similar pattern as this one. In both surveys the immunization coverage rates for under-fives is about half of the coverage rate for under-ones. The coverage rates for males and females, for under-fives, are of the same magnitude for all the regions. We were not able to compute male/female coverage for children between 12 - 23 months due to the small size of the sample. 15 • TABLE3B Card + History Immunization of Children Less Than Sixty Months by Region and Sex March, 1995 Region I - Mont- Region II- Region III - Antigen serrado County M F T Total Children 398 416 814 BCG% 89 88 89 DPT% 63 63 63 OPV% 59 63 61 Measles% 61 64 62 Overall% 53 54 53 • Region II - Harbel includes Harbel, Dolo Town and Smell-No- Taste . . Region III - Bassa refers to Buchanan City and its environs only. 16 Harbel" Bas sa •• M F T M F T 455 455 910 511 517 1028 92 89 90 80 81 80 56 47 51 16 18 17 56 50 52 18 18 18 61 58 59 36 40 39 47 42 44 13 15 14 Weighted Average M F T 1364 1388 2752 88 87 ~8 57 56 57 54 57 55 58 61 59 48 48 48 ·~ 2.2 Diarrhea Diarrhea is the second . most common cause of morbidity after malaria. Though the case fatality rate for diarrhea is not as high as other diseases, in terms of absolute numbers, diarrhea is the number one cause of mortality among children. ~,~'J. ~ .,~~ During the MI CS training workshop, the interviewers were instructed to go through each question of the diarrhea questionnaire with mothers or caretakers of children less than sixty months old who have had diarrhea in the last two weeks and circle the number corresponding to the mother's or caretaker's response. The diarrhea questionnaire was basically designed to determine what type of home treatment the child had when he/she had diarrhea. The two definitions of ORT treatment were considered in the analysis. The "Old Definition" or the "Pre-1993 Definition" treatment is defined as the number of diarrhea cases among children under-five years in the last two weeks who were given ORT packet solution and/or recommended home fluids. At the workshop a list of home fluids which included, among others, SSS, rice water, coconut water, breast milk, soup, water alone, orange juice, etc. was given to the interviewers. The "New Definition" is defined as the number of diarrhea cases among children under-five years in the last two weeks who took "more" recommended fluids and continued eating at some what less, the same, or more amounts. Table 4 presents data for the two basic defmitions for diarrhea home treatment. The first data on the table present the magnitude of application of the Old Definition by mothers or caretakers. The figures show that, on the average, 94 percent of the children who had diarrhea received home treatment according to the Old Definition. This is not surprising as the old definition includes all children with cases of diarrhea who received some kind of acceptable fluid, which most mothers do. The second data represent the application of the New Definition and the data show that the home treatment according to the New Definition is less applied by mothers or caretakers. The table shows that, on the average, only 26 percent of the children who had diarrhea were treated by mothers or caretakers according to the New Definition. For both definitions, ORT usage rates were ofthe same magnitude for all the regions. 17 . • 11, " TABLE 4 Proportion of Children Less than Sixty Months with Diarrhea Case~ Given ORT by Region March/i995 • Region I Region.III . Montser- Region II ij3assa Weighted Type of ORT Given rado Co. Harber ' Average Total Children 215 254 391 860 ' Old Defn.% 94 93 95 94 New Defn% 25 33 26 26 2.3 Timely Complementary Feeding and Breast Feeding 18 Mothers or caretakers of children were asked four major questions in order to determine whether their children were introduced to timely complementary and/or breast feeding. The first two questions of the breast feeding questionnaire were to determine whether the child has ever been breast fed or is still being breast fed. The third question was a prompt type which was designed to determine whether the child had received, since yesterday, any food item such as vitamin, plain water, sweets, fruit juice, tea, ORS, fresh milk or infant formula, other liquids, solid or semi-solid, only breast milk, etc. The interviewers were instructed to prompt the question to the mother or caretaker of the child and circle the code for her response. The fourth question was, since yesterday, has the child been given anything to drink from a bottle with a nipple or teat. The data on Table 5 indicate (1) the proportion of children between ages 6 - 9 months old who received timely complementary feeding, (2) the proportion of children between ages 12 - 15 months old who continued breast feeding and (3) the proportion of children between ages 20 - 23 months old who continued breast feeding. The information on the table show that, on the average, 17 pet:cent of children between ages 6 - 9 months old were introduced to timely complementary feeding, 78 percent of children were breast fed until they are ages 12 - 15 months old, while 25 percent of children were breast fed until they aie between the ages 20 - 23 months. The regional breakdown shows that children in Region I, which includes the capital city, seem to be more likely to be introduced to supplementary feeding, while children in the other two regions are more likely to be breast fed for a longer time. According to the 1986 DHS, the average length of breast feeding was 13 and 18 months for urban and rural residents respectively. The survey also shows that the duration of breast feeding varies with age (women below 30 years breast feed for a shorter duration than those above 30), and with level of education (women with secondary or higher education breast feed for an average of 10 months compared to 17 months for women with primary education and 19 months for those with no education). The present data do not allow such comparison. However, a sentinel survey conducted in Monrovia in 1993 placed the age at complete weaning two and half months above the pre war duration of 13 months. TABLE 5 ~ .