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Diarrhoeal Diseases Control and Acute Respiratory Infections Household Case Management Survey, Vientiane Municipality, Lao People's Democratic Republic, 19 April - 10 May 1993 : report

31 décembre 1993 Organisation mondiale de la santé

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Texte intégral

(WP)ICP/CDD/001-E Report series no.: RS/93/0082 (Annex 1)

English only

REPORT ~

DIARRHOEAL DISEASES CONTROL AND ACUTE RESPIRATORY INFECDONS HOUSEHOLD CASE MANAGEMENT SURVEY VIENTIANE MUNICIPALITY, LAO PEOPLE'S DEMOCRATIC REPUBLIC 19 April- 10 May 1993

Joint report of the National CDD and ARI Programmes and WHO

Not for sale Printed and distributed by the Regional Office for the Western Pacific of the World Health Organization Manila, Philippines July 1993 WHOifVPRO LffiRARl

lianiUJ.

Pki/tip~

2 o DEC 1993

NOTE

The views expressed in this joint report are those of the survey team and do not necessarily reflect the policies of the World Health Organization.

This joint report has been prepared by the Regional Office for the Western Pacific of the World Health Organization for the Government of Lao People's Democratic Republic.

CONTENTS

1. 2.

INTRODUCfiON ................................................................................................................ 1 BACKGROUND................................................................................................................... 1 2.1 Lao People's Democratic Republic........................................................................... 1 2.2 National ARI and COD programmes....................................................................... 1

3. 4.

OBJECfiVES OF TI-lE SURVEY .................................................................................... 2 METI-IODS............................................................................................................................. 2 4.1 4.2 4.3 4.4 4.5 Geographic area covered............................................................................................. Sampling design............................................................................................................. Survey instrument......................................................................................................... Training of supervisors and surveyors....................................................................... Analysis of data............................................................................................................. 2 3 3 4 4

RESULTS ............................................................................................................................... 5 5.1 Diarrhoeal diseases...................................................................................................... 5 5.2 Acute respiratory infections ....................................................................................... 10 5.3 Breast-feeding............................................................................................................... 13

DISCUSSION........................................................................................................................ 13 6.1 6.2 6.3 6.4 6.5 6.6 Annual diarrhoea incidence and two-week ARI prevalence................................ Care-seeking behaviour .............................................................................................. Home management of diarrhoea .............................................................................. Drug use........................................................................................................................ Breast-feeding............................................................................................................... Care for diarrhoea and acute respiratory infections from the health system ................................................................................................ 14 14 15 15 16 16

CONCLUSION ..................................................................................................................... 16 ANNEXES: ANNEX I - LIST OF SELECTED CLUSTERS ....................................................... 17 ANNEX 2 • SURVEY QUESTIONNAIRE ............................................................... 21 ANNEX 3 • LIST OF PARTICIPANTS ...................................................................... 55 ANNEX 4 • SCHEDULE OF TRAINING ................................................................ 57 ANNEX 5 • SUPERVISOR'S CHECKLIST.............................................................. 61 ANNEX 6 - SURVEY SUMMARY ............................................................................ 63 ANNEX 7 • LIST OF DRUG CLASSIFICATIONS ................................................ 67

EXECUTIVE SUMMARY

A control of diarrhoeal diseases (CDD)/acute respiratory infections (ARI) household case management survey was conducted in Vientiane Municipality, Lao People's Democratic Republic from 19 April to 10 May 1993. The survey was designed to collect information on population's knowledge about the diseases, care-seeking and home treatment practices. The objectives of the study were the following: (a) to assess diarrhoea and acute respiratory infection case management practices in the home; (b) to collect baseline data on diarrhoea and ARI morbidity in children under five years of age, and on major programme indicators; (c) to use data collected on care-seeking behaviours of caretakers to guide programme decisions about health education messages for the public and training of health workers; (d) to assess breast-feeding practices in children under 4 months of age;

(e) to develop national technical capabilities to carry out similar health surveys in the future. Data were collected through interviews with caretakers of children under 5 years of age using a standard cluster sampling technique. The survey focused on children with diarrhoea, cough or difficulty in breathing in the two weeks preceding the data collection. A total of 2593 households were surveyed and the same number of caretakers were interviewed. Some 4111 children under five years of age were found. Of these children 7% had diarrhoea on the day of the interview or in the past two weeks. When converted to incidence and adjusted for seasonality, this indicates approximately 1.3 episodes of diarrhoea per child in a year. Some 22% of the children had cough and 3% had pneumonia on the day of the interview or in the past two weeks. The characteristics of care-seeking behaviour were found to be very similar in both diseases: Regardless of whether their child had diarrhoea or ARI, the mothers were not very well aware of when they should seek care from a health care provider. Few caretakers knew which signs to look for in the sick child. Only about one flfth of the mothers had correct knowledge of when to seek care for a child with diarrhoea or ARI. Both CDD and ARI programmes need to focus on informing caretakers about when to take their children to health care providers. This could be achieved by giving more emphasis on the communication component during training courses and by developing country-specffic, appropriate communication messages. Considering the early stage of the COD programme, the promotion of ORS has been successful. The relatively high oral rehydration salts (ORS) and oral rehydration therapy (ORT) use rates- 40% and 55%, respectively- are an encouraging fmding. However, it

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should be noted that the survey did not give information on how ORS was prepared, i.e., the proportion of caretakers who prepared ORS correctly. In contrast, the extremely high rates of unnecessary drug use in treating diarrhoea and ARI indicate a serious problem in home management. As many as 88% of the children received one or more drugs for diarrhoea, and some 25% of children with ARI were given a harmful drug. This finding also implies a problem in the quality of care provided by both public and private health care sectors. Both CDD and ARI programmes should give high priority to efforts to reduce inappropriate drug use. In children under four months of age, breast-feeding is a common practice but exclusive breast-feeding is rare. It is worth noting that the proportion of children who were bottlefed is 39%. This is likely to increase owing to the persistent marketing efforts of infant formula manufacturers. Integrated evaluation of the CDD and ARI programmes followed logically the combined training courses they have conducted. It also demonstrated an effective way to conserve personnel and other resources within the MCH Institute and further encouraged programme integration. By conducting this study a baseline was established, against which changes in diarrhoea and ARI morbidity and major programme indicators can later be measured. It must be emphasized, though, that the data collected are only representative of Vientiane Municipality, not the entire country. Since significant differences are highly likely to exist between the Municipality and rest of the country, further surveys are needed to collect data from different areas to make nationwide estimates.

1. INTRODUCTION

Acute respiratory infections and diarrhoeal diseases continue to be major causes of mortality and morbidity in children under five years of age in developing countries. To assist national disease control programmes in effective planning, management and evaluation of their activities, the Acute Respiratory Infections (ARI) and Diarrhoeal Diseases Control (CDD) programmes have recently developed a methodology for combined assessment of diarrhoea and acute respiratory infection case management practices in the home. The survey is designed to collect information on population's knowledge about the diseases, careseeking and home treatment practices.

2. BACKGROUND

2.1

Lao People's Democratic Republic

Lao People's Democratic Republic is a landlocked country with 4.3 million inhabitants. The estimated infant mortality and under-five mortality rates are 101/1000 and 148/1000, respectively (United Nations Population Division estimate for 1990). Acute respiratory infections and diarrhoeal diseases are regarded to be among the largest contributors to these rates, which are among the highest in the region. 2.2 National ARI and CDD prowammes

The national COD programme was established in 1982 and the national ARI programme in 1987. They are under the responsibility ofthe Maternal and Child Health Institute (MCHI). The activities of the COD programme have been mainly concentrated on training of government health workers in correct diarrhoea case management, establishment of oral rehydration therapy (ORT) corners at provincial and district level hospitals, and supply and distribution of oral rehydration salts (ORS). The ARI programme has also trained staff in clinical case-management, and distributed antibiotics, although not on a regular basis. The CDD programme is distributing ORS to the government health facilities in the provinces. Drugs for ARI, however, are rarely available in these facilities, and the caretakers of children usually need to buy them from private pharmacies. The ARI and CDD programmes started conducting integrated training courses in 1991. Each of the hospitals and dispensaries in Vientiane Municipality now has at least one member of staff trained in standard CDD and ARI case management. During the training, health staff have been trained in giving advice on home treatment of diarrhoea and ARI but no major communication activities targeted at the public have taken place.

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3. OBJECfiVES OF THE SURVEY

No current data are available on home treatment practices of either diarrhoea or acute respiratory infections. In order to obtain data for effective planning and to strengthen the capacity of national staff to conduct evaluation activities, a combined CDD / ARI household survey was initially planned during the CDD Review and Planning Meeting in Vientiane in January 1993. Preparations for the survey were started shortly after the meeting. The objectives of the survey were formulated as follows: (a) to assess diarrhoea and acute respiratory infection case management practices in the home; (b) to collect baseline data on diarrhoea and ARI morbidity in children under five years of age, and on major programme indicators; (c) to use data collected on care-seeking behaviours of caretakers to guide programme decisions about health education messages to the public and training of health workers; (d) to assess breast-feeding practices in children under four months of age;

(e) to develop national technical capabilities to carry out similar health surveys in the future.

4. METHODS

4.1

Geo~auhic

area covered

The country is divided administratively into 16 provinces and one municipality. Vientiane Municipality contains the capital and has a population of about 450 000, divided between rural and urban areas. The estimated proportion of children under five years of age is 15 % of the total population. A community-based survey was conducted in Vientiane Municipality and Champasak Province in 1986 to estimate morbidity and mortality from Expanded Programme on Immunization (EPI) target diseases and diarrhoeal diseases. In the Municipality, the incidence of diarrhoea was calculated to be 2.1 episodes per child per year, and some 27% of children with diarrhoea were treated with ORS. Vientiane Municipality has the most developed health infrastructure in the country: there are six central hospitals, eight district hospitals and 35 government dispensaries. According to the EPI databank, an estimated 40% of the population lives within three kilometres of a government health facility. There also exists an extensive network of private pharmacies and practitioners which is rapidly expanding. Seven of the eight districts in Vientiane Municipality were selected as the survey area in view of their accessibility and since they have a population large enough for the

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survey. The Municipality is also an area in which the impact of the CDD and ARI programmes is expected to be greatest. 4.2 Sampling design

The survey was conducted from 19 April to 10 May 1993. This period coincides with the beginning of one of the diarrhoea peak seasons. Data were collected through interviews with caretakers of children under five years of age, using the standard WHO cluster sampling technique. The survey focused on children with diarrhoea, cough or difficult breathing in the two weeks preceding the data collection. The sample size was 1etermined according to the procedures described in the WHO Household Survey Manual. The total number of children required in the sample was calculated to be 4000 (40 children per cluster). There are no reliable previous data on diarrhoea and ARI morbidity or careseeking and treatment rates of these conditions. Therefore, the sample size was based on the rough prevalence estimates of 10% for both diarrhoea and pneumonia, and 95% confidence level. The communities in which clusters were located were selected from a comprehensive list containing all the 438 villages in the seven selected districts of Vientiane Municipality. From this sampling frame 100 villages were selected according to "probability proportionate to population size" principle. A village was chosen as the unit in which the clusters were located for logistic reasons and because it is an easily identified administrative and geographical unit (Annex 1: List of selected clusters). Within the villages, the groups of households in which interviews were conducted were identified by means of standard random selection procedures. Each team of surveyors covered one cluster a day and found at least 40 children in a cluster. 4.3 Survey instrument

A draft WHO manual for a combined CDD/ARI household survey was used as a basis for developing the questionnaire and survey procedures. The survey instrument was adapted to take into account local conditions, terminology and national CDD and ARI policies. The survey questionnaire included four sections corresponding to different topics being investigated. Each section was printed on differently colored paper: ( 1) White: This section contains questions asked at all households; questions asked at all households with children under age five about symptoms experienced in the past two weeks; caretaker's knowledge of when to seek care, and how to treat diarrhoea at home; and questions about breast-feeding and fluids given to children under the age of four months. (2) Green: questions about careseeking for cough and drugs used for cough.

