Community distribution of anti-malarial treatment – Pilot program

PVO COLLABORATIVE RESEARCH:
BASELINE SURVEY OF THE RWANDA COMMUNITY
DISTRIBUTION OF ANTI-MALARIALS PILOT PROGRAM
Concern Worldwide, International Rescue Committee,
World Relief
August 20, 2004
The Child Survival Collaborations and Resources Group
www.coregroup.org
Abstract
The Rwanda National Integrated Malaria Control Program is collaborating with
health management teams and three international private voluntary organizations
(PVOs) – Concern Worldwide, The International Rescue Committee, and World
Relief – to implement a pilot program for community-based distribution of antimalarial medication in Kibilizi, Kiboga, and Kirehe districts. The program is funded
by the CORE Group, the U.S. Agency for International Development (USAID),
and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM). Future
plans include implementing the program in three additional health districts with
funding and management from UNICEF. The National Malaria Control Program
is providing guidance, training, and all medications; the PVOs and their local
partners are using existing child survival programs to implement and monitor the
programs. Community health workers chosen by communities and trained by
health districts and their PVO partners will distribute the drugs. In order to evaluate the situation in each community as well as inform program design, the PVOs
and their partners conducted surveys in each of the three pilot districts. The results of these surveys, including results for three key baseline indicators, are presented in this report.
The surveys were conducted in January 2004 in Kibilizi District in Butare Province, in May 2004 in Kibogora District in Cyangugu Province, and June 2004 in
Kirehe District in Kibungo Province. All three surveys used Lot Quality Assurance Sampling (LQAS) for both sampling and analysis of survey results. A total
of 589 children and caregivers were included in the surveys, including 357 febrile
children. In Kibilizi and Kibogora, malaria indicators were included as part of a
wider survey, whereas in Kirehe the survey was conducted especially for the malaria program. However, all three surveys were designed to ask similar questions
to address malaria indicators. A member of the Kirehe Health District management team with LQAS experience gave on-site technical support for the surveys
in Kibilizi and Kibogora.
The surveys showed that few young children with fever receive timely, appropriate anti-malarial treatment as recommended by the Rwandese Ministry of Health:
only 16% of children included in the study in Kibilizi District, 9% in Kirehe District,
and 20% in Kibogora, receive timely and appropriate treatment as opposed to the
Abuja target goal of 60%. About a third of children receive no treatment; of those
being treated, many are treated after twenty-four hours or with an inappropriate
first-line anti-malarial drug. Knowledge of danger signs is reasonably good in
Kirehe and Kibogora Districts but very poor in Kibilizi Districts; in all three districts, work remains to increase awareness of the danger signs – particularly
anemia and convulsions – as well as awareness of the need for all fevers to be
treated. These results confirm the urgent need for a program to make malaria
treatment more accessible for febrile children in Rwanda.
1
INTRODUCTION & PROGRAM BACKGROUND
Malaria is the principal cause of morbidity and mortality in Rwanda, causing
40% of health center visits and 43% of deaths1 in the country. Children are at
particularly high risk. In Rwinkwavu, in 2002, community health workers reported
5882 deaths of children under 5 in the community, almost three quarters of which
were attributed to febrile illness. Only 423 of these deaths occurred at health facilities.
The Ministry of Health recommends two major strategies to lessen the burden of
malaria: the use of insecticide-treated bednets for prevention, particularly among
vulnerable groups including pregnant women and children under 5; and early diagnosis and treatment with combination therapy amodiaquine and sulfdoxine/pyrimethamine. To improve compliance, the Ministry of Health has arranged
for blister packets containing a complete course of treatment to be made available at a subsidized price of 20 cents (US).
However, current treatment through health centers leads to unacceptable delays
in treatment. In a survey conducted in Kibungo and Ruhengeri health districts by
the National Malaria Integrated Control Program with the Quality Assurance Project, children less than 5 years of age were found to get appropriate treatment an
average of 3 days after the onset of fever, whereas the World Health Organization (WHO) recommends treatment within 24 hours. Reasons for this delay include distance from the health center and the cost of treatment. For these reasons, caregivers often prefer to purchase treatment from local pharmacists and
pill-sellers who are closer and cheaper, but often do not provide proper treatment
advice regarding dosing and duration of treatment. These factors also account
for Rwanda’s low utilization rates for government-sanctioned health facilities, less
than 0.24 visit per person per year, compared with an expected value for developing countries of 0.5 to 1.
To address the related problems of high malaria mortality and low use of health
facilities, the Ministry of Health’s National Malaria Control Program has authorized the distribution of first-line antimalarial medication by community health
workers. The National Malaria Control program has decided to implement the
policy in a few districts initially, and has chosen sites that benefit from child survival support from organizations including Concern, IRC, and World Relief. The
following sites have been identified:
- Kibilizi Health District in Butare Province with Concern Worldwide
- Kirehe Health District in Kibungo Province with IRC
- Kibogora Health District in Cyangugu Province with World Relief
Originally, the three PVOs submitted a proposal to CORE to implement the pilot
in one health center catchment area of each health district mentioned above.
Support from CORE was obtained for a period of 12 months starting September
1
MOH information system, 2001
Health animator report, Rwinkwavu Health District, 2002
3
MOH information system, 2002
2
2
15th 2003. Later, the National Malaria Control Program decided to extend the pilot to all health centers in the three health districts of Kibilizi, Kirehe and Kibogora
and to extend the length of the pilot until December 2005.
Program Objectives
The overall goal of the program is to pilot-test the ability of community health
workers to provide front-line anti-malarial treatment in rural community settings.
