Primary health care: results of a questionnaire survey designed to be carried out by village health workers in onchocerciasis-freed area

WORLD HEALTH ORGANIZATION OB/pma It Onchocerclasis Coi:trol progpa.i:rce .fu: the Vol.ta _Jasi:r ltrea Epid erniolo6;ica1 Eva1ua-bion Lrinit [ecirnical Document OW /flit/ et.5Z PRN'/I4"RY iIEAITH CA.i.i] : Results of a questiorrnaire survelr d.esigned. to be'carrj.ed out by village health wqlkers iir onchocercj.asis-freed a.Teas B), Dr Ou.nar tsa ORGANISATIOI\I MONDIALE DE LA SANTE I Ouagadougou, Ist Julyi . 1981. I I;'hiOI'illTIOli 'Ihe policy of p-r:.ina.ry healtii care iras -or:er aciop tecl by most of the co'.rrrtries i',vol.ired j-n blre ()nchocerciir.ric co-:i;ro1 prog,pa-'nrac. -Before sucir a roliclr is introcluceiL it is necess.rL1r to colduct abtrsic srrrvey of t.re nc.-il1;h of tire vi.Ll-a,.'le ];opn.la'cionc, coveringti:e cnLj-r:e coirntr:y. -ily cat.lloguinq" ireal-ilr l,i:o;lens gr-.,'-L heallth- rel-ated probrenrs, th:-s r,asic rjr;-rvejre pe-rrrrits r:eali-s'uic plar:ieg: (t) of tire lrer,l.t;ti se:.v:'-t:es reqLiar6)d ar,iL of their lor:a.bion, fror,i the locaI lc.re1 to the ccn-i,r:;rl_ levcl- (Z) of tlre nulltberj of health 1:eiso,rr;e1, i:r terris cf quan-i;it;g and qrnlity; (il of the healtir iru.cl;.et. 'llut who snoulcl c-rrry out a sut'velrthat the physicialis r?esirorisiblc for the ox never visi-b the vil_fa, .:es -:rder il:ei:r: askecl to make a tour of the vil-la-.es c:llikelihood that t-:c- su,-:-'rc:[ tro..i]rJ. not be of this kirld- i -'ire 'l;rtith is health of a , ,t..cn area rarely superv.lsi-on" f.e 'bhey i.rere bris n-"ture, th:re is e.r-er;' carriecl o'"r'b. [he vi]lage healtl:r woricers, who carry or-it their dubies r,rithin the vilrages for which the.r a.::e responsir'r1-e, seem rrrore a1:propriatefor this; tar,sk, proviced tl:at thej-r level of competerrce i-r: ta,i<en carefully j-ri.to acr:ou::t. The at't:lched. qr,rr-:st-iorr"raj-re uas desiilperJfor this plrpose. rt represents tire .fliraf form of a tr-ra-ttquer:tiorrnaire that was trj-cd out on 277 tarlities arr-I r,'hich makes every allor,,'ance for the level- of comprehension of the jsterviolrer ancl the falilres inbervie,,red.. 'Lrire inform::ti-on co]lccted fronthese 2ll fanrlies (18 villages) ir, neni;:, rvory coart, r1a1i aird Togo forrns tirc sr:bject of the -0resent jlaper. 1 a Drjr:ki::e-water sr.lpplie s (talre r) '-[en of t]rc 18 ville.rges -i:rvesti.,"ated. olrtain flrr:ir <i.ri:rlling rnrater frou the nea^r'est ri'irer, irhile serren villages.T?t-ilicir wa,terfron r'rel]s, only one of whicl-i is encl-os:cl ancl rrrovid.ed. r,lith a p.nn!r,lthe other r,rell-s i,je o]ren, ,,,'i.;h no raisr-,d surrourrd.. rwo viI]a.ges obtain waber br.rtlt from the rir..er (.1r-, sg,l-son) az:d frorn a weL](rainy season) ' one village, v,irich i',as a verf r]r:ricirs lrater supply proble:r, ]ras created. ar:. artificia.l- iallc (iurfo:rb."r.r:-,.bsly infectecl by nracurculus mecLj:rcnsj.: (guinea-r.rorrn) to me,:t its i:eeds. once this lakc dri;s up tire viliagers l-rave to._.,btaj-a rrrater from thc tslacj< Yclta (re rn awa;-) b}- truck, at a ccs;t o.f !00 ctrA francsper 200-1it::e dru:r. 2. ltrashing (cIothes a.nd. peotrle ) rn all the vll-l r,,es the rro;ler: clo the ,rashinl; near tcr bhe ,,rater source" This is also geiierarllr- tire pl.ace vrhere flrc r,roraen ancl child.ren who h:,.ve to f.:tcir ryater a.ncl wash tiremselves. ?Le iaen ancl o1c1 ,rec.lIe r,r'rsh t.re-Lselves e.t honc, in a'irlace set r-r.sici.e for thispuilpose. /c 21. -Disposal of itouile hol-cl ,rras le s 4. Xxc.i:c ta dis po Si-"1 ( i'riri.e rI) q riorrtehtid uastes ar.'e nearl_y alr,iays clis.].l.s3otr of cl_ose .to'bli'r conpo.,u:d, at a riistance of 2 _ 40 m. ,:hi" ,usul-ts j-tr a seriesof rribb-ts,' ^-11 r'p;i- i:i tl:e v-r-11a,-es, -rrhich ar:e sc:-,,-ttr:re..l- abou.t oypo"il'cr3r, .;i-rrl ancl rrtlcl. rinforblrr.ttel.,. i-b ,Ls also l;hc ,:lace i,,hr;rethe e.xcre;a cf s:lal-i- citil,ire::r. .rre i._istlosccl of. .[ixc.r,,:-i;a ,,lisposlLI ::l .birc busit ir: ;rac-i;i:;e<i b3_ 1{ of hire 1gv-i1la. es. In four vi1la,ps il-most al] fa-til-ies h,r.re at least onelatr-Lrr-,r r,/hicl-, is geit:ra,il;, ;:-rs-b a irole .i:: th., .rou,rrJ.. r"xcreta disl0sa1 in th.: 'uusr:. tal;c:s place at ,3:r:eab1y va.r.;r,in5di,:L;rnces :[ro:.: t;re conlro,;:ris anci/or ttre -";;;;s oJ] drj::kin;_:-r,,a.i,.ersu-;,ri_y (5Oo ,n). C_hildbir. i;h (f,aUfe fffi rhe families ,,:tervielrecr rerortcd lJ! cleliveries rr.iring theye?tr. All the rlothcrs a;e stlfl- a1ive. - 95 deliveri:s (lO,qii,) r,rere per:fcrrrred ir tli._,vi11a.re bv atrad::.i;icl:aI birti: a.ttencianb, onr.r. one ,f ;;."r-4", ,r.l"i""lhas .received brainin:3 j:: jrer rnoLiiel tong1r., ^ 31 aetio'::ins^ (24.4,() were rerrro,:ined at 'che n.ra-ires.t hearlthcentre, ZG of the,: at tlie ,-iorr;o" lr"r.f-il_, cc:rtre. i:r theotirer seve, cases the wo:,ren t:r,:Lr-e-r-r-eri o, foot, by fic;.cle orby moped, r?;r.e 1-3. blr ca"r:; - serren dcl-ivcrir:t (5.2.,\) took place Al-toipther only la.4r,( of delirreri,:,., vi1lagp. in a liost.ri'bal cen.tre. i;ooli i.tia.cc outside tjre 5.1 Cost of deli'rery itlte cost c.fl r-1,,:fivcr;, v.ri..il r,Ji,lely accoi:iii:ir_"Lo -bttc tyfehealbh urit Lir._.1-v,,,i i'-rh1e rrill) . -u of 5.f"1 ki the (7 O. q),5 of ,1eli r.e-:.ie s ) 'Ihe trari.itional bi:cbh i,.i;tendant ir ;3enerali1, l,erir-i r,t k_ttd., ;:i;l ;"3..?;r,i,,' chicl:e,s ir+o::trr ZJo to 65rj cint r=u.r"=) ^or siairry- '\t Tanou5gou, ,.,riicre 'bire .;ra,ri-bi.,nar- bi-rill abten.la-rt has beengir.eri trajnini; j:r ]rr_.r -;ioth:::. ton6;ue, tirt. ch"l.r:..p for delivery isfixed at 200 0i"A francs. j'reve::tile1.