1Household survey manual: Diarrhoea case management, morbidity and mortality (CDD/SER/86.2 Rev. 1 (1989), Geneva, Diarrhoeal Diseases Control Programme, World Health Organization, 1989.

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(3) Yellow: questions about careseeking for ANAs (ARI needing assessment, i.e., having fast or difficult breathing), drugs used for these conditions. (4) Pink: questions about treatment of diarrhoea , use of oral rehydration salts (ORS) and recommended home fluids, use of drugs for diarrhoea, and sources of advice for ORS (Annex 2: Survey questionnaire). The translation of the forms was reviewed by a group of staff working with the programmes. In March 1993, the questionnaire was first field-tested in two villages. After required revisions, a second pre-test was carried out at out-patient departments of two hospitals. 4.4 Trainine of supervisors and surveyors

The interviewers were health workers from Mother and Child Health Institute, Institute of Health Education and Vientiane Municipality Health Services. The supervisors were staff from the MCH Institute, National Institute for Hygiene and Epidemiology and Vientiane Municipality Health Services (Annex 3: List of participants). The training of surveyors and supervisors was conducted in two stages at the MCH Institute (Annex 4: Schedule of training): First, a five-day training course in English for ten supervisors was carried out. The training included the following components: thorough question-by-question explanation of the survey instrument, role plays, drills and group discussions on the use of the questionnaire and survey procedures, as well as supervisors' duties. One day was used for field practice and the supervisors also participated in the field practice during surveyor training. During the data collection, close attention was paid to the quality of supervision (Annex 5: Supervisor's checklist). Following the supervisor training, the two national coordinators and two supervisors trained 30 surveyors with a similar schedule. The surveyor training was conducted in Lao and included two days of field practice. 4.5 Analysis of data

The data were analysed using standard software. A Lotus 1-2-3 spreadsheet, developed by the WHO/CDD and ARI programmes, was modified to meet the requirements of this survey protocol. The formula used for the calculation of the limits of precision (95% confidence intervals) of a rate accounts for the non-random component (design effect) due to the cluster sampling procedure (i.e. homogeneity within clusters). 2 Data were entered at the end of each day after the supervisors and coordinators had reviewed and checked the forms for errors and inconsistencies. In this way it was possible to continuously monitor the quality of data. There was practically no need to clean or disregard the data collected, which speaks of their good quality. The monitoring of field procedures and the recording of information during the survey made the data ready for analysis as soon as the survey was finished. Subsequently, the comprehensive survey report was prepared, and preliminary copies of the report, computer printouts and graphics were available to the national CDD and ARI programmes within one week following completion of data collection.

2Bennet S. et al.: "A simplified general method for cluster-sample surveys of health in developing countries", World Health Statistics Quarterly 44(3): 98-106 (1991).

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5. RESULTS

A summary of all the rates obtained with their respective limits of precision is presented in Annex 6. 5.1 5.1.1 Diarrhoeal diseases Diarrhoea prevalence and incidence

A total of 2593 households were surveyed and 4111 children under five years of age were found. Of these children 269 (7%) had diarrhoea on the day of the interview or in the past two weeks (Figure 1). When converted to incidence and adjusted for seasonality, this indicates approximately 1.3 episodes of diarrhoea per child in a year. Fifteen percent of the diarrhoea cases were dysentery.

Figure 1. Two-week prevalences Diarrhoea, cough, ANA*

25 20

15 10 5

COUGH

DIARRHOEA

ANA

1•%

OF CHILDREN

*ANA -Acute respiratory infections needing assessment

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5.1.2

Key CDD programme indicators (a) Correct knowledge of home therapy:

The criteria for this indicator consist of knowing to increase fluids and continue feeding during a diarrhoea episode, as well as knowing at least two reasons of when to take a sick child to a health worker or health facility. Some 20% of caretakers knew at least two reasons for seeking care for diarrhoea, 42% knew they should give more fluids, and 77% knew they should give the same amount as normal, or more food during diarrhoea. However, only 9% of caretakers knew all three rules of correct home care (Figure 2).

Figure 2. Knowledge of home treatment of diarrhoea % 100r---------------------------------------~

40 20

CARESEEKING •

FLUIDS

FEEDING THREE RULES

% OF CARETAKERS

CORRECT KNOWLEDGE = ALL THREE RULES

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(b)

Correct case management:

In slight contrast to the rates obtained in knowledge interviews, 62% of the cases were actually given more fluids during diarrhoea, and 49% of were given the same amount or more food. During an episode of diarrhoea 31% of the children were treated correctly, i.e., were given both increased fluids and continued feeding (Figure 3).

The apparent discrepancy between knowledge and practice may reflect the way questions were asked in the knowledge interview section of the questionnaire: It sometimes seemed difficult for the mothers to understand the knowledge question and distinguish it from what they usually do. The order in which the questions were asked may also have influenced the results: knowledge questions were asked before practice questions.

Figure 3. Diarrhoea home management practices %

100.----------------------------------------,

FLUIDS

BOTH INCREASED FLUIDS AND CONTINUED FEEDING

CONTD.FEEDING

CORRECT MANAGEMENT

OF CASES

(c)

Access to ORS

Access to ORS was measured by a community investigation carried out by the supervisors. This indicator determines if the people in the cluster have a regular supply (government or private provider) of ORS in their community. In Vientiane Municipality 85% of the population was found to have access to ORS. When access to ORS was reported in the cluster, the provider of ORS found was a private pharmacy in 60% and a government provider in 35% of the villages.

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5.1.3

Use of ORS, RHF and ORT

ORS solution was given in 40% of the diarrhoea cases. When ORS was given, the main sources of advice to use it were government health staff (34% of cases) and village health workers (24% of cases). The advice to use ORS was given by drug sellers in 18% and by private practitioners in 15% of cases (Figure 4).

Figure 4. Source of advice to give ORS GOVERNMENT

PHARMACY VILLAGE HW OTHER According to the national COD policy, rice water, coconut water or tea are the recommended home fluids (RHFs). Some 40% of diarrhoea episodes were treated with one or more RHF. The oral rehydration therapy (ORT) use rate was found to be 55%. This rate includes cases given ORS and/or a RHF (Figure 5).

o/o

Figure 5. Oral rehydration rates

100.---------------------------------------

ORS USE •

RHF USE

ORT USE*

o/o OF DIARRHOEA CASES

ORS AND/OR RHF

OAT ORAL REHYDRATION THERAPY RHF = RECOMMENDED HOME FLUID

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5.1.4

Drug use

As many as 88% of the children received one or more drugs for diarrhoea. Multiple drug use was widespread: 24% of the cases received two, 19% three, and 12% more than four different drugs. Fifty-one percent of diarrhoea cases received antibiotics but only 12% were given an antidiarrhoeal drug (Figures 6 and 7). A considerable proportion, 26%, of the drugs given could not be identified. This has an effect on the accuracy of the findings: the actual rates of drug use are likely to be even higher. Since the proportion of dysentery was only 15% of diarrhoea cases, the antibiotic use is clearly excessive. Despite the extensive antibiotic use, only 28% of children with dysentery received an antibiotic considered to be appropriate according to the national

CDD policy (ampicilline, co-trimoxasole or nalidixic acid).

Figure 6. Drug use - Diarrhoea

% 100r-----------------------------------~

88 80 60 40

ANY DRUG

ANTIBIOTIC OF CASES

ANTIDIARRHOEAL

26% OF DRUGS GIVEN COULD NOT BE IDENTIFIED

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Figure 7. Multiple drug use in diarrhoea

% 35,---------~3~2------------------------~

15 10

5 0

NO DRUGS 1 DRUG

2 DRUGS

3 DRUGS 4+ DRUGS

OF CASES

5.2 5.2.1

Acute respiratoty infections Two-week prevalence of ARI:

Some 22% of the children had cough and 3% had pneumonia on the day of the interview or in the past two weeks. 5.2.2 Key ARI programme indicators: (a) Correct knowledge of when to seek care:

In order to count as having correct knowledge, the caretaker had to mention either fast or difficult breathing, since these are the key signs to recognize in pneumonia. "Abnormal breathing" was added as a local term referring to breathing difficulties. Using this standard, 18% of caretakers knew when to seek care for a child having illness with cough. Specifically, 7% of caretakers knew that fast breathing, 10% that difficult breathing and 2% that abnormal breathing was a reason to seek care (Figure 8). Fever was mentioned as a reason to seek care for a child with cough by 38% of the caretakers.

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Figure 8. Care-seeking knowledge - ARI

% 100~------------------------------------~

80 60 40

-.----.

. . .

--.. . -. . . -------.

- .

----. . -. -. . -. . . -. . -.

. .

----.-. . --- . ---

...

-. - - . . . . - ---

- - . ---

...

--.

. . .

. --. . -. .

. .

--- -

. . .

- . . .

. . .

. . -. . .

. .

. . --- - . . . . . - .

. . . . . - - .

- - . . . . . . . . . - - ...... - .

..... - -

.. - . . .

...... .

- - .

-- .... - .. - .

BREATHING - .

- .. --

.. -

-. -

- - ..

- ....

- .. - . . . . . . . . . . . . .18 - . --

. - - .

