Endline Report (Comparative Study) on - UNICEF –...

Endline Report (Comparative Study) on

Health Education/Orientation

through Interpersonal Communication and Social Mobilization

for Promoting Key Health Behaviors of Earthquake affected districts

Submitted to

UNICEF Nepal Country Office

UN House, Pulchowk, Lalitpur, Nepal

Submitted by

Nepal Public Health Foundation

Kathmandu, Nepal

February, 2016

i

Table of Contents

List of Figures ............................................................................................................................................... ii

List of Abbreviations .................................................................................................................................... iii

CHAPTER I...................................................................................................................................................... 1

INTRODUCTION ............................................................................................................................................. 1

1.1 Background ......................................................................................................................................... 1

1.2 Overview of the Project “Health Education/Orientation through Social Mobilization for promoting

key Health Behaviors” ............................................................................................................................... 1

1.3 Relevance of the Endline Survey ......................................................................................................... 3

1.4 Objectives of the End line survey ........................................................................................................ 4

CHAPTER II .................................................................................................................................................... 5

METHODOLOGY ............................................................................................................................................ 5

CHAPTER III ................................................................................................................................................... 7

AREA OF THE RESEARCH ............................................................................................................................... 7

CHAPTER IV ................................................................................................................................................... 8

FRAMEWORK OF BEHAVIOUR CHANGE ........................................................................................................ 8

CHAPTER V .................................................................................................................................................... 9

RESULTS ........................................................................................................................................................ 9

CHAPTER VI ................................................................................................................................................. 20

CONCLUSION AND RECOMMENDATION .................................................................................................... 20

ANNEX ......................................................................................................................................................... 23

ii

List of Figures

Figure 1: Steps of behavour change ................................................................................................ 8

Figure 2: Age of the respondents .................................................................................................... 9

Figure 3: Ethnicity of the respondents .......................................................................................... 10

Figure 4: Religion of the respondents .......................................................................................... 10

Figure 5: Education level of the respondents ................................................................................ 11

Figure 6: Critical time of hand washing ....................................................................................... 11

Figure 7: Methods of water purification ....................................................................................... 12

Figure 8: Treatment of diarrhoea .................................................................................................. 13

Figure 9: Vaccination during MR campaign ................................................................................ 13

Figure 10: Heard and timing of ANC ........................................................................................... 14

Figure 11: Danger sign during pregnancy .................................................................................... 15

Figure 12: Heard and timing of PNC ............................................................................................ 16

Figure 13: Danger signs in PNC ................................................................................................... 16

Figure 14: Danger signs in new born ............................................................................................ 17

Figure 15: Heard about colostrum feeding and its importance ..................................................... 18

Figure 16: Importance of Exclusive Breast Feeding..................................................................... 19

iii

List of Abbreviations

ANC

BCC

Antenatal Care

Behaviour Change Communication

DDRC

DHO

IEC

District Disaster Relief Committee

District Health Office

Information, Education and Communication

FGD

HP

Focus Group Discussion

Health Post

IPCS

NHEICC

Interpersonal Communication Skill

National Health Education information and communication center

NPHF Nepal Public Health Foundation

PNC Post Natal Care

UNICEF United Nations Children's Fund

VDC Village Development Committee

1

CHAPTER I

INTRODUCTION

1.1 Background

After 80 years of mega earthquake, Nepal was terribly shaken by powerful earthquake of

magnitude 7.8 of 25th April and 7.3 of 12th May, 2015. The official reports states that the 31 out

of 75 districts have been severely affected and approximately 8 million lives which is about one

third of total population, has been estimated to have been affected. Among the affected, 2.8 million

were children according to United Nations Children’s Fund (UNICEF). 14 out of the 31 districts

which were harshly hit were declared the ‘Crisis hit’ district, to prioritize and speed up the rescue

and relief work. The official report states that earthquake claimed life of about 8700 people, around

22000 were injured and around half million houses has been destroyed. The old monuments which

marks the glory of country has turned into rubbles and hundreds of aftershocks terrorized the

people. At the same time, country witnessed a generous help from a large number of national and

international organizations through the recue and relief operation. Likewise, an encouraging

pledge has been made to support in rehabilitation and reconstruction.