*", tt i-" .rno-wib is not coll-ecteduntil tlre bir Lrr a'ctenrrant r,:as issu.rn bhe bi.r bir cer i i ,.ic:;tc . .l-,irisis a si:cci,rl provj_sion.lrorbhy o.i ab-be,rtioa. 5'l'2 -!l r!4g-lreaLtlr qellgqs (24.4% of ,1er-iveries) tjere fl.le coi.,;t of oeliv,ry varico r.r.iclelJr but is always hi;-1h. 3- i."or oxa;np1e, the co:t is JCOO ;lJ-A franos at .crna (-flor thevil1a,:B of yr-'raro), 60oc crTA at r3nsui!ta-(;;; ,*r"*.ii)'iio."Eoofrr;ncs at Sr.ra-1.,a',+a (for iipessidd).",r.t ii";;;;, ,,rh:.,:e1;hc::e is aheal-i;l: cent::e, the .rioo"t i,riton;.tic -iss-,re "Lnrii.,rr irr,,:rcri:_rtionsrai:;es the plice of lel-irery to iLjr:tvL,r,.tr,re o1- 12,J0 cIi,A fr.:ncs. rn] .:i ,, vil.lrLge , mo:t -fi-,..ri,r ie s s tatecj t:.r.t iinrl-rr*u- the traclitiorralbil tir a,'bte,: ,:.ant . AImos t al]_ ,,ron:err ,,rho h,. ye on friote b1. b.:'-c3.c],: or 1ly .:,oped.. 5.1.1 In hos (5 .22,', of Lie_t i-,re i ie sr\ -l;o tra,.el r,'o a healili cer:bre do so Lal s 5.2 lYactice of clelively 5.2.1 In bhe v 5.2.2 In he"r.lth ce.rtre s 6. Fceding of t ne chl-IC 6.1 rnitial 1;'ecd.ing (ralre rv) ljlhe cost of d'ef i,er;r ir: beconi:r51 exo.r:bi-ta.-r-b ir -viei.,r o:' trreprof if,ssiinS; oa tratrspo-rt : 24Oa C-,,.A fra,lcs br,tvreeir }o:r,;.ou a;rr._Dapaon, a distanc? ,fr.il \.! 4OO Cl,,A francs bctweea rlan6a., atr,:.. lass,zr,a disi;ance of 2! krn (bur; t-re ,r.eliver1,. iriil cost J!ot) cFA francs).The v:.ll-ai{ers a'e obli,,+d to;n;lle use o_f moped.s. ft is i..ro,,ro:tcicr:bhat so;;re \/olr?n .:ive bi-rttr .-i,.uin.: th; j";;:" Thc traiitio.-ra,r- birth abten,l.ant r,rashes ,cire uonan l.ritir hott+ater and soal- -lhe always cuts ilre .lrbifj-c;Ll corc-l r,rith a ,.,zorbl-arie (rarcly r;ith a l*ii;i.-l;" na-,re} is bire::,iasired *i.bh warnlrater q;r,'l soap and trr.ated vrith incLi.;er.or= pr-.o,i*cts aniLsuosequentll' 1,'i51, slrea butter" [he use ofl shea, butter to speetlttp the sepa.rtio. of thc co:-'d is practisecL everyvrhei,c. Desnite our insiste:.t q:-r,:s'bi-oning, no c?ses cf ,nb1-'.ici:.ftetanus vrerc bror4;hi ro oirr nobice. Tire bi.r_,th attenrl_;...rrt gen r:rIJ1. cuts the unl;11ica.I co::cl, r+igrscissors flanecl -i:l alcol:oll trea;s the navel r.,,Lth iocllnated al_coholand often trea'bs tire -.':.bvrs eyes i,i.i-t'rr e |ev lirops of r\r,a",ro1 orsi]l-er nitra-be. 4_1.!_ogetlre_r LJJ ch)lrj*,:en ryerc 1:o:.n c1r-,rinr-:, tire .year, : - 127 are still a1ive., - 5 ciea during the fi-L:st moi:th of r-ife f.rcr,i rmr1ete::;,ijned carrsesbut none from -betanus or jarudice; - 2 died after one nonth of age, - I ruas stil_l_-born. IJ1 wo.,nen. . i.e . 9To,(, iil.actise breast_feeding on1y. L-io*rr/omcn (ro,6) pracii-se ,ixc.r'r""Ji"r*-izgoo-cu ';;;;"= per month i:ercirild for rvo'ne. at_-Beiriasso). A wor,ran ..t ,-ai:rrela quicltry ha.d to3'ive up bottle-feedin1,,', pority because or il:e cost but r:rainly becauseof her c1:il_c1 rs ?iincurabl; dia;rltoea,i. .,./4 46.2 f:rtrocLuction of Seni-solids ( rarte ,1) rhe a;.e at r'rhich th-:' mothc,: arics ce:ui--:or-it1s bo ilrc c,rird.rsdiet -rarie s cons;i_dcra'olyr - Ln 37 cases (28.v,.t') tir-ls b.,.:ins i:: ti,e s;econcl or thirri.:cnth; - it is very corlulori b-, the r,.p of six i;o eic:ht nc,.fl::; 41,6 otbabies, inclx_lin ; those wiile cr:u:t:n:. t"oirfrj, - 9"6r,( (15 r,ron,.:rr) r-rrait the chif ,s fi=st bi,rthclar-. /7O.) Shamc of the f.lnil.\- mcal (raue vr,t 5.4 Ai:e of r,reanirrg (rai:re vrr) l. 7.1 I:e the vil1ap;e 'Is a gcncra] rrr1,-'tirr: child starts'bo sha.r:e i-, tirr: ia-milymeel aro'..m.cr, tire fifth rnonil:. r-:rcru-c1in,.; tne ireriocl of tootirerupti-r:n, 6{ ,o,,re-r (+l .4.%) introd.,:ce tire chiic1 to the fanri1i,. nealbetween thc agcs o.i ri're ancr ei,,ht rnonthi. +e "o,ron- rli.iili "ittwiren thc. clLilcl is onr-. yoar oIj. Tlrc conten'b o.t anii:r,.i .,rotcins i:r tj:,-, fanil3. ,aea1 variest^li'fely. As a ;pneral ::rile , l1c.,cver, suclt 1,ro-bej31s axe r,ire3 u\,reeat-bl:eia whcn,.,re can get titeiitrr. .Ihere is f;encrally a nrejudicea,3al..st ei{gsc vrhi-oh a.-'e rrcl-ievccL_to prodrice goit:.,e o;: imbecilityor i;o turn t}:re cirilcl i_ntc a thief. ?hc age of ,..,canj:tg v_r.rie s r..rideJ,3r : - ll-.7/o at iils;t birth"r.ay; - 16.il\ at gecor:<L birbhclay; - A7.U'/o a.t thirj birilrday. 7l-.q( of criilcren alre vrea,erl betiveea rea.rni::i., to walk anctht,i.:: seconcL Lrirthclay. - Ir/eani-irp; when a f,rtirc'r preglrancy occllrs ,n:ry corstitute ausefu] nethod of -spacin.q pr"63i.,"cies, but its nr-rtr.itional implicationsneerl to bq looked i::to. Cqst of disease The ,'rnor-;r'rtr; s1:ent by vilrag:rs on treatin,.r a i-.-l-ven d.iseasedepend largely or lhe pI rte of treatr,,or.i.