2 0 FAST DIFFICULT ABNORMAL CORRECT KNOWLEDGE*

• % OF CARETAKERS * CARETAKER MENTIONS EITHER FAST, DIFFICULT OR ABNORMAL BREATHING

(b)

Careseeking from appropriate providers for ARI needing assessment (ANA)

ANAs are cases of acute respiratory infection needing assessment, i.e., having fast or difficult breathing. An appropriate provider is defined as one who has been trained in standard ARI case management and supplied with appropriate antibiotics, or other providers expected to deliver adequate ARI case management. In this survey government hospitals and health centres were defmed as appropriate providers. After recognizing that the child had breathing difficulties, the caretakers sought care from appropriate health care providers in 33% of these cases. In practically all of the cases this was also the first provider they went to.

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Care was sought from pharmacies and private practitioners in 49% of ANA cases. When a child had cough 62% of caretakers sought care from either pharmacies or private practitioners, and only 16% went to government facilities (Figure 9). Eighteen percent went to traditional healers in case of ANA.

Figure 9. Careseeking for ARI PRIVATE RNMENT LLAGE HW PHARMACY OTHER VILLAGE HW

GOVERNMENT**

ANA* * ARI NEEDING ASSESSMENT ** APPROPRIATE PROVIDER 5.2.3 Drug use (a) Antibiotic use for cough:

COUGH

It was found that 56% of children with cough were given an antibiotic. This provides an estimate of inappropriate use of antibiotics in children with no signs of pneumonia.

(b)

Harmful drug use for cough or ANA

Drugs were defined as harmful on the basis of the following criteria: Recommendations of the ARI programme Drugs containing the following ingredients: codeine, alcohol, high dose antihistamines, steroids, topical anesthetic sprays, topical nasal decongestants in infants, phenylephrine, phenylpropanolamine, atropine, toxic expectorants. If a drug contained more than one of the following potentially harmful components it was considered harmful: dextromethorphan, low dose antihistamines, mucolytics, pseudoephedrine.

All injections for cough were considered harmful. (Annex 7: List of drug classifications)

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According to these criteria, 25% of children with cough or ANA were given a harmful drug. Another 25% of drugs given for cough or ANA could not be identified. Since unidentified drugs were not counted in the numerator of antibiotic use for cough and harmful drug use rates, the rates for inappropriate drug use are probably underestimates. 5.3 Breast-feeding

A high proportion, 91%, of children under four months old were breast-fed in the last 24 hours. However, only 8% were exclusively and 34% predominantly breast-fed (Figure 10). As an indicator of infant formula use, some 39% of the children were bottlefed.

Figure 10. Breast-feeding practices children under 4 months

BREASTFED 91%

PREDOMINANTLY 34%

NOT BR 9%

PARTIALLY 58%

ALL CHILDREN

BREASTFED CHILDREN

6. DISCUSSION

It must be emphasized that the data collected are only representative of Vientiane Municipality, not the entire country. The situation in the Municipality probably represents a best-case scenario: the CDD and ARI programmes in this area are the most developed in the country. Since significant differences are highly likely to exist between the Municipality and rest of the country, further surveys are needed to collect data from different areas to make nationwide estimates.

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6.1

Annual diarrhoea incidence and two-week ARI prevalence

The annual incidence of 1.3 episodes of diarrhoea per child per year found in this study is lower than the previous estimate of 2.1 episodes per child per year from 1986. Moreover, the prevalence rate of 7% is relatively low considering the timing of the survey, which coincided with the start of diarrhoea season. To determine whether there has been a true decrease in the incidence rate or not will require further studies. A true decrease might be a reflection of the significant improvements in socio-economic conditions, that have taken place in the survey area over the past seven years. The two-week prevalence figures for cough (22%) and pneumonia (3%) are in line with what was expected, since it was not the peak season for pneumonia. No previous community-based data are available for comparison of the ARI frequencies. 6.2 Care-seekin~

behaviour

The characteristics of care-seeking behaviour were found to be very similar in both diseases: Regardless of whether their child had diarrhoea or ARI, the mothers were not very well aware of when they should seek care from a health care provider. Few caretakers knew which signs to look for in the sick child. Only about one-fifth of the mothers had correct knowledge of when to seek care for a child with diarrhoea or ARI. When a child has an episode of diarrhoea each of the three rules of home care play an important role in preventing dehydration and death. In contrast, there is no evide~ce to suggest that home treatment of coughs and colds prevents progression to pneumonia. Therefore, in case of possible pneumonia, the ARI programme emphasizes prompt and appropriate care-seeking. When a child had a cough, care was sought in the majority of cases from pharmacies and private practitioners. Similarly, when a child had ARI needing assessment, almost half of the cases went to seek care from the private sector. Approximately one-third of the ANA cases went to appropriate providers first after development of breathing difficulties, which can mean significant delay in the rest of the cases. Both CDD and ARI programmes clearly need to focus on informing caretakers about when to take their children to health care providers. This could be achieved by giving more emphasis on the communication component during training courses and by developing country-specific, appropriate communication messages. In particular, the ARI home care instructions should be carefully adapted to the community and communicated directly to families in health facilities or in the community. In view of the major role played by the private drug sellers and practitioners, appropriate providers for ANAs cannot continue to be only restricted to the government sector. They must be expanded to include private practitioners as well. Strategies should be developed in order to reach them with correct information and training. A situation analysis and a country assessment are required to investigate the feasibility of different approaches in this difficult task.

3childhood Pneumonia: Strategies to meet the Challenge". Proceedings of the First International Consultation on the Control of Acute Respiratory Infections (ICCARI), Washington D.C., U.S.A., December 1991. London, U.K., AHRTAG, 1992.

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6.3

Home mana&ement of diarrhoea

The high increased fluid rate is a promising finding. However, this cannot be entirely attributed to programme efforts because no major communication activities have taken place, but rather may mainly represent a baseline level of mothers' usual behaviour. Almost half of the children received less food. This finding reinforces the significance on focusing communication messages on the importance of continued feeding in addition to improving mothers' knowledge of when to seek care. Considering the early stage of the CDD programme, the promotion of ORS has been successful. The relatively high ORS and ORT use rates are an encouraging finding. However, it should be noted that the survey did not give information on how ORS was prepared, i.e., the proportion of caretakers who prepared ORS correctly. Moreover, the very high ORS access rate cannot be taken as indicative of the rest of the country, because a similar extensive network of private pharmacies and health facilities does not exist in other provinces. Since the findings imply that drug sellers tend to advise mothers to use drugs instead of ORS, focusing on improving their prescribing practices will be an important strategy in further promotion of 0 RS. ORS has received much attention in the past but there have been no major efforts to promote recommended home fluids. The potential of using recommended home fluids in the prevention of dehydration is therefore probably still underutilized. Since RHF's are cost-effective, the home fluids seem to be accepted and there seems to be no tradition to restrict fluids during a diarrhoea episode, it should be feasible to reinforce the promotion ofRHFs. Education and information on treatment of dysentery should receive more attention since there seems to be no notion among caretakers that dysentery should be treated differently from watery diarrhoea. 6.4 Drut: use

The extremely high rates of unnecessary drug use in treating diarrhoea and ARI indicate a serious problem in home management. They also indicate a problem in the quality of care provided by both public and private health care sectors. It is well established that most drug use for diarrhoea and antibiotic use for cough is inappropriate. While more than half of both diarrhoea and cough cases received an antibiotic, antidiarrhoeal use was not very common. It appears that antibiotics are being regarded as a standard solution to various health problems. It is also alarming that a quarter of ARI cases received a drug classified as harmful.

Furthermore, the excessive drug use also indicates that families are spending considerable sums of money on drugs that are not only unnecessary but often harmful. Both CDD and ARI programmes should give high priority to efforts to reduce inappropriate and harmful drug use. Development of a training package for drug sellers should be considered. Since many factors influence regulation of pharmaceuticals, collaboration with other programmes, such as the Essential Drugs Programme, is crucial in this issue.

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6.5

Breast-feedin~

In children under four months of age, breast-feeding is a common practice but exclusive breast-feeding is rare. It is worth noting that the proportion of children who were bottlefed is 39%. This is likely to increase owing to the persistent marketing efforts of infant formula manufacturers. The issues of supporting breast-feeding and legislation concerning infant formula should be addressed promptly by collaborative efforts. Health workers should be trained in breast-feeding counselling skills. The data collected should be communicated to organizations involved in breast-feeding promotion and the responsibilities for coordinating breast-feeding activities should be clarified. 6.6 Care for diarrhoea and acute respiratorv infections from the health system

Even though the study was not designed to assess the quality of health care provided, the fmdings imply that the quality of care from both private and public sector needs to be improved. This is especially the case with drug prescribing practices. The fmdings also confirm the low utilization of government health services. A possible reason for this may be the lack of appropriate drugs and supplies these facilities often face. A facility-based assessment is required to evaluate the quality of diarrhoea and ARI case management at hospitals and health centres.

7. CONCLUSION

Disease control programmes require different types of information at various stages of the programme. At the early stage of programme development data are needed on the extent of the target diseases for effective planning. By conducting this study a baseline was established, against which changes in diarrhoea and ARI morbidity and major programme indicators can later be measured. A key issue is that the information collected should be used in further programme development, and the findings of the survey should result in changes in programme planning and implementation. Integrated evaluation of the CDD and ARI programmes followed logically the combined training courses they have conducted. It also demonstrated an effective way to conserve personnel and other resources within the MCH Institute and further encouraged programme integration. The objective to strengthen national technical capabilities was successfully accomplished, and the MCH Institute now has a team capable of conducting similar surveys in the future.

- 17 -

ANNEX 1

~1u~u1u ~ §nr.Ban c~a~1e1m~n NAME OF THE CLUSTER VILLAGES FOR THE SU~V;:Y:

~U~1J -C!.USTER NO.

~1U~U

~1U~UU~2 !

1 2 3 4 5 6 7

9 10

'' :2

_. 1 •

15 .o 1 -

17 18 19

mJn1c§au No.OF HOUSES u.~um:uB I CKANTFJGUOREE DISTRICT: 12 V. 276 ~e:m~1n n1J I SISAWATH 202 Oieftcm~a I KATSADEE NEVA 2~moJcm~g I KOUALUANG NEVA 384 amau I SEEHOME 295 284 ~~JDu iJ I"XIENG YEUN m1u,en I HI-SOK 312 297 e:::r.o•iJ I XA-VANG 330 iJ~~JU1J I THONGSANGNANG 233 '~ue:mo1J I PHONSAVANG 283 nJU1~IDU I DONGPALA? 282 GiJ~u~1~n I THONGKANK~~ TAI 285 mJ~u I THONG TOUM U1~1UU1Q1INAXAITHONG DISTRICT:B v. u1n~sn I PAK liATT 200 1J1111UU1QJ"'tn I NAXAITHONG T.>.I 21i ' . u'Ju1J i NAYANG _oo m~2o I HOUA KOUA 205 ~h~ "'tn I ELY TY 155 u1msu I NA THON 37 twuuoJ I PHOL MOUANG 158 1J1~1 I NA GNA 194 NAME OF THE VILLAGES

mJmnn TOT~L

?0?.!