~ ~ ' ~ . "Coo Timely Complementary and Continued :dreast, Feedings of Children Aged 6 - 23 Months by Region March, 1995 Region I Montser- Region II Type of Feeding rado Co. Harber Timely Complementary Feeding for Children Between Ages 6-9 18 12 Months Continued Breast Feeding For Children Between Ages 12- 15 77 83 Months Continued Breast Feeding For Children Between Ages 20 - 23 24 40 Months ·Region II - Harbel includes Harbel, Dolo Town and Smell-No- Taste . . Region III - Bassa refers to Buchanan City and its environs only. ~4 Acute Respiratory Infections lARD Region III Bassa •• 12 82 25 Weighted Average 17 78 25 According to clinical records, ARI is the third most important cause of morbidity and mortality among children, with a higher c'ase fatality rate than malaria and diarrhea. Early identification of the symptoms of ARI by mothers or care takers is important in order to seek early treatment. 19 • Mothers or caretakers of children below the age of five years were asked what symptoms would lead them to take their child/children to a health provider (clinic, doctor, community health worker, etc.) when he/she is ill with cough and/or cold. Mothers who responded either fast breathing or difficulty in breE;lthing, irrespective of the other answers, were considered to have some knowledge of the signs of ARI. Mothers or Caretakers who did not · indicate either of the above two symptoms were not considered to have knowledge about the signs of ARI. Hence, Table 6 s~ws the ~roportion of mothers or caretakers of under five children who have some knowredge of ARI. Region I- Montserrado County 45% TABLE 6 Proportion of Mothers/Caretakers of Under Five Children Who Know the Signs of ARI by Region March, 1995 Region II- Region III- Harbel· Bas sa • 49% 46% Weighted Average 45.4% ·Region II - Harbel includes Harbel, Dolo Town and Smell-No- Taste. ··Region Ill - Bassa refers to Buchanan City and its environs only. 2.5 Water and Sanitation 20 Prior to the war, provision of water supply and sanitation was to a large extent biased towards urban areas. Nationally, 30 percent had access to safe supply of water; 45 percent in urban areas and 23 percent in rural areas. Access to safe sanitation facilities had been very low - about 5 percent of the total population. During the war, many people have left their usual residences and congregated in to safe areas in three counties. The results presented here, which are only for Region I, which is Montserado County, may not therefore, reflect the situation in the long run as the configuration of the population may change dramatically in the corning years. The interviewers were directed to ask the questions in the water and sanitation questionnaire once for each household visited. The interviewers were asked to record the number for only one answer. However, if a respondent gives more than one answer, the interviewers were instructed to enter the most usual source of water supply or sanitation facility. The water and sanitation questionnaire was designed to determine the "safe and convenient" categories for water supply and sanitation facility. Household residents are considered to have access to "safe and convenient" source of water supply ifthe following ~. - i''""-:-~ - •-' . :. '. ·~ . _·i ' . categories are fulfilled: (a) piped-in dwelling, (b) public tap, (c) tube well or borehole, (d) protected dug well or protected spring and (e) located not further than one kilometer. Similarly household residents are considered to have access to "safe and convenient" sanitation facility if the following conditions are met: (a) flush to sewage system, (b) flush to septic tank, (c) pour flush latrine, (d) covered by dry latrine, and (e) located in dwelling or less than 50 m away. ~~~- ' The information on Table 7 indicate (1) the proportion'·bf number of household residents with access to "safe and convenient" water supply and (2) the proportion of number of household residents with access to "safe and convenient" sanitation facility. It should be noted that most of the residents in Region II and III are displaced persons living in a camp situation where facilities are used by large number of people and in a non-consistent manner. The questionnaire, however, did not adequately capture the reality in the two regions. TABLE 7 Proportion of the Population with Adequate Access to Water and Sanitation-Region I March, 1995 Facility Region I Montserado County Proportion of Population with Access to Water 79 Proportion of Population with Access to Sanitation Facilities 2.6 53 Nutrition Nutritional status assessments were infrequent prior to the civil conflict. The only nation wide assessment dates back to 1976. At that time chronic malnutrition or "stunting" (as indicated by a height-for-age measure below 90% of the reference median) was identified as the main nutrition problem in