Although it is not possible to predict with accuracy which diseases will occur following certain

types of disasters including earthquakes, generally, diseases can be distinguished as either water-

borne, air-borne/droplet or vector-borne, and contamination from wounded injuries. The most

documented and commonly occurring diseases are water-borne diseases, i.e. diarrheal diseases. In

our current context, earthquake affected individuals are staying in overcrowded areas/camps. Thus,

there is a probability of transmission of respiratory diseases like diarrhea, cholera, typhoid,

tuberculosis, measles etc.

1.2 Overview of the Project “Health Education/Orientation through Social

Mobilization for promoting key Health Behaviors”

The evidence shows that apart from the direct effect on the lives during disaster, the communicable

diseases result in the increase in mortality and morbidity. In the aftermath of disaster; the degraded

environment, poor sanitation and hygiene, poor access to nutritious food, non-

2

functioning/disruption of health services such as immunization, endemic existence of organisms,

create the favorable situation for communicable diseases which might sometimes outnumber the

actual casualties during the earthquake. Thus proper communication was a must, to educate the

people about the threats of disease outbreak and prevention methods. Following the earthquake,

NHEICC prepared the post-earthquake communication plan, Nepal, May-October 2015 that shows

the urgency of communicating health risk to affected population in the 14 districts, especially with

the arrival of monsoon. The audience analysis in the plan, depicts the need of interpersonal

communication, community mobilization to reach the primary audience i.e. general population.

Major health promotion systems through FCHVs as well as health facilities were not fully functioning at

that point due to the earthquake. At such situation there was a great need of this program to prevent the

possibilities of outbreak of the various diseases.

The objectives of the project are as follows:

To provide relevant health-related orientation/education for mothers and children both in

shelters and outreach clinics.

To mobilize community networks to access behavior-change communication interventions

to improve health-care and feeding practices for mothers and children.

The strategies of the project are as follows:

IPC session: Provide counselling/information to affected population about key health

messages through social mobilizers along with the service providers

BCC/IEC materials: Distribute BCC/IEC materials (comprehensive BCC/IEC package

produced by UNICEF)

Radio Programme (Bhandai-Sundai): Introduce Bhandai Sundai programme to community

for post disaster response and psycho-social counselling.

UNICEF supply: Delivery UNICEF supplies from DHO to HP in consultation with

UNICEF district focal person

3

1.3 Relevance of the Endline Survey In this current era of development, coordinated effort of Government and Non-government

organizations along with the active involvement of community people helps accomplish any health

related aims. The assessment of needs of the people is a must for this. After the massive earthquake,

NPHF with the support of UNICEF Nepal has launched the IPCS project in highly affected 11

districts.

In order to measure the success of the project, it is imperative to compare the baseline data with

the endline so that changes can be measured over time to assess the change in health related

knowledge and change in health-related behaviors. Keeping this view in mind, a baseline survey

was conducted in June in 330 implementation VDCs/municipalities among the target group of the

health education interventions before they were provided with the health education. The people of

the same communities were asked similar set of questions at the end of the project i.e., December

to measure the changes over time to see if the educational and behavioral interventions had brought

some changes among the people covered. In addition, the people of 110 non-working VDCs of the

eleven project implemented districts were also asked the same sets of questions at the end of the

project in order compare the results between working and non-working VDCs.

Among the most affected segments of the people, the condition of women and children is more

likely to be deteriorated as they are more vulnerable to the diseases and other undesirable health

conditions. This endline survey was conducted in order to compare its results with the results of

the baseline survey, to identify whether the health education activities through social mobilization

conducted by the project had been effective.

4

1.4 Objectives of the End line survey

1.4.1 General Objective

To assess health related knowledge and practices among the women of earthquake affected

districts of Nepal

To compare the data of baseline with endline to identify the effectiveness and impact of

the programme.

To compare the results of working and non-working VDCs to identify the effectiveness

and impact of the programme.

1.4.2 Specific Objectives

To assess the demographic status of the people of the selected VDCs of the earthquake

affected districts.

To identify the knowledge regarding diarrhea.

To assess the knowledge and practice related to hand washing and use of toilet.