1387 1312 2153 1604 1333 1575 1907 1 ·~cs 1.206

1786 1~i0

1570 12.05 12.90 a·- 0 ~

1!51 955 666

1059 612

21 22 23 24 25 26 2i 28 29 30 31 32 33

ngumuu I DONE NOUN U11J~I1 I BAN XY tran<tmil I KOK GNY ~1J~ ! XANG KOU nJtnn I DONGDOK a 51~ I XEEVELY U~UU1 I BAN NA ~1Cl£l01CJ I LAT KOIE twu"'t~ I PHOL XY m1nan~1 I TKA DOK KHAM ~eJaEiu I SAING OUDOH iiiJilJ I THONG KANG Gi~~oJ I HOUA XIENG

u."t~m1!'1

X? TF.A NEE

DISTRICT:21 480 169

v. 1487 1096 477 1367 1667 1594 2457 1751 1193

. ..

79 242 498 255 408 288 180 53 117 265 327

32 586 1713 2042

- l8 -

Annex 1

34 35 36 37 38 39 40 41

U"':Jgu I liA LOHE O:)~~"'U I DONG KOAI l!lllll:J<;i~.S:J INONG KOU VICNG lJ"'Vl'llJ I NA TliAM c:5un~ciJ'l I VEUNKAEAO ll"'!:l'l I NA XA uc~n I BO LAK lJ"'Cl"'lJ I NAT AN U.III"'Og'lU~Il'l

::a a 990 1~19

150 173

214 54 96

12:57 225 450 c, ---0 1

314

123

7S2

HATXAI?HONG DISTR: 15 V. 294

42 _., A." 44

latl'lll1rl I SEE TP..AN TAI UI'Ht2n I THA MI:\. ~ucw 0 I TliiN ?!iiA ! Ill 'Hl ii!J ll '1

1457 SH 1.3~/

214

z.;z lii

45 'o .. A.- I

48 49 50 51 52 53 54

55 56

I F_>cT r:_;~iSA u'tll I BO-O lll'lOOilncd\~ I HATDOKK.::O iluat:J::J I SOM-VANG ilu::J:::nun I SOMSANOUK ' Ul'lU~:J I THA MO.~'fG fi:)'lw2 I DONG ?EOS.::E m 'lC f\g I THA DEUA tn'lw:: I TF...A ?F..A mu1ns.:;n I HAK E!:>.. 'tnuc:mlJg I DONF. !!EUA ~~'lUCrc1:J I KOIE DAING u.1gC2ClD'l I XAYSETTHA Vl'lCliD~:J1L'1 I T~.T LOUANG TAI Vl'lOID~::lC:111~9 I TEATLOUANG NEUA 59:J~n I HONG KA~~ !3!:J~Illl I SEESA..'fGVONE DIST.~

95.;.

126 11i

5::9

428 322 219 267 283 215 :!.70 122 244 17 V. 259 292 39i

622 2<:56

, --.

-O:::"l.

12~5

.1..:.:--s 1533 1.273

1C1.6

535 1 --:::~ ~

- -

57 58 59 60 61 62 63

2.;52

'twumuc:m09 I ?HOLT~>cN NEUA IIIU9:JUillJ I NONG BONE 'twuc~~c:mBs I PHOLKAING NEUA ~euu::uc:mue I CHOMMANEE NEUA

257 289 233 154 266

·!

2051 2473 1233 , 1 71 -~--

64 65 66

67 68 69 70 71

~lluu::0n'l:J I CHOMHANY KANG U'l't~ I NA XY 'tuu::l::lll~'l:J I NOL SAVANG c:B9:Ju9u I MEUANG NOIE U'l~~'lu'tn I NA KOIE TAY 'twutnB:J I PHOLTHONG ~::l:J::l:lll~'l:J I SENGSAVANG

1459 1013

182 369 129 238 127 82 130

ZZ51 95i

H08 lZ43 ! .

507 100ii

- 19 -

Annex 1

sg~~W~U

'73

I HONG SOU?HAP 'uu~:m~u I NOLSAVANZ

226 43

1354 410

75 76

77 78 79 80 81 82 83 84 85 !,

u.~'tno I SE!-KOT DISTR:: 13 V. I VAT TAY THON lH ~UIJ~ I OUP MOUNG 181. ~q~ucmflg I SEET~;N N!UA 275 111UQ~U~WQ~cmfl9/NONG BOUATHONG 311 'WU~'l I PHOL KnAM 99 n~u~~n I DONG NA SOK 252 ~n1nffi~

1112 1093 15:Z3

6C2

IIIUQ~~n~cm~Q I NONG TAING NEUA

1603

252

a.; 87

U%ID"'l I NALAO la1£1,CIIli'la I SZEKAY TEOl!G NEUA cBa~~"'l ~~ I HEUANG VA THONG ~~uc§g~m~ / SEE BOUANH!UANG dl"'l:J~:J I KAO LEAD n~oma~ I TAD THONG 'wus:mO'lO I PHOLSAVAD

153 219 258 173

11 iO 1.054 1249 1654

185 106

1331 625

88 89 90 91 92 93 94 95 96

c;ii'ltJQ(l I i<AO GNOD 2: w"'luma~n 'l~ I SA?H..;NT:iONG KANG IIIUQ:).>;\u I NONG CH..;;N lii~w'lUWQ~ITHON PF..ANTH0!1G w:'tw I PHAPHO w:1ll I PHAXAY

236 154 396

-'.!.0-J

... 1

.......

. .

1011.

3094 -~1"7

355 202

?""-

1329 !.Z~7

'wu2:111~U1n1PHOLSAVAN

TAY

174 145 31 -o 330 312 112

lii~n1~ I THON KANG

S.25 -.:.:.~

?---

S7 98 99 100

ui'lwi::J"'lU"tlliTHA PHALAN XAY 'utJ-\cD"'l~~ I PHOL PA?AO TnONG :~'i~c;m5u I Si\NG VEUIE '19uci:in1fl I CHOHPHET TAY "'twu::l::mo-i::J I PHOL SAVANG

2299

2C73

e.::. 1805

282 133

SiO

- 21 -

ANNEX 2

Il"!CU~:

~u~u: -----------1 ~-.~

f.t""

5um

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------------

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LINE

TOTAL u~:;;:.."sou ~ ~ f'\

I I I fl

1 . ilttina"JQ. ilr.::'~ 5

fl ~?

I I I I I I III Y: II I I I I I I I I I I

2. -=i'11JOU:ME'1l!iJl;;:C1 5

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iltCins"lf! u~ 5 tl ~? /

2. o:\'11.r.ll.1.:Ma~'m"JC"l 5 tl

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ilteirn;"lf! ill~ 5 fl jp

I I

2. o:\'lwutCine~~o:o 5 fl

I I I I I I I ~

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2. <i'1J.r.)U;Cins~;;:C1 5

I I I I I

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I Page Totals

1~ 2~

- 22 -

Annex 2

~~"1U: 5u~ I I

~~S.:J:i.,g:t~C1: ~!JnoC'ln"1:

-----

. J.,cfk§au ~cnn ~

--------TOTAL

I> c ~

r•··•·•·••.}> .

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· · · · •·• • •:· · · · · ~ec;fl'1 J\~ ·••''·••-•••·· '_· [> <' > >I } I\ ... :... _

~···· I

····.'·- '··'·:·:· I ....... /· : '

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f:;ffi;~~~r(_- :·:-:.:;:.-: . < • 'lmt]'llJ! 8'1n'1u~~n'l~cuuveuuu ·~

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m'lnun~ ~vsuuum'l ~~~d~n? C1 = nun~ • !J : \~~c~n • B=~U::J 6 'lmc~enmu'lDc ~v~ ai-..:::Cie~'l~ ~";Jud'in. tj"miiic~en

!JC1

= iib::m~,tJS=US,

tJ!

~mC'lcmu.,::: ~~~u0:

u =U;), ~

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=C~8!), 2 = 2ii0

[1!

lt]BnmB~l

•

1 B"1n'1)J;II> l 1\Bl 9:

me~{J"l tj.,Cis~n'1u, 'liiJr.i.,u\tlm'1c~v\a mu.,lilmib

7 ~.,6C1e~n.,u'l~c~v~. 'lffi~'l~jj.,fi~.,;sucn~~\tl.

tt:::l::::2iiuJJ"1C!Jc§au i:ieunov~cnn'l~. W'lviD~fliai.,u\Clfu.J'lllinu.,fi~.,;sucnnO!nEi'ubUl, u;~m.i.,u\tJ~lil s 2

- 23 -

Annex 2

~~'lU: ~'C.in~cm'1: u

~~:S:)~'11J.l~C1: - - - - ----------

-----

~mtj"ll.J6"1tj"ll.JCgJ'lfi nuqc;_u.;JcC1ne'1~m~rl 5 tJ ~ll\n:JC~U 1Hl~ml'bu. 'Cl~~:J;;l..,~u ei..,;;l..,w..,C1 QC1U.~cCin~m~:J u u u TOTAL

~"1ctlcwu 8

C1"ll.JEl~.,JJgC1,mu2e:Jc"'"1

• c~;J"1&1=t,ndlu?e. ~neJ~uDe'ln"1u~C1&.! ~:)'>~::w..,\tJuu

•

lx···.··>···

u.we1 ID\tJ1s:Jmu? ~m;J"1~neuJJ'1Ce:) ~:)::uJ..,v ( Vl~~ e"1n"lu~neuu..,

a U1"1t.J'l"'b b m"1v7'>~Bnunn::R(m..,v?'>~~C1l

I I

c d

I I i

I I ....

~:iMJJ"1C1Ru

•••••••••••••••••• •••••

e C~UID'lt.JgUIS"ln"lLmun f

j··.····· ··········. ···. . .

I ' I

D'•2 ~ m..,v~"'D~o:JCi:J

I I I········.···· l .·.•·· >

RurfuJ ~\~~ e'ln"1u~~gu

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us ~n~nn'l"'~(~~~eu u

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......

EJo"llJ5u~~nne:Jt1e'1n"1u

•

IDm"1V~"1Gu~~en~~nc~ul

- 24 -

Annex 2

J"'cflc~u 10

I I I I I I I I I r )r(

I I

t1"11JElO"'lJgC1cmu~a:)'"'"1

U.OO ffi\tJ\s:>mlJ? '?m;J"10t113UlJ'1CI3~ ~~l!UJ"'fJ ( /J?= a'1n"1u~neuu"'

• coz"'OI;mt']anma~. ;:mEloul:la"'n"1u?c:fuJ ~~"':::W"'ttltJu • •

•

~"''fJCiJuJ"'[l'1t1C oie S"''n;Ji)ufln ~oJ.,

I. ( .· } .. ·..···· .··

> ·. .