under fives. Acute malnutrition or "wasting" (as indicated by a weight-for-height measure below 80% of the reference median) was not identified as a problem in the country. A community based survey in 1985 showed that chronic malnutrition was 27% while acute malnutrition was only 1%. The civil conflict worsened the food and nutrition situation. It created an acute scarcity 21 • l 22 of food due to the disruption of food production, which resulted in widespread hunger and malnutrition with its associated high morbidity and mortality among children. The available data reviewed on acute malnutrition since the war show a significant increase. For example at the peak of the emergency iB 1990, the acute malnutrition rate in Monrovia was as high as 35 percent. Nutritional status in displaced shelters is far from satisfactory. Surveys of acute malnutrition by international NGOs in displaced camps between June 1994 and March 1995 show a range be~een' 5% - 26%. ,, In this MICS the interviewers were instructed to measure the weight and height of each child less than sixty months old after the questionnaires for all cliifdren in the household are complete. The interviewers were directed to take care in recording the measurements for each child. They were instructed to make sure that the measurements for a particular child is not interchanged for another. The interviewers were also taught to measure the heights of children in either the lying down or standing up position. For those children who may be afraid of the interviewers and/or the measuring equipment, the interviewers were instructed to solicit the help of their mothers or caretakers and/or give them some sweets in order to obtain their cooperation. It is also worth to note that children who were very sick or very young (usually below six months) were not included in the measurement exercises. Table 8A presents the prevalence of Weight-for-Height Malnutrition data. The table shows that, on the average, the global acute malnutrition rates for males, females, and total are 10.6, 8.1 and 9.3 percents (Z Score< -2 SD), respectively. The table shows that, on the average, the severe malnutrition rates for males, females and total are 2.9, 3.0 and 2.9 percents (Z Score < -3 SD), respectively. The table also presents the acute malnutrition rates as measured by Weigh-for-Height < 80% of Median for males and females for all regions. From Table 8A, it can clearly be seen that the global and severe malnutrition figures for Region III are relatively high as compared to those of Regions I and II. Malnutrition rates measured by Weight-for-Height below 80% of Median are normally lower than those measured by below -2SD. Table 8B displays the prevalence of Height-for-Age Malnutrition. The information on the table represent the malnutrition rates as measured by Height-for-Age for males, females and total for all regions and the weighted average. From the table it can also clearly be seen that chronic malnutrition figures for Region III are, again, relatively high as compared to those of Regions I and II. The data on the table show that, as usual, malnutrition rates measured by Weight-for-Age below 80% of Median are lower than those measured by below -2SD for all regions. Compared to pre war data, we observe a significant rise in acute malnutrition rate (from an average of 1% to 7% ); it is believed that the acute malnutrition rate in areas which are not covered by this survey could be much higher. The level of chronic malnutrition, on the other hand, is of similar magnitude in both periods - quite understood since chronic malnutrition is not very sensitive to short term changes in nutritional status. Indicator <-2SD <-3SD <80% of Median <70% of Median TABLE SA Prevalence of Weight-For-Height Malnutrition Among Under-Fives by Region and Sex March, 1995 Region I - Mont- Region II - Region III- serrado County Harbel· Bassa·· M F T, M F T M F T 10.5 7.8 9.1 9.8 6.5 8.2 11.8 11.0 11.4 2.6 2.8 2.7 4.0 3.4 3.7 4.1 4.2 4.1 7.2 6.1 6.6 7.5 7.2 7.4 9.4 9.9 9.7 1.9 2.1 2.0 3.6 3.0 3.3 3.5 3.7 3.6 ·- 1·· -_ . " __ ._-·-··~. •" ·: ;J < _:;. ;t:; . Weighted Average M F T 10.6 8.1 9.3 2.9 3.0 2.9 7.5 6.7 7.0 2.2 2.4 2.3 . !Ill· l'· 23 Indicator <-2SD <-3SD <90% of Median <80% of Median 24 TABLE8B Prevalence of Height-For-Age Malnutrition Among Under-Fives by Region and Sex March, 1995 Region I - Mont- Region II - Region III - serrado County Harbel Bas sa M F Tr M F T M F T 31.1 29.4 30.2 35.6 30.0 32.8 46.0 43.8 49.9 19.4 15.1 17.2 15.7 14.1 14.9 27.8 25.4 26.6 24.2 20.7 22.4 22.8 20.5 21.6 36.3 32.2 34.2 6.9 4.0 5.5 2.3 2.1 2.2 8.3 8.3 8.3 ' ' Weighted Average M F T 33.3 31.1 32.8 20.8 16.3 18.1 25.5 22.1 23.8 6.7 4.4 5.6 . ·- •· 2. 