- The fanrrly is bhe -ifu':;t li,k i:'r brlc Lreatraent chai,.to the vi11a6p healer r.>r tjle }ealer frirl flri_- :n.::t vi11a..;ecosts one o.r two chic.,,iens. ll.ecor.rrse ,'cneraIly i/ith the jlcreasjrrg; i:rterest in noderri lrecrj.cjne, houevor, the'Lrea-bmerit of rlisease 1n iire vil_l-atle ha;: become verJr expelsivc. andtaefort'.:rrately bad. rn the vir}rges some lrerr-rq:]olin 1:harrnaceuLicalproducts (chloroquine, sulfa5;uanid.ine, di'r:.t.-;r";;) ;oJ-'ffi -;;"four tlmes as mucrr as -in the town rnlrrr,ro"iu" ir"ui. iii. -F;""" exa-:rp1e, olle ehloroquinc berl:fet costs 12,50 C-TA fra:rcs jrt thevillages of fvory Coast, liali anC Togo, a-s,-r1aj.nst 9.85, J.!O and1'20 crA f:rancs respectively J:r tire pha,r,:r:.cic,r or tiro"" cor:ntries. t_tt ..../ ) 5- rn Reni:: the r:i'ice: of ,,.Lrugs ir t'c villa3es 1,.e,:r no rel-.,tion totire official prices : clilr.,roqr,rj,i.r costs {.!c ci.A francs irr tronar, 15 in the village : sulfa5l-ra,ici,e "n,rio 1.45 cr'A fra.'cs ft:tor,m ar:cl 20 in the vi]l-a.ile. ft must i_,c sbres,;rci, hor,,rc.yer, fl:a,ti-e Beni:l d-r'i1s I'rere rol.)oi be-.cr]}. j.,r shorb sir-,-,pl.y ,'iru:i:r,;, the s-orveype-.'iod. r'b sr;,:ils 'bira.t thc exor.b-r-1 ...nt irri_c..s ckr rgecl in tire vi1la6resare tire wcrii of' ce,_.ta.iit ..rf.rc11;11s1ous tr.tLfer;j, ioh,., ,rro we.Ll- j_nfor.gcclci' the vi1la;.;erst lrealtr: 1;roblerns and their dii-ficulLiciJ irr obtaj:lin3; sirpplies a;:d shainc.l-css15r sxp1,r11 flr-i r: situ.:i,ion. rhe rr:srrlt is Lirat bjr:. rr,Lir,-r.g;er hulrs rrh..i-Lever he car,n ar:rcitrea.ts hin:el.f : in ati :utcr. .rogr_l , foi. exa^rrplc , an a.i,,ceck cfina]-,aria, dj_arrhoea or ciysentery is tri,a.ted. ,^,rLl., 10 tirblcts ofchloroquinc, sulfaguarlicl j1., or C.ife.b,:,r1one .i-.espcctilre1.,,. If ,jot.teirriproveine:rb occ'r.s aftr-.r i,ai,,ici; 'Lir". 'iir';t felr ia.trrc bs fl,r:treatnent ir; often ira.l-terl ,.:,iriL ilrc _r.est of bhe-babl-ets are storedunder tre usr_:.a.l r_msuitable 2ond.itiois. Penicill_ in r arri lrerz'-i i culur. ly benzathjne ben zJrlpenrcif 1 jn ;a-re tire miracle crulrs i+iiicrl i?cure everlrthin,ii,r. rhese substancesare s-irl to itrestore vi,_;oul a:r<l prrrify thc blcocl',. U::fortr.:n:.te1y, we for-ind it lnpossibre c-,,.er)nrrhere to cle-bernine the-ir range of useancl particula.rly their pr',ice, sj,ce the trade.rs h,ve mana,gecl bocreate a .lrystique aJ;out tiie,n. rn the I(ol-ondicba re3'ion of ilali, a s*bstance rsrovm as?tquatorze" (forteen) i.-l cuirently j*n ci;:culation, and userl fortire tr:eatment cf scorpion'oites v,,hic.i-r are extrc;rre1y ccrnrrop j11 thatrerien. The treatr:-rent co;r:ists of taking two t:rr-.r_cts costin3!O iIa1 i fra;rcs a piece. It is not clc:rr wh.r,t active _ingredientsthe tablcts contain. iIealbh lcrsonncl ,ila1r 1," autirori-secl bo seff pharn:,.ceutica1prod-ucts, but ilris sy,l,ue.:l was not i,ve,;i;i.,aLecl . 7 ,2 rr: heal-th centrcs a;rd iros r:itl.l- Paticnbs are rrrrelpr s;ent ,Lo tir,: h,,:.lfl: cent:rlc; a;-LC 5os1:ita1s. Ihe rcasons fo,:: this are. - the cosl; of 1-rr"escriptions, - flre cost of tr,:ns;lort, - the exor:'oitant cost of flrc corpse. For example, if a vil_la11er: f,olr Ta,ougo, has a ciistu::bin;3.case of d.ysentcry trea.tcrL at TeurguiSta. it costs iri.n 2200 Cr.,-A fra"rcs(fzoo for drugs an,l 10OO foc trrisp""il. .Li'o.r a villager frora Taga,.}i, .Lreatinent of c1y-:entel?y at3ond.ou,:{ou hospital.costs 45oo cFA francs (r5oo ior drugs aurd-J00o foLbransl,ort). I.rreatriren b of a nara,ria at,i;ac.,r at ;re )jorgouhealth centre cosbs 7Ot) g;4 frar:cs (,laatc X). , r a/5 5Thcse prices do not i:rclucie hospitaiiz :,i.on (irea, food., sup,oleincntary exanntr r.tions), the ,rrpu,:.,.,u;i of bhe lreople accon-pa.nyjngthe ;-rr1f,isr'6, o:r: the cost o.i::eturning a. corl)s.je fo:: burial j:-r the vi11age. 9 The transport cLrar6ics 11.ivc:n arc fc:: a one-v,,a1- jou_zney irl. flre pa tient. a The f arrii-1y econoii-)i Jhe qu.,stiorutaire 1^ras tl-rable Lo establish :ny ::,:timate of fa;riJ-;,, inco::tc. ',lhis hind of rlue;-:tion is e;iL-remely r_1 i;tastcful to all the village::s. .llre questlorurni--re on11r te.n.5ed cleterri:re .Lhe main c::ops g:ro1,rne the -lzr,i:rj-l-yts seconr.l:r'y acbivibies, ancl curren-b l- ive :: tock tic soLr-rce s o 0rgq4iziLtions trr the villaTes tir,rrc are i'loveilents r-,.:n b;r the ruling p:rtyfor nen, vroinen a.r-Ld. yo',;.rrg -;eop]e. one or two villa3cs h.ve r.alzl extension ,.,iorkers. Alrrrost iralf 'che vrllages h-,ve a school_ r,rlth atleast three cla$scs. 10. Co:-rments llhe que::tionnaire highlights a nurber of re,-,r.li-ties for irhicli rtany counbries are ta.hing appropriate mcasures. 10.1 The farnily hy,qiene form T1ris 1:i:esents bluntly t-r:: cru-cial 1rrobleir of rj.rinl<ini.;-r.rat,^r supp11. f'cr tite viffa.ip popul-ations. 1lhc prolter sol,rj;ion to .