I : .:.·

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·.··•.··:r.•.

m.; l:kaen'?ue"'"iu a"'n"'u68gu;a"''n"'umungu I

·.... <,,·: . ~

.·. · ·....· I .· .

.. •· I .··..

·.... ·. I <

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)

us • 11

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·•··: .•. :{

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~nonn"''"''::: ! i/l ?::lu'eum".l.. &!~ ~~n~e~ (2 e'1n'1U ID no"''nu'?~en~aC),~lJ

- 25 -

Annex 2

~~')lJ: ("'!- . . . . .

............. .

i1(J;;):J:;,' lur.:JC1: :-............ . '1. ~i:ln~Cln'l: ............. . •

7mt]"1lJEi'lt'J"1lJC$.,Ou., ~~u.;;)cnn m~n 5 f) ~rl!n::JID:JEl'lc~u~llcrin m~n 5 f)

u<J7~mii:JU.t'J~~:J ::;"':su Ei"1:::i<JtJ"1(1 ~~u.;;)cnn ~mfh • ~

TOTAL

12 c~;;)'lakrinqemne:J, '"''~

M+

.,~7mcrinRuJ"1rn~evrio., dh~J? ~Rucai"1Crl'l, ~

fuJw<Jvn~"'' fi.,?

us= us •

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13 c~::J"1~cnnqenma:J.

c.,., )<

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11, 12. 13 lir'IW

.....

ro"1lJSt!~~nCie~. u

- 26 -

Annex 2 U'l~u~=---'o' n <'>~

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5ual

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...

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~.,5u~C'ingu::J?ud~aufi ~., bmm~"ltJ\uc~au§j;?mu'

- 27 -

Annex 2

U"lCU~:.

';'

_ _ __ I

~;'1U:

-----~

~q5~~~~~= ~.

'Cmt]"ll.lei'1t]"ll.lUnl);Jnucnn0ID9"ln'1u\ a 'Cut:;JEJ::: 2 e'101~CJ'1UU'1U

~'C.in~nn '1:

--------------. TOTAL

~~::J~nenc~sl'UJ"lU.~::J "1"lnei'1tJ"ll.l~ o. ~"l5uc~v~ 0 ;) • J"lcecsau I I I .

i : . .

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C;)::J"11J1'1;)/1J'1::J ........... lle"lmlJ\e m"lu\~w"l\r.Jt);)

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I 21

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t.· ·••••••·•••·••••••••••••••••••••••••••••· . ·< !

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22.

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m"lu\~w"l\t!u;:v~::r ~ 'CU1UUJ'1V ( ~

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uou·nc.;?

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Annex 2

- 28 -

~~'1U:

----TOT~L

:;h:5'urJn::Jom u 25 'C01:22iu~ !.!.:J::~::Bm.J~. 11~u ;;) w ~ ~

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02 03

:I I

04 05 06 07 08

il :1 I !J

I i

09 010 011 012 013 014 015 Total

i' 'I

I i [I

- 29 -

Annex 2

~u~u:

...

___________

5u!il

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----------TOTAL ~,,.·,·<?;:;::3'-

J~d:kwu ~cnn 27 28a 28b

: ..:-::-., i c.,

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f) l..iCStlU UL ,;l,:o::E1~r)~UE\ 29 '!"1l.JCnnCJ.,UI;n u , ~ n ~ ~~ '"'

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ml.J'1EJ c 31

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n B d ~\~ "':::l.Jn"\U CE\"l:::CU::J; t]'1Wn C'\

8ucl"laue1:::~'1v

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V~ 25 32 n'1U8Cfl")::: ~:::Um'1UOUEh~fJS~ u •

- 30 -

Annex 2 ';' U"'CU~

" :____

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------------

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TOTAL

rr== I

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Annex 2 ~u'1u:

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- 34 -

Annex 2

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- 35 -

Annex 2

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- 38 -

Annex 2 CDD/ARI HOUSEHOLD SURVEY QUESTIONNAIRE

Lao People's Democratic Republic. May 1993

CLUSTER NUMBER: DATE:

NAME OF-COMMUNITY: SURVEYOR: SUPERVISOR :

ASK AT EVERY HOUSEHOLD. RECORD ANSWERS BELOW.

D I

1.Are there any children less than 5 years old, including newborns, living in this house? YES = Y NO = N If NO, enter 0 by question 2 and go to the next household. 2.How many children less than five years old live in this Record the number of children less than 5 years old. LINE house~

USE A COLUMN FOR EVERY HOUSEHOLD VISITED

TOTAL

Household Serial Number 1. Household with children < 5 years~

I I I

lv: I I ' I

Number of children < 5 years in household ·~

I I -

Household Serial Number 1. Household with children < 5 years:> Number of children < 5 years in household

IY:

I I I I

Household Serial Number 1. Household with children < 5 years? Number of children < 5 years 1n household

Household Serial Number 1. Household with children < 5 household Households with children < 5 years to revisit: 1. years~

I Y:

2. Number of children < 5 years in

I I

2. 3. Page Totals 1.

II II

- 39 -

Annex 2 CLUSTER NUMBER: DATE: I I NAME OF COMMUNITY: SURVEYOR:

COMPLETE ONE COLUMN FOR EACH CHILO UNDER AGE 5.

D TOiAL

Household Serial Number Child's Name 4 I ! I

lr-~-----------.-----------+-+_,~~r-+-4-~~~,~

Please tell me if dysentery {name) has had any of ~~~~~-------t--i---r--t--4---r--4--~--~,~----~1 these symptoms or fever \ problems in the last 2 weeks, including t----------t---i--+-+-t---J--t-+--:l.f----11 today. Has (name) t-il_ln_e_s_s_w_it_h_c_o_u~g~h---+-+-t--i--t---1--t--f-~if----il had ... ? I r-~~----~_,--+--r~--~~-4--+-~~--~1 sore throat I

----

Prompt for each listed symptom. Tick if yes.

watery diarrhoea "fast breathing

J--'-~------+--!--t-+-+---1i--t-+-+---ll

If no shaded symptoms, no coloured pages are needed; skip to 7.

"'difficult breathing "'abnormal breathing

I I Both

lf----+-------L~-+-+-+--+----+--+--+----+-..::______,1 5 If "' symptom(sJ ticked, ask: Was/were "' symptom(sJ due to a problem in

the chest or a blocked nose' C = Chest N = Nose OK = Does not know

C, N

Other

If any "C" or "OK," leave the tick by the * symptom(s). Otherwise. cross out the tick by the * symptom(s). This child does not have fast or difficult breathing due to a chest problem.

Choose what coloured pages this child needs, if any, based on order of priority below. Record: P = Pink

G: Y: P:

Y = Yellow G = Green = Diarrhoea = • symptoms = Cough

or dysentery

If no coloured pages needed, complete t!Jis page for next chl'ld in household. If child needs coloured pages, go to first coloured page and write household number and name of child. When you have completed this page for every child in household, go to question 8.

- 40 -

Annex 2 CLUSTER NUMBER: DATE: NAME OF COMMUNITY:

SURVEYOR: SUPERVISOR : ASK THESE QUESTIONS TO ONE CARETAKER AT EVERY HOUSEHOLD WITH A CHILO UNDER AGE 5. USE ONE COLUMN FOR EVERY CARETAKER INTERVIEWED. Household Serial Number

;o iAL

Children commonly have ollnesses with cough. Wh3n should you take a child with cough to a health wori<er or health facility? Do not prompt. Tick all signs mentioned. a. !list breathing b. difficult breathing c. abnormal breathing d. unable to drink e. getting sicker/very sick f.

I I I

I I

fever noisy breathing

I I l---

I I

not eating/drinking well not getting better

I I I

I I !

any other sign 1.11 does not know I

I I

9. 10

The supervisor will tick for corr~cr knowledge. I 1 or more signs in bold box)

Another common illness is diarrhoaa. When should you take a child with diarrhoea to a health worker ~r caalth facility? Do nor prompt. Tick all signs mentioned.

r I

many(4-6) water•/ stools repeated(> 3 times) vomiting marked thirst not eating/drinking well fever blood in stool not getting better/getttng sicker

I I

I any other sign (,/) does not know : 11. I I

The supervisor will tick for correct knowledge. (2 or more signs in bold box}

- 41 -

Annex 2

CLUSTER NUMBER: DATE:

NAME OF COMMUNITY: SURVEYOR: SUPERVISOR :

ASK THESE QUESTIONS TO ONE CARETAKER AT EVERY HOUSEHOLD WITH A CHILD UNDER AGE 5. USE ONE COLUMN FOR EACH CARETAKER INTERVIEWED. TO TA

Household serial number

12.

When a child has diarrhoea, should the child be given less, about the same, or more fluids 7

I M: I I I I

L = Less, none S = About the same M =More DK = Doesn't know

I I

I S +M:

13.

When a child has diarrhoea, should the child be given less, about the same, or more food?

L = Less, none S = About the same M =More DK = Doesn't know

14.

If there is a child under age 4 months (0-3 months) in the household, go to next page. If there are no children under age 4 months, go to any coloured sections needed for . children in this household. If no coloured sections are needed, go to the next household. The supervisor will tick for correct knowledge in 11, 12, and 13.

i 15. I I I I I

- 42 -

Annex 2

CLUSTER NUMBER: DATE:

NAME OF COMMUNITY:

SURVEYOR: SUPERVISOR : COMPLETE ONE COLUMN FOR EACH CHILD UNDER AGE 4 months (0-3 MONTHS I. Household serial number Child's name

,LJ ;

16.

Since this time yesterday. has !name) been breast-fed' Y; Yes N; No If NO, skip to question 18. Since this time yesterday, did (name) receive ... 7 Prompt for each item. Tick if received. a. Vitamins. m;neral supplements, medicine b. Plain water c. Sweetened or flavoured water d. Fruit juice e. Tea or infusion

I ;

17.

w I

' I

I I I I

I I ' I ! !

I I

I I '

f. ORS solution g.lnfant formula h. Tinned. powdered, or fresh milk I.

' ! ' i

I I I

I I

!\ ;

Solid or semi-solid food Bottled soft drinks

I i! ''

j. k. Other fluids (specify)

Iii .1

: ' : '

'' I

18.

Since this time yesterday. did (name) drink anything from a bottle with a nipple/teat? Y; Yes N; No

J 1 I i

I i

! I

19.