7 Primary Education The proportion of school aged children attending schools was low in Liberia even before the war. In fact the economic decline in the 1980s has considerably affected enrollment rate. In 1988, for example, the percentage of school aged children entering first grade was only 34%, much lower than the 1984 rate of 52%. There are no national data on enrollment since the war; however, a comprehensive s~ool surVey in Monrovia in 1994 showed a Gross Enrollment Ratio (GER) of 65% and ii'Net Enrollment Ratio (NER) of 32%. The MICS for Region I shows a higher GER and NER; this may be due to an overestimation of the denominator (which was based on estimated total population figure) in the former survey. Both the 1994 school survey and the MICS, however, indicate that the gap between boys and girls enrollment has narrowed down compared to the pre war level. In 1986, the male/female ratio in primary schools was 60/40. At the same level, the present ratio is 52/48. In the MICS, the education questionnaire was directed to mothers or caretakers of all children ages five and less than fifteen years old in the household. The questions that were posed to the mothers or caretakers of these children were (a) has child ever attended school?, (b) is the child currently at school this year?, (c) which grade and level is the child currently attending?, (d) was the child attending school last year? and (e) which grade and level did child attend last year? The preliminary results for this education questionnaire are found on Table 8 below. Table 9 presents (1) gross enrollment rate which is the proportion of children ages five and less than fifteen years old currently enrolled in primary school, (2) net enrollment rate defined as the proportion of children currently enrolled in primary school of primary- school age and (3) primary school entry rate- proportion of children of school-entry age who are currently attending grade I. Note that the primary school age is defined to be between 5 - 12 years, inclusive, while primary school entry age is defined as between 5 - 7 years, inclusive. The data on Table 9 show that, on the average, there is no significant difference in the indicators for males and females. The table shows that the primary school entry rates for males and females in each of the three regions are less than 50 percent. The net enrollment rates are greater than 55 percent for males and females in Regions I and II; while the net enrollment rates are less than 45 percent for males and females in Region III. 25 - ---- --·- --- - ------ -- TABLE 9 Primary Education Indicators for Children Aged 5 - 14 Years Per Region and Sex March, 1995 Region I - Mont- Region II- Region III- Indicator serrado County Harbel' Bassa . M F T M F T M F T I Gross Enrolhnent 76 67 72 66 66 66 55 43 49 Net Enrollment 61 55 58 59 58 58 44 36 40 Primary School Entry 44 40 42 47 49 48 30 35 33 Rate••• . 'Region II - Harbel includes Harbel, Dolo Town and Smell-No- Taste. · "Region III - Bassa refers to Buchanan City and its environs only. Weighted Average M F T 73 64 69 59 53 56 43 37 41 ••• The primary school entry rate is not higher than the Net Enrollment ratio as may be expected. This may be due to either the inclusion of five year olds, who in the majority do not attend school, or due to the tendency of fewer and fewer children going to school in the past few years. If the later is the cas7;.¢le Net Enrollment Ratio could be reduced in the future. . 26 , .• ~· · · . • ! APPENDICES 3.1 Confidence Intervals for Selected Immunization Indicators SE = Standard Error LCL =Lower Confidence Limit {at 95o/o, ' this =.mean- 2(SE)} UCL = Upper Confidence Limit {at 95%, this = mean + 2(SE)} Deff = Design Effect ., ,-. ' ., ~c. IMMUNIZATION COVERAGE RA"'TES WITH 95 PERCENT CONFIDENCE INTERVAL 1. VALID OVERALL IMMUNIZATION COVERAGE FOR CHILDREN BETWEEN 12- 23 MONTHS REGION I REGION II REGION III WTD AVR. COVERAGE% 57.3 46.6 14.9 50.6 SE% 4.0 3.5 2.7 3.1 LCL% 49.3 39.6 9.5 44.4 UCL% 65.3 53.6 20.3 56.8 Deff 1.007 1.005 1.006 2.0763 2. MEASLES COVERAGE REGION I REGION II REGION III WTD AVR. COVERAGE% 66.7 59.8 31.0 61.6 SE% 3.9 3.4 3.5 3.0 LCL% 58.9 53 .0 24.0 55.6 - UCL% 74.5 66.6 38.0 67.6 Deff 1.007 1.005 1.006 2.01 3. CHILDREN PROTECTED AGAINST NEO-NATAL TETANUS REGION I REGION II REGION III WTD AVR. COVERAGE% 78.3 89.3 63.7 76.8 SE% 2.7 2.0 2.7 2.1 LCL% 72.9 85.3 58.3 72.6 UCL% 83.7 93.3 69.1 81.0 Deff 1.004 1.004 1.003 1.997 27 ·• · · 3.2 List of Selected Clusters 3.2a List of selected Clusters for Region I - Montserrado County Cluster Zone Comm. . ,-,. . -~, ' Number Code Zone Code Community Block ' 101 0100 New Kru Town 0102 Duala Market East A 102 0100 New Kru Town 0105 Mombo Town East A 103 0100 New Kru Town 0108 Fundaye B 104 0100 New Kru Town 0113 Popo Beach B 105 0200 Logan Town 0203 Jamacia Road B 106 0200 Logan Town 0206 Little White Chapel D 107 0200 Logan Town 0210 Central Logan Town c 108 0300 Clara Town 0305 River View B 109 0300 Clara Town 0309 Freeport Dev. E Community • 110 0400 West Point 0401 Power Plant Comm. A 111 0400 West Point 0403 General Market Area B 112 0500 Cen. Monrovia A 0501 Rock Crusher A 113 0500 Cen. Monrovia A 0505 Randall/Lynch St. A 114 0500 Cen. Monrovia A 0508 Central Monrovia B - 115 0600 Cen. Monrovia B 0605 Buzzi Quarters A 116 0600 Cen. Monrovia B 0607 Bishop Brooks B .<, 117 0600 Cen. Monrovia B 0612 Jallah Town B 118 0700 Sinkor 0703 Cooper's Clinic B 119 0700 Sink or 0707 Pyne People Comm. c 120 0800 Lakpazee 0806 Central Lakpazee B . 121 0900 Old Road 0903 Carbral Estate c 28 l , , Cluster Zone Comm. Number Code Zone Code Community Block 122 0900 Old Road 0'911 . · Key & Death Holes A 123 1100 Paynesville A 1101 Duport Road South E 124 1100 Paynesville A 1107 To~ Hall Area H 125 1200 Caldwell 1201 North Road Comm. c 126 1200 Caldwell 1206 New Georgia Town M 127 1200 Caldwell 1211 Upper Cald. NIE H 128 1300 Hrewerville 1304 Hrewerville K 129 1300 Brewerville 1308 Rick Community H 130 1300 Brewerville 1312 Helaparkor Comm. E 131 1400 Paynesville H 1402 Neezoe c 132 1400 Paynesville H 1406 Red Light Comm. c 133 1400 Paynesville H 1410 Duport Road North H 134 1500 Gardnersville 1502 Kesselle Comm. A 135 1500 Gardnersville 1507 S. Tolbert Estate A 136 1500 Gardnersville 1513 Town Hall Comm. A 137 1600 New Georgia 1602 Hamersville Oldfield F 138 1600 New Georgia 1607 Iron Factory F 139 1800 Careysburg 1809 Kponei' s Town H 140 2200 Benson ville/ 2201 Central Hensonville A Mount Coffee 29 3.2b List of selected Clusters for Region II - Harbel Cluster Number Community , Block 201 Dolo Town E 202 Harbel ·t.