Specific objectives include:
1. To increase the proportion of children under 5 years of age with uncomplicated malaria who received correct treatment from a trained provider
within 24 hours of the onset of symptoms to 60% as per the Abuja Target;
2. To demonstrate that community health workers can appropriately use
simple case management guidelines for children under 5 with fever;
3. To increase caregivers’ awareness of the danger signs of malaria in children.
a. Objectives of the baseline survey
A baseline study was conducted in the three pilot districts in order to gather data
on three malaria indicators:
1. Percent of children under five years with fever in the past two
weeks who received correct malaria treatment in the 24 hours following the onset of fever4
2. Percent of caretakers of children under five years who can correctly
cite at least two signs that febrile children need urgent attention
3. Percent of caretakers of children under five years who know that
young children with fever need treatment within 24 hours
The results of the surveys will be utilized to guide implementation of the pilot program by identifying priority geographic areas within each of the pilot districts.
Survey Methods
Sampling
Three separate surveys were carried out in each of the intervention districts. In
all three cases, the interviewees were caretakers of young children and the interviewers were members of the PVO staff or local health districts. LQAS5 sampling
was used. Briefly, LQAS is a form of stratified random sampling in which:
1. The work area is divided into sub-zones or “supervision areas”. For all three
surveys, the sub-zones consisted of health center catchment areas. The Kibilizi and Kibogora surveys had seven sub-zones each. In Kirehe, there were
ten sub-zones.
4
Denominator: children under five years surveyed who had a fever in the last two weeks. “Correct” treatment means first-line treatment with an Amodiaquine-Sulfadoxine-Pyrimethamine combination
5
The LQAS method is described in more detail in the individual survey reports.
3
2. Nineteen households were selected at random in each subzone. For all three
districts, selection was carried out in two stages. A list of cells (communities)
for each sub-zone was obtained, with a population estimate. Systematic random sampling proportional to size was used to select nineteen cells.6 A numbered list of households was compiled for each of the selected cells, and a
household chosen through a random number obtained either through Excel or
by selecting random numbers from a currency bill.
Note: Concern Worldwide and its partners in Kibilizi Health District used parallel
sampling, with four different targets: mothers of children 0-11 months, mothers of
children 12-23 months, men aged 15-49 years, and women aged 15-49 years.
Questionnaire7
The questionnaires were developed in French by PVO staff and members of the
local district, and then translated into Kinyarwanda. In Kibilizi and Kibogora, malaria indicators were included as part of a wider health Knowledge, Practice and
Coverage (KPC) survey, whereas in Kirehe the survey was conducted for the
malaria program.
Interviewees
in Kibilizi and Kibogara all mothers of children in the specified age range were
interviewed for the larger KPC studies. Only the responses from a subset of
women who reported their children had fevers in the last two weeks were used
for analysis of the malaria program indicators. In Kibungo Province, the survey
was carried out specifically for the malaria program, therefore only mothers who
reported children under five years of age with fever in the last two weeks were
interviewed.
Analysis
Initial analysis for the three surveys was done immediately after the survey, using
the manual tabulation and analysis method developed for LQAS surveys8 (Sample analysis sheets from the Kibilizi and Kibogora are included in the annex). For
Kibungo, the survey results were entered electronically and re-analyzed using
Epi Info software. The methods used are summarized in the following table:
Table 1. Methods used for the baseline surveys
PVO
Place
Kibilizi District,
Butare Prov.
CWI
Dates
(2004)
Jan 19-31
-
Interviewees
Mothers kids 0-11 m
Mothers kids 12-23 m
Female adults
Male adults
6
Sampling
method
LQAS
Number
Interviewees
- 133
- 133
- 133
- 133
Supervision Areas
In some cases one large cell had several households chosen, so there were less than nineteen cells chosen.
For copies of the questionnaires or any further information please contact the point persons for each organization listed on page 10.
8
The method was developed by Joe Valadez and is available in the LQAS trainer’s manual.
7
4
7
IRC
WR
Kirehe District,
Kibungo Province
Kibogora District,
Cyangugu Prov.
Jun 1-3
- Mothers kids <5 y with
fever
LQAS
- 190
10
Apr 30 –
May 8
- Mothers kids 6-59
months
LQAS
- 133
7
Results
As shown in Table 2, caretakers’ awareness of the danger signs of malaria and importance of urgent care varied across the three sites. Mothers with children under five
appeared much more aware of danger signs of febrile children requiring urgent attention (56 to 58%) than the general adult population (17-20% in Kibilizi).
The proportion of children with fever who received care from a trained provider for malaria was low, ranging from 9 to 20%, far short of the Abuja target of 60%. The majority of mothers of young children in Kibogora (75%) know that children with fever need
treatment within 24 hours, while awareness is lower in Kirehe (46%).
Table 2: Results for major indicators
Indicator
% of children under 5 years
with fever in the past 2
weeks who got correct malaria treatment in the 24
hours following the onset of
fever
Place
Kibilizi
Kirehe
Kibogora
% of caretakers of children
under 5 years who can correctly cite at least 2 signs
that febrile children need
urgent attention
Kibilizi
% of caretakers of children
under 5 years who know
that young children with
fever need treatment within
24 hours
Kibilizi
Kirehe
Kibogora
Interviewees
Mothers children
with fever 0-23 m
Mothers children
with fever 0-59 m
Mothers children
0-23 m
Female adults
Male adults
Mothers children
with fever 0-59 m
Mothers children
0-23 m
n
Correct
%
95% C.I.
116
18
16
9 – 22
190
18
9
6 – 15*
51
10
20
9 – 31
133
133
23
27
17
20
11 – 24
13 – 27
190
110
58
51 – 65*
133
74
56
47 – 64
Not included in questionnaire
Mothers children
190
87
39 – 53*
46
with fever 0-59 m
Mothers children
132
99
68 – 82
Kibogora
75
0-23 m
* Calculated using Epi Info. All other confidence intervals estimated using the formula for binomial confidence intervals: p+/-1.96*square root (p(1-p)/n)
Kirehe
5
Graph 1: Mother’s reported actions for child fevers, Kibogora and Kirehe
Districts
Kibogora
99
27
7
Take to health fac. w/in 24 hrs
Take to health fac. after 24 hrs
Kirehe
87
0%
20%
76
40%
60%
27
80%
Don't take to health facility
100%
Graph 2 illustrates variations in responses of mothers across the three districts. It
is important to note that the duration and nature of malaria interventions in each
site has varied. There are no significant differences in social, economic or political determinants among the three populations.