I ' I When you have asked the above questions for each child under age 4 monchs, go to any~ coloured sections needed for children in this household. If no coloured sections are , needed, go on to the next household. -~

- 43 -

Annex 2 CLUSTER NUMBER: DATE: NAME OF COMMUNITY: SURVEYOR: SUPERVISOR :

ASK THESE QUESTIONS FOR CHILDREN WITH COUGH IN THE LAST 2 WEEKS WHO WERE SELECTED IN QUESTION 6 FOR GREEN PAGES. TOTAL Household Serial Number Child's Name 20. Did you seek care outside the home for (name) when he/she had this illness with cough? Y =YES N =NO If NO, go to question 22. 21. Where or from whom did you seek care? Tick each provider mentioned. Prompt only for traditional healers. a. Traditional healer Monk

c. Government hospital or health .center d.

,LJ I

Village health-worker TBA's

including

f. g. h.

Private practitioner /clinic LWU -member Pharmacy, drug seller, store, market Relative or friend (outside household) Other provider <specify)

7 green

- 44 -

Annex 2 CLUSTER NUMBER: DATE: NAME OF COMMUNITY: SURVEYOR: SUPERVISOR

COMPLETE ONE COLUMN FOR EACH CHILD WITH COUGH IN THE LAST 2 WEEKS TOTAL Household Senal Number I

Child's name

I I I I

Was (name) given any drugs for th1s 1ilness with cough? (pills, syrups, capsules. injections) N =No Y =Yes If NO, go to question 29. How many types of different drugs was (name) given? Record the number.

I I

Record the names of drugs used in table below and the range /e.g., D ,-0 3 ).

FOR SUPERVISOR

Record the names and forms of the drugs. If unknown, record ..unknown and form. (pill, syrup, capsule or iniection)

har mful dru<J

antib1 otic

cou ghre med y

trad med

unk now n

other

anti mala rial

anti as thmat IC

antp yreti c

, o, o, o. o, o, 07

I I

I I I il i I I

o. o, o,. o, o,, D,

! I

o,. D,. Total

' :

- 45 -

Annex 2

CLUSTER NUMBER: DATE:

NAME OF COMMUNITY: SURVEYOR: SUPERVISOR:

COMPLETE ONE COLUMN FOR EACH CHILD WITH COUGH IN THE LAST 2 WEEKS.

TOTAL Household Serial Number Child's Name

29.

If there is another child in the household for whom you recorded a coloured section in question 6, go to that coloured section. If there are no more children who needed coloured sections, go to the next household. The analyst will determine if the child was given an antibiotic for the cough. Tick if an antibiotic was given. The analyst will determine if the child was given a harmful drug. Tick if a harmful drug was given. The analyst will count the number of unknown drugs listed in 25.

30.

: :

31.

32.

9 green

- 46 -

Annex 2 · CLUSTER NUMBER: NAME OF COMMUNITY: SURVEYOR: SUPERVISOR: ASK THESE QUESTIONS FOR CHILDREN WITH SYMPTOMS IN THE LAST 2 WEEKS WHO WERE SELECTED IN QUESTION 6 FOR YELLOW PAGES. TOTAL

DATE:

Household Serial Number Child's Name

Did you seek care outside the home when (name) developed fast or difficult breathing (or ernie term)? If NO, go ro question Y =YES N =NO

38. 34 Where or from whom did you seek care? Tick each provider mentioned. Prompt only for traditional healers. a. Traditional healer Monk I

I I

*c. Government hospital *ct. Government health centre or clinic *e. Community-based practitioner associated with the health system. including TBA's

I I

*t. g. h. I.

I Private practitioner/clinic Pharmacy, drug seller, store, market Relative or friend (outside household) Other provider (specify)

Which provider did you go to first after (name) developed fast, difficult or abnormal breathing. Circle this tick.

I 36. I I

: 137. I I I

Supervisor will tick if child went to any provider (i.e., tick in bold box above).

Supervisor will tick if caretaker went to • provider first.

Iy~l?w I

- 47 -

Annex 2 CLU::lTER NUMt::lt:H: NAIVIt Ur

COMMUNITY: DATE:

COMPLETE ONE COLUMN FOR EACH CHILD WITH Household Senal Number Child's name

SURVEYOR: SUPERVISOR: SYMPTOMS IN LAST 2 WEEKSTAL

Was (name) given any drugs for the illness with fast/difficult breathing (or ernie term)? (pills. sy. ups, capsules, injections) Y= Yes N =No If NO, go to question 45. .

How many types of different drugs was !name) given? Record the number. Record the names of drugs used in table bela w and the range

Ex 01-03

FOR SUPERVISOR

Record the names and forms of rhe drugs. If unknown. record "unknown" and form. /pill, syrup, capsule or injection)

HAA MFU L ORU G

ANTI BlOT!

cou GHR EME DY

TAAO MED

UNK NO WN

OTHE

ANTI AST HMA TIC

ANTI MALA RIAL

ANT PYA ETIC

I I I I I

i I I

o, o, o. o, o, 07

I I I I I '

' !

o, D, D,o D, D,, D, D,.

I i I

I I I

o,. TOTAL

11 yellow

- 48 -

Annex 2

CLUSTER NUMBER: DATE:

NAME OF COMMUNITY: SURVEYOR: SUPERVISOR

COMPlETE ONE COlUMN FOR EACH CHilD WITH

SYMPTOMS IN THE LAST 2 WEEKS.

TOTAL

Household Serial Number Child's Name

I II

~D ' I

I I 45. If there is another child in the household for whom you recorded a coloured section in question 6. go to that coloured section. If there are no more children needing coloured sections, go to the next household. The analyst will determine if the child was given a harmful drug. Tick if a harmful drug was given.

46.

47.

The analyst will count the number of unknown drugs listed in 41.

itj

12 yellow

- 49 -

Annex 2 CLUSTER NUMBER: NAME OF COMMUNITY: SURVEYOR: SUPERVISOR :

DATE:

ASK THESE QUESTIONS FOR CHILDREN WITH DIARRHOEA IN THE LAST 2 WEEKS WHO WERE SELECTED IN QUESTION 6 FOR PINK PAGES. TOTAL Household Serial Number Child's Name

l 'I

I 48 During (name's) diarrhoea did (name) drink much less, somewhat less, about the same, or more total fluids (including breast milk and formula) than usual? L I

I 'I 'I ' I

= less

or none i ' '

I '

S = about same M =more

Does (name) take solid or semi-solid food? N ==NO Y =YES If NO, skip to question 51

I I

I M:

During the diarrhoea did (name) eat much less, somewhat less. about the same, or. more food than usual? (Food includes breast milk and formula.) L

= less or none

S = about same M =more

I ! I

I I I I I I I I I I I

52.

If question 50 was skipped, the supervisor will now complete it by copying the answer given in 48. The supervisor will then tick if the child received increased fluids and continued feeding.

\ I I

I I I I

I '

I I I

- 50 -

Annex 2 NAME OF COMMUNITY: SURVEYOR: SUPERVISOR :

CLUSTER NUMBER: DATE: I

COMPLETE ONE COLUMN FOR EACH CHILD WITH DIARRHOEA IN THE LAST 2 WEEKS. Household Serial Number Child's name TOTAL

53.

During the diarrhoea did (name) drink ... ? Ask about each listed fluid (but do not show DRS packet). Tick if received. a.Water b.RHF: Rice Water c: Traditional medicine d: e:ORS solution f: RHF: Coconut Water

I I

g: h:RHF: Tea t:

I Any other fluids (specify)

54. I I I I I I

If DRS was used got to question 57, otherwise go to question 74. The supervisor will tick if one or more RHF's was used. The supervisor will tick if DRS and/or RHF was used.

55.

~ I

I I I

56.

I I I

14 pink

- 51 -

Annex 2 CLUSTER NUMBER: DATE: NAME OF COMMUNITY: SURVEYOR: SUPERVISOR : ANSWER IN THE TABLE

ASK THIS QUESTION FOR EACH CHILD GIVEN ORS. BELOW.

57. Who advised you to give 0 RS solutini..Uo"-'-tnLL-_u.la!.da:umJJ;;e)

Tick in box.

TOTAL Household Serial Number Child's Name 57. Source of advice about ORS: a. Monk Government provider

Villagehealth-worker d. Private practitioner Pharmacy/drug seller Relative or friend Other

Don't know

• .

- 52 -

Annex 2

CLUSTER NUMBER: DATE:

NAME OF COMMUNITY:

SURVEYOR: SUPERVISOR : COMPLETE ONE COLUMN FOR EACH CHILD WITH DIARRHOEA IN THE LAST 2 WEE~.AL

Household Serial Number Child's name

74.

Was (name) given any drugs for diarrhoea? (pills. syrups. capsules, injections! Y= Yes N =No If NO, go to question 80. How many different types of drugs was (namel given?

75. 76. I I I I

Record the number. Record the name of drugs used in table below and record range here The supervisor will record the total of children given 1, 2. 3, or 4 ... drugs. 1: 3:

77.

2: 4+:

FOR SUPEnVISOR

Names of Drugs

APPR OPRIA TE AB

OTHE R AB

ANTI DIAR RHO EAL

AN TIP ROTOZ OAL

UNK NO WN

ANTIH ELME NTICS

ANTI PYRE TICS

ANTlE METIC

OTH ER

D, D,

I I I

-·-

o. D, D, D,

o. D,

o,. D., Dl, D,, D,. D,,

D,. TOTAL

- 53 -

Annex 2

CLUSTER NUMBER: DATE:

:-.lAME OF COMMUNITY: SURVEYOR: SUPERVISOR:

COMPLETE ONE COLUMN FOR EACH CHILD WITH DIARRHOEA IN THE LAST 2 WEEKS. TOTAL

Household Serial Number Child's Name

80.

Was there blood in (name's) stools? Y = Yes N =No OK = doesn't know

81.

If there is another child in the household for whom you recorded a coloured section in question 6, go to that coloured section. If there are no more children needing coloured sections, go to the next household. The analyst will tick if the child was given an ant/diarrhoeal. The analyst will tick if the child was given an antibiotic. The analyst will determine if the child with dysentery received an appropriate antibiotic. Record N/A if the child did not have dysentery. For the child with dysentery, record Y for yes if an appropriate antibiotic was given. Record N for no if no antibiotic was given or if an inappropriate antibiotic was given. The analyst will tick if the child was given an antiprotozoal. The analyst will count unknown drugs listed in 78. -

82. :83. :84. : :

: 85. : 86.