{:his problemis to i:rovj-rj.e tiie villaiics urii,ir pr-i::rp oDcr:r,tecL .,rel__Ls. l,Jor,yarlays 'twelI or-lrratl:onstt er,:re r-rnder r,ray in al-nost el"ery corx.try, vrith very itraisevorthy results. ,.lo\,,/evrlr, a l-o-t of vrells rer.,rain bo be du11 cndthis is a bu.rden orr the 'lta-,te bucl,_let. nJ: ??eqr.litnfulsrr sol_u.tion would be to i:rtrociuce :r, rtsociar co'lponent', into ]oca} lrr:iva.teerrternri:e. lthis coi;ir-ro.,e{li r..rour,. conlist of provi_ii::g i;eurp-operaterltiell-s fcr a. ce.:tain ni-rr-,'oer cf vil-li.,rc.sr tire nr-lrber: ilepen.lirg o,the size oi" i,lre cornpany. rn retulr--,n thc state r+oulcl ]eave -Lheseprivate co;i1-;)ani-cs e.n'b.i-:el-y free Lo r,lrlli,,- usc of ilreir huaanitarian worl< fcr ;ulve,:tisin.l ir-rrposes. 'l'hc j:rtern.,'rion;rl Dr1=r:king-,,,iater iana jlai-lita-br,m D::cad_e r'-sJ c:Ll--a_,ent1y in llroGre:;s, ar-rcl_ the idea i:utfor:i^rard. by tirr: Center for Di_se.ise ConLrol to ul;e flre gulnea-vrorm as a-n ind-icator f cr a.scessin; resul-bs shoul-c.r. :-,e arlopbecl byI,ienbcr .ltlr.be s. ,Ihe uncoirtroli,:C dr_u:rpi:rg of househo}l wastes irr ,uhe vi]1a,1esis extremely cor:ornoi'l . -/r.s i:- result of -bite herrlth ,:,lucatioil sesslons which we regularrl;,. org'ani-ze, j-t, ijeens to us ilrr,t .bhe villager:s are rnor:e i:r fa\.clrf: of a sir6;1c dul_p i.n the f orrl of a irole, iocated about 5oc no froil the viila,.;e anil t:a.ltini; the pr:cr,ailj:rg rvind cli::ecti-on into accorlrt. As regarclij excre ba clislosai, r;rle lLcsl-er"L villages are nore infavo-';r of bhe usc of famrl;. }a-brircs. fn sorre villages (not covered by this sr-irvey) there are trro or three conuron l-atrjles. rlrese arc Lelrerally u:;cd by Lhr; school-chj-ldren but do not seernto bc popular with the rrirl-agers. rn hunirl ar-e{}s prclierenr:e isgencrally,riven to excr'-;ua d.is-posal in tire open a.ir: b-rr-: -"gse latrjrresqulckly -Lend. to fill r,ritjr grorrncl i,ratcr et ver1. f ittle rlei: u,_r. /z .../ | . 7l-0.2 Delivery forn )espite the cxir;tence of l-ica,lth :-;el:vices, tjrc -b:r:acLibicnalbi-i'th attcrdazit still- .rerfoi'n-s TO.4)( o_li ,:]sf lr.ries. ier vrorl< hasbeen improrre,:L to rsc.i-rc cxtent: use ,lf a razor bla.i-c i:isteail of ak:-bchorr.knii,; to cut flie unbilical corct, use of hot water and soagr, -'-lc" tie rlid not record *..r" case of u,:rb;-f:r-ca1 teta.nus .rurirrg tIrc survey, althoiilli: this bv no ,iordts -inrl-:lca'i;es thai; ,-Lr:rbil-i-c--r.l tetanu-s cj'ocs rot occlr.r jn Lhe vill-:.ri?jes. lirese trad.itiunal birbh attcnc,tants can pci,'f<-ri:rl vrork of 51oocl qua-Li.ty if thel, :r.r:c ;.lii.en a shoi:-L pe:riocl oft:'aj_tiri;, lref'erabl;r i.n therir lrother tonila,:. J,,lar:y coL,:rtries ha-rc iaade sul:'s1;a.:rt-tar pro'ri:ess in thc br:aini-n:j of lri-rilr abtencl.mts, brit a 5peat cleal- reLiains bo l;e ,l6rns, It _ts es,.rentiai to stress the urgenb rreerl fo:': tlre c\ief r;icd-ical officer of bhe cr-:-gti ict coflccr]lu-rl to c1'-'lr]' out ::r:,3-urlarr evalua-i;.Lons of bhesc lti,:'th attenC_a.rrts,failing whrch no el.l;iirr-:te ci ej'ficiency is possiblc. The crucialproblera ::ernains; thc reil..rner-,a'l;io;r of thc traj:rerl birth a;.i;enr1a;rts"A n,l,rber of experir,rentD ha,.,,e been nrarle rriilr vary,iri5 success : cooperabives, appoint,,eiri; a.s Sbate ei:r.r,Icyees, pa.r',.,ent of fees, etc. 'Ihe fact ret,trrins titat nr-,bionwicle "o.."rrg, is exi.re:nsive iortire .itate. Apart frorn the trai,:ecl bir:th atte.l,i;uits, a littrebasic trariring, ancl above alr a su1:p1y cf ,:,bstetr:ical equip;ncn,b, cafl irelp a trr.,.ii'.-ronaf birbh a-L-bend.ant-bo achj-eve a.great clea.l- more.Pay'ilent of tlrc trarlir.ionar birth a'tten,.La,nb cos-bs very little, ancLthe cirrrent ltra.ctice seerrsj r,re11 :rtl:reci.r,tccr, l,rr th,: vilr:,1p:r:sbecar-rse it i: in keepi:r,T vi-tfl, flre vil-l-a.1e cufiirre. o,:. tlic rrhol_ethe inost appropri-ate r,ethoclology sceins to he to trai:r tiretraditionarl birtir a-L l,enria..r:'bs, to evafuste bi:e, qlral1ty of t,lej_r work, anc to let tlrem. prac-bise jrr acco::clance r,rj-flr thci:r,olm culture. 10,J lt'he child. feecl f o-rra B.reast-feed.lng oil.ly, vrjricL: is practlnocl iry 9T% of 1he r.,ro,re:rr shou]ci contrnuc tc be llirrer. el,crli- et.l.coilJr-,.l.crtl*lt_,t. Ild1.-s.. 11., zr.c.tivities shoulrL be d.ir',;cted r.r'b ,,./ojrcn vho rlo :rtrt ,:r;,lctise breast__f,e;r_.:riiilr! exclusi-,reI;i. iiutriti-oi-r er.iucr:.-tir-r:: sjroulC .ttre,;s ilre ea::lF inl;:oCuction of seili- sol-id- -fcocls into tlre 1-r;1]lyts d.iet. Tlte crur:tion of teeili r-s r betterind"icator Llran a";re -i'(x allowing thc chilrL io slure i:i tire fa,r:i1yireal because tootir er,.rptiorr is i,.igibl-e: an.rj, above ,:_11, is watchld.for by the r:aother. rrhc real problem, i.r fact, is rrot the age of weanlng i-'ut Llre very fani-li-a:: onr- of ilrc ,"gri-" sur,)p1-., of :ni,ualproteins jn the cliet once flie chil-ci starts =iro.riri: i,r the farnilymeal" ih-rtritioi-r. eC'lca'ti-rn', ;;ir,--rl'.irl strer,s tlrc r,ir.le of prc-lei:rs oblai:tedfroil l-oca.l procluc-bs ail4 .ii;lc air.r. do its uti,rorr L to ciestroy f,ns nr],-stiqlle sr-i-rrourrrlir:i; the egiq,. Oe the r,v'l:ok:, a comoj_n:.tion ofnutri'bior: educa'bion aacl bhe pirysi,.,.Io,3ica} ::1-r,ci-ng. of bir,.bhs throu;hbreast-feedi:r5 seel:is -birc nos.t aciequate a-r1;r-,oach. Cost of cllsease Tlie cssential- poi:rt brou,.,:].,t out b1. the quect.i onnair"e is undou-btedly thc' exorbi-bairt cost of liealth; this cost is closely bor:,ncl up witli the retail l:::ices of clrr-ri;s in tirc villages a-rr,r" -bltcpror'iteeri.rg on transport. liithin the prin:ry ilealtir care contextit is essential to lciovr such fe.cts j:r orrLer tt drar,i up a realj_sticbuclget. As we l::"'v-e s.