Graph 2: Results for major indicators
% women who know that febrile
children should be treated promptly
Kibogora
% women who know 2 or more danger
signs for malaria
Kirehe
Kibilizi
% febrile children who received correct
malaria treatment within 24 hrs
0%
20%
40%
60%
80%
100%
The two-week point prevalence of fever among surveyed children confirms the
high burden of febrile illness across Rwanda. Point prevalence ranged from 44%
to 53% in Kibilizi and Kibogora respectively. In the past year, bed net coverage
reached 45% of mothers of infants which may partially account for the lower burden in Kibilizi (infants 0-11 months 36% and children 12-23 months 51%). The
survey in Kirehe specifically targeted children with fever and could therefore not
be used to calculate fever prevalence.
Place of Treatment: In Kirehe, 38% of surveyed children with fever received no
treatment while one-third (33%) received care at a health facility. The use of
pharmacies, traditional healers, and birth attendants was less frequent, as shown
in graph 3.
6
Graph 3: Site of treatment for febrile children, as reported by mothers,
Kirehe District (n=190)
Health facility
33%
Pharmacy
19%
Other
4%
No treatment
38%
TBA
3%
Traditional
healer
3%
Timing of treatment at health facilities: Of those febrile children who received
treatment, the majority were treated later than 24 hours following the onset of
symptoms.
Graph 4: Timing of treatment for febrile children, as reported by mothers
Kibogora
9
21
Treated within 24 hours
Kirehe
32
36
Kibilizi
10
11
0%
20%
40%
60%
80%
Treated after 24 hours
100%
Note: Data for Kibilizi is for children 12 to 23 months only.
Of the febrile children treated at health facilities or pharmacies, the majority were
treated with the appropriate first and second line anti-malarial treatments as
shown in graph 5. Only 1% received Chloroquine. Sixteen percent of the mothers did not know what medication was given. Correct first-line treatment is Amodiaquine with Sulfadoxine and Pyrimethamine.
7
Graph 5: Treatment given for febrile children at health facilities or pharmacies, as reported by mothers, Kirehe District.
Quinine
28%
Amodiaquine /
Sulfadoxine /
Pyrimethamine
51%
Sulfadoxine /
Pyrimethamine
1%
Chloroquine
1%
Don't know
16%
Other
3%
Awareness of specific danger signs in Kirehe as shown in graph 5 is greater for
difficulty in eating or drinking and listlessness, while convulsions, anemia and
coma are less well known.
Graph 5: Danger signs for fever cited by mothers, Kirehe District
58%
Unable to eat or drink
56%
Listless
28%
Convulsions
16%
Anemia
5%
Coma
0%
20%
40%
60%
80%
% mothers citing sign
8
100%
Conclusions and Recommendations
While each district differs slightly, the three surveys show similar overall trends
indicating that geographic and financial issues are the largest reason for not accessing timely and appropriate treatment.
In all districts few children receive prompt treatment with the correct antimalarial from a trained provider. PVO staff and partners cite several reasons
for this, most of them linked to access and resources: the health centers are far
away, and caregivers cannot afford to pay for consultation and medicines. The
situation appears to be worst in Kirehe District, possibly because it is larger geographically.
Survey results show that many children receive medications after 24 hours (see
graph 3). The surveys indicated that some caregivers might rely on traditional
medicines, while others are not aware of the potential danger of fevers. However, the relatively large proportion of mothers who state an intent to treat their
child at health centers indicate that external (e.g., distance and cost) rather than
internal (e.g., belief in traditional medicine) barriers play the greatest role in their
decision to seek treatment for their children. All of this suggests that making
treatment more geographically and financially accessible will have a large impact
on the number of children receiving access to correct first-line treatment for malaria.
Caregivers are aware of danger signs and the need for prompt treatment, at
least in Kirehe and Kibogora Districts. Knowledge of danger signs appears much
lower in Kibilizi District. Some of these answers may reflect perceived desirable
answers. Not all signs are equally known: education work needs to focus on
recognizing anemia. For convulsions and coma, low recognition may simply reflect the fact that these signs are so obvious that mothers did not even think to
mention them. Alternatively, convulsions may be viewed as symptoms of a different type of problem, such as poisoning. Qualitative research should be undertaken to understand caregivers’ view of anemia and convulsions in particular, as
well as why knowledge appears to be so much lower in Kibilizi.
Recommendations
The results of the baseline studies indicate that:
-
The proposed pilot program for antimalaria drug treatment is needed and
should be implemented as soon as possible.
This program should include an educational component, particularly in Kibilizi
District to address gaps in knowledge and practice.
Increasing awareness of the danger signs of malaria is necessary, but field
staff should be careful to emphasize that all fevers need to be treated.
9
Next Steps
A national technical committee for community malaria treatment brings together
the National Malaria Control Programme, the three PVOs, Cooperation Belge,
UNICEF and USAID to design, monitor and disseminate this pilot program. Results from the baseline assessment have been reviewed by the committee and
used to fine-tune implementation strategies, particularly as they apply to training
and health education messages.
Starting in mid-year 2004, under the supervision of health facility personnel,
community health workers will be trained and equipped to provide first-line treatment for simple fever of children under-five based on agreed algorithms. Children with danger signs and all adults with fever will be referred for care at the local health facility.
A final survey is planned after 18 months of pilot implementation to assess
changes in care-seeking practices and awareness of mothers with febrile children under five. The pilot experience will be shared at an end-of-project national
workshop in Kigali and will serve as a platform for a Ministry of Health decision
on adopting supervised community treatment in all districts.
For further information contact:
Emmanuel d’Harcourt
The International Rescue Committee
122 East 42nd Street
New York, NY 1018
[email protected]
Melanie Morrow
World Relief
7 East Baltimore Street
Baltimore, MD 21202
[email protected]
10
Michelle Kouletio
Concern Worldwide Inc. (US)
th
104 East 40 Street, Suite 903
New York, NY 10016
[email protected]
II. Annexes
1.