19 pink

-55-

ANNEX 3 LIST OF PARriCIPAITS SURVEY COORDINATORS Dr Sisountha Pongpradid, National COD Manager, MCHI Dr Somchan Xaiseeda, National ARI Manager, MCHI Dr Pekka Nuorti, WHO, Manila Dr Anders Tegnell, WHO, Vientiane

LIST OF SUPERVISORS- CDD/ARI HOUSEHOLD SURVEY I. Dr Somchid Akkavong ChiefofMCH CDD Programme ARI Programme Epidemiology National ARI Committee National ARI Committee National ARI Committee National CDD Committee National CDD Committee Vientiane Municipality Vientiane Municipality Vientiane Municipality National Institute of Hygiene and Epidemiology Mother and Child Health Institute Mother and Child Health Institute Mother and Child Health Institute Mother and Child Health Institute Mother and Child Health Institute

2. Dr Oukeo Khounmanivong

3. Dr Ladthiphorn 4. Dr Nee Phol Dr Chansouk Chanthapadid

6. Dr Kanthong Seehalad 7. 8. 9. Dr Leesouaku Leeyiavea Dr Maneesone Oudom Dr Katthaoudone Phandouangsee

- 56 -

Annex 3

***************************** NAME OF SURVEYORS FOR CDD/ARI SURVEY NO. 1

NAME MA. KHAM MORN MA. SAYBOUATHONG Dr. KHAM HOUE MA. VIENGSAY MA. VONGKEO MA. PHOU KHAM DR. PHETSAMAY MA. SEEVIENGKHORN MA. CHANTHAVEE MRS. KHAM VANH DR. PHETSAMORN MRS. BOUATHONG DR. SEE SANA MRS. SOU VANH Dr. BOUA LAVANH MR. THONG THAP DR. KHANTALAT MR. KHAMPASEUT DR. PHAYPASEUT MA. KHAM LA DR. MANEECHANH DR. KHAM PHAY MA. SANG VANE MRS. BOUN SOU DR. KHAM PHEETHOUNE DR. SENG SAY DR. CHID SAVANG DR. VAN SAY MS. BOUA PHANH DR. BOUNCHAY DR. DAODOUANGCHAN

POSITION MCH II

INSTITUTION HATSAYFONG DIST. II

2 3 4

5 6 7

" " " " MCH

" SAYSETTHA DIST. "

" SEE KHOT DIST.

" "

9 10

" " II

11 12 13 14

" " " " II II

SEESATTANAK DIST.

" " SAY THA NEE DIST. "

15 16 17

" CHANTHBOULEE DIST.! II II

HYGIENE STAFF II

18 19 20

PHC MCH II

STAFF

" NASAY THONG

" " DIST.

22 23 24

OPD STAFF MCH STAFF

" II

" TRAINING STAFF INFORMATION

HEALTH EDUCATION

26 27

" II

" EPIDEMIOLO.

NIHE

29 30 31

" ARI COMMITTEE INFORMATION

" MCHI II

- 57 ANNEX 4

SC&mJLE OP TRAIRDIG

TRAINING FOR HOUSEHOLD SURVEY SCHEDULE OF SUPERVISORS DAY I C19 April) 0800-0900 Registration and Opening Note I Introduction to the survey Note 2 Demonstration of interview Example A Break Explanation of white pages Note 4 Lunch Identify children under 4 months Exercise B Fluids on breast-feeding page Exercise C Break Role plays from white pages

0900-0930

0930-1000

1000-1030 1030-1200

1200-1400 1400-1430

1430-1600

1616-1630 1630-1700

DAY 2 (20 April) 0800-0900 0900-1000 Explanation of green pages Role plays from green pages Exercise F Break Explanation of yellow pages Role plays from yellow pages Exercise G Lunch Explanation of pink pages Note 14 Break Drug identification Role plays from pink pages Exercise 1

1000-1030 1030-1100 1100-1200 1200-1400 1400-1600 1500-1530 1530-1600 1600-1700

- 58 -

Annex 4

1600-1630 1630-1700

CTD

DAY 6 (24 April) 0800-0900 Review questionnaires Note 30 Survey schedule Note 31 Break Conclusion for supervisors Note 32

0900-1000

1000-1030 1030-1200

- 59 Annex 4

TRAINING FOR HOUSEHOLD.SURVEY SCHEDULE OF SURVEYORS DAY 1 (26 April) 0800-0900 0900-0930 Registration and Opening Note I Introduction to the survey Note 2 Demonstration of interview Example A Break Explanation of white pages Note 4 Lunch Identify children under 4 months Exercise B Fluids on breast-feeding page Exercise C ·Break Role plays from white pages DAY 2 (27 April) 0800-0900 0900-1000 1000-1030 1030-1100 1100-1200 1200-1400 1400-1500 1500-1530 1530-1600 1600-1700 Explanation of green pages Role plays from green pages Exercise F Break Explanation of yellow pages Role plays from yellow pages Exercise G Lunch Explanation of pink pages Note 14 Break Drug identification Role plays from pink pages Exercise J

0930-1000 1000-1030 1030-1200 1200-1400 1400-1430 1430-1500

1515-1530 1530-1700

- 60 -

Annex 4 DAY 3 (28 April) 0800-1000 How to decide on questions to ask Note 19 Exercise K and L Break Role plays from different pages Exercise M Lunch Role plays from different pages Exercise N Break Household selection process Exercise 0 and P Note 22

1000-1030 1030-1200

1200-1400 1400-1500

1500-1530 1530-1700

DAY 4 (29 April) 0800-1200 Field practise Exercise Q Lunch Review Questionnaires Note 25 Break

1200-1400 1400-1500

1500-1530 1530-1700

CTD

DAY 5 (30 April) 0800-1200 Field test with supervision Note 27 Lunch Review questionnaires Note 30 Break Survey schedule and conclusion for surveyors Note 31

1200-1400 1400-1500

1500-1530 1530-1700

- 61 ANNEX 5

SUPERVISOR'S CHECKLIST

The supervisor's main task is to make sure that the surveyors follow all instructions and conduct the work in cluster exactly as was taught during the training course. To obtain meaningful data, all surveyors should ask and record the questions in exactly the same way. 1. Before starting the work in the cluster; Give the surveyors the set of questionnaires intended for the cluster. Find the village leader and the centre of the village. Select randomly the first household and direction where surveyors should go.

During work in the cluster Accompany one team of surveyors at a time. Observe interviews and give feedback and answer questions. Complete ORS access investigation for the cluster.

Before leaving the cluster Check that: Identification data is at the top of each questionnaire page. Total number of children found is 40 or more. Households with children

< 5 (question 2) are all listed on pages 2 and 3.

Check that the total number of households (question 1) corresponds with total number of columns used on pages 3, 4 and 5 (caretakers). Appropriate coloured sections were used for children needing them. Check all forms for errors and inconsistencies.

If data is missing, have surveyors revisit the household to obtain missing data. Keep all completed forms from one village (cluster) together and in order. Clip them together. Put all forms from one cluster in a large envelope and write the number of the cluster on it. 4. As soon as possible, after finishing the cluster (not necessarily in the village). Carefully check all entries and totals of surveyors for errors. Correct them. If there are problems, report them to the coordinator and discuss. Do the line totals and cumulative totals. Do the questions designated for the supervisors on the questionnaire. Also, do line totals for these questions.

- 63 -

ANNEX6

SURVEY SUHIIAR Y:

COO h

I I I I I I I I I I I I I .I I I I I I I

DETAILS Country: Lao PDR

Ul<S (~pprox.

aau diarrhoea two week prevalenoel 0.07 0.20 0.42

bSE 0.010 0.02! O.Ol5

Correct knowledge of careseeking Locality: Vientiane Hun Correct knowledge about fluids Urban/rural: Month/year: Nur.O.r

Both Correct knowledge about foods Hay 1993 C~rrect

0.77 0.09

0.028

knowledge l rulos

o.o:a 0.0$3 O.Ct!

of clusters: So~o-nple

100 Increased fluid rate C;n:inyed fe~ding ra:~

o..sz

size: Children< 5 years:

4111 Corre~:

case

~anagemenc

rite

0.31

o.an

I I I I I I I I I' I I I I I I I I I I

Calculations based on: C~ildren

I I I I

with diarrhoea:

Z.S~

CRS use rate RHF

0.40

D.O!Z O.C57

use r.:u:e

I _I I I I I I I

C~T

rate (CRS anc/or llHF)

0.55

0.079

Scurce of advice for ORS: Moni( Go¥~r~T.eo:

o.oz provider

0.025

I I I

Villase health·~orker ?ri•ate physician Pharmacy/drug seller lltl at i ••I friend Other

0.34 0.24 0.15 o. 18 0. II

o. :or

o. 115 O.Oal

o.oas 0.006 0.018

0.01

i I I I I ·I I I I I I I I

- 64 -

Annex 6

suaver !DETAILS

SUMMARY:

coo

oru~ R~tes

a.>.ros Lao PDR Vi ent i ane """ Drui use rate

aue 0.1!8 ni.IIC~r

2xs: O.OSi

l (country:

l (Loc~lity:

l (Urban/rural:

Both

l IHonth/yur:

Hay 19Y3

Use oi following Use oi ·1 drug Use oi Z drugs Use oi 3 c;ugs Use of 4• drugs

of drugs: 0.32 0.24 0.19 0.12 0.061 0.049 0.052 O.C4~

I INU!Cer of lclustors

ICO Pr::c:r:i~:-:

I I I I

or c.ases o.h:c:;, ar: dysentery

0.15

J.c~a

a. 12 0.51 0.43

O.. QS~

I I I I I 1 I

a.oez 0.15~

o.co o.z~

a. ~co

I I

o.:o; o.::o

I I I I

L I I

CRS Ac:ess F~annac

0.~5

has prov iC~r

~cv:rl"llnent

Ctner

0.60 0.35 o. 15

IHST~-CTl·····················································································································

- 65 -

Annex 6 SURVEY ~T:

Aal r3tes

·----~----------------------------·----------------------------------------------·----------------------------·--·------------

I I I

DETAILS CoU>try:lao PDR Locality: Vientiane llunicipality

RAiSS

Rate signs 0.18

2xse 0.02

I I

Correc: knowl.C;e for cJrtseeking

I I I I I I I I I I I I I I I I I

Knowl.C;e ol a SFtcific reason for careseeking: Urban and rural llonth/Ttar: /lay 1993 Oiificult ore>thing 0.07

0.01 0.02 0.01

Hurber of clusters: Saapla si1e (~ousen~lcsl

0.10 0.02

100

Abnormal breathing Fl.!ver

2593

o.Ja

a.oJ

C.Jr~seeicin; f:::r ~!lA's fr::a a;:prc:pria::e(•) ~rcviders:

