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VL IRS COVERAGE ESTIMATE: FINDINGS FOR IRS 2014 (April-June ). VL ELIMINATION PROGRAM Concurrent Monitoring and Learning, TSU-Bihar. Contents. 1. Context. 2. VL theory of change. 3. Spray coverage. 4. Quality of spray. 5. Spray awareness. 6. Annexures. 1. - PowerPoint PPT Presentation
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VL IRS COVERAGE ESTIMATE: FINDINGS FOR IRS 2014 (APRIL-JUNE )
VL ELIMINATION PROGRAMCONCURRENT MONITORING AND LEARNING, TSU-BIHAR
Context1
VL theory of change2
Spray coverage3
Quality of spray4
Spray awareness5
Annexures6
Contents
• IRS activity is being done by the spray squads in all VL affected villages in 33 VL affected
districts of Bihar
• CARE is providing supportive supervision to the spray squads under the BMGF funded VL
Elimination Program.
• The supportive supervision is done through KalaAzar Link Workers (KLW) who monitor the
spraying of each spray squad, help them in maintaining the quality of spraying and provide
support on the same.
• However, there is no data collection procedure in place to reliably report the coverage and
quality of spraying.
• This coverage estimate study aspires to provide project level and district level coverage
estimate of VL IRS activity and to determine change in coverage over time.
• Besides coverage of spraying, this study also attempts to provide estimate of quality of spray
related indicators and will track the change in quality over time.
Context – Need for coverage estimate study1
VL theory of change
Effective IRS Reduction in Vector density
Reduction in case incidence
Focus of Coverage Estimate study
Effective IRS is driven by
a) Maximizing coverage of IRS spray in affected areas
b) Spray squads performing high quality sprays in affected areas
c) Awareness generation amongst general population about the importance of IRS sprays
2
Total coverage as per CE study
2,156
# of HHs Partially sprayed
11,880
1,506
7,020
# of HHs Fully sprayed
# of HHs actually sprayed
# of HH visited by IRS squad
# of HHs not visited by IRS
squad
2,178
5,627
# of HHs covered in
sprayed villages
17,50719,013
9,176
Total # of HHs
covered in the survey
526
# of HHs not sprayed
- refusal and other reasons
# of HHs from villages not
sprayed because of termination of
round
IRS coverage as per CE study (# of HHs)
~48% of HHs were actually sprayed by IRS squads (partially or completely) ~37% of HHs were completely sprayed ~18% of the HHs visited by IRS squads (~11% of total HHs) refused for spraying
Partially sprayed
HHs refused to be sprayed
Excluded from spraying
HHs not refused but not sprayed
Consideration set
3
HHs sprayed
Reasons
11%
8%
35%
3%
26%
16%
others
Any male member/head of family was not present
Post Spray there is a very strong foul smell in the house
Some rooms were locked
Food materials were kept in the rooms
It leaves marks/spots on the wall which looks ugly
Portions of house that were partially sprayed
69%
9%
3%
17%
1%
Only outside of the house was sprayed
The cowshed was left unsprayed
The kitchen was left unsprayed
others
Only a few rooms were sprayed; rest left
Note: Total % of responses have been normalized to 100%
Key reasons for Partial spray
Of the total 2156 cases of Partial spray,
3
No Spray (2704 cases)
Refusal (2178 cases) No refusal (other factors) (526 cases)
16%
51%
10%
23%
No adults was present in the house
Other
House Locked
House was under construction
13%
21%9%
1%
27%
17%
11%
Any male member/head of family was not present
It has a strong and foul smell
It increases the problem of leeches
It doesn’t decrease the problem of mosquitoes (increases)
It leavers marks /spots on the wall which looks ugly
Others
It is poisonous can be dangerous to children
Key reasons for No spray3
Note: Total % of responses have been normalized to 100%
Quality of IRS spray is defined basis multiple dimensions based on actions taken by Spray squad
Determining Quality of spray
Dimension Metric for measurement % houses covered
Complete wall exposure
Spraying corners and cracks 42%
Spraying up to height of 6 ft. 41%
Calendars and posters removed before spraying 22%
Neatness of sprayUniformity of spray done by spray squad 39%
No DDT stains left on the walls 30%
Prevention of contamination
Household items moved away at time of spray 38%
Food items/ utensils / fodder covered before spray 35%
Furniture moved at time of spray 22%
4
A
B
C
Note: Denominator = Number of HHs sprayed = 9176 HHs
Parts of house that were sprayed
Varanda sprayed
Cowshed sprayed
32%
38%
68%Separate kitchen sprayed
22%79%
62%
87% 13%
Sprayed
Separate toilet sprayed
Not sprayedCoverage of house parts
Spray quality in house parts
44%
Sprayed
51%
Spray in Cowshed upto 6 ft.
Spray in Varanda upto 6 ft.