2.
3.
Map of the provinces in which the survey was done.
Questionnaires
List of supervision areas (sub-zones)
11
a. Map of Rwanda with the provinces included in the survey
Ruhengeri
Byumba
Umutara
Gisenyi
Kigali
Kibuye
Kigali-Rural
Gitarama
Kibogora
District
Kirehe
District
Gikongoro
Cyangugu
Kibungo
Butare
Kibilizi
District
12
b. Questionnaires
Kibilizi District – Concern Worldwide
a) FEMMES ET HOMMES ADULTES DE 15 a 49 ANS
A1
1. Umuriro mwinshi/
Forte fièvre
2. Kweruruka/Anémie
3. Guta ubwenge/Coma
4. Kurabirana/Perte de
connaissance.
5. Ibindi/Autres
6. Ntabizi/Ne sait pas
Ni ibihe bimenyetso by'uburembe bya
Malariya?
Quels sont les signes de danger du
Paludisme?
b) MERES AYANT ENFANT 0 A 11 MOIS
I1
Muzi inzitira mibu?
Connaissez-vous une moustiquaire?
I2
I3
Murayifite?
Avez-vous une moustiquaire?
Kanaka yayirayemo?
(Nom de l'enfant) a-I-il dormi sous une moustiquaire
cette nuit?
I4
Irakarihije?
Est-elle impreignée?
1. YEGO/ Oui
2. OYA/ Non
1. YEGO/ Oui
2 OYA/Non
1. YEGO/Oui
2. OYA/Non
[SKIP TO C7]
[SKIP TO C5]
1. YEGO/Oui
2. OYA/Non
I5
Mbese namwe mwayirayemo iri joro ryakeye?
Avez-vous dormi sous une moustiquaire
cette nuit?
1. YEGO/Oui
2. OYA/Non
I6
Iyo mwarayemo iteye umuti(Karishya)?
Est-elle impreignée?
1. YEGO/Oui
2. OYA/Non
I7
Mubyumweru 2 bishize kanaka yaba
yararwaye?
(Nom de l'enfant) a-t-il été malade au cours
des 2 dernières semaines?
Yagize ibihe bimenyetso?
De quoi était-il malade? (Signes)
1.
2.
I8
13
YEGO/Oui
OYA/Non
[SKIP TO C7]
[SKIP TO C10]
1. Guhumeka insigane/
Respiration rapide.
2. Kuruka/Vomissements
3. Impiswi/Diarrhée
4. Umuriro/Fièvre
5. Kwituma amaraso/
Diarrhée sanglante
6. Inkorora/Toux
7. Ibindi/Autres
I9
Igihe kanaka yararwaye mwamuvurije he?
Ou a-t-il été traité au cours de cette
maladie?
I10
Mwavuje hashize igihe kingana iki afashwe
Après combien de temps a-t-il été soigné?
1. Ntaho/Nul part
2. Ku muvuzi wa gihanga.
Chez le guerisseur
Traditionnel
3 Ku mubyaza wa gihanga/
Accoucheuse traditionnelle.
4. Kumujyanama w'ubuzima
Animateur de santé
5. Muli farumasi/Pharmacie.
6. Kwa muganga/Fosa
7. Ahandi (Havuge) Ailleurs
1. Mu masaha 24/ Dans 24 heures
2. Nyuma y'amasaha 24/
Après 24 heures
3. Ntabizi/ Ne sait pas
c) MERES AYANT ENFANT 12 A 23 MOIS
C1
Muzi inzitira mibu?
Connaissez-vous une moustiquaire?
C2
C3
Murayifite?
Avez-vous une moustiquaire?
Kanaka yayirayemo?
(Nom de l'enfant) a-I-il dormi sous une moustiquaire
cette nuit?
C4
Irakarihije?
Est-elle impreignée?
1. YEGO/ Oui
2. OYA/ Non
1. YEGO/ Oui
2 OYA/Non
1. YEGO/Oui
2. OYA/Non
[SKIP TO C7]
[SKIP TO C5]
1. YEGO/Oui
2. OYA/Non
C5
C6
C7
Mubyumweru 2 bishize kanaka yaba
yararwaye?
(Nom de l'enfant) a-t-il été malade au cours
des 2 dernières semaines?
Yagize ibihe bimenyetso?
De quoi était-il malade? (Signes)
Igihe kanaka yararwaye mwamuvurije he?
Ou a-t-il été traité au cours de cette
maladie?
14
1.
2.
YEGO/Oui
OYA/Non
[SKIP TO C8]
1. Guhumeka insigane/
Respiration rapide.
2. Kuruka/Vomissements
3. Impiswi/Diarrhée
4. Umuriro/Fièvre
5. Kwituma amaraso/
Diarrhée sanglante
6. Inkorora/Toux
7. Ibindi/Autres
1. Ntaho/Nul part
2. Ku muvuzi wa gihanga.
Chez le guerisseur
Traditionnel
3 Ku mubyaza wa gihanga/
Accoucheuse traditionnelle.
4. Kumujyanama w'ubuzima
Animateur de santé
5. Muli farumasi/Pharmacie.
6. Kwa muganga/Fosa
C8
Mwavuje hashize igihe kingana iki afashwe
Après combien de temps a-t-il été soigné?