~ . . T ., 203 Harbel ' B 204 Harbel F 205 Harbel c 206 Harbel M 207 Harbel s 208 Harbel u 209 Harbel p 210 Harbel H 211 Harbel 0 212 Harbel G 213 Harbel L 214 Harbel K 215 Harbel N 216 Harbel Q 217 Harbel J - 218 Harbel I ' 219 Harbel R ~- 220 Harbel R 221 Harbe1 D 222 Harbel X 223 Smell-No-Taste D . 224 Smell-No-Taste G 30 Cluster Number Community Block 225 Smell-No-Taste G 226 Smell-No-Taste • A 227 Smell-NO-Taste A - 228 Smell-No-Taste ; A 229 Smell-No-Taste E 230 Smell-No-Taste E 231 Smell-No-Taste F 232 Smell-No-Taste F 233 Smell-No-Taste F 234 Smell-No-Taste B 235 Smell-No-Taste B 236 Smell-No-Taste B 237 Smell-No-Taste B 238 Smell-No-Taste c 239 Smell-No-Taste c 240 Smell-NO-Taste c 31 ' ' I 3.2c List of selected Clusters for Regio~ III - Bassa .Cluster Community . Number Code Community Block 301 3001 Lower Buchanan \ I t•\ . :~ 302 3001 Lower Buchanan . . 0 303 3001 Lower Buchanan L 304 3001 Lower Buchanan E 305 3001 Lower Buchanan M 306 3001 Lower Buchanan D 307 3001 Lower Buchanan J 308 3001 Lower Buchanan p 309 3001 Lower Buchanan K 310 3001 Lower Buchanan G 311 3001 Lower Buchanan c 312 3001 Lower Buchanan B 313 3001 Lower Buchanan B 314 3001 Lower Buchanan Q 315 3001 Lower BucHanan F 316 3001 Lower Buchanan H 317 3001 - Lower Buchanan H 318 3001 Lower Buchanan H ~ 319 3002 Central Buchanan A 320 3002 Central Buchanan B 321 3002 Central Buchanan B 322 3002 Central Buchanan c 323 3002 Central Buchanan D 32 Cluster C.ommunity . . . -- Number Code Community 324 3002 Central Buchanan . 325 3002 Central Buchanan 326 3003 Upper Buchanan ~\ 327 3003 Upper Buchanan 328 3101 Gorr Zohon 329 3101 Gorr Zohon 330 3101 Gorr Zohon 331 3302 Bexley 332 3201 Neekrein 333 3404 Dwen's Town 334 3403 Sonwein 335 3307 . Peter Harris Town 336 3307 Peter Harris Town 337 3310 Goingbo· 338 3102 Before Flour Mill 339 3102 Before Flour Mill 340 3102 Before Flour Mill ·This community was not ~cessible at the time of the survey. Block E F ' . A ' c E G H E B A A E F c A F G I. 11 33 i i • 3.3 Sample MICS Questionnaire and Interviewer Instructional Manual 3.3a Sample MICS Questionnaire . ' CLUSTER NO. STRUCTURE NO. HQJISEHOLD NO. MINISTRY OFPLANNING AND ECONOMIC AFFAIRS & UNICEF MULTI INDICATOR CLUSTER SURVEY MARCH 1995 HOUSEHOLD QUESTIONNAIRE INTERVIEWER: Begin by introducing yourself, WE ARE FROM THE MINISTRY OF PLANNING & ECONOMIC AFFAIRS AND UNICEF AND WOULD LIKE SOME INFORMATION THAT WILL HELP US IMPROVE THE HEALTH AND WELL-BEING OF CHJLDREN. THE QUESTIONS WILL TAKE ONLY A FEW MINUTES. Household Information Panel County: Cluster number: Date of interview City/town/village: Structure number: (day/month/year): Household number: I I -- -- -- Interviewer no.: Name of head of household: Call-back necessary? Supervisor no.: Yes I No Time: -- A.M./P.M. No. persons in HH Material of dwelling floor: 1 wood/tile Number of rooms in usually resident: 2 planks/concrete 3 dirt/straw 4 other dwelling: Data entry clerk no.: All forms completed? 1 Yes 0 No Region 1 2 3 4 If not, why not? 1 Refusal 2 Not at home Urban 1 Rural 2 3 HH not found/destroyed 4 other 34 • INTERVIEWER: CAN YOU TELL ME THE NAMES AND AGES OF ALL WOMEN OVERAGE 15 WHO USUALLY RESIDES HERE? Fill in the following information about each woman in the household, listing the first woman's name in line 10. First ask for names, and then go back and ask f~; each woman in turn, naming her: HOW OLD ARE YOU? HAVE YOU EVER HAD A CHILD? If she answers yes, ask about own-born children living with her, own-born children living elsewhere and own-born children who are now . dead. (For this part of the questionnaire, you need to make it clear that you are not interested i1.\. the children of other women (i.e., children adopted or fostered into the household). If the woman is not p::esent, ask the head of household or other women to supply the information for her. If you cannot obtain the answer to a question, do not leave a blank space: put a 99 in the space provided for the answer. Mother Listing Form Line 1. 2. Children ever-born to mother: no. Mother's Age in name years Living at living home elsewhere Died Total Male Female Male Female Male Female children 10 20 30 40 50 60 70 35 . Fill in the Preinancy History Form below for every mother listed in the Mother Listing Form on page 1. If the woman is not at home, you may ask for the information about her from another woman living in the household-for example, her mother, adult daughter, co-wife, etc . . . Structure no.__ Cluster no. Household' no. INTERVIEWER: For each woman with at least one birth (alive or de'fld) listed on the previous table, ask ,, each woman in turn about her last three pregnancies: FIRST, I WOULD LIKE TO RECORD SOME INFORMATION ABOUT YOUR MOST RECENT PREGNANCIES. WAS THE OUTCOME OF YOUR LAST PREGNANCY A LIVE BIRTH, A STILLBIRTH OR A MISCARRIAGE? Make sure the woman understands that a live birth is any child who breathed or cried after birth, even if he/she lived only a short time. Fill in the table below, once for each woman, going back as far as three pregnancies. If the woman has never given birth don't use the pregnancy history form. Pregnancy History Form Woman's Pre gnan Child's For live births only: Age at line no.: -- cy name death outcome• (months) Name: -- Child's sex: Date of birth: Still 1 =Male (dd I mm I yy) alive? 