To identify the knowledge and practice related to diarrhea, pneumonia and measles.

To assess the knowledge and practice regarding Antenatal Care, Postnatal Care and

newborn care.

To explore the knowledge and practice related to breastfeeding and colostrum feeding.

5

CHAPTER II

METHODOLOGY

2.1 Study Design

This study was done to assess health related knowledge and practices among the women who have

children under five years old in the 11 earthquake affected districts. The result was compared with

the baseline survey done in the same setting before the beginning of the project and the survey

done in 110 non-working VDCs to show the degree of changes.

2.2 Study Setting

The study was conducted in total 330 project implemented VDCs and 110 non-working VDCs of

11 earthquake affected districts of Nepal. The 11 districts were Lalitpur, Bhaktapur, Kavre,

Sindhupalchowk, Dolakha, Ramechhap, Sindhuli, Dhading, Gorkha, Nuwakot and Rasuwa. The

working VDCs were chosen based on the magnitude of damage in coordination with District

Disaster Relief Committee (DDRC) before the start of the project. The non-working VDCs were

selected on the basis of feasibility and closeness to make comparability in the socio-demographic

characteristics with the working VDCs.

2.3 Study Population

Mothers of under-5 year children were the study population of the endline survey and non-working

VDCs survey. Every SM conducted one Group Focus Discussion based on random selection of

one ward of their respective VDC.

2.4 Study Duration

The study duration of the IPCS programme was of six months i.e. June 15 to December 15. During

this time interval, the baseline and endline surveys were done in working VDCs and a survey in

non-working VDCs was done at the end of the project.

.

6

2.5 Sample Size

The total sample size of the endline survey was 2,288 respondents from total of 330 FGDs of

working VDCs and a total of 807 respondents from non-working VDCs. Six to eight mothers of

under 5 years children were chosen for group interview from each working VDCs. A total of 2,380

respondents were interviewed in the baseline survey of the working VDCs.

2.6 Data Collection Tools and Techniques

The endline survey tool had both qualitative and quantitative components.

Data were collected by Focus Group Discussion

2.7 Validity and Reliability

Through guidance and supervision of IPCS team and UNICEF.

Cross check of data for errors and inconsistencies.

2.8 Data Analysis

Collected data was entered in SPSS 16 for statistical analysis.

Data was presented in tables and graphs for descriptive statistics.

Quantitative findings are expressed as rates and proportions and presented in tables, graphs

and charts.

2.9 Limitations of the Study

Although considerable care was taken in designing the questionnaire to avoid ambiguity,

the quality of the responses to a number of questions was highly dependent on the

skills of the surveyors.

Due to the short interval between baseline and endline (6months), research focused on changes

in knowledge rather than behavior itself, as behavior change takes place in longer span of time.

However, this study also tried to capture some behavior changes which can be done within short

time of period.

7

CHAPTER III

AREA OF THE RESEARCH

The main focus of the baseline research conducted by IPCS project in different 11 districts of

Nepal focused on the following areas:

Hand washing and use of toilet

Water Purification

Menstrual Hygiene

Diarrhea

Pneumonia

Measles

Antenatal Care

Post Natal Care

New Born Care

Breast Feeding/Colostrum Feeding

Source of Health Information

Among the above given areas, the important sub-areas were:

Knowledge on critical time of hand washing

Practice on water purification

Knowledge on treatment of diarrhea

Practice on measles vaccination

Knowledge on antenatal care, number of times and danger signs

Knowledge on postnatal care, times and danger signs

Knowledge on institutional delivery

Knowledge on colostrum and breastfeeding

8

CHAPTER IV

FRAMEWORK OF BEHAVIOUR CHANGE

Figure 1: Steps of behavior change

The given figure shows the steps of behavior change. The IPCS programme has directly worked

on steps 1, 2 and 3 i.e. be completely unaware of the service, gain awareness through

communication and consider the service based on knowledge gained from several sources. The

step number 4 is related to behavior change which takes time for the community people and this

can be seen after a long time period which is ultimate aim of our programme.