4
Maintaining the spray in the wall
• Among the Households sprayed, only 4.7% were told by the spray squads to maintain the
spraying in the wall
• On an average, the spraying was told to be maintained for 3.75 months
• However, 23.1% among them (those who were told by the spray team to maintain the
spraying in the world) did not maintain the spraying, the walls were painted or mud plastered
at the time of the survey
Stencilling• Stencilling has been done outside of 57.9% of the HH
Maintaining spray and stenciling4
Awareness about IRS
Of the total 19013 respondents, only 379 – mere 2% had advance information about IRS
Yes46%No
54%
Informed about correct reason for spray
Yes20%
No80%
Informed about date/ range of date for spray
Yes14%
No86%
Aware of correct reason for doing IRS
Yes41%
No59%
% population told that IRS was done to kill mosquitoes
Others
Mukhiya/ Sarpanch/ Pradhan
29%
6%
7%
9%
2%
40%
6%
Relatives/ Neighbors/ Friends
Link worker
Spray squad member/ supervisor
ASHA/ AWW
Other PRI member
Source of information about IRS
General awareness level about IRS and the reasons for doing the same is poor
5
Denominator = 379
Denominator = 379
Denominator = 19013
Denominator = 19013
• Overall IRS coverage is 48% of total households
– IRS coverage in kuccha and semi pucca houses is 53%
• Major reasons identified for refusal and partial spray of IRS are
I. IRS leaves mark in the wall which is difficult to remove
II. Foul smell of after IRS spray
III. Unwillingness of HH members to remove food items stored in rooms
IV. Absence of male members/ adult members in the house when spray team visited
• Only 5% HHs were advised by spray squads to maintain the spray in the wall
• Stencilling was done in 58% houses
• Only 2% of HH were informed about IRS in advance – Major sources of information were
a) Spray Squad
b) KLWs
c) PRI members/ FLWs were very less in proportion as source of information about IRS
Key takeaways from VL CE study
• To provide district level estimate, sample size per district has been calculated as 800
assuming the following:
– 95% confidence interval
– 5% absolute precision
– For using the most conservative estimate of the population parameter for coverage, we
used 50% as the expected proportion
– Design Effect of 2 to adjust for the clustering.
• Identifying a 10% change in the district level estimates between two consecutive rounds with:
– 80% power
– 95% confidence interval
• Overall sample size calculated at the project level=20,000
Final Sample Size
Final sample size after the end of data collection till mid of August, 2014 is 19013. Data collection
in a few districts could not be completed because of late start of IRS rounds in those districts
Annexure: Sample size 6
• Out of 38, total 24 districts were chosen excluding
‒ those districts where no Kala Azar cases were found and
‒ those districts where total number of Kala Azar affected villages were less than 40 (to
avoid complete subject selection)
• From each selected district, 40 villages were selected using Probability Proportional to
Size(PPS) method from the list of all Kala Azar affected villages in that district.
• From each selected villages, 20 Households (HH) were selected.
• The remaining 9 Kala Azar affected districts (where no. of affected villages < 40) were clubbed
together as one
• 40 villages from all the villages of these 9 districts were chosen using PPS
• From each selected villages, 20 HH were selected.
• If one village is chosen more than once in the sample list( for example, n times), total 20*n
HH were selected from that village
• The total sample size becomes (800x24)+800=19,200+800=20,000 HH
Annexure: Sample distribution 6
Selection of AWC in the village
• The data collection will start from a certain AWC of the selected village
• If there are more than one AWC in the village then
I. The AWC codes of all the AWC will be written in ascending order
II. If no. of AWCs is an odd number then the middle one will be selected as the selected
AWC
III. Else( if no. of AWCs is an even number), the total no. of AWCs will be divided by 2. The
AWC whose position in the ascended list is same as the quotient will be chosen
For example, if there are 5 AWCs in the village with codes 119, 125,112,134,129 then first those
will be sorted in ascending order and the middle one( i.e. 125) will be selected.
If there are just 4 AWCs with codes as 111, 92, 102, 134 then first it will be sorted as
92,102,111,134. Then 4(total no. of AWCs in the village)/2=2nd one in the list i.e. AWC 102 will be
selected
Annexure: Sampling – HH selection (1/3)6
Selection of Index Household
• From the AWC household registrar, total number of household in an AWC will be determined
by the data collector
• In AWC where cellphone connectivity is there
– The data collector/BMLE coordinator will call the District MLE coordinator(DMLE) and
inform him about the total no. of households in that catchment area. The DMLE will
generate a random number between 0 and ‘total no. of households in the catchment area.
The household in the survey register which has the same serial number( household
number) as the randomly generated number, will be chosen as the ‘Index Household’
• In AWC where cellphone connectivity is not there
– To generate a random number, the BMLE will divide the total number of household in that
AWC catchment area by 2 and after discarding the values after the decimal of the result,
will add 3 with it. The household in the survey register which has the same serial number
(household number) as the randomly generated number, will be chosen as the ‘Index
Household’. For example, if there are total 159 household in the AWC catchment area,
index household number will be (159/2)+3=79.5+3=79+3=82
Annexure: Sampling – HH selection (2/3)6
Selection of Households for Interview
• The data collector will leave 4 houses from the index house using Right Hand Rule and the 5 th
house will be the first house for interview.
• In the same way, the data collector will skip 4 houses after one house of interview and will
choose the 5th house for interview.
• This will go on till the required no. of houses is covered.
• If there are 20 or less number of structures/houses, all of them have to be covered
Annexure: Sampling – HH selection (3/3)6
25.2
35.8
39.0
Type of House
PUCCA SEMI PUCCA KUCHA
85.1
14.8
0.1
Religion
HINDU MUSLIM Others
21.4
3.3
60.3
15.1
Caste
SCHEDULED CASTE SCHEDULED TRIBE OBC OTHER
Among the SC population, 70.3% is Mahadalit
Annexure: Socio Demographic Profile of respondents
6