Multiple Indicator Cluster Surveys Data dissemination and further analysis workshop

1. Multiple Indicator Cluster SurveysData dissemination and further analysis workshop Child Health MICS4 Data dissemination and Further Analysis

2. Child health Immunization,Diarrhoea, Pneumonia, Malaria

3. Countdown to 2015 Decade Report (2000-2010)

4. Child Health in MICS4 Presentation overview Immunization

5. Background WHO Expanded Programme on Immunization It is recommended that all children receive the following immunizations: • At birth BCG (tuberculosis) and Polio 0 • At 6 weeks Polio 1 and DPT 1 (diphtheria, pertussis, tetanus) • At 10 weeks Polio 2 and DPT 2 • At 14 weeks Polio 3 and DPT 3 • At 9 months Measles • Hepatitis B (HepB) and Haemophilusinfluenzae type B (Hib)have same schedules as Polio and DPT • Up-to-date information on recommended vaccines can be obtained from www.who.int/immunization/documents/positionpapers/en/index.html

6. Indicators In MICS4, immunization indicators are calculated as • the percentage of children aged 12-23 months who received each specific vaccine at any time before the survey and by the age of 12 months (before their first birthday) and • the percentage of children aged 12-23 months who received BCG, DPT 1-3, Polio 1-3 and measles at any time before the survey and by the age of 12 months

7. Methodological issues • The model schedule is adapted in some way by most countries so that it more closely meets their needs. • Most importantly, the survey questions should reflect the national immunization schedule and take into account recent changes or vaccine introductions (if any)

8. Methodological issues • In surveys, coverage estimates are obtained from information copied from observed child health cards and from maternal recall of specific immunizations. • Immunization or child health cards are not subject to recall bias, but are not always accurate. • Cards may not be shown to the survey interviewer, or immunizations may not have been recorded on the card.

9. Methodological issues • In these cases, maternal recall may provide additional information. • Maternal recall, however, can either over- or underestimate the true level of coverage • Some suggest that maternal recall should not be used to determine coverage estimates, since it may introduce recall bias. • Others maintain that inclusion of recall data yields a more accurate coverage estimate.

10. Methodological issues • Indicators are calculated for children aged 12-23 months: • All children should have completed all vaccinations by this age • Their experience is the most recent experience which is not truncated

11. Calculation Children vaccinated according to card data + Children vaccinated according to mother’s recall = Total number of children vaccinated For children without cards (or who have cards with missing or incomplete dates), how do we compute the percentage of children vaccinated by 12 months of age (before the first birthday? • Assume the proportion vaccinated by 12 months of age is same as for children who have cards.

12. Example: BCG Percentage vaccinated according to card 85.2 Percentage vaccinated according to mother’s report +3.7 Total percentage ever vaccinated 88.9 Percentage vaccinated by 12 months according to card 98.0 Apply percentage 88.9 x .98 Percentage vaccinated by 12 months 87.1

14. CH3: Neonatal Tetanus Protection • Estimates the percentage of women age 15-49 years whose last live birth within the 2 years preceding the survey was protected against neonatal tetanus • Found in women’s questionnaire • Complex calculation: women can be protected from neonatal tetanus in a variety of circumstances based on the receipt of vaccinations in the previous years

15. CH3: Neonatal Tetanus Protection • Percentage of women age 15-49 years whose last live birth within the past 2 years was protected against neonatal tetanus • Calculation: The information contained in the first five columns of this table are calculated in a hierarchical fashion: • (Column 1) Received at least two tetanus toxoid injections during the most recent pregnancy (MN7>=2) • (Column 2) Received one tetanus toxoid injection during the last pregnancy and at least one dose prior to the pregnancy (MN7=1 and MN10>=1) OR received at least two tetanus toxoid injections, the last of which was less than 3 years ago (MN10>=2 and MN11<3) • (Column 3) Received at least 3 tetanus toxoid injections over lifetime, the last of which was in the last 5 years (MN10>=3 and MN11< 5) • (Column 4) Received at least 4 tetanus toxoid injections over lifetime, the last of which was in the last 10 years (MN10>=4 and MN11< 10) • (Column 5) Received five or more tetanus toxoid injections (MN10>=5) at any point • The last live birth for all women who fall into one of the first 5 columns is considered ‘protected against tetanus’ and should be included in the sixth column. • In many surveys, the sample sizes may be too small to present breakdowns by background characteristics.