9

CHAPTER V

RESULTS

5.1 Demographic Information

5.1.1 Age of the respondent

The given graph shows the age of respondents. The age of the respondents below 18 years was

higher in non- working VDCs than in baseline and endline survey of working VDCs. The

respondents of age group 19-30 years were higher in baseline survey and the age group 31-60 was

almost same.

Figure 2: Age of the respondents

5.1.2 Ethnicity of respondent

The graph below shows the ethnicity of the participant. In baseline, endline and non-intervention

study was almost same. More 70% of the respondents were Janajati or Dalit. The other ethnicities

were Chhetri, Brahmin, and Muslim (respectively).

37 8.3

79.273.8 74.5

17.8 19.2 17.2

0

10

20

30

40

50

60

70

80

90

Baseline Endline

Working VDC Non working VDC

Below 19 yrs

19-30

31-60

10

Figure 3: Ethnicity of the respondents

5.1.3 Religion of the respondent

Above table shows the various religions of the respondents who were addressed. More than two-

fourth was Hindu in baseline and endline of working VDCs and non-working VDCs. The other

religions were Buddhist which was more than one-fifth, Christian. Islam and Kirat were in

negligible proportion respectively.

Figure 4: Religion of the respondents

13 13.3 1517.8 17.6 15.8

56.3 56.3 55.3

12.4 12.8 13.8

0

10

20

30

40

50

60

Baseline Endline

Working VDCs Non-woring VDCs

Ethnicity

Brahmin

Chetteri

Janjati

Dalit

Muslims

75.3 75.7 78.1

21.4 21.9 20

2.5 1.8 1.40

10

20

30

40

50

60

70

80

90

Baseline Endline

Working VDC Non working VDC

Religion of the respondent

Hindhu

Buddhist

Christian

11

5.1.4 Education level of the respondents

The figure below reflects educational level of the respondents. It shows that the proportion of

illiterate population was low in endline survey than in baseline and non-working VDCs. Other

level of education was almost same in the working and non-working VDCs.

Figure 5: Education level of the respondents

5.2 Knowledge on critical time of hand washing

Critical time of hand washing includes hand washing before eating, after defecation and urination,

before cooking, before feeding child and after disposing child faeces. Critical time of hand washing

is higher in working VDCs than the non-working VDCs of the programme. There is almost 25 per

cent increase from baseline to endline survey of the working VDCs. The non-working VDCs has

quite low proportion (8.3%).

Figure 6: Critical time of hand washing

14.7

10.9

15.7

28.2 27.2

24

17.7 16.6 15.5

26.2

3027.2

13.3 12.2

17.7

0

5

10

15

20

25

30

35

Baseline Endline

Working VDC Non Working VDC

Illiterate

Literate

Primary

Secondary

Higher Secondary

20.224.6

8.3

05

1015202530

Baseline Endline


Critical Time of Hand Washing

Critical Time of Hand Washing

12

5.3 Practice of water purification

The graph reflects the various methods of water purification that were practiced in community.

The percentage of method of water purification by boiling was significantly increased to 90 % in

endline survey from 52 %. Similarly other methods of water purification were also increased from

the baseline in case of working VDCs. More than half i.e.56 per cent of the respondent used boiling

method for water purification in non-working which was low than the endline survey of the

working VDCs and similar was found in other methods of purification.

Figure 7: Methods of water purification

5.4 Knowledge on treatment of diarrhea

The graph reflects the knowledge regarding the treatment of diarrhea. The knowledge regarding,

Zinc and ORS as a method of treatment of diarrhea was increased to 40% in endline survey from

the baseline of the working VDCs. Similarly the proportion of respondent answering all four of

the methods (i.e. ORS, Zinc, increased fluid and continuous breastfeeding ) as the treatment of

Diarrhea was also increased to one-fourth (.i.e. 25%) from 21.6%. But in case of non-working

VDCs, the knowledge regarding both was found significantly lower than the baseline and endline

survey of the working VDCs.

