MICS4 Survey Design Workshop

Multiple Indicator Cluster SurveysSurvey Design Workshop

Questionnaire for Children Under Five:

Care of Illness

MICS4 Survey Design Workshop

Presentation overview

• Pneumonia

• Diarrhoeal diseases

• Safe disposal of children’s stools

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Leading causes of child deathsPneumonia and diarrhoea are the leading causes of under-five deaths

– causing an estimated 40% of child deaths each year globallySource: WHO Global Burden of Disease estimates (2004)

Note: Globally more than one-third of under-five deaths is attributable to under-nutrition

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Pneumonia

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Background (Pneumonia)

• Refers to cases of suspected pneumonia (previously referred to as acute respiratory illness)

• Suspected pneumonia includes children reported to have an illness with a cough accompanied by fast and/or difficult breathing in the previous 2 weeks

• Simple cases of cold are filtered out with a second question: “Were these (symptoms) due to a problem in the chest or a blocked or runny nose?”

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MICS Indicators (Pneumonia)

Pneumonia (no change from MICS3)

• #3.9 Care seeking for suspected pneumonia % under fives with suspected pneumonia in the previous 2

weeks who were taken to an appropriate health provider

• #3.10 Antibiotics treatment of suspected pneumonia % under fives with suspected pneumonia in the previous 2 weeks who

received antibiotics

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– Prevalence of suspected pneumonia

– Care-seeking for suspected pneumonia

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– Antibiotic use for suspected pneumonia

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Method issues (Pneumonia)

• Seasonality of suspected pneumonia may affect comparisons over time and across countries

• Does not measure timing or dosage of treatment, or type of antibiotic used

• Methodological work underway to assess validity of caregivers’ responses regarding treatment by drug type for major childhood illnesses (CHERG)

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Diarrhoeal diseases

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Background (Diarrhoea)

• Treatment recommendations have changed several times over past few decades

• Current treatment recommendations include fluid replacement (including breastfeeding) with continued feeding and zinc treatment

• ORS packets (specifically low-osmolarity ORS) are most effective for preventing & treating life-threatening dehydration due to diarrhoea

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Background (diarrhoea)

• If ORS packets not available, recommended homemade fluids or increased fluids of any type also help prevent dehydration

• Continued feeding supports fluid absorption and improves nutritional status

• Zinc treatment reduces stool volume, including diarrhoea severity and duration

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MICS Indicators (Diarrhoea)• #3.8: ORT with continued feeding - % under fives with

diarrhoea in the previous 2 weeks receiving ORT (ORS packet or recommended homemade fluid or increased fluids) and continued feeding

• Compound indicator reflects multiple components of treatment recommendations (except zinc treatment since data are largely unavailable at present)

• Previously reported ORT indicators not included (e.g. home management of diarrhoea and ORT use)

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MICS Additional Indicators (Diarrhoea)

Components of treatment recommendation (indicators)

• ORS packets % under fives with diarrhoea receiving an ORS packet (includes pre-packaged ORS fluids or fluids from an ORS packet)

• Recommended homemade fluids % under fives with diarrhoea receiving recommended homemade fluids (customized to national guidelines)

• Increased fluids % under fives with diarrhoea receiving more to drink during the illness

• Continued feeding % under fives with diarrhoea receiving either more, same or somewhat less to eat than usual during the illness

• Zinc treatment % under fives with diarrhoea receiving zinc

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– Prevalence of diarrhoea

– Fluids and foods

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– ORS packet or recommended home fluid

– Treatment for diarrhoea

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Method issues (diarrhoea)

Customization of survey questionnaire• Adapt locally to include common names/brands used for ORS

packets (including pre-packaged ORS fluids and fluids from ORS packets)

• If no pre-packaged ORS fluid available in the country, delete this category

• Adapt locally to include country-specific recommendations for homemade fluids based on national or medical guidelines. Ingredients promoted by government to make these fluids should be included in this category.

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Method issues (diarrhoea)

Other methodological issues• Compound indicator – current treatment indicator reflects multiple

components of recommendation (except zinc). Evaluate components to help interpret overall coverage value.

• Changing recommendations, changing indicators – lack of comparable data to measure progress in diarrhoea treatment

– ORT use (1980s to early 1990s) - % U5s with diarrhoea receiving either an ORS packet or recommended homemade fluid

– Home management of diarrhoea (early 1990s to early 2000s) - % U5s with diarrhoea receiving increased fluids and continued feeding

– ORT with continued feeding (early 2000s to present) - % U5s with diarrhoea receiving ORT (ORS packet, RHF or increased fluids) with continued feeding

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Method issues (diarrhoea)

Other methodological issues (continued)

• Diarrhoea prevalence varies by season and timing of outbreaks, and caregivers understanding of what constitutes a diarrhoea episode. Does not measure duration or severity of diarrhoea, nor extent of dehydration accompanying episode.

• Does not measure number or timing of interventions used during episode, or whether ORS or homemade fluids were correctly prepared

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Method issues (diarrhoea)

Other methodological issues (continued)

• Customization of survey questionnaire often not done. For some countries, national guidelines for home fluids may not be defined or readily available to survey managers.

• Wording changes for ORT questions over time may affect responses (although surveys translated into many languages which also may lead to slight differences in question wording)

• Zinc included as response category, not as separate question – more work needed to see how this affects response

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Method issues (diarrhoea)

Other methodological issues (continued)

• Methodological work underway to assess issues outlined above, including whether accuracy of zinc responses improves if separate question included (CHERG)

• Forthcoming UNICEF and WHO report on diarrhoeal diseases to assess prevention and treatment coverage; set for release in Oct/Nov 2009

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Safe disposal of children’s stools

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Background (Child stools)

• Children’s stools tend to carry a higher pathogen load than adult’s stools

• Many children defecate in or around home, as well as play in areas where stools are found

• Safely disposing children’s stools is critical for reducing the number of diarrhoea cases

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MICS Indicators (Child stools)

• # 4.4: Disposal of child’s faeces - % under threes whose (last) stools were disposed of safely

• Adequate disposal includes used a toilet/latrine, rinsed in a toilet/latrine or buried stools. Adequacy of throwing in garbage depends on solid waste collection.

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