-rer:, thc cost o.[ ,]iease i.eq.-ri.:es 10 cor,lreflt. /a ooc/O 10.4 B11. Concluslons ilea.lth ;rrol.,lenrs P-re so nrJ.]eror,ts a.nd r.'arieci bhat i-b is vj-rtual1;r i:lpossii-,l<-' to solve lhcr,, r.,j-'chout compreteiy _r'ed.csi6ni::g th,e hea.Lflr s1/eterti. Acccr:clingfy, ,'r.lnost every countr}r jras oittc.rl for: bfte policy of ,'lrinary healtii care. ,lut opt:':rg is not enough : it is also n(lcci j,'saly to r-les13n and, bo plan. tienerall;. s reallini,, i oi-rti-or: for prina.r'', irr.:r.11'th. c ;rct i.,.rir.. ', rtoul-,.]. seelr ,uhai; the cle "r:iy clefincdarc i-s not fol-ior,nrcd 1:J,- ca_rr:ful}y consid.ered. Tl:e iinlrecsicn o'oi;ajnc.rl oli clla,Lbtin,T "ritjr tirc perl;onneI o-f health c,:ntL:es is thot: (f) they are rL1?ri.-ri€ oi' thc lre.alth can:e ccncelt, p:rccire conteit'b oi tiie primary (z) ttrey riisi:rter,-:rct the oi:jective of jrealbhfor alr by tireye.rr 20i)0. Thc e_lforts na.cle bJ, tl:e :,,lii) ]iLagiona,l Oii.,ice and l,ire he:,1th irceirs organizeri- at di.s-brict l_evel_ l:a.ve nctpro.l,.rced the cxnecteri bene:iits :,.;b tirc Local l_evel. Vflnat can bc done (r) rYi-r:raz'y lreal-th c?-re can oa.-/e no cjrance of snccess r:nless it -isprr,ii:crly urderstooii ar.c]. ;r,ccerrte,l , bo'bh b;,/ biie poritica.l clecision- m,a.ilers of alf d:scit,lilr.es and bj' flre vil1aL;,B pcpulations. .It is necesserrJ" Lo cxplajn and pcrsuade on a lar:ge ;rcrrlo, ,,iaf,<in6; use ofthe iaass rned:La, alc'bo enter in'bo a fr,,rnk dialo6y;re lritn tj:e.3cople cl:lefIy concer:led. rt is necessary to irelss-vei.e and excr.-cise pa-cie:rce. ftr_Lypersuasiernr 1)erscvel-'al1.)o .,rrid 1),'r"-[ience c?j] l-et,rl a, ,lj-lister o-l finance or a vi.]Iage pl:r"rter to see heirfr;L not :lsi al !?,.rtpro,[ictiver] nece,:sitybut as t-u ke.lr factor i:r socio-ccorlor'rrLc d-er,.elofnen-b. lrhe ltrimaLr.g consequence of such a dialoil;e is that i;ire villagB::.: Lrecorre :r,vrare oI thei:: invalrrab]-e coitritlrrbiorr to LLre nationa] econoi,ry, ail ?wit-ireiress tlu.t j-:l 4en.:::zL11y foll.or,x:d by:. conflic"L of i::terc.J-bJeleacii:rg thc;,r uo cons'ba.r'LIy ::rc::t:;Lse tireir: ,1et,iurt1 :s. A start shoulo ue ,,,:ic1e b]. j-rtroiuoin;- ir r,con;ulso:ry Irea.l th contpoaen'b" -i::to a1l sc;c-io-econ,_,r_tic 6le r7(_.1 6pr1i,lnt pro jL:cts. (Z) Prim:Lry llealth oare c,:r.i hl,re a cjr;-'Jtce of :Lrr:ce.;s on1.--,r if it is supt.,orted, b)r a rel-iabl-e i-racl<,12'o,"ytr1 S.-r-rvelr. i][is slrvey rnust determinefor e:ich vi11a3e ; - tire srtecilic healtjr neecis: sanitatirx, trea.trnelrtr lreveirtion, se::viccs i,_r-,d pelsonnel, etc., - the vilIe B cco,lomlr all Jhc ,:::c,ro.r:-bion of exper:.li-brre o1 health; - Oor'ilnuni_cati_on rOutes I - e'tiO. 3) ft is necessaxy to fu.zu up a l:eailtir bud.gct, taking.:.ll thesefac-bors ilto iLccormt. (+) Perfcr,n;:ncc ;aust hc reg.rlarl.r ev-,.tuaLed.. 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O o tIOdo0 +,DO r.l ! :JdOlr o\ o o o\ tp .ilo o@qa .dogld 6l O o N Eia o O >. o H od .il oo coo r o N 6 I4 ot doE-, tC (a () o o .o c H H @ 6l o O \o E(,OEZ2H rrldo O+"iE l).EE-l E-HE, \o - b0_tr .d d o og{ I +J @d ol{ m d d il obx 'dlaH'd dd+oAo <q{ @q € o oq{ d o X 't A CB {J o Er nrst $- N t: F{o Er Lr\ o\ oIr. HA rd E] E. €-.z H ho @ cd H r.4 Etl t'tiil cl(rn HFO d, A. c) r-j o ts O c\ coE 2 o b0l{ o @ {J c,l o Fr o o .c F-t cd o d q .d a fu o ET 3l N \o n N o r trd sd Fq o EO B{oA o o ET o{, .r{ a q op. \oN N oN c3d d .ri ddc ..{ ro o C d F{ o {J o oi E r d HdN o co ItdoCu0OJXoE-.o \o o u I E odtrd ,dop. t\ O H lf d r{ ot t4 o .o aoF O tr\ d F,l CC E # o .A 1,(d u)d €< O tlodq0 -PO(s.o ,dOt{ o o o\ IF#oo bi)@3 .HO cq6 N o o al E-6 o o Eo H Iq CJ 'd o @ o o r N 6 I o trdF a o a0 N O o Fto .o o M - z H?; El @ o tr'd + o >. o v rno ,b3 r{..1 d.d.d+ >€{J ddkd o Lrrc, .E+r,o tri+o r{'lrCo d+HOodd EI r-l dtBr{ ^o.P-C+ -c}/Pgiidoodt -q&, El trd-P +, o o{r{oEd r{d d Pr o .c H J ET F o *',{.+-,-.- o o o tr rl I o .C TJ ..{ tr) .d @ o .d .D d .o tr .d o + o ri o E c o Eo F +3o @ o o .d o ctrA r{ddo .d .d t{ a I .H AJ5d o H t rJ C) F. Fl F.o F F1!!t--On@rN$a\L.\dN cr\ Lr\ HN \o @ .d @ @ op. ao bo o iq tr di o0d cn rn (5O F rf\ o @N NJ .J ..1 dd oj r1 oh JJ o n CD tr N Id tr o E< O\N u I Eto t{5O LA rn Hi dd o .14 ri 14 o ,o NA\ CJ r-i fJ E rt .d d d b0 €-, Id rd5o v, o\ I .il ai @ 'il ca N F :3 r-) fro H Io rJ .rl o EO r o\ Ito E{ \o n o tr o ,o ao sH E1E oq CI o >. V \o @ A lrl H< O +H=Ea==o-oE'x s r{N(n+r\str-dJGNOF{ t4 it trd ox os a0tr ..1 tJ a E q o .Hp d trt o +,q C .{ o .cI tr o Eo F qq o o o o odka .-{d o .d .d t{ a H ( -d d , i o HH t r-l o F. 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LA Cd Fl o *d s< €r .A oO I'r&o H ao Fi Lfl CJ r-l .d Eti d d oi s E- N alodbo+!{ro c! ,dO! aaNU\ o\ t, .do@Q0 a, .rl O N N Io c-l .d oo@a C\ H E] EA Ito doE- bO \os o Ho .ot M s \+ og d+ o >. \o \o a aFl tr:H(5 c) o EI+:==E=EOH tr>c q cj.oEJ4"d H =dN\o@ss'dbii co N f\ = Ebc }f o F S{ d o @ e0 .d fr qJ q(, .ilp d .o ,{d @E @ o .