15
7. Ahandi (Havuge) Ailleurs
1. Mu masaha 24/ Dans 24 heures
2. Nyuma y'amasaha 24/
Après 24 heures
3. Ntabizi/ Ne sait pas
Kirehe District – The International Rescue Committee
République Rwandaise
Ministère de la Santé
DS KIREHE
International Rescue Committee
Kibungo Child Survival Program
LQAS NO|____| |____|
SOUS—ZONE NO|____|
QUESTIONNAIRE NO|____| |____||____|
Ce questionnaire est reserve aux enfants de moins de cinq ans d’age qui ont eu une fievre dans les deux dernieres semaines
ITARIKI Y’IBAZWA
ITALIKI
Jour
UKWEZI
Mois
UMWAKA
Annee
DATE D’INTERVIEW
IZINA RY’UBAZA (Nom de l’Enqueteur)________________________________________
IZINA RY’UMUGENZUZI (Nom du Superviseur) _________________________________
IVURIRO (Centre de
Sante):__________________
UMURENGE (Secteur)
_____________________
AKARERE (District Administratif)
_____________
AKAGARI (Cellule)__________________
UBWUMVIKANE / Concentement
Muraho, Nitwa
nkaba nkora ------------------------. Tura kora ubushakashatsi k’ubuzima bw’ababyeyi n’abana. Twabasabaga kudufasha muri ubwo bushakashatsi. Ndashakaga kubabaza ibibazo bijyanye na malariya ihungabanya ubuzima bwanyu hamwe n’ubw’abana
banyu. Ibizavamo bizafasha akagari k’ubuzima ka KIREHE mubarirwamo hamwe n’abaterankunga
kurushaho gukemura ibibazo by’ubuzima muhura nabyo cyane cyane ibiterwa na malariya. Ntabwo
mbafata igihe kirekire. Ibyo mutubwira byose biraba ibanga hagati yacu.
Kudusubiza ni ubushake bwanyu, kandi mufite uburenganzira bwo kudasubiza ikibazo mwasanga kibabangamiye. Gusa turizera ko ntakibazo bibatera. Hari ikibazo mwaba mufite kubyo mbabwiye?
Bonjour, Mon nom c'est…………..agent de……………Nous sommes entrain de faire
une étude sur la santé de la mère et de l'enfant. Je vais vous poser quelques questions
en rapport avec le paludisme qui perturbe votre santé et celle de vos enfanfs. Les résultats de cette étude aideront le District sanitaire de KIREHE et les intervenants à mieux faire face aux problèmes
de santé en general et ceux causés par le paludisme en particulier . Je ne vous prendrais pas beaucoup de
temps. Rassurez-vous que tout ce que vous allez me dire restera confidentiel. Vous avez le droit de répondre ou
de ne pas le faire pour une question qui ne vous plait pas. Mais nous espérons que ce n'est pas du tout gênant .
Avez-vous un problème sur ce que je viens de vous dire?
IYO USUBIZA YANZE, MUSHIMIRE, UMUSEZERE, UGENDE. MUGIHE YEMEYE,
MUBAZE NIBA AFITE UMWANA URI HAGATI Y’AMEZI 0—59 KANDI NIBA YABA YARARWAYE MURI IBI BYUMWERU BISHIJE KANDI YARAFASHWE N’UMURIRO. NIBA
ARI NTAWE, MUSHIMIRE, UMUSEZERE, UGENDE. NIBA AHARI, TANGIRA IBIBAZO
KUVA KURI NOMERO YA MBERE.
Si la personne à enquêter refuse, remerciez-la et quittez en lui souhaitant bonne journée
16
Si elle accepte, lui demander si elle a un enfant de 0 -59 mois qui a ete malade de fievre pendant les 2 dernieres semaines, interviewez-la en commençant par le Nº 1. Et si elle n'a pas cet enfant , remerciez-la et
quittez-la en lui souhaitant bonne journée.
1.
MWITWA BANDE?
Quel est votre nom?
2.
NYIRI URUGO NINDE?
3.
UMWANA URI HAGATI Y’AMEZI 0-59 YITWA NDE ? Comment s’appelle votre enfant age
de 0-59 mois ?
KANAKA ( umwana uri hagati y’amezi 0—
59)
ITALIKI
UKWEZI UMWAKA
Jour
Mois
Annee
YAVUTSE RYARI?
4.
Qui est le nom du chef de menage ?
Quelle est la date de naissance de(Nom de l’enfant
age de 0-59 mois) ?
5.
F. UMUKOBWA/ Fille
IGITSINA
Sexe
NI HEHE KANAKA YAVURIWE ?
Ou (Nom de l’enfant) a-t-il été
traite ?
6.
M. UMUHUNGU/Garçon
A.
B.
C.
K’UMUBYAZA WA GIHANGA/ Acc traditionnelle
D.
K’UMUJYANAMA W’UBUZIMA/ Animateur de
sante
NI UWUHE MUTI YAHAWE ?
(Kwerekana imiti yose ishoboka)
(Nom de l’enfant) a –t-il recu ub de
ces traitements ?
(montrer les differents pilules
et paquets)
8.
9.
K’UMUVUZI WA GIHANGA/ Guerisseur traditionnel
E.
MURI FORUMASIYO/ Agent de la pharmacie
F.
KWA MUGANGA / Fosa
G.
7.
NTAHO / Nulle part
AHANDI (havuge)/ Autre(preciser)_______________________
1.
AMODIAQUINE/FANSIDAR
2.
CHLOROQUINE
3.
FANSIDAR
4.
QUININE
5.
AUTRES
8.
NTABIZI /Ne sais pas
MWAMUVUJE HASHIZE
IGIHE KINGANA IKI?
1.
Apres combien de temps a-t-il ercu
ce traitement?
8.
MU MASAHA 24 AFASHWE Dans les 24 heures
NYUMA YA MASAHA 24 AFASHWE Apres 24 heures
NTABIZI Ne sait pas
2.
NI IBIHE BIMENYETSO BYATUMA WIHUTIRA KUJYANA UMWANA KWA MUGANGA ?Quels sont les signes de maladie
qui indiquent que l’enfant doit etre soigne
rapidement, dans les 24 heures?
17
0.
UMURIRO NTIWAVUZWEMO / Fievre non
mentionee
1. UMURIRO WAVUZWEMO / Fievre mentionnee
10.
11.
UMWANA WANYU ARAMUTSE AGIZE
UMURIRO, WAMUKORERA IKI ?Qu’est ce
que vous faites pour votre enfant en cas de
fievre ?
UMUVUZA HASHIZE IGIHE KINGANA IKI
AFASHWE ?Quand le faites-vous soigner?