An·t sec;uen: e Ca\;~\aticr.s

0.33

0.12

based on:

firs:: aft~r :!'l!l:;:r,Jet",! of fiSt

I I

r C~il.:ren

diftic~tt ~r:1thing

0.12

oi:h

.\~1

103 11 752 46 C~.-~S~tkir.g

Chil~ren

With

~N~

and

diarr~Otl

co Children with ccugh and diarrhce Two •etk prevalence of ANA Cough

Chil~ren ~ith

Tr3di;i~nal

fer ~~A's he!l:r HOS;l i :Jl

~0:2:

Mcr.k. G::~verr.-nenc

hS<:

ca~erment

heal:h center ar clinic

Villa9e 0.03 0.22 0.01 0.02

healt~·~orkor ir.ol~ing TS~

llri·,ate practiticncr Pharmacy/dru; seller Ktlative or frier4 Other Carts~eking f~r ==~in fi~~:

0. 11! 0.01 0.19 0.16 0.17 0.00 0.24

0.21 0.02 0.09 0.09 0.11

0.25 0.02 0.00

0.00 0.09 0.09

O.Ol

o.co 0.02 0.00 0.04 0.03 0.04 0.0\ 0.06 0.01

Trlditional he•l•r Mor.k Cc·•err."nent Hospi al/heal :!l Center Vill•ge health·worker including TBA Private practitioner l~'U·meuober

0.03

0.00 0.16

0.06 0.18 0.00

Pharmacy/drug seller Rel•tive or frier.d Ct~er

0.44 0.01 0.00

o.co 0.04

Antibiotic use ior c:..;n :tar:ni..,L ~rug ui~ io;r ,;:..;;;, Qr AHA Uno~cntiiied cr~;s

0.56 O.Z5

;iven ior

c:u~h

~YA

o.a:.

0.25

- 66 -

Annex 6

I I I I I I I I I I I I I I I I I I I I

DETAilS Country: l~a

RJte

ZxSE 0.04

PDR

r~ce

0·3 month•

0.91

locality:

Vientiane Mt..n

E•cl aF race 0·3 m

0.08

0.0!.

Urban/rural:9oth Preecmin~nc ~;

0 · lon 0.34 O.lQ

0.07 ~.~Q

Kontn/yur: Kay 1<;'11 Scttttde~~:r7

Nl..o'T.Cer of cl~.;sters:

1!!0

Calculations

bas~~ c~:

Children Q·j

mc~:o

277

I I I I I I I I I I I I I I

- 67 -

ANNEX 1 LIST OF DRUG CLASSIFICATIONS DRUG ll Sf

Classi fi cation~

Antibiotic H~rmful druq Cough remedy Antipyretic Anti i=:ithm.1t ic

Antihelmintic Anti protozoal Anti ... tic Antidiarrhoeol Antillllarial tor dysentery

Anlibiotic

~pprcpri~te

No BlAND

N~E/GE~ERIC N~E

CON TEN! p~eudo~phedrine, de~trometarfan

CLASSIFIC-'TION har:aful drug ant ihel•int ic har11iul drug .nti•sth~tic

Ac1ited

2 Alcopar l Algolropine 4 Aminophylline 5 Ampicillin 6 Alllox i I

bcpheniua promethazine, amincphyll ine ~picillin

plraset~l

7 .ln'.oxyc iII ine 8 Analgin 9 Ant~c·tl

An:ox i' ill in ar.1o,.; yc i ll i r.e ;r.et.!mi ;:ol t

""tibiotic (appropriate for dysentery) •ncibiccic (apprpriatt for dysentery) an;i;i~tic

(apprpriate fer

~,sentery)

an:i;:yretic c~lor~nenirOJmine,

.:.l. nyarox, inJ;resi·..:.• 3cetamino~nf!r~,

10 11 12 1l 14 15 16

Asc in AstmJsolone Aspirin Alropinc Aureomycinc Baby cough syrup Baby's rota cough syrup 17 hctri:n 18 a~ctrine

phenylt::nrir.e

ephedrine AS.\

otner h1rmful drug h>r:ootul drug antipyretic

3trr.pir:e tetr3cycl inc:

pllrH e.Crl:t d!pnc!"'nycr~':'i ~~

cotri•no.r.JlOl~

19 lecancox 20 hnacril 21 !JiS:)l'IOO zz Busccpan 2l Calyptin 24 CaJillho • pncun inc 25 Carl:>on 26 Clamoxyl 27 Cloramfenicol 28 Chloroquine 29 Cocci Ia 30 Coni~tan · 31 C:rr.cJntrin

n.Jtri i

dip~.;.~.l~

ontidi>rrhccol, harmful dru; ant ibiat ic c:us~ r.,.edy horm;-..l crug on:iaiotic (appropriate !or C/Stnttry) •ntil:>iotic (lppropriatt for dysentery) c:~;;~ remedy har;:nful Cru;c:-..:;;, remedy ~rGnlide

di ~nenhYcJ•· Jtair.c &rc.n:ria.dn

n·Cutyl·hydrcsir.e

antiemetic drug

eodein, t.lrbon

bellad~n~

tJmpher, bromine amoxyc ill i r.e

har:oaiul drug coush remedy other

antibiotic (appropriate for dysentery) antibiotic

cloramienie:l chloroquine iur~zalidin,

neomycin. k3al in

anc ioaalari al •nt idiarrhocal har:ni~l

<:hl or;;hen1 ;~1ni r:c pyr:mt~l

drug

~n; ~n lnyl pr::.plnol.:.mine' phenylprop.lnol~ine,

i!'1tL11int1c

32 Oecolgcn 33 Oicophen syrup 34 Disento 35 Disintose 36 Erythrocine l7 Erythr~eine 38 Eucalyptine 39 btencill ine 40 Filnsidar 41 Fecol 42 Fl~!IYl

.JCft:.01lincpncn, acet~minoph~n.

en I or~ncni rJmine

chlorphenir.aine turatolidin, neomycin, kaol in·pectin

nJr::oiul drug har10iul drug 1nt idi~trrhoeal

neomycine erythromycine erythroonyc ine eucalyptus, codcin, c~mpher penicilline sulpha Acet;xni nophen, chlurphcno rami ooc, phenylephr inc Hetronid~zol

lntibioc:ic

antibiotic Jntibiotic har,.ful drug lntibiotic

anti1111larial harmful drug ant ipratotoal

43 fluver~~al 44 G•nidan 45,Hawkben 46 Hawkperan 47 HlB B~by cough syrup

t lubcndaz:Jle sul LJguolnic:iin met:end~zole metoclwpr~m1oe

antihelminlic ~c:ibiotic

ontihel:nintic •nti~ec:ic

onenthol

ccugh remedy

Annex 7 No B~AND N4~E/CENERIC

- 68 -

"AHE

cmHE~T

CL~SSIFIC~TION

48 49 50 51 52 53 54 55 57 58 59 60 61 62 63 64 65 67 68 69 70 71 72 73

Hon11sing

ASA

Hui le Comenoll!e lmodium Injection for cough lyafin K> Say Pho Lac tool lariam Lcmot i l

antipyretic

natural oils loperJmid any dextrom~torf~n,pseudoephedrin,chlor~henicole

remedy anti diarrhoeal

ecu~h

har:nful harmful drug antipyrttic:

aeidophi lus mefloquin~ opi~,.;m

56 L!'cpard Hebencbtflll!

tincture

dipnonoxyl~te

other antimalarial h•r:•f·.Jl drug anti diarrhoeal antihe\;n~ntic

mel::end.ltcle metr.,nid:l~ole

Metrenidazole Met us san 11yecsamt~cng

anti;:r:tozoal h.u~;u!

=e:<: .-01r.e-::or f .1n, c~! .:::-;:hen i r ;mi r.("

arug

11intHOl N3sol Neg ram

carr imox.:n-::t ~ tiab'!!'nd:JZ:Jle n~~h.Jzol ir.e, chlor;:H·oph•n~yrid,:,mine

an:ibiotie (lpproprate for dysentery) !r.tihe!rnintic:

har:nful drug ar.tibio:ic (appropriate for eysontery) harr'!'.ft..:l Cr•..:g

n:llidixic acid

Neo·c.cdion

CoCein c~l::roq".Jine r.:.et~mizole mec:~i

66 Nbaquine

Notalgin No·1algin Ole~my:ine ?,~e::ol

ar.':::niltarial antip-/r'!tic: a~d ;:::yr~~ic

zcle

c~:r:lcyct

ine

an: ibb: ir ar::lp-tr~tic:

~Jr)t~C:l~ol p:~r:~cet:1mol

74 75

n 78 79 80 81 82 83 85 86 87 88 89 90 91 92 93 94 95 96 97 98

ParJcet.3mol Peniei ll ine Pher,er;:m Pheni;an Piperazine Polaramine Povanyl Pri"'''eran Pyraeone ;{inutan

c~!1ici

ll ine

ar.:ipyretic antibio::ic h!:-;.;f•Jl drug h3r:':'lf•.Jl drug an:~:-.et::'lintic:

j:rc~~ch.:nir:e

pro:n•rhazineo

pij:ercuine ~exchlor~heniramtne

harr:.ful drug ant ihtl~int ie antiemetic drug

pyrviniU'ft me~ocloprJmide

p.:lr3setatnol p3rOJcet3mol. pht:onylpropanol:mtint

Salbutamol Set::)r.ox.

antipyretic hlrrnful drug antiasthmatic lr.:idiarrhoeal antiheot~intic

s>lbutamol \c;;cr.:::;mide

Skorn·oi p · St:-!ptcmycin Sul SCD Sulfadiatzin" Terpine gonnon Ttt raeye l i "" Theralene Theophylline Theo24 Ti fly Totapen Trisulfa Tussidyl Tylenol Ventol ine

pi;:::erJzine ~hl;:r;luc:not

e~ S~Jsf:n

an~i!~!~i~tancispas~oidic

streptomycin sulf.ldi:~zine

antibiotic antibiotic anti biotic

sulf.:ldiazine

codeine tetracycline at imetazine

harmful

dr-~g

ar.cibiotic

theQj:hyll i ne theephyll i ne phenylprop3n0l3mine, ampiciltir.e sul f:arin•ecopri.n .lcer.lminophen ssalbuCJmol ~SA

harmful drug ant ias:r.mat ic :~r.tiasthmatic

phcnyl~phrine, c~or~heniramine

h"'"' u l drug ar.ri~iotic (3pprcpriate for ~s.ntery)

antibiotic (appropriate for dysentery) uni.na·.on ancipyrecic anti3sthmatic Jnt ipyret i c anciemetictantispasmaidic C'lU9h

99 Vic:lol syrup 100 Visceral gin 101 Uhite Senjamin

phlorglueinol pl3nt e111.tract

remedy

Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Technical Documents

Date d'adoption 31 décembre 1993

Source Organisation mondiale de la santé