63%72%

24.9%

52%

90%

55.7%50% 54%

22.6%

0%10%20%30%40%50%60%70%80%90%

100%

Baseline Endline Control


Methods of Water purification

Filtration

Boiling

Chlorination

13

Figure 8: Treatment of diarrhoea

5.5 Vaccination during Measles-Rubella campaign

The graph shows the proportion of respondent who had vaccinated their children during MR

campaign. In intervention group more than four-fifth (83%) of the children were vaccinated

during the measles campaign conducted by Government of Nepal which was slightly higher than

in non-working VDCs i.e. 79.6 % The campaign was conducted after the baseline survey of the

programme. The proportion children who were vaccinated during MR campaign was only 83 per

cent. The coverage was low as in our Group Focus discussion; the mothers with children below 9

months (not eligible children) were also included.

Figure 9: Vaccination during MR campaign

37.8 39.8

31.3

21.625

11

05

1015202530354045

Baseline Endline


Treatment of diarrhoea

ORS+Zinc

ORS+Zinc+Breast feeding+Increased fluid

83 79.6

17 20.4

0

20

40

60

80

100

Intervention


Vaccination during MR Campaign

Yes

No

14

5.6 Antenatal Care

5.6.1 Knowledge on ANC and timing according to protocol

Almost all of the respondents have heard about ANC i.e. 99 % in endline survey which was

increased from 81 % in baseline survey in case of working VDCs and similar was found in case

of non-working VDCs which was about 95 per cent. In case of the knowledge on times of ANC

visit of the respondents, the proportion of respondent answering correctly i.e. (4,6,8 and 9 month)

was increased to 78 per cent from 52 per cent whereas in non-working VDCs there was only

almost half (47%) which was comparatively lower than that of working VDC’s .

Figure 10: Heard about and timing of ANC

5.6.2 Knowledge on danger signs during pregnancy

The figure shows the respondents’ knowledge regarding the danger signs during pregnancy. In

case of working VDCs, the proportion of knowledge has significantly increased from baseline to

end line. Excessive bleeding was the main danger sign responded in both baseline and end line

survey which was increased from 35 per cent to 76.6 per cent. Other danger signs like lower

abdominal pain (21.6% to 69%)), fainting (21.1% to 47%), fever (17.6% to 50%), discharge of

white fluid (14.1% to 52.8%), severe headache (16.5% to 54.5%), blurred vision (1.5% to 37.2%),

prolonged labor (1% to 29.8%) have increased in the end line survey. In case of non-intervention

the proportion of knowledge regarding danger sign was higher than baseline and lower than in

endline of working VDCs. Among the danger signs of pregnancy, excessive bleeding was the main

danger sign in non-working VDCs.

81

99 95

50

77

47

0

20

40

60

80

100

120

Baseline Endine


Antenatal Care

Heard about ANC

Knowledge on timing of ANC asper Protocol

15

Figure 11: Danger sign during pregnancy

5.7 Post Natal Care

5.7.1 Knowledge on PNC and its timing

The figure shows the respondents who had heard about the PNC. The proportion has

significantly increased in the endline from 81 per cent to 88 per cent in case of working VDCs

but in case of non-working VDCs, the percentage was even lower than in the baseline of working

i.e. 46.3%. In case of intervention group, the proportion of respondents giving correct answer

regarding times of PNC visit was increased to 67 per cent in endline. In case of non-intervention

VDCs, the percentage was lower than in baseline i.e. 36.6%.

34.7

76.6

58.4

21.6

69

37.3

15

53

30

16.5

54.5

26

1.5

37.2

17

0

10

20

30

40

50

60

70

80

90

Baseline Endline


Danger signs during Pregnancy

Excessive bleeding

Lower abdominal pain

Swelling of limbs

Severe Headache

Blurred vision

16

Figure 12: Heard about and timing of PNC

5.7.2 Knowledge on danger signs during postnatal period

There was significant increase in knowledge among the respondents in the endline survey

regarding the danger signs of PNC. The proportion increase for excessive bleeding (55.4% to

87.2%), lower abdominal pain (18.6% to 51.4 %), severe headache (11.1% to 58.6%) and blurred

vision (0 to 45%), in case of working VDCs. In case of non-working VDCs, the proportion of

knowledge was relatively higher than the baseline but lower than the endline survey.