1.
NDAMUVUZA/ Je le fais soigner
2.
IKINDI/ Autre :__________________
Q12
1. MU MASAHA 24 AFASHWE Dans les 24
heures
2.NYUMA YA MASAHA 24 AFASHWE Apres
24 heures
NI IBIHE BIMENYETSO BIGARAGAZA
UBUREMBE BW’UMWANA WAFASHWE
N’UMURIRO ?
12.
Quels sont les signes de gravite chez un
enfant presentant de la fievre?
A. KUTONKA/ Incapacite de boire-teter
B. GUCIKA INTEGE/ Asthenie
C. Coma/ Guta ubwenge
D. GUHWERA/ Convulsions
E. KWERERUKA /Paleur extreme/anemie
F. IBINDI /Autre _________________
13.
NINDE WABAFASHIJE MUBYARA
KANAKA ?
Qui vous a assite dans l’accouchement de
(Nom de l’enfant) ?
0.NTAWE / A domicile
1.KU KIGO NDERABUZIMA CG IBITARO / FOSA
2.UMUBYAZA WA GIHANGA/AT
3.UNDI /Autre :__________________
14.
15.
NIBA ARI UMUBYAZA WA GIHANGA,
YAKORESHEJE KITI ?
Si c’est l’AT, a-t-elle utilise le kit ?
MURI INO MYAKA ITATU ISHIZE HARI
INGARUKA WABA WARAGIZE MU GIHE
CYO KUBYARA ? Pendant les 3 dernieres
annees, avez-vous eu des complications
lors, pendant et apres l’accouchement ?
NIBA ARI YEGO, NI IZIHE ?
Si oui, lesquelles ?
a.
1.
OYA/ Non
2.
YEGO/ Oui
OYA/ Non
1. YEGO/ Oui
A. GUTINDA KU NDA/ Travail prolonge
B.KUVA CYANE/ Hemorragie
C.KWANGIRIKA KU MYANYA
NDANGAGITSINA/ Dechirure des organes
genitaux
16.
D.GUTINDA KUVUKA KW’IYANYUMA/
Retentionplacentaire
E.UMURIRO /Fievre
F.GUTA IBINUKA/Perte nauseabonde
G.IBINDI /Autre _________________
17.
NINDE WAGUFASHIJE MU GUKEMURA
IZO NGORANE ? Qui t’a assiste dans ces
problemes ?
0.NTAWE / A domicile
1.KU KIGO NDERABUZIMA CG IBITARO / FOSA
2.UMUBYAZA WA GIHANGA/AT
3.UNDI /Autre :__________________
18
18.
NIBA ARI UMUBYAZA WA GIHANGA,YAGUKOREYE IKI ? Si c’est l’AT,
qu’est-ce qu’elle a fait ?
0.YAMPAYE IMITI CG YANKOREYE IBINDI/ A donne
des medicaments ou autres
1.YANYOHEREJE KWA KU KIGO NDERABUZIMA CG
IBITARO / FOSA
NTA BIBAZO MWABA MUFITE MWAMBAZA?
AVEZ-VOUS DES QUESTIONS A ME POSER OU QUELQUES CHOSES A AJOUTER?
0. └┘OYA/Non
0. └┘YEGO/Oui
(andika ibyo bibazo n’igisubizo yahawe)
/Noter les les questions et les reponses donnees
REBA KO IBIBAZO BYOSE BYASHUBIJWE!!
VERIFIEZ SI TOUTES LES QUESTIONS ONT ETE POSEES!!
MURAKOZE CYANE. TWIZEYE KO IBYO MWATUBWIYE BIZADUFASHA KURUSHAHO GUKEMURA
IBIBAZO BY’ABANA N’ABABYEYI MU KAGARI KANYU K’UBUZIMA. TUZABAGEZAHO IBYAVUYE MURI
UBU BUSHAKASHATSI MU GIHE KITARAMBIRANYE.
MERCI BEAUCOUP DE VOTRE PARTICIPATION. NOUS ESPERONS QUE QUE L’INFORMATION QUE
VOUS NOUS AVEZ DONNE NOUS PERMETTRA D’AMELIORER LA SANTE DES MERES ET DES ENFANTS DE VOTRE DISTRICT SANITAIRE DE- KIREHE. VOUS SAUREZ LES RESULTATS DANS LE
PLUS BREF DELAIS.
19
WORLD RELIEF – Kibogora
République Rwandaise
Ministère de la Santé
DS KBOGORA
LQAS NO|____| |____|
World Relief Rwanda
Umucyo Child Survival Program
SOUS—ZONE NO|____|
QUESTIONNAIRE NO|____| |____|
Ibibazo birebana n’indwara ya marariya bigenewe ababyeyi b’abana bafite
amezi atandatu kugeza ku mezi mirongo itanu n’icyenda
Questionnaire sur le paludisme reservé aux mères des enfants de 6 à 59 mois
du DSK
ITALIKI
ITARIKI Y’IBAZWA
UKWEZI
Jour
Mois
UMWAKA
Annee
DATE D’INTERVIEW
IZINA RY’UBAZA (Nom de
l’Enqueteur)________________________________________
IZINA RY’UMUGENZUZI (Nom du Superviseur)
_________________________________
IVURIRO (Centre de
Sante):__________________
AKARERE (District Administratif)
_____________
UMURENGE (Secteur)
_____________________
AKAGARI (Cellule)__________________
UBWUMVIKANE / Consentement
20
Muraho, Nitwa
nkaba nkora muri Minisiteri y’Ubuzima,
Akarere k’Ubuzima ka Kibogora.Tura kora ubushakashatsi ku buzima bw’ababyeyi n’abana.
Twabasabaga kudufasha muri ubwo bushakashatsi. Nashakaga kubabaza ibibazo bijyanye
na malariya. Ibizavamo bizafasha akagari k’ubuzima ka KIBOGORA mubarirwamo hamwe
n’abaterankunga kurushaho gukemura ibibazo by’ubuzima muhura nabyo cyane cyane ibiterwa na malariya. Ntabwo mbafata igihe kirekire. Ibyo mutubwira byose biraba ibanga hagati yacu.