2=Female 1=Y O=N 1. Last 1 2 1 0 2. Next-last 1 2 1 0 3. Second- 1 2 1 0 last 4 1 = LIVE BIRTH, 2 = STILlBIRTH, 3 = MISCARRIAGE/ABORTION. 36 i • I , . . , . ! •. STRUCTURE NO._ CLUSTER NO. HOUSEHOLD NO. INTERVIEWER: NOW FILL IN THE CHILD LISTING FORM BELOW ABOUT ONLY THE CHILDREN UNDERAGE 15 FOR WHOM THIS WOMAN IS THE PRIMARY CARETAKER (THAT IS, HER LIVING CHILDREN AND ANY OTHER CHILDREN IN THE HOUSEHOLD THAT SHE CARES FOR, EVEN IF THlY ARE NOT THE BIOLOGICAL CHILDREN OF ANY WOMAN IN THE HOUSEHOLD-I.E., FOSTERED CHILDREN, STEPCHILDREN, YOUNGER SIBLINGS OF THE WOMAN}. STOP LISTING WHEN YOU REACH A CHILD OVERAGE 15. THEN ASK: ARE THERE ANY OTHER CHILDREN YOU CARE FOR WHO LIVE HERE, EVEN IF THEY ARE NOT AT HOME NOW'!;1:_HESE ru Y INCLUDE CHILDREN IN SCHOOL OR AT WORK. IF YES, L/ST THESE CHILDREN. ADD CONTINUATION SHEET IF NOT ENOUGH ROOM ON THIS PAGE. IF CONTINUATION SHEET USED, TICK HERE. 0 CHILD LlsllNG fORM WOMAN'S NAME· . LJNE NO· . CHILD 1. CHILO'S NAME: 2. CHILD'S 3. DAY, MONTH, YEAR OF BIRTH? 4. AGE 5. AGE 5 OR LINE sex: (D DIM M I y VI IN YEARS OVER? NO. 1 =MALE Y=1,N=O 2=FEMALE 1 2 i I I 1 0 1 2 I I I 1 0 1 2 I I I 1 · o 1 2 1 0 1 2 1 0 1 2 1 0 1 2 1 0 CONTINUE TO COMPLETE THE CHILD LISTING FORM FOR EVERY WOMAN IN THE HOUSEHOLD WHO IS A PRIMARY CARETAKER, USING ONE TABLE FOR EACH WOMAN. COPY LINE NUMBERSFORALL CH/LDRENOVERAGE 5 TO THE EDUCATION QUESTIONNAIRE. COPY LINE NUMBERS FOR ALL UNDER-FIVESTO THE SEPARATE QUESTIONNAIRES FOR CHILDREN UNDER FIVE YEARS OF AGE, ONE FOR EACH UNDER-FIVE. 37 '· WATER AND SANITATION QUESTIONNAIRE STRUCTURE NO. CLUSTER NO._ HOUSEHOLD NO._ ASK THE QUESTIONS IN THIS QUESTIONNAIREONCE FOR EA.CH HOUSEHOLD VISITED.RECORDTHENUMBERFOR ONLYONEANSWERIN THE SPACEAT RIGHT. IF A RESPONDENTGIVESMORE THAN ONEANSWER,ENTER THE MOST USUAL SOURCEIFACILJTY: 1. WHATIS THE SOURCE OF DRINKING WATER FOR MEMBERS OF YOU~ HOUSEhOLD? PIPED-IN DWELLING 1 UNPROTECTED DUG ~ELL PUBLIC TAP 2 OR SPRING, TUBE WELL OR BOREHOLE 3 RAINWATER PROTECTED DUG WELL OR PROTECTED SPRING 4 POND, RIVER OR STREAM TANKER-TRUCK, VENDOR OTHER 2. HOW FAR IS THIS SOURCE FROM YOUR DWELLING? ON PREMISES LESS THAN 100 METRES 100M-LESS THAN 500M 1 2 3 500M-1KM MORE THAN 1 KM DON'T KNOW 3. HOW LONG DOES IT TAKE TO GET THERE, GET WATER AND COME BACK? 5 6 7 9 4 5 9 No. OF MINUTES 0 . . WATER ON PREMISES 888 DON'T KNOW 999 4. WHAT KIND OF TOILETFACILITYDOES YOUR HOUSEHOLD USE? FLUSH TO SEW AGE SYSTEM FLUSH TO SEPTIC TANK POUR FLUSH LATRINE 1 2 3 COVERED BY DRY LATRINE 4 UNCOVERED LATRINE 5 No FACILITIES o GO TO NEXT 9 QUESTIONNAIRE 5. HOW FAR IS THE FACILiTY FROM YOUR DWELLING? IN DWELLING LESS THAN 50M AWAY 38 1 2 50M ORMOREAWAY DON'T KNOW 3 9 . ' EDUCATION QUESTIONNAIRE STRUCTURE NO. CLUSTER NO. HOUSEHOLD NO. THE QUESTIONS IN THIS QUESTIONNAIRESHOULD BE ASKED FOR ALL CHILDREN IN THE HOUSEHOLD AGE 5 YEARS AND OVER (OR OVER SCHOOL-ENTRY AGE). "' LINE NO.: -- LINE NO.: - LINE NO.: - LINE NO.: -QUESTIONS NAME: NAME: ~ . NAME: " NAME: . 1 . HAS (NAME) EVER ATTENDED SCHOOL? YES 1 1 1 1 1 No 0 <> GO ON TO NEXT CHILD 0 0 0 0 OK 9 <> GO ON TO NEXT CHILO 9 9 9 9 2. IS HE/SHE CURRENTLY AT SCHOOL THIS YEAR? Yes 1 1 1 1 1 No 0 <> GO TO QUESTION 4 0 0 0 0 OK 9 <> GO TO QUESTION 4 9 9 9 9 3. WHICH GRADE AND LEVEL IS GRADE --HE/SHE CURRENTLY ATTENDING? 1------------- ------------ ------------ ------------LEVEL: PRIMARY 1 LEVEL SECONDARY 2 -- 4. WAS [NAME} ATTENDING SCHOOL LAST YEAR? YES 1 1 1 1 1 No 0 <> GO ON TO NEXT CHILD 0 0 0 0 OK 9 <> GO ON TO NEXT CHILD 9 9 9 9 5. WHICH GRADE AND LEVEL GRADE -- DID [NAME) ATTEND LAST - YEAR? 1-------------1-------------1-------------f-------------LEVEL: PRIMARY 1 LEVEL SECONDARY 2 -- -< 39 \ 'I QUESTIONNAIRES FOR MOTHERS THE FOLLOWINGQUESTIONSARE DIRECTED TO ALL MOTHERSOF UNDER-FIVESIN THE HOUSEHOLD. FILL IN THE MOTHERS' IDENTIFYING NUMBERS AND NAMES IN THE SPACES PROVIDED • . . TETANUS TOXOID (TT) QUESTIONNAIRE STRUCTURENO. CLUSTERNO. HOUSEHOLD NO. MOTHER LINE NO.: MO:ttfER LINE NO.: MOTHER LINE ., NO.: QUESTIONS NAME: NAME: NAME: 1. DO YOU HAVE A CARD OR OTHER DOCUMENT WITH YOUR OWN IMMUNIZATIONS LlSTEO? YES (SEEN) 1 YES (NOT SEEN) 2 No 0 DON'T KNOW 9 2. WHEN YOU WERE PREGNANT WITH YOUR LAST CHILD, DID YOU RECEIVE ANY INJECTION (E.G., TO PREVENT HIM/HER FROM GETTING CONVULSIONS AFTER BIRTH, AN ANTI-TETANUS SHOT, AN INJECTION AT THE TOP OF THE SHOULDER)? YES 1 No 0 OK 9 3. IF YES, HOW MANY DOSES OF TT DID YOU RECEIVE DURING YOUR LAST PREGNANCY? NO. OF DOSES: IF THE MOTHER REPORTS TWO TT INJECTIONS DURING THE LAST PREGNANCY, STOP HERE. IF SHE HAS RECEIVED FEWER THAN TWO TT INJECTIONS DURING HER PREGNANCY, CONTINUE TO QUESTION. USE THE FOLLOWING QUESTIONS: 4. DID YOU RECEIVE ANY TT INJECTION (AT THE TOP OF THE SHOULDER) AT ANY TIME BEFORE YOUR LAST PREGNANCY, EITHER DURING A PREVIOUS PREGNANCY OR BETWEEN PREGNANCIES?- Yes 1 No 0 OK 9 5. IF YES, HOW MANY DOSES DID YOU "'· RECEIVE? NUMBER OF DOSES: 6. WHEN WAS THE LAST DOSE RECEIVED? MM/YY: MM/YY: MM/YY: (RECORD MONTH AND YEAR OR OR OR OR NUMBER OF YEARS AGO.) YEARS AGO: YEARS AGO: YEARS AGO: ADO UP RESPONSES TO 0.3 AND 0.5 AND ENTER IN BOX(ES) BELOW: 7. TOTAL DOSES IN LIFETIME: 40 i ~ ~ . CARE OF ACUTE RESPIRATORY ILLNESS QUESTIONNAIRE STRUCTURE NO: CLUSTER NO. HOUSEHOLD NO. . LINE NO.: LINE NO.: LINE - - NO.: - QUESTIONS NAME: NAME: NAME: ~, ;. . -, -- -- 1. COUGH AND COLD ARE COMMON ILLNESSES. WHEN YOUR CHILD IS ' Ill WITH A COUGH AND/OR COLD, WHAT SIGNS OR SYMPTOMS WOULD LEAD YOU TO TAKE HIM/HER TO A [UST APPROPRIATE HEALTH PROVIDERS- E. G. , CLINIC, COMMUNITY HEALTH WORKER, DOCTOR] OR OTHER HEALTH PROVIDER? DO NOT PROMPT. CIRCLE THE NUMBER FOR EACH ANSWER MENnONED. MORE THAN ONE ANSWER CAN BE CIRCLED. WHEN HE/SHE: 1A. HAS A BLOCKED NOSE 1 . 