17. Child Health in MICS4 Presentation overview Care of illness tables • Diarrhoea (3 tables) • Pneumonia (4 tables) • Malaria (6 tables) Beyond the tables

18. Diarrhoeatreatment • Diarrhoea prevalence – varies by season and caretaker reporting • ORS (Oral Rehydration Salts) – recent push to scale up • Recommended home fluids vary according to country

19. Diarrhoea treatment • Preventing dehydration is key to child survival • Feeding should continue during the diarrhoea episode

20. Diarrhoea treatment • ORT = Oral rehydration therapy = ORS and/or recommended home fluids and/or increased fluids • Key diarrhoea indicator in this table – ORT with continued feeding (based on four components) • Zinc is another key intervention

21. Key diarrhoea indicators Percentage of children with diarrhoea in the two weeks preceding the survey, who received: Bhutan MICS 2010

22. Child Health in MICS4 Presentation overview Care of illness modules • Diarrhoea (3 tables) • Pneumonia (4 tables) • Malaria (6 tables) Beyond the tables

23. Pneumonia • Definition of suspected pneumonia = cough + rapid/difficult breathing + problem in the chest • Suspected pneumonia prevalence – varies by season and caretaker reporting • Appropriate health providers includes public and private sources (excludes private pharmacy) • Two key pneumonia indicators = careseeking and antibiotics

24. Antibiotic treatment Percentage of children with suspected pneumonia in the last two weeks who received antibiotics Bhutan MICS 2010

25. Antibiotic treatment Percentage of children with suspected pneumonia in the last two weeks who received antibiotics

26. Antibiotic treatment Percentage of children with suspected pneumonia in the last two weeks who received antibiotics Based on 54 unweighted cases!

27. Antibiotic treatment Percentage of children with suspected pneumonia in the last two weeks who received antibiotics Based on 54 unweighted cases! Note that *all* treatment indicators based on a subset of children!

28. Pneumonia • Note this table is based on mothers/caretakers of all children under-five • The two danger signs are fast breathing and difficult breathing • Open-ended questions can lead to challenges during data collection

29. Pneumonia MICS4 tables cover three essential steps needed to reduce deaths among children under five with pneumonia: 1. Recognize a child is sick 2. Seek appropriate care 3. Treat appropriately with antibiotics

30. Essential steps for reducing pneumonia deaths among children 1 2 3 Mongolia MICS 2005

31. Pneumonia • Inhaling smoke from solid fuels is hazardous • Variation by region • How valid are data in CH10?

32. Child Health in MICS4 Presentation overview Care of illness modules • Diarrhoea (3 tables) • Pneumonia (4 tables) • Malaria (6 tables) Beyond the tables

33. Standard MICS4 malaria tables • Household availability of insecticide treated nets and protection by a vector control method • Children sleeping under mosquito nets • Pregnant women sleeping under mosquito nets • Anti-malarial treatment of children with anti-malarial drugs • Malaria diagnostics usage • Intermittent preventive treatment for malaria

34. Take advantage of increasing focus on health for dissemination, advocacy and analysis! Further use of data

35. Health interventions across the continuum of care Countdown to 2015 Decade Report (2000-2010)

36. A second look at diarrhoea-related data? From Diarrhoea: Why children are still dying and what can be done

37. A second look at pneumonia-related data? Treatment • Careseeking behavior • Antibiotics Key prevention measures • Adequate nutrition (including breastfeeding and zinc) • Immunization (measles, Hib and pneumococcal conjugate) • Reducing indoor air pollution • Water, sanitation and hygiene

38. Thank You!