Kudusubiza ni ubushake bwanyu, kandi mufite uburenganzira
bwo kudasubiza ikibazo mwasanga kibabangamiye. Gusa turizera ko ntakibazo bibatera. Hari ikibazo mwaba mufite kubyo
mbabwiye?
Bonjour, Mon nom c'est…………..agent de……………Nous sommes entrain de faire
une étude sur la santé de la mère et de l'enfant. Je vais vous poser quelques questions
en rapport avec le paludisme qui perturbe votre santé et celle de vos enfants. Les résultats de cette étude aideront le District sanitaire de KIBOGORA et les intervenants à mieux faire face aux problèmes
de santé en général et ceux causés par le paludisme en particulier . Je ne vous prendrais pas beaucoup de
temps. Rassurez-vous que tout ce que vous allez me dire restera confidentiel. Vous avez le droit de répondre ou
de ne pas le faire pour une question qui ne vous plait pas. Mais nous espérons que ce n'est pas du tout gênant .
Avez-vous un problème sur ce que je viens de vous dire?
IYO USUBIZA YANZE, MUSHIMIRE, UMUSEZERE, UGENDE. MUGIHE YEMEYE,
MUBAZE NIBA AFITE UMWANA URI HAGATI Y’AMEZI 6—59. NIBA ARI NTAWE,
MUSHIMIRE, UMUSEZERE, UGENDE. NIBA AHARI, TANGIRA IBIBAZO KUVA KURI
NOMERO YA MBERE.
Si la personne à enquêter refuse, remerciez-la et quittez en lui souhaitant bonne journée
Si elle accepte, lui demander si elle a un enfant de 6 -59 mois, interviewez-la en commençant par le Nº 1. Et
si elle n'a pas d'enfant de cette tranche d'âge remerciez-la et quittez-la en lui souhaitant bonne journée.
14.
15.
16.
17.
MWITWA BANDE?……………………………………………………….
Quel est votre nom?
NYIRI URUGO NINDE?…………………………………………………..
Qui est le nom du chef de ménage ?
MUZI GUSOMA?
1. Yego
2. Oya
Savez-vous lire?
Oui
Non
MUKORA IKI ?…………………………………………………………...
Quel est votre emploi ?
UMWANA URI HAGATI Y’AMEZI 6-59 YITWA NDE ? Comment s’appelle votre enfant âgé de
18 6-59 mois ?…………………………………………………………………………
KANAKA ( umwana uri hagati y’amezi 6-59)
19 YAVUTSE RYARI ?
Quelle est la date de naissance de(Nom de l’enfant
age de 6-59 mois) ?
21
ITALIKI
UKWEZI
UMWAKA
Jour
Mois
Année
F. UMUKOBWA/ Fille
IGITSINA
20 Sexe
N. UMUHUNGU/Garçon
MU BYUMWERU BIBIRI BISHIJE, KANAKA
YABA YARA RWAYE?
0. OYA/ Non
21 (Nom de l’enfant) a-–t-il été malade pendant les 2 der-
1. YEGO/Oui
nières semaines?
Niba igisubizo ari « oya » jya ku kibazo cya 13
YAGARAGAJE IBIHE BIMENYETSO?
Quels ont été les signes de sa malade?
13
A. GUHUMEKA INSIGANE Respiration rapide et/ou difficile
13
B. KURUKA Vomissements
13
C. IMPISWI Diarrhée
22
13
D. UMURIRO fièvre
E. INKORORA Toux
13
F. IBINDI (bivuge) Autres (préciser)_______________
13
YAVURIJWE HEHE ?
Ou Kanaka a-t-il été traite ?
Niba avuze ahandi hatari kwa
muganga jya ku kibazo cya 13
Si elle cite autre part que la FO23 SA, va à la question 13
A.
NTAHO / Nulle part
B.
13
KU MUVUZI WA GIHANGA/ Guérisseur traditionnel
13
C.
KU MUBYAZA WA GIHANGA/ Acc traditionnelle
13
KU MUJYANAMA W’UBUZIMA/ Animateur de
D.
santé
E.
13
MURI FORUMASIYO/ Agent de la pharmacie
13
F.
KWA MUGANGA / FOSA
G.
AHANDI (havuge)/ Autre (préciser)__________________
YAHAWE IYIHE MITI ?
Quel traitement a-t-il recu initialement?
24 (montrer les differents pilules et
paquets)
1.
Amodiaqine/Fansidar
2.
Chloroquine
3.
Fansidar
4.
Quinine
5.
Autres :………………………………………………………
6.
MWAMUVUJE HASHIZE IGIHE
KINGANA IKI? Apres combien de
25 temps a-t-il été traite?
13
Ne sais pas
3.
MU MASAHA 24 AFASHWE Dans les premières 24 heures
2.
8.
NYUMA YA MASAHA 24 AFASHWE Apres 24 heures
NTABIZI Ne sait pas
22
NI IBIHE BIMENYETSO BYATUMA WIHUTIRA KUJYANA UMWANA KWA MUGANGA ?
Quels sont les signes de maladie qui indi26
quent que l’enfant doit être soigné rapidement dans la Fosa ?
UMWANA WANYU ARAMUTSE AGIZE
UMURIRO MWAMUKORERA IKI ?
Niba igisubizo atari « 1 » jya ku kibazo cya
27 16
Qu’est ce que vous faites pour votre enfant
en cas de fièvre ? Si la réponse n’est pas
« 1 », va à la Q16.
NIBA Q14 ARI « 1 » MWAMUMUVUZA
HASHIZE IGIHE KINGANA IKI ?
Si la réponse a Q14 est « 1 », Vous le faites
28
soigner après combien de temps?
NIBA Q14 AR « 2 » GANA KURI 16
2. NTIYAVUZE UMURIRO ( Fievre non mentionee)
3.