{ o 3 o Eo F +r a .d .o d o .d 'dk g bo .d nJ d d o H :l FI +>,tr t{ooq.> a'Atrd .loFr rd+ 'Hq{o o o@o r,J H oq H .o oos1J -C rr trd o(, C^odFrho o.Grd .or.{ oi5d o tr >.r{do.o> cC tsv&'doFiH+.C okPtq3OEjp{d oqrao odoOdF(f\Pl{+ \oo+jo opOOqr +..OO oo o Hl-d -, 11h dl+ 4 (3N+lOp .dlo o oE oI+, do @ld o d r{olo-C(t{ -cl@ P olo .c@t{|tu@P ooloo .d lo > @ti ol tu ,d .rtd f{l h0 >r)looClt{otr ol 5 tr Jol Lra.d hOl.d il .d .(l t* +rPlddl+r d cJ .Jl 4Ctu olt,o,dJl .d o IIq{ rD P aJl ril oooPl .C .< .dlB E4 E-ldIHlrtt o 'd F o o o .d ,rA o @ o o .d .c o o ts+ 3{ o od o E +)t F h -lHd H o o h0 <ttr 'r{ .d o ..t dll. -1H(J o o @ .d +J tr d o d '.{I rld tro .r'l + 'rlod& o E4 o1 L-dd H] o + HH EI Fi 'ro .d rl o rJ +i ! q{ d o Tt a o0 EId oo d oo .Atrq<& fl'J{r+l{oo& o d .cH9FJ t{r{opa0 d od ,q r-l rd od5loo @ .rt Lool:d .r.{ dodo €.dCoOH +dd .qx o +p, tu ''t trPo o .co+rd r{O 'd O.+o , rrl -:+; a,! .d 'r !3B SHitrd +d9.doast# -Bid o>L bo .d I'lLd !1 6gi - F6 oE^ OBHdai aq o'do .q 'c cdFTFLT a* (5 oF tr CJ bo d cq ti oo EooJ4 (t\ N od @ @ oa o Lr\ c{ +5 oooOqrE O\o to &o c3 CON OEc.oJ4 N6 HiE rd qd 'rlIJ .dg .t @ d r-{ o >) +) o 3 t4 s.@Egldoo d HdN t4 ladotr0,o5XoFP M .!. toal 5dOPr M cd F{ o c 0l h4 Lf\ ol o -tEtr.o14 >,nc) c1 Eoo,rdOC)OtLn s rntN \o C.r E{a o &o H p s ,oF Eo ,r4ron d F{ d E v !4 .d4 cl u0 qJ F. oo cto .d t0 .P :Jtrodp :J C.JOt{ t5 .r{ O@ ti) .oa .do ccl o v Iq d .d oo idEtr.oJ oro6EN H F] @ Ito E- CO c) c\ Js. Oo \o olro .oto !4 og crl o >' t4 oooqrEoldOH(no @ EqFOE EJt'l >OH <F1h,l f=l ora ooq0 .qdPF{ dd'd io{, t{d.{+rdHllooH,CO r{d{J .d Ao o .t fr H oo E ooNrf\ (\N Lr\tr\t'- tr'- s@ Lnor-O NC)(n \o H J E oorn rn C'- N oo u\Lr\ t-. t.- o o oo E- a O O >r O H LJ\ Oco tn O\N Lf\ oNO NN orn6N rF- H E] EA ooLno noto G\O N ootr\O @Lnf\rc + otdo t{A r{d o P5 o E &d tr{ o 11p + rl o H .d n or o h o 1.< o + or{p d+ r{ od .d dd H cit b0d aH .{ a {J o F{p d r{ o o @ t{ rl+ oq{ .d a o .r{ od Etrd q cbo ooo .( 'rlPfu o. .do opO ..1 .rl dlr '.{g> oo a@ .t +{ ooHt{aab0 bo .rl ilqr ctr tr I{oogFqo Cr-,{. oo FrF lt tr o 'r{ @ r{ o o .,{ trq +o @ E o ri o h -{d o -to rc .d h oIil Ft '.1 or .d d o , ..J o o o o .d A o o d .d0 a ;l HI E U Elo H o{ aa r.l c-.o o =C c EI {5tr^ oh o.dD}ddo rrC +o qr at{ d +)o no>)C)p o E J4 N ooo Eii o\ oO a trd o E{ oO6r Ho .r{ >d \f o ldod+11.d@ -ro, oo CO d o ilAtr o a o .o n o\ r-.{ >r .dk fl,i-oi =r{ rnt-- oe- .d Jdt{o .l ciF{ {r cJ+Ed oo e-- on .d @ o tr H ( oo .Fld rrP 'rl oqo Gr llg cJFlq o o G LA u o ?-.{ @ d o inN 6 dco t{ t{ d r\ @ o C)N ht{ o+ A o oha o \o o N a)O6 d EODE:,oo OO Srtr- o !o d d .dgo o qO^OcJP .(H@iol5.doo>a ,dXodtrdolotr bo>o olH ot{ PCoobood dE.++.dr{> 6!o, .do CJ'+oo H^ .ddd ,E{#00trHt{o6, om F{ qrv -q^PO r{ O,doOE, .dv 50otrbo+trgao(qo @ rrlts:OFHJ> <c4rd rdEa :l EI PRIUI-RY iiE rl,Ti{ C ,RI SIIR]EY BAsIC D.,T Iorm I : General information on the village Country... Villaee: name and nunber latitude and longitude region prefecture sub-prefe cture Sufvey dale: Year nonth day Population Census population No. of feniLies listed No. of faniLies intervieYed Dominant tribe Econonlc activities Principal Secondary 0thers ! Nearest aail road - rurme and rlistance Nearest narket - narne cnd distance - transport price generally charged by carriers Ilearest health centre : - name and distance - transport price enerally charlled by carriers Nearest hospital : - nane and dlstance - transport price generally char.e,ed by carriers Ilealth services Nunber of : riealth rorkers ..... Treditione.l birtLr attendants Trained birth ottendants . Nurses. ..... [ldwlves. .... .. Doctors. Nunber of gulnea-worn cases :... ..... . contracted in the village .. contr:,cted elserhere Schools: Primary : No of classes .. No. of pupils Secondary: No of clas jes. . .... . .. No. of puplls Rural Developnent Nunber of: Rural extension workers Projects....... Companies .. Deuocratic orsanizations (please tick) Party....... trlonenls....... Youth . Brotherhood.........Cooperative...... Elrllsg r -Rice( ) 4it1et ( ) maj-ze ( ) sorghum ( )ccssavzr.( )y*.( potatoes ( ) plantains ( ) -Coffee( ) eocoa( ) cotton( )sugarcane ( )fruit( ) Livestock l -cattLe( )goats ( ) piss( )poultry( ) crops and Ii'restock shoul-d be nunbered Lr 21 31 4, J el,c. in orJer of inportance. e.e. if the villagets nain crop is 4i11et; followed by cassava, plantr,ins and rice, the entry slioulil read: Rice (4) nil1et (1) nalre ( ) sorghun ( ) cas.:ava (2) yans ( ) pot:-toes ( ) ptanta:.ns (3). The sane procedure shoufcl be foiLowed for the industrial crops; ccffee, ooooa' cotton, etc., and for Livestock: cattle, 6oats, etc. I C ountry Forn II : FamiLy hyaiene Family ],1o. Dr inkine-ua ter suppl r* Fron nerfest river (ple-,ce tic)<) - I'traoe.... Distlrnce fron vi11,-r,1.1e..... r-l,l-sez.son...... Dry seas,:n Lret se:tson... ... Fron connunal- viLla,:e lell - No. of wells - No: of wells rith punp - No. of ne1ls raiti ra.ised surround - No. of nelis witlcut nrise,f surround From fanilv well - No. of weI1s wibir r::,ised surround - No. of ref 1s .,riti.out