REPORT HOUSEHOLD SURVEY OF BILASPUR DISTRICT (Chhattisgarh …rltrird.cg.gov.in/pdf/ROHFW/Field...

Regional Office of Health and Family Welfare and Regional Leprosy Training and

Research Institute, Govt of India, MoHFW ,Raipur Chhattisgarh state

1

REPORT HOUSEHOLD SURVEY OF BILASPUR DISTRICT

(Chhattisgarh state) ON

MDA EVALUATION

Date of MDA 2012 – 9th to 11 May 2012 in rural area - 22th to 24th April 2012 in urban area

Regional Office of Health and Family Welfare and

Regional Leprosy Training and Research Institute, Ministry of Health and Family Welfare,

Govt of India, Raipur, Chhattisgarh state

Evaluation Team Dr Sunil Gitte, M.D. (PSM), Deputy Director

Dr Ravi Rao, Medical officer, S.Dhruw, I Maisih, PMW,

14th

- 18th

May

2012



2

INDEX PAGE No.

BACKGROUND 03

OBJECTIVES 03

METHOD OF SURVEY 05

OBSERVATIONS 08

SUMMARY 13

CONCLUSION/RECOMMENDATION 15

FORMAT I- BILASPUR DISTRICT 17

PHOTOS 19



3

BACKGROUND OF MDA EVALUATION

A Post MDA evaluation survey was conducted with the objective to review the

progress of the single dose of diethyl-carbamazine (DEC) and Albendazole,

administration and to understand the functioning of the programme to

recommend mid-term amendment.

It has been observed in the past that the actual drug consumption was lower

than the reported coverage by peripheral health workers or / volunteers. As per

the norms, the drug is to be consumed by the eligible population in the presence

of drug distributor but on many occasion, the drug was handed over to the family

members for consumption later on. It has been observed that a substantial

proportion of community members do not consume the drug. Therefore, it is

important that the mid term assessment should be conducted by the

independent team members who are not directly connected with the MDA

programme in the selected area. The assessment shall be completed within three

weeks of MDA so that the community will be able to recall the events without

memory lapse. The purpose of the MDA evaluation in the BILASPUR district is the

mid-course corrections and to suggest necessary steps for further course of

action.

Objective:

i) To review the progress of activities of single dose DEC mass

administration in the selected district.

ii) To make an independent assessment of the programme implementation

with respect to process and outcome indicators.

iii) To recommend mid-course corrections and to suggest necessary steps for

further course of action.



4

MAP District Bilaspur As of 2011 India census, Bilaspur had a population of 26, 62,077. Males constitute 51%

of the population and females 49%. Bilaspur has an average literacy rate of 72%, lower

than the national average of 74%; with male literacy of 83% and female literacy of 60%.

15% of the population is under 6 years of age.

In the year 2011, new Mungeli district carved from Bilaspur district. But MDA was

carried out by Bilaspur District Health administration. MDA 2012 was carried out into

two phases due to Gram Swaraj Abhiyan

http://en.wikipedia.org/wiki/Census



5

METHODS: Survey area: Bilaspur District The teams of ROHFW visited the study district and tried to collect data by desk

review, in-depth interviews, on site observations, and from the community.

A) Selection of households: The PHC should be stratified in to 3 groups

depending upon MDA 2012 coverage as given below:

Sr. No

Category MDA Coverage %

1 PHC with coverage below 50 2 PHC with coverage between 50-80 3 PHC with coverage above 80

In case there is no PHC in a particular category, two blocks from the next

category may be selected.

In each category, PHC should be selected randomly

From each of the selected PHC, one village should be selected randomly for

household survey.

In each village, 30 households should be covered. The detailed questionnaire

is enclosed at Annex. 1

Similarly, in urban areas one ward should be selected randomly for the

evaluation of the programme.

In each selected ward, 30 households should be covered.

In this way, in each district, 120 households will be surveyed for the purpose

of MDA evaluation.