NAMUJYANA KWA MUGANGA (Je le fais soigne à
la FOSA)
4.
IBINDI (Autre) : _______________________
16
1. MU MASAHA 24 AFASHWE
(Dans les 24 heures)
2.NYUMA Y’AMASAHA 24 AFASHWE
(Apres 24 heures)
8. NTABIZI (Ne sait pas)
G. KUTONKA/ KUTANYWA
NI IBIHE BIMENYETSO BIGARAGAZA
UBUREMBE BW’UMWANA WAFASHWE
AHINDA UMURIRO ?
29
1 . YAVUZEMO UMURIRO ( Fievre mentionnee)
H. GUCIKA INTEGE
Quels sont les signes de gravite chez un enfant présentant de la fièvre ?
I.
GUTA UBWENGE
L. IBINDI
NI IZIHE NDWARA ZIKUNZE GUFATA
ABANA MURI AKA KARERE MUTUYEMO ?
30 Quelles sont les maladies fréquentes chez
les enfants dans votre milieu ?
Niba igisubizo kuri 17 ari «1» jya kuri19
MWABA MUZI INDWARA YA MALARIYA ?
31 Connaissez-vous la malaria ?
MUZI UBURYO MALARIYA IKWIRAKWIZWA /IKIYITERA ?
Asthenie
Coma
J. GUHWERA/ KUGAGARA
K. KWERURUKA
Convulsions
Pâleur extrême
Autre _________________
1 . YAVUZEMO MALARIYA ( Malaria mentionnée)
2 . NTIYAVUZEMO MALARIYA ( Malaria non
mentionnée)
1. YEGO ( Oui)
2. OYA ( Non)
1. YEGO ( Oui)
Niba asubije « Oya » jya ku kibazo cya 21
32 Connaissez-vous le mode de transmission
de la Malaria ? Si la rép. est « 2 » vas à la
Q 21
33
Incapacite de teter/
boire
2. OYA ( Non)
1.UMUBU ( Moustiques)
IKWIRAKWIZWA N’IKI /ITERWA NI IKI ?
Quel est le mode de transmission ?
2.IBINDI Bivuge ( Autres,
citez) :……………………………………
23
21
19
NI BANDE MALARIYA IZAHAZA KURUSHA
34 ABANDI ?
Quel est le groupe vulnérable pour le paludisme ?
35
36
37
38
39
40
41
MWAKWIRINDA MUTE MALARIYA ?
Comment pouvez-vous vous protéger contre
le paludisme ?
MWABA MWARIGEZE KUBONA
/KUREBESHA AMASO INZITIRAMIBU ?
Avez-vous déjà vu une moustiquaire?
Niba asubije «Oya» kuri 23, jya ku kibazo
cya 28
MWABA MUFITE INZITIRAMIBU?
Niba asubije « Oya » jya ku kibazo cya 28
Avez-vous une moustiquaire?Si la rép. Est
« 2 » vas à la Q.28
KANAKA (Umwana uri hagati y’amezi 6 na
59) YAYIRAYEMO IRI JORO?
Niba asubije « Oya » jya ku kibazo cya 28
Kanaka( L’enfant de 6 à 59 mois) a-t-il dormi
sous la moustiquaire cette nuit ?Si la rép.est
«2» va à la Q 28
IRAKARIHIJE ? (Niba asubije « Oya » jya ku
kibazo cya 28
Est-elle imprégnéé? Si la rép.est «2» vas à
la Q28
MUHERUKA KUYIKARISHYA RYARI ?
Quand a- t-elle été traitée pour la dernière
fois ?
HARI UMWANA WO MURI URU RUGO
WABA WARITABYE IMANA ATARAGEZA
KU MYAKA ITANU MU MWAKA USHIZE
WA 2003 Y’a-t-il un enfant de moins de 5
ans décédé au cours de l’ année passée(2003) dans cette famille ?
1. ABANA BARI MUNSI Y’IMYAKA ITANU
( Les enfants de moins de 5ans)
2. ABAGORE BATWITE ( Les femmes enceintes)
3. ABANDI ( Les autres)
1. YAVUZEMO INZITIRAMIBU( Moustiquaire mentionnée)
2. NTIYAVUZEMO INZITIRAMIBU ( Moustiquaire non
mentionnée)
1.YEGO (Oui)
2.OYA( Non)
28
1. YEGO (Oui)
2. OYA (Non)
28
1 . YEGO ( oui)
2. OYA ( Non)
28
1.YEGO ( Oui)
2. OYA ( Non)
28
1.MBERE Y’AMEZI ATANDATU ( Avant 6 mois)
2 . NYUMA Y’AMEZI ATANDATU ( Après 6 mois)
1. YEGO ( Oui)
2. OYA ( Oya)
NTA BIBAZO MWABA MUFITE MWAMBAZA?
AVEZ-VOUS DES QUESTIONS A ME POSER OU QUELQUES CHOSES A AJOUTER?
1. OYA/Non
2. YEGO (Andika ibyo bibazo n’ibisubizo yahawe)
Oui
(Noter les questions et les réponses données)
REBA KO IBIBAZO BYOSE BYASHUBIJWE!!
VERIFIEZ SI TOUTES LES QUESTIONS ONT ETE REPONDUES!!
Murakoze cyane. Twizeye ko ibyo mwatubwiye bizadufasha kurushaho gukemura ibibazo by’abana
n’ababyeyi mu kagari kanyu k’ubuzima. Tuzabagezaho ibyavuye muri ubu bushakashatsi mu gihe kitarambiranye.
24
c. List of supervision areas
Kibilizi
Gikore
Kansi
Kibayi
Health facility
Kibilizi
catchment areas
Kigembe
Kirarambogo
Mugombwa
Kirehe
Bukora
Gahara
Gashongora
Kabuye
Kirehe
Musaza
Nasho
Nyabitare
Nyamugari
Nyarubuye
25
Kibogora
Gatare
Hanika
Nyamasheke
Kibogora
Rangiro
Ruheru
Yove