Figure 13: Danger signs in PNC

61

88

4643

67

36.6

0

20

40

60

80

100

Baseline Endline


Postnatal Care

Heard about PNC

Knowledge on number of times ofPNC

55.4

87.2

73

18.6

70

47.5

11

58.6

32

8

49

27

2

45

18.7

0

10

20

30

40

50

60

70

80

90

100

Baseline Endline


Danger signs in PNC

Excessive bleeding

Lower abdominal pain

Severe Headache

Swelling of limbs

Blurred vision

17

5.8 Knowledge on danger signs of newborns

The graph shows the knowledge of the respondents about the danger signs of new born. The level

of knowledge has been increased significantly in all indicators in the endline of working VDCs

which includes; hypothermia (i.e. 35.7% to 65.5%), not feeding well (25.6 to 69.5), Asphyxia

(13.2% to 70.6%), cord infection (10.4 % to 49.6%), low birth weight (9.6 %to 46.9%) and rashes

(9.5% to 41.3%). In non-working, the proportion was higher than in baseline in all of the danger

signs except hypothermia which was even lower than baseline i.e. 25%. The knowledge on danger

signs were higher in the endline of the working VDCs than non-working VDCs.

Figure 14: Danger signs in new born

5.9 Breast Feeding

5. 9.1 Knowledge on colostrum feeding

The graph below shows the proportion of respondents who have heard about colostrum feeding

and its importance. In comparison to baseline survey, more of the respondents have heard about

colostrum feeding in the end line survey i.e., 80 per cent to 95 per cent. But in case of non-working

VDCs, the fewer respondent have heard about colostrum i.e. 69 %.

There has been significant increase in knowledge regarding the importance of colostrum feeding

in endline study. The knowledge on responses like “increase in immunity power” has increased

35.7

25.6

13.2 10.4 9.6 9.5 9

65.569.5 70.6

49.6 4741.3 43

25

37.4 35.7

20.427.5

18 15.7

0

10

20

30

40

50

60

70

80

Danger signs in New born

Working VDCs Baseline

Working VDCs Endline

Non-Working VDCs

18

from 51% to 79% in the endline, similarly “helps in physical and mental growth” from 33% to

67% and “high level of nutrient value” 23% to 71%. Where as in non-working VDC’s the

percentage of knowledge on importance of danger sign is slightly higher than baseline study and

less than endline study of working VDCs.

Figure 15: Heard about colostrum feeding and its importance

5.9.2 Knowledge on importance of exclusive breast feeding

The graph below shows the knowledge about importance of exclusive breast feeding. There has

been greater awareness regarding the importance of exclusive breast feeding in end line. The

proportion for “helps in physical and mental growth” has increased from 42% to 72%. Similarly,

for “increases immunity” has increased from 35% to 80%, “high level of nutrient”, from 12% to

69% and for “bonding between mother and child” has increased from 10% to 50%. In non-working

VDCs, the awareness about the importance of breast feeding was higher than the baseline and

lower than the endline survey of the working VDCs.

80

51

33

23

95

79

677169

60

38

46

0

10

20

30

40

50

60

70

80

90

100

Heard aboutcolostrum

Increaseimmunity

power

Helps inphysical and

mental growth

High level ofnutrient

Importance of Colostrum Feeding

Working VDC Baseline

Working VDC Endline

Non Working VDC

19

Figure 16: Importance of Exclusive Breast Feeding

42

35

12 106

72

80

69

50

38

59.4

50

42.5

33

16

0

10

20

30

40

50

60

70

80

90

Increaseimmunity

Helps inphysical and

mental growth

High level ofnutrient

Bondingbetween

mother andchild

Acts as naturalfamily

planningmethod

Importance of Breast Feeding

Working VDCs Baseline

Working VDCs Endline

Non-working VDCs

20

CHAPTER VI

CONCLUSION AND RECOMMENDATION

Women and children are the more vulnerable group during disaster like Earthquake. In particular,

pregnant women affected by the disaster require continuous health services such as antenatal care,

safe delivery services, post-partum care, and, for those who experience complications, emergency

obstetric services. After such disasters, different diseases can be distinguished as either water-

borne, air-borne/droplet or vector-borne, and contamination from wounded injuries. The most

documented and commonly occurring diseases are water-borne diseases, i.e. diarrheal diseases.