6

Reported coverage of district Bilaspur by BMO

sr No Name of Block@ Total

Population Eligible

population Population

Covered MDA %

coverage 1 Bilaspur Urban 353198 300218 238359 79.4 2 Marwahi 131709 111953 110222 98.5 3 Gourella 124636 105941 85202 80.4 4 Pendra 91190 77512 75169 97.0 5 Kota 218058 185349 169827 91.6 6 Lormi 230461 195892 196432 100.3

7 Mungeli 247955 210762 187615 89.0 8 Patharia 168188 142960 122923 86.0 9 Takhatpur 269480 229058 180010 78.6

10 Bilha 326303 277358 240733 86.8 11 Masturi 275264 233974 215120 91.9

Total 2436442 2070977 1821612 88.0 @ Source by DMO office

B) Modified Sampling

The BLOCK was stratified into 3 groups depending upon MDA 2012 coverage

of BILASPUR as given below

A) Fixed and Random sites based on above coverage

Sr.no

Category District MDA COVERAGE

Fixed AND Random sites

BILASPUR

1 BLOCK with coverage

below 50 00


between 50-80 02


above >80 09

(* The readymade data of the PHC Coverage/village are not available at district or Block)



7

b) The Blocks was stratified into 3 groups depending upon MDA 2012 coverage –

Sr no

Category MDA

Coverage

BILASPUR district

No of PHC/URBAN

Name of village/

ward

1 Block with coverage

below 50% NO PHC NO VILLAGE


between 50-80%

Bilaspur urban Ward no

40,41 Belpan PHC Podikala


above >80%

Ratanpur Urban Karhaiyapara

Nawagaon PHC Lalpur

Amadand PHC Amadand

*From above category, 3 Block was selected randomly.

*From each of selected block, one village was selected randomly for survey.

*In each village, 30 household should covered.

**One urban area was selected randomly and from selected urban area ,one ward

was selected randomly. The 30 households were surveyed in selected ward.

Data analysis: Data was analyzed on the same day and entered in Microsoft Excel

sheet and results were shared with Chief Medical officer (CMO) cum Joint Director

and District Malaria Officer. The VBD consultant was not available during

discussion.

Funds: The IEC funds were not analyzed due to lack of availability of document

during survey.



8

RESULTS: Table-1 –Age and sex distribution of surveyed eligible population Particulars Male Female Total

Adult 296 (32.5) 264 (28.9) 560(61.4)

Children (<14 year)

184 (20.1) 168 (18.3) 352(38.6)

Total 480 (52.6) 432 (47.4) 912 (100%)

In surveyed population, 53% were male while 47% were female. 39% were children less than 14years of age. Table-2 -Coverage of MDA in the eligible population

Sr no Profile No

1 Total Houses surveyed 150

2 Total survey population 912

3 Total eligible Surveyed population 807

5 Person consume DEC tablets 509

6 Person not taken DEC on MDA 2012 298

% of actual DEC taken 63%



9

Table -3. Area wise coverage of MDA in Urban and Rural area of Bilaspur

Sr no

PARTICULARS

Bilaspur Block

Kota Block Kota Block Pendra Block

Takhatpur Block

Bilaspur (URBAN)

Ratanpur (URBAN)

Nawagaon Lalpur

(RURAL)

Amadand(Rural)

Podikala (Rural)

1 Total Houses

surveyed 30 30 30 30 30

3 Total eligible

population 179 161 117 137

213

5 Person not taken

DEC on MDA 2012

119 115 0 9 55

6 % of actual DEC

taken 33.5% 28.5% 100% 93%

74%

The urban area coverage was significantly low as compare to rural area. The

overall drug consumed coverage was 64% in surveyed houses. This district

reported coverage is very high which needs to review the activity by state.

The population of the district as per census 2011 is 26, 62,077 but total

population of district taken by DMO is 24, 36,442 which need to be updated.