raised surround Uater for aninal.s Sane source as ,lrinkin,q-water for fanily (please tlck) - .L wtrat sesson: drl,. .. .. lret . - lpecial drinkiru; t"o$, : yes. no. .... .. . ... - llo trougl, Different source fron fanilv - Dir:tance fr,-ln f -.nil,rrs veter supply Where cLothes zre tashed (please tick) - At fanily drinkin6;-water source - ,rt different -'rater source lIhere people'*ash It fanilv dr ter source - wo4en - chiltlren rit speclqlL location in the coupound _ &en - o1d people - wonen - children Excreta dlsposal fn the bush Comuunal vi1Ia1e latrine: number Fanily latrine: nunber Disposal of household wastes Near corypound !'ar from conpound Connunal village dunpl .. numbe.r - distance fron villa_rle Number of guinea-roru cases in famify Contrrcted in the ',,il,Iage : Contracted else',rhere : PR]t\i RY ]'iE'.LTii Cr.RE SUR\EY B-" SIC DiI;, llill.-a. nrne and number Survey datc : Year , month, day Nane of iread of fauily : PRII'{ RY IIE/II,TH C.,RE SURYEY i].,SIC DJ.I. .lountry Yillate : nane and nunber Survey date : ,,'eirr Forn IIl - Deliveric s the fernil-v FaniLy No. IJane of head of fanilv : Tota1 number of woirie*. e --l'inr rl i:; oa.st veer . I}i Ti{E VILL',GE ,-ttended Bv traditi onal birth attendant No. of deliverie.r No. of c,,nfined wonerr sti1l rrlive IJo. of confined wonen r;iro died during delivery Cost rf a deli",ery (estinated) Care give to nother Washing with hot water and soap : nutrber Uashing uith hot ,rrater but no soap : number Inteke of nedicinal substances : nulaber No intake of nedi-cinaI substances : nunber Refused to reply : nunber C ord Cut with nerr ra,ror-b1ade Cut with oLd razor-blade Cut with cold lrnife Donrt knou Treated uith indigenous substances Not treated Donlt know Chilclrs conditi,rn at birth Nornal ..... Too big monhJ.'r, day f,:o snal . Live-born tn.l 1i.re-born but fr ,m Llve-born cut Sti1l-borir Born deforne.J Born deforne,r stil,J- :1i re die,l durrar-, firs I month : - te t- nu:.; - jr"undice - doril t kr.)crr dieri Curing .rear and stilf allve but rlied during 're:.r '-t birth nugber Care of ch -rgyrol or silver nitrrte -upplied to grTes -ntl tetanus serury 0ther Irl one Dontt know F'ORI,I TIT ( C,:ntcl . 1 VilLasc: lane &nd nu+bor r''aririly IIo: SCIEEjSLI- yrior - rrronbl:r - dt"y Name oj. i{ rcl ,, j li,1r1ily: TI; A :IE,\LTII CINIRI abur,nded by t"roined bir th abLor"lant or uidril; na., o heal-th c-ntre llis iance t'ron vrllagc llu;rbr,r o, rieliv,,r: . s lluilbcr o^ cor,i'it'lrd lronen s bill aLiv., r"{u:r}, r oi' corf in d wom,n who died in labor:r Rr: rs ons i cr qq4iqsron (p1:ase tick) i' ,rsonal cc'nvcnil nce 0n so*Jon,lls advrc., 0n ad.ricc ol traCitional birth aii,-.ndant i^ea,-ls {), Lransirort us,jd Ioo i; 'l'wo-',ul::'lt:,1 v.,iricIr Jart ( cost) l:r (co:t) Iiuribrr oi courpanions .lare provided i'or r:cther (cost) (cos r,) tiashin6 wl1;h not watcr and soap l,ioshlng wilh hot aat.-.r but no soap ,lrugs pr,- s,;rib.:cl llo drugs pr.'scrib.rd Donit knov Cor,j CUL,ribh f1an.:d scissors uu i, wi brr s i,r ril-iz, d. scissors I)onJ i know , r.atsd Ilo L tr::at. cl Donr t know Chil-d. lg conLlit,ron ab lrirL,, :lormal ioo sna11 ..... Too big L,i'ze -born and s Lill alivr- Liv,,-born but died during first Donth from: - t. tanus - jaundicr' - otL-,'r - ionrt know Li, ,-born but Jitl during y-ar Stil-l Lrorn Dorn d -1 or;:c-,r and stil1 aI ive Born ,j:f ormcd but di,.d during y,-"rr Car-. of chiid at birth ,\rgyrol or sil"'rcr nitratc applied to eycs .;irr t,i t: tanus Scrun 0 l"h or .ilona Donr t krrow )urrrre tlie stay j-n t're h,-a,1th centre '.lcre drugs supplied free of charge" ilert. drugs paid for? CosLi l,Ias acconirlodation fr:,,? Was acconnodaLion paid for? cost? FoR' I il ( c ont.l ) dayf j.ll"ae" : nane and No , Surr/cv .la LL : yLar' : non Llr: ri'ani1y Uo. llan, ol -leeC ol ri^,nitv: I]T IOSPIIAL att--nd,,d bv uidsirc or pnvsician 'laue. of hospital .ilis i;anc ironi vi11ag.. lio. of' d;-1ivr,'ric s: l'lo. of coafined woucn 1.o. oi co:,fincd wor,n lloo: oi confincd wornen il,:asons r'or adBission 'lotal-: by ca,rsarianS sti-l-l al-i-,.e whc died in labour (p1. as,, tick) P,'r s cnaf i dhi..cnicnc,-, l'.- I aJUn soneoncls advlc(' 0n'h3atth centrc r'i advice : '' : , , ., i.t ,0n'adviic "ol' villagc traditioriel birth att-:nda;,t 1 ,-,.' l, I ,t,. ;)l : 11..sns of transoort used - F,ool Two-whr(,1cd vchicl,: (cos t) Cart (cos L,) Car (cos',) llunb,r o companions ....... (cost) lar: provid: d for oother W.rshing wiLh hot wat,-.r and soap 'fashing wibh hot w.ater but no soap Drugs prtscribed iio lrugs pr.scribed Donl |" knor C or"t Cur" wi,"h flan,:d scissors Cul vilh slrerilised scissors Donlt know Tr. at"d llol tr,:at.:d Donlt know lhiLdrs condil,ron at bi.rNh liorual ...... Ioo sraff ......'loo big ..... Livc-born and s Lill- alive Li re-born but died during f irst ,ronbh fr:rn: - te banus - jaundice - othr:r - dont t knotr Liv-.