1A 1 1 1 18. HAS TROUBLE SLEEPING/EATING 2 . . . 18 2 2 2 1C. HAS A FEVER 3 . 1C 3 3 3 10. IS BREATHING FAST 4 10 4 4 4 . 1E. HAS DIFFICUL TV BREATHING 5 . 1E 5 5 5 1F. IS Ill FOR A LONG TIME 6 . 1F 6 6 6 1G. OTHER 7 . 1G 7 7 7 1H. DON'T KNOW 9 . . 1H 9 9 9 • i i ' ' ,- - · . ·. 41 I \ . ' . QUESTIONNAIRES FOR CHILDREN UNDER FIVE YEARS OF AGE THE FOLLOWING QUESTIONNAIRES ARE DIRECTED TO THE MOTHERS OR CARETAKERS OF ALL CHILDREN UNDER AGE 5 IN THE HOUSEHOLD. A SEPARATE FORM SHOULD BE FILLED IN FOR EACH CHILD UNDER5 YEARS LISTED IN THE CHILD LISTING FORM. FILL IN THE NAME AND LINE NUMBER OF EACH CHILD ALONG WITH THE CLUSTER AND HOUSEHOLD NUMBERS INTHESPACEATTHETOPOFEACHQUESTIONNAJRE.GOTHROUGHEACHQ()ESTJONTJ'ITHTHEMOTHER.CIRCLE THE NUMBERCORRESPONDINGTO THE MOTHER'SRESPONSE WHERE INDJ&!TED.MAKE SURE ALL IDENTIFYING INFORMATION IS FILLED IN CORRECTLY, UNTIL ALL CHILDREN UNDERAGE 5 H~ VE BEEN COVERED. DIARRHOEA QUESTIONNAIRESTRUCfURENO.: CLUSTER NO. HOUSEHOLD NO. CHILD NO. CHILD NAME ----- QUESTIONS RESPONSE 1. HAS [NAME} HAO DIARRHOEA IN THE LAST 2 WEEKS? (DIARRHOEA IS DETERMINED AS . PERCEIVED BY MOTHER, OR AS THREE OR MORE LOOSE OR WATERY STOOLS/DAY OR BLOOD IN STOOL.) YES 1 No 0 o GO TO NEXT QUESTIONNAIRE OK 9 o GO TO NEXT QUESTIONNAIRE 2. DURING THIS LAST EPISODE OF DIARRHOEA, DID [NAME] DRINK ANY OF THE FOLLOWING? (PROMPT AND CIRCLE CODE FOR ALL ITEMS MENTIONED.) 1 =YES 2=NO 9=DK Y NDK 2A. BREAST MILK? 2A. 1 0 9 . 28. CEREAL-BASED GRUEL OR GRUEL MADE FROM ROOTS OR SOUP? •••••••••••••• 28. 1 0 9 2C. ACCEPTABLE HOME FLUIDS (E.G., SSS, RICE WATER, COCONUT WATER)? •.••••• 2C. 1 0 9 20. ORS PACKET SOLUTION? •••••••••••••••••••••••••••••••••••••••• 20. 1 0 9 2E. OTHER MILK OR INFANT FORMULA? 2E. 1 0 9 . 2F. WATER WITH FEEDING DURING SOME PART OF THE DAY? •••••••.••••••••••• 2F. 1 0 9 2G. WATER ALONE? 2G 1 0 9 . . . 2H. DEFINED "UNACCEPTABLE" FLUIDS (HOT SOUP) 2H. 1 0 9 . 21. 1 0 9 21. NOTHING o GO TO QUESTION 4 . . . 3. DURING [NAME]'S DIARRHOEA, DID HE/SHE DRINK MUCH LESS, ABOUT THE SAME, OR MORE THAN USUAL? MUCH LESS OR NONE 1 ABOUT THE SAME (OR SOMEWHAT LESS) 2 MORE 3 -DoN'T KNOW 9 4. DURING [NAME}'S DIARRHOEA, DID HE/SHE EAT LESS, ABOUT THE SAME, OR MORE FOOD THAN USUAL? (IF LESS, PROBE: MUCH LESS OR A LITTLE LESS THAN USUAL?) -<. NONE 1 MUCH LESS 2 SOMEWHAT LESS 3 ABOUT THE SAME 4 MORE 5 DON'T KNOW 9 42 BREASTFEEDING QUEsriONNAIRE: STRUCTURE NO.:_ CLUSTER NO._ HOUSEHOLD NO. _ CHILD NO. CHILD NAME------- 1. HAS [NAME] EVER BEEN BREASTFED? YES 1 NO 0 o GO TO QUESTION 4 OK 9 o GO TO QUESTION 4 2. IS HE/SHE STILL BEING BREASTFED? YES 1 NO 0 o GO TO QUESTION 4 OK 9 o GO TO QUESTION 4 3. SINCE THIS TIME YESTERDAY, DID HE/SHE RECEIVE ANY OF THE FOLLOWING? PROMPT AND CIRCLE CODE FOR ALL ITEMS MENTIONED. 1 =YES 2 =No 9 =OK 3A. VITAMIN, MINERAL SUPPLEMENTS OR MEDICINE ••••••.••••••••••••••••••• 38. PLAIN WATER ••••••••••••••••••••••••••••••••••••••••••••••••• 3C. SWEETENED, FLAVOURED WATER OR FRUIT JUICE OR TEA OR INFUSION •••••••••• 30. ORAL REHYDRATION SOLUTION (ORS) •••••••••••••••••••••••••••••••• 3E. TINNED, POWDERED OR FRESH MILK OR INFANT FORMULA ••••••••••••••••••• 3F. OTHER LIQUIDS (BOILED HERBS) ••••••••••••••••••••••••••••••••••••• 3G. SOLID OR SEMI-SOLID (MUSHY) FOOD ••••••••••••••••••••••••••••••••• 3H. RECEIVED ONLY BREAST MILK ••••••••••••••••••••••••••••••••••••• 4. SINCE THIS TIME YESTERDAY, HAS [NAME} BEEN GIVEN ANYTHING TO DRINK FROM A BOTTLE WITH A NIPPLE OR TEAT? YES 1 No o OK 9 YNDK 3A. 109 38. 1 0 9 3C. 1 0 9 30. 1 0 9 3E. 1 0 9 3F. 1 0 9 3G. 1 0 9 3H. 1 0 9 43 •• • , • f ~~ IMMUNIZATION QUESTIONNAIRE STRUCTURE NO. CLUSTER NO. HOUSEHOL:P NO._ CHILD NAME ----- CHILD NO. . ' -· IF AN IMMUNIZATIONCARD IS AVAILABLE, COPY THE DATES FOR EACH TYPE OF IMMUNIZATION BELOW. IF NO DATE FOR VACCINATIONIS RECORDEDON THE CARD, OR IF NO CARD IS AVAILABLE, USE PROBING QUESTIONS TO FIND OUT IF THE CHILD RECEIVED THAT VACCINATION,AND IF SO, HOW MANY DOSES. RECORD THE MOTHER'S RESPONSE FOR EACH VACCINE DOSE IN THE SPACE PROVIDED. ' QUESTiONS 1. IS THERE A VACCINATION RECORD CARD FOR (NAME)? Yes 1 No 0 OK 9 2. BCG Yes 1 NoO DK9 3A. DPT1 YES 1 NoO DK9 38. DPT2 YES 1 NoO DK9 3C. DPT3 Yes 1 NoO DK9 4A. OPV1 YES 1 NoO DK9 48. OPV2 YES 1 NoO DK9 4C. OPV3 YES 1 NoO DK9 5. MEASLES YES 1 NoO DK9 6. BCG SCAR? (CHECK FOR SCAR, AND SEE OPnONAL PLACEMENT IN THE ANTHROPOMETRY OUESnONNAIRE.) Yes 1 NoO NOT EXAMINED 9 2. HAS [NAME] EVER BEEN GIVEN A BCG VACCINATION AGAINST TUBERCULOSIS-THAT IS, AN INJECTION IN THE RIGHT SHOULDER THAT CAUSED A SCAR? 3. HAS (NAME] EVER BEEN GIVEN .,VACCINATION INJECTIONS" -THAT IS, AN INJECTION IN THE THIGH OR BUTTOCKS-TO PREVENT HIM/HER FROM GETTING TETANUS, WHOOPING COUGH, DIPHTHERIA? HOW MANY TIMES? 4. HAS (NAME] EVER BEEN GIVEN ANY "VACCINATION DROPS" TO PROTECT HIM/HER FROM GETTING DISEASES-THAT IS, POliO? HOW MANY TIMES HAS HE/SHE BEEN GIVEN THESE DROPS? 5. HAS [NAME) EVER BEEN GIVEN . VACCINATION INJECTIONS" -THAT IS, A SHOT IN THE ARM, AT THE OF 9 MONTHS OR OLDER)-TO PREVENT HIM/HER FROM GETTING MEASLES? 