Graph 1 showing the beneficiary who actual swallowed the DEC tablets in presence of Drug distributor



10

Out of 807 beneficiaries, none of the interviewed beneficiaries had

consumed the DEC+ Alb tablets in the presence of the drug distributors.

This Distribution drive depends only on anganwadi workers and volunteers at

urban area and ASHA in Rural area. There is minimal involvement of Peripheral

workers at rural area in the present drive. Most of the distributors distributed

the Drugs without giving any information to the beneficiary.

Graph 2- In Urban and Rural area opinion of beneficiaries as who should be the Drug distributor

In Urban area Anganwadi worker was preferred more as the drug distributor.



11

In rural area the ASHA workers are preferred more than the other workers, this

might be due to following reasons–

a) Local community workers

b) She can spend more time in village

c) She is close to the villagers than any other worker

In urban area Anganwadi workers are more preferred.

Graph 3 Reasons of non-consumed drugs by beneficiary

Various sources of the health information regarding the MDA None of the interviewed members had any information about MDA. IEC is very

poor in both urban and rural areas and it is restricted to only banners on the wall

of Health institute. However, the level of awareness about the morbidity

management in the community was low. Very few subjects with LF, who were

interviewed, could answer the proper method of care. The training on morbidity

management was not given to the identified cases.



12

Drug distributor persuaded swallowing of the drug in his presence

None of the drug distributor had persuaded the beneficiary to swallow the Dec

tablets in his/her presence. This drive was focused only on the distribution

instead of persuaded swallowing of drug in his/her presence.

The interviewed person helps the drug distributor for drug

compliance in his village or mohallah

None of the interviewed persons helps the drug distributor for drug compliance

in his village or mohallah. There is lot of scope for involvement of the community

members in MDA activities. DMO and VBDs should call meetings of the

community leaders at block and urban settings. Most of the community members

are not aware of the MDA activities in their area.

Side effects of DEC +Alb in surveyed population: Out of the surveyed beneficiaries, none had experienced any side effects. None of

them were informed regarding side effects and if occur, where to report

Comments of Action Plan:

The action plan had good micro plans with detailed information on how to

proceed for an activity and could easily serve as a model for the programme,

while no such plan were available in District , where, the work was coordinated

from PHC level, without much input from district malaria office and without

proper planning.

The VBD consultant should involve on the preparation of detailed micro plan,

which was not provided to evaluation team.



13

SUMMARY

The MDA activities in the surveyed districts are going through the stage of

planning and implementation and appear to be weak. In none of this

surveyed area of districts, the local authorities sought the active help or

cooperation of the community members for the implementation of MDA

activities. There is need of intensive health education campaign to make

the community aware about LF and, increase their participation in the

programme. None of the drug distributor explained to interview person

and family members regarding DEC intake on elimination of Lymphatic

Filariasis and details of transmission of the disease.

Fear of drug, lack of information of tablets and absence from home due to

travel/Marriage season was the main reason for not taking drug (DEC) on

MDA 2012. The children were not allowed to consume the tablets by their

parents due to fear of drugs.

None of beneficiary swallowed the tablets in presence of Drug distributor;

the consumption of drug is very low in urban area and good in rural area.

In area where there was prophylactic drive of tab chingumsulf, the

consumption is very good. Some of people assumed and consumed these

tab as malaria prevention tablets



14

Drug distributor visited all surveyed houses and distributed the drugs in

rural area but in urban area, some of the houses were missing due to lack

of coordination of two workers and also due to unclear demarcation of

wards.

None of the drug distributor had persuaded swallow of the DEC in his or

her presence in 150 houses.

None of the surveyed population has helped the drug distributor for drug

compliance in village/urban area. None of the beneficiaries have prior

information regarding MDA.

The local volunteer/agencies were not actively participated in MDA

activity in urban area.

None of the beneficiary had experienced side effects.