-born but Cied during year Stilltrorn Born,l:forned anC stilt alive Born dcforned but died during ycar Care of child at birth Argyrol or silver u:-+,rate appJ-icd +,o cycs An bi t..'banus s€.ruy 0th:-r r'lon0 Donrt krow D rrr tng th centr,: W.:r:. drugs supplied frr.,e of chtrgei rderr: drugs paid f or? cost.' Was accommodation lr,-e? 1,,[.1s .!cconmodation pald for? cosi,? : stav in the hea PRIIL\RY il rILTI CnRi SUR','tiY -r,i s 1i D; I,i! lountrv:.....i...... \ij.lIaec: naro and'Io. Surtry da+"e: yiar, nontlr , day Foru Ii;: l-cedins of th,, chil rJ within th': fani-I .tl arriiV No. Initia.f i.,cdrne Breas bi'eedir€ B o ttl e-t' : "din6 I{ixr.d le ; ding Itraoe oi head of f eEily Jost pe1 nontir p-r child Cost 1, r rlcnlh pcr ch1ld &e ab uhich seni-sol id foods are introluccd ( in rron:hs ) (vithin,rach set or'brackcts ;nt;:r th- nunber oi'woil.n gi,in6 seni-sotid foods at th; ccrr"rponding age) 1( ) z( ):( )+( ) i( i ( I7( ) B( )e( ) 10( )11( )rz( ) 13( )r,r( )15( jt6( )11( )18( )rr( )zo( )zr( ) zz( ) zt( ) ,4( ) 25( lz6( lzt( )ze( )ry( ):o( )31( )tz( )tz( ) sq( ):r( ) 36( ) I:.enplc: il one wonan giv,,s seni-solids et J nonbls rnd I wonon giv; thsn at I uontirs, th,,for.iowingentryismad':1( ) z( ) :( ) +( ) l( ) 6( ) 7( ) ":B(3) 9( )ro( )eto. , - C.ri1d sits - r'oo lh orup bion - ChiId crarlg - Ciiil-d waLks - ller pr.gnancy Agc at which child starts sharing iamilv 4ea1 ( in nor,ll.s ) . Proce.,C as above. t,l \ 16( ) 2',1( ) () e( )())-o( )( ) 31( ) /\t)1r\) i 1 -t>( \ r)T() ( ) 13( )( ) 21( )())5( ) 14( ) 25( ) 36( ). ( ) 7( ) ( ) 18( )( ) ze( ) - lhild sils - foott: eruption - l;:ild cravls - Clrild waLks - llew pregnancy Ase of w:aninq (in months). Proceed as llbrv 85 l2 ?3 )+ 10 21 )2 Ii( ) 26( ) 15( ) 25( ) to 30 77 28 5() 1'l( ) 27( ) ( ) 7( ) a( ) e( )()18()19()ro()( ) 2e( ) to( ) 31( ) 10( ) 1r(tt( ) 22( t2( ) tt( )12()u) zll I z,r) :-i( i ss \] t1 t4 25 Jo'28 foot h erup cion Child crar^'ls Ohild vralks Ilew pr':gnancy Inclus:.oL qf qnmaL,prgqelns 14 d1q! Iiumb';r of times per ru,- 'k: r( \ z( ) :( ) +( ) l( ( me.rt, f i sii, c,gg s ) ) Random ( )6( 7( PRIIL\RY -,-Elillil C^RII SURWY Di.TA Villagc: u.,.re and lJo. Survey date: year , nonth , Jay , Cost of iLl-ricss tx lit ia:rilr- :a.:,rc oI', iruld or' farrily I ountrv: Poru V. Family No. Fr\T1 ll;T 'illl}\'- D I]] YILLIIGE Do vou oftBn treat fanilv l,urrrsc],''l Yes ..... products? i{o If so. what r: e Co v;'.,;rake of Dtarmac.;u Iialaria attack: ,lo. c'f c.rf Jro,luine iab1. bs Diarrhoea: ldo. o-i ;ulfagui:niding tabl,,ts Dysentcry: Iio. of dif u t,arscnc labf ,rts Eound injury: 1 tub,, of ointnent: How do vou obtain the ..utical Droduct s't PEchase in a pharrnacy. If so, r,rhat do ycu pay for - I chloro.;uine b:LLrlct - 1 sulFaguanii-rnc tab1..t - 1 difctarsonu tablr b - 1 Aspirin tablr: b - 1 Anpoul" of bcnzathinr bcnzylpenicillin - 1 tubc of or-ntrr,:nt f or r;outriis - Others Pr:rchase from traders. I1l so; ruhat do you pay f or: - 1 c]:Loro.-tuine tabt rt - 1 sulfaguani.line tablut - 1 difctarsonc t,:rbl. l; - 1 aspirin tal,l r L - 1 anpoul. of bcnzalJrin,-. benzi'lpeniciffin - 1 tube of oin-brrr-nL for wounds - Others Purchasc fron h,:altli DcrsoluoL. rii:lt do you pay f or: - 1 chloro,iuin.. l,abl,:t - 1 sulfaguanidri:: trlbl( t, - 1 riif c lars,;iri- ;;r'i1,- f, - 1 .Lspirin t,,;t':. r, - 1 ampoulr, of i,'(inza b-r i111. b,,,nr:y1p-nicrf l-in - 1 tub--- of arir, L-;l'r-rt i'cr vorr:.ds - 0thers. Iorm I i(ccntd) pani_r-V 1.O. Nane of lread of t':uilv PriIIilliT TRil-iIiD Il) i'. H'ldi,i'.i 'J-E.JTRI 'ave you ;vcr sont a patient frou ycur funi.ly to a :e:,1th c. irtr.; llar_rc o{' ccntrr, Distancc fro:r viIIage l{eans o.C transport: - foot - tro-wheeLed vehicl.: (cost) - cart (cost) - car (cost) it tir" l:ealth centre Yo,rr p.- bi..nt r,ras suef ering froin: - drugs werc frec - you paid Your pati.nb was suffering from 3 - drugs were free - you pald . for .Jrugs For drugs C ountry: Villagc: Nane and ]Jo. Your patient rras suffering fron: - drugs were free _ you paid ...... Sur :y dat;: Yea-r , nonth , day . .... for drugs Ycur patj.ont ras suffering fron: - drugs were fr,:; _ you paid ... ... If tLc l'cr drugs paticnt wq.s adBitted - Drugs wcre free - You paid .. . ... i'or 61r*" - Lccomnodation chargi,s amouni,c.l to ......., . acconpanicd?"ias the pati - I'io. of persons - Cost of thcir trausport iave vuu v r had to transo a bodv back Lo tirc yil-lncc? - Hcr nuch did this cost'? C oun+,r't': r'orm V : ( r;"ni,c ) Far,.ilv i.lo. Ha,,l you cver sent a n3[lb,jr of your iarai]y Name of hospital Distance from village I{eans of transp631. - foot - two whoel-e6 rru6iq1. (cos'u) - cart (cost) - car (cost) At thc hospitaL tr o hcspitall' Your pat:.r;rt was suffcri-ng from : - drugs wcre fr,e - you paid i'lrr ,lrugg Yo'.r pabient was suffering fron : - drugs were frec - you pai.d for drugs Y,:ur pativnt was surfering fron : - drugs were frce - you paid for drugs Your patiint was suffering frou g - drugs vrr:ra free - you paid for drugs rf th,. patiint was adnitt.d Drugs ftrre J"ree You paid .. for Crugs ricconmodation chargcs ,rnount( d to . ...... . Yillage: Nane and ilo. Sur -.,:y dalt,: Year, nonth, day, N,rnu ot')e.rri o1' j'atuiirr Pi.l'I.!iii'l TII;.|Trll Iil l{0SPIT.rL lJas th€i Dat i., t accompaniud? No. of p{rrsOns Cost cf tireir transporl ilavc you evcr had to transport a bodv bacti to tho villagr,? IIow nuch did this cost?