44 Y=1 N=O DK=9 DATE OF IMMUNIZATION (DAY) (MONTH) (YEAR) ANTHROPOMETRY QUESTIONNAIRE STRUCTURE NO:_ CLUSTER NO._ HOUSEHOLD NO. INTERVIEWER: AFTER QUESTIONNAIRES FOR ALL CHILDREN ARE• COMPLETE, THE MEASURER WEIGHS (AND . OPTIONALLY MEASURES) EACH CHILD. RECORD WEJGHT(AND HEIGHT, IF MEASURED) BELOW, TAKING CARE TO RECORD THE MEASUREMENTON THE CORRECTQUESTIONNAIREFOR THAT CHILD (CHECK CHILD'S NAME) • . . . ,, MEASUREMENTS CHILD NAME CHILD No. RESULT OPTIONAL PLACEMENT: (SEE IMMUNIZATION QUESTIONNAIRE QUESTION 6) 1. BCG SCAR? (CHECK FOR SCAR.) Yes 1 No 0 NOT EXAMINED 9 2. WEIGHT (KG) •••••••••••••••.•••••.••••••••.••.••••••••••••••••••• 00.0 3. HEIGHT/LENGTH (CM) . DDD.D -------------------------------------------------------------------- --------- 3A. MEASUREMENT MADE: LYING DOWN 1 STANDING 2 4. RESULT: MEASURED 1 NOT PRESENT 2 REFUSED 3 OTHER 9 MEASUREMENTS CHILD NAME CHILD No. RESULT OPTIONAL PLACEMENT: (SEE IMMUNIZATION QUESTIONNAIRE QUESTION 6) 1. BCG SCAR? (CHECK FOR SCAR.) YES 1 No 0 NOT EXAMINED 9 2. WEIGHT (KG) •••••••••••••••.••••••••••••••••••••••••••••••••••••• DD.D 3. HEIGHT/LENGTH (CM) •••••••.•••••••.••.••••.••••.•.•••••••••.••• 000.0 -------------------------------------------------------------------~ t--------- 3A. MEASUREMENT MADE: LYING DOWN 1 STANDING 2 4. RESULT: MEASURED 1 NOT PRESENT 2 REFUSED 3 OTHER 9 MEASUREMENTS CHILD NAME CHILD No. RESULT OPTIONAL PLACEMENT: (SEE IMMUNIZATION QUESTIONNAIRE QUESTION 6) 1. BCG SCAR? (CHECK FOR SCAR.) YES 1 No 0 - NOT EXAMINED 9 2. WEIGHT (KG) •••••••••••••.••••••••••••••••••••••••.••• • ••.••••••• DD.D 3. HEIGHT/LENGTH (CM) ••••••••••••••••••••••••.•••••••••. • ••.••••••• DDD.O -------------------------------------------------------------------- -------- 3A. MEASUREMENT MADE: LYING DOWN 1 STANDING 2 4. RESULT: MEASURED 1 NOT PRESENT 2 REFUSED 3 OTHER 9 THANK THE MOTHER FOR HER COOPERATION 45 , , l . • ' 3.4 LIST OF SURVEY PERSONNEL* No. NAME 1 T. EDWARD LIBERTY 2 CHARLES NAGBE 3 WILLIAM CURRAN 4 FRANCIS GOMOY AN 5 JULIUS HARMON 6 FAITH LAWRENCE 7 JAMES SAWO 8 CLEARANCE PAASAWE 9 DANIEL F. KINGSLEY 10 A . K . TARWAY-TWALLA 11 AUGUSTINE FAYIAH 12 ALPHONSO TRYE 13 EMMANUEL SIAFA 14 STEPHEN KOHN 15 ANTHONY SHERMAN 16 RICHARD MASSAQUOI 17 HAWA BARCLAY 18 NICHOLAS NIMENE 19 NPOLEON WESLEY - 20 JOHN DAVIES 21 FRED SWEN -'· 22 CHARLES KANGBA 23 WASHAMA HOFF 24 JERRY AKOI 25 RICHARD A. KPADEH 26 GLANIA FLUMO 27 VIOLA WESLEY 46 !. TITLE ·• COORDINATOR ASST. COORD. & .;. PROGRAMMER ASST. COORD. SUPERVISOR SUPERVISOR SUPERVISOR SUPERVISOR SUPERVISOR SUPERVISOR SUPERVISOR SUPERVISOR INTERVIEWER INTERVIEWER INTERVIEWER INTERVIEWER INTERVIEWER INTERVIEWER INTERVIEWER INTERVIEWER INTERVIEWER INTERVIEWER INTERVIEWER INTERVIEWER INTERVIEWER INTERVIEWER INTERVIEWER INTERVIEWER ORGANIZATION MIN. OF PLANNING MIN. O~HEALTH ' MIN. OF PLANNING MIN. OF PLANNING MIN. OF PLANNING MIN. OF PLANNING MIN. OF PLANNING MIN. OF PLANNING/U.L. MIN. OF PLANNING MIN. OF PLANNING/U.l. MIN. OF PLANNING MIN. OF PLANNING MIN. OF PLANNING/U.L. MIN. OF PLANNING MIN. OF PLANNING MIN . OF HEALTH MIN. OF HEALTH MIN. OF PLANNING MIN. OF PLANNING MIN. OF PLANNING MIN. OF PLANNING MIN. OF PLANNING MIN. OF PLANNING MIN. OF PLANNING MIN. OF PLANNING MIN. OF HEALTH MIN. OF PLANNING \ \ i i i • . -. I • • No. NAME TITLE ORGANIZATION 28 BEN LIBERTY INTERVIEWER MIN. OF PLANNING 29 ROLAND LAWRENCE . INTERVIEWER • MIN. OF PLANNING/U.L. 30 EVA LANSSANAH INTERVIEWER MIN. OF PLANNING 31 LUE SOLLIE INTERVIEWER - f"MIN. OF PLANNING 32 ALICE KROMAH INTERVIEWER MIN. OF HEALTH 33 HENRY Z. KYNE INTERVIEWER MIN. OF PLANNING 34 JESSIE PAYNE INTERVIEWER MIN. OF PLANNING 35 LAHAISASAY INTERVIEWER MIN. OF PLANNING 36 MATTHEW GORVEABOE INTERVIEWER MIN. OF PLANNING 37 STEPHEN T AMBA INTERVIEWER MIN. OF PLANNING 38 JACKSON PENNEH INTERVIEWER MIN. OF HEALTH 39 JAMES Y ANGBIE INTERVIEWER MIN. OF PLANNING 40 HELENA 8ROPLEH INTERVIEWER MIN. OF PLANNING 41 ROXANA SOKO INTERVIEWER MIN. OF PLANNING 42 ELIZABETH KAIFA INTERVIEWER MIN. OF PLANNING 43 MORRISON K . NYALLEY INTERVIEWER MIN. OF PLANNING 44 JOHNNY 80AKAI INTERVIEWER MIN. OF HEALTH 45 GERTRUDE NEUFAILLE INTERVIEWER MIN. OF HEALTH 46 VICTORIA KPAH INTERVIEWER MIN. OF HEALTH 47 JULIETTE NYANFORH INTERVIEWER MIN. OF HEALTH 48 VERONICA BUOY INTERVIEWER MIN. OF HEALTH 49 CECELIAN DAVIES INTERVIEWER MIN. OF HEALTH 50 GBOYAH TUGBEH INTERVIEWER MIN. OF PLANNING 5'1 MOMO KAMARA INTERVIEWER MIN. OF PLANNING 52 VASHTI GOE INTERVIEWER MIN. OF PLANNING 53 BEATRICE DUANA INTERVIEWER MIN. OF HEALTH 54 PETER GWEH INTERVIEWER MIN. OF PLANNING 55 JANJA Y JONES INTERVIEWER MIN. OF HEALTH . 56 MARTIN BELLA INTERVIEWER MIN. OF HEALTH 47 I ,. . ""' No. NAME TITLE ORGANIZATION 57 PETER GREAVES INTERVIEWER MIN. OF HEALTH . ' . 58 THOMAS T ARPLAH INTERVIEWER MIN. OF PLANNING 59 JOYCE SARTEE INTERVIEWER MIN. OF HEALTH -~ • 60 ROSE E. JONES INTERVIEWER •~IN. OF HEALTH 61 THELMA BENSON INTERVIEWER MIN. 'OF HEALTH 62 MORRIS BRYANT INTERVIEWER MIN. OF PLANNING 63 TARNUE K. SAWO INTERVIEWER MIN. OF PLANNING 64 ZAZA FORKPA INTERVIEWER MIN. OF PLANNING 65 WOLOBAH TELLEWOY AN INTERVIEWER MIN. OF PLANNING 66 GEORGE C. HARRIS INTERVIEWER MIN. OF PLANNING 67 JOHN BRYANT INTERVIEWER MIN. OF PLANNING 68 BENJAMIN JONES* INTERVIEWER MIN. OF PLANNING/U.L. 69 JOHN RANDALL INTERVIEWER MIN. OF HEALTH 70 MAMIE SANKOWOLO INTERVIEWER MIN. OF HEALTH 71 THOMAS NAH INTERVIEWER MIN. OF PLANNING 72 SANDO BLIDI DATA RECORDER MIN. OF HEALTH 73 GERTRUDE NEUFVILLE DATA RECORDER MIN. OF HEALTH 74 CLAVINIA VARNEY DATA RECORDER MIN. OF HEALTH 75 AUGUSTINE KPADAH DATA RECORDER MIN. OF HEALTH * OVERALL GUIDANCE AND SUPERVISION WAS PROVIDED BY MR. SELESHI JEMBERE- MONITORING AND EVALUATION OFFICER; UNICEF/LIBERIA. 48

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