15

CONCLUSIONS/RECOMMENDATIONS

1) The major focus of the staff was on the paper work. The implementation

was very poor in the district. The health education activities were not done

satisfactorily. There was limited knowledge and awareness about LF and

MDA amongst the community members. The local modes of awareness

generation were almost missing. The authorities had used TV, Posters and

newspapers for IEC activities, which had limited penetration in the rural

population. IEC activates need to improvement in rural as well as urban

area. These activities should be done timely and more frequently before

MDA.

2) The Community participation In MDA needs improvement by conducting

area wise meetings. The voluntary organization should be involved in the

activity especially in urban area where the coverage is low.

3) The tablets were distributed during the day time, when most of the

population goes to their work place, leading to insufficient coverage.

Therefore, in future, dates should be finalised after due deliberations and

input from the community. The timing for the tablet distribution should

also be made in the evening to make it convenient for the community.

There is definitive need to ensure that drug distributor meets the person.

They may go to the area in evening time or may have to pay one more visit

at the time convenient for the locals.The drug consumption in presence of

drug distributor need to be increased in urban as well as rural areas.



16

4) The home-based management of a case of LF is a part of the strategy to

eliminate LF. However, the level of awareness about the morbidity

management in the community is very low. Very few subjects with LF, who

were interviewed, could not answer the proper method of care. The

training on morbidity management was not given to identified cases. IEC

activity regarding Morbidity management in-patients who are suffering

from the elphanttitis should be targeted.

5) The dates of MDA were not properly thought about. The MDA was

rescheduled in rural area.

The ROHFW, Raipur was neither informed by State Programme

Officials nor by NVBDCP division about MDA 2012 drive for elimination

of Lymphatic Filariasis in Chhattisgarh state. The coordination of these

important activity help proper planning, implementation and

evaluation.



17

Format I MDA Evaluation report of RD team District: Bilaspur Name of Investigator: Designation : Particulars

1 Name of Village/GULLI selected 2 Population of selected village/ward 3 Name of PHC 4 No of beneficiaries interviewed 5 Total no of Beneficiaries in selected

houses

6 No of beneficiaries consumed tablets 7 No of beneficiaries not consumed

tablets

8 Percentages of consumption 9 District average consumption

10 No of House visited by the drug distributor for MDA in elected houses

11 Percentages of House visited 12 No of beneficiaries swallowed tablets

in presence of drug distributors

13 Percentage of beneficiaries swallowed drug in presence of drug distributor

14 Reasons for not swallowed the drug

A No information about LF/MDA/DEC B Fear of Drug C Beneficiaries on empty stomach at the time

of DD visit

D Side reaction of Drug E

F Complication of previous year MDA G Other

15

A ANM B Health Worker ( Male) C Anganwadi worker D NGO E Volunteer F Students G Other

16 Source of Information about MDA Activity



18

A Health Worker ( Male) B Anganwadi worker C NGO D Volunteer E Miking F Davandi G Radio H TV I News paper J Handbills K Other

17 No of beneficiaries experienced side effects of DEC

Details of side effects of DEC A Nausea B Headache C Fever D Rash E Dehydration F Fainting attack g Other

18 Whether you are aware about the nearest treatment facility center for treating side effects of DEC

19 If treated place of treatment A PHC B Rural Hospital C Private Hospital d Others

19 Information of the line listing of Elephantitis and hydrocele.



19

Bilaspur Urban- Household

survey

Interaction of Household and

AWW



20

Interaction with Community Members

Person with Lymphedema Leg not consumed

Drugs on special activity due to lack of

Knowledge



21

Recovered DEC+Alb Tab after

Distribution

Involvement of DM and CMO rally on

MDA day



22

MDA Posters

REPORT HOUSEHOLD SURVEY OF BILASPUR DISTRICT (Chhattisgarh …rltrird.cg.gov.in/pdf/ROHFW/Field...

Documents

Transcript of REPORT HOUSEHOLD SURVEY OF BILASPUR DISTRICT (Chhattisgarh …rltrird.cg.gov.in/pdf/ROHFW/Field...