The main objective of the endline survey was to compare results with the results of the baseline

survey and to the results of survey done in non-working VDCs of the 11 earthquake affected

districts, to identify whether the health education activities through social mobilization conducted

by the project had been effective and met its objectives. Data was collected by questionnaire using

face-to-face interview technique by researcher him/herself as like baseline survey. Total 2,288

respondents were interviewed in the endline survey and 807 in non-working VDCs survey.

The endline survey shows a great increase of knowledge and practice, which was also greater than

the control VDCs taken at end of the programme for comparison. The indicators which have

increased are as follows:

Proportion of critical times of hand washing has been increased to 24.6 per cent in endline

survey than in baseline and the proportion was significantly low in case of non-working VDC.

There was increase in awareness about the methods of water purification practiced in

community in endline survey of working VDCs and in non-working VDCs; the proportion was

even lower than in baseline except boiling.

There was increased knowledge regarding the treatment of diarrhea in endline survey of

working VDCs and the proportion was significantly lower than baseline in non-working

VDCs.

83% of children were vaccinated during MR campaign in working VDCs of the programme

and similar about 80 per cent children were vaccinated in non-working VDCs. However, this

is not an actual coverage, as sample included mothers who has below 9 months old baby.

21

Almost all of the respondents had heard about ANC in our working VDC and the similar about

95 per cent were found in non-working VDCs. The proportion of respondent answering

correctly according to protocol was increased in endline survey than in baseline in working

VDC and in case of non-working VDCs the percentage was even lesser than the baseline.

There was significant increase in the knowledge of the respondent regarding danger signs of

pregnancy from baseline to endline survey in working VDCs. The level of knowledge in non-

working VDCs was higher than the baseline and significantly lower than the endline of

working VDCs.

About 88% of the respondents have heard about PNC which was more than the baseline as

well as than in the non-working VDCs survey. The proportion of respondent answering

correctly the number of times was also high in endline survey than in baseline and the non-

working VDCs.

Proportion of respondent with knowledge regarding the danger sign of PNC was found higher

in endline survey than the baseline and in non-working VDCs the proportion was higher than

baseline of working VDC.

Proportion of respondent with knowledge regarding the danger sign of new born was found

higher in the endline survey of working VDC than in baseline and that of non-working VDC.

More than nine-tenths of the respondents have heard about the colostrum feeding which was

higher than the baseline of working VDCs and non-working VDCs. There was increased

knowledge regarding the importance of colostrum feeding and exclusive breastfeeding among

the respondent from the baseline and the proportion was a higher in endline of working VDCs

than of non-working VDCs.

From survey results (baseline, endline and non-working VDCs) it was found that good results have

been achieved in the overall health situation related to hygiene, sanitation, diseases, ANC, PNC,

Newborn care and breast feeding. It means that the project launched in the 11 districts had

improved the knowledge and certain degree of practices related to different health related issues

especially in the pregnant and lactating women and mothers who have under 5 years children.

However, owing to the great involvement of many other organizations in the districts, it may be

hard to claim that only this project attribute all changes.

22

Though good improvements were noticed after the implementation of project, it should not be

forgotten that it takes time to consolidate behavior changes, so more follow up is necessary for

further improvement.

23

ANNEX Annex: 1

Group Focus Discussion guideline

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Ps xKtf leq} ul/;Sg' kg]{5 / DC nfO{ a'emfO{;Sg' kg]{5 .

Post Assessment on Health (Knowledge, Practice)

Nepal Public Health Foundation, IPCS Project

Group Focus Discussion (GFD) Guideline

24

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(Piyush, Aquatab)

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SODIS

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26

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27

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28

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29

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31

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32

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33

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34

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35

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P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 /]l8of] l6eL ;fdflhs

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kfdKn]6 /

ˆnfo/


36

Annex: 2

Photographs

FGD at Jhaukhe VDC, Bhaktapur FGD at Hariharpurgadhi VDC, Sindhuli

Malu VDC, Dolakha Khimti VDC, Ramechhap

37

Sikre VDC, Nuwakot Jyamire VDC, Sindhupalchowk

Tripreshor VDC, Dhading Kavrenityachandeshwor VDC, Kavrepalanchowk

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