Health and Nutrition Knowledge, Practices and Coverage Survey 2019

Lebanon

Organization: Medair
Location: Lebanon
Grade: Administrative support - FG I, Function Group 1, Contract Agent
Occupational Groups:
- Public Health and Health Service
- Statistics
- Nutrition
Closing Date: Closed

Health and Nutrition Knowledge, Practices and Coverage Survey 2019

Lebanon

The objective of the survey is to collection data on key health and nutrition related indicators at the household level, including the following thematic areas:

Health seeking behavior
Diarrhea and respiratory tract infection management for children
Vaccination
Reproductive health (including antenatal care, postnatal care and family planning)
Breastfeeding practices
Access to reproductive and psychosocial services

BACKGROUND:

In 2019 the Syria crisis entered its eighth year with almost 1 million registered, and as many as 550,000 unregistered Syrian refugees continuing to reside in Lebanon, a third of whom live in the Bekaa Valley (UNHCR Data Portal, July 2019). The protracted nature of this conflict has seen the number of refugees residing in Lebanon remain relatively stable since 2014 and the number is not expected to decrease in the immediate future. Syrian refugees make up as much as a quarter of Lebanon’s total population, with 80% of these refugees being women and children. The presence of refugees in such high numbers has strained the political, economic and social stability of the country, stretching basic services and systems that have weakened the host authorities’ capacity to respond to the increased needs, especially in education, water supply and healthcare. Difficult living conditions exacerbated by the weather and poor sanitation and hygiene situation in refugee settlements have a strong impact on the public health situation of the refugees and has increased the risks of outbreaks of communicable diseases.

Since 2014 Medair has been supporting Ministry of Social Affairs (MOSA) Social Development Centers (SDC) implementing a project to improve refugees’ and affected host communities’ access to primary health care (PHC) services. Medair, in close collaboration with MOSA, currently supports sixclinics in Central, West and North Bekaa, with a focus on mother and child health, in addition to mental health and psychosocial support. Medair supports clinics through the provision of human resources, medicines, equipment, capacity building and supportive supervision to each of the clinics.

Community Health Volunteers (CHVs) in the SDC catchment area deliver a community health promotion package and have been trained on relevant health topics including exclusive breastfeeding, family planning, essential maternal and newborn care, early marriage, lice and scabies treatment and referral systems. Community midwives provide antenatal care, postnatal care and family planning. CHVs and community midwives carry out household visits, community outreach in Informal Settlements within SDC catchment areas and as well as meeting refugees and vulnerable host communities in community shared places.

SURVEY PURPOSE

The Knowledge, Practice and Coverage (KPC) household survey will measure standardized health and nutrition indicators for Syrian refugees and vulnerable Lebanese, in the Medair-supported SDC project areas. The purpose of the survey is to provide robust data that will inform Medair, MOSA, Ministry of Public Health (MOPH) and other NGO programming and provide a strong evidence base to current and potential donors. The analysis will serve to compare key indicators across key target groups, as well as enable a comparison with the 2016,2017 and 2018 KPC surveys.

SURVEY METHDOLOGY

The survey to be conducted will use a cluster design to enable the calculation of 95% confidence interval point estimates with acceptable degrees of precision. The sampling frames will be distinct for both Syrian refugees (made up of those living in informal settlements) and vulnerable Lebanese, such that two cluster surveys will be conducted.

OBJECTIVES OF SURVEY

The objective of the survey is to collection data on key health and nutrition related indicators at the household level, including the following thematic areas:

Health seeking behavior
Diarrhea and respiratory tract infection management for children
Vaccination
Reproductive health (including antenatal care, postnatal care and family planning)
Breastfeeding practices
Access to reproductive and psychosocial services

KEY INDICATORS TO BE MESAURED

The specific to be measured are:

Programme area	Indicators
Socio-demographic info	% of mothers of children ages under 5 years who got married before the age of 18 years (early marriage)
	% of mothers of children ages under 5 years who do not know how to write and read
	% of households (HH) with a crowdedness index above 1.5
Health care access general	% of mothers of children aged under 5 years of age in project area who went to qualified health services when they needed medical services
Health care access general	% of mothers of children aged under 5 years of age in project who visited any Medair supported SDC during the 12 months prior to the survey
Reproductive Health (RH) services	% Women in the targeted communities who correctly identify available RH services
	% WGMB in the targeted communities who correctly report where to access RH services
	% Women in the targeted communities who report that they would be comfortable and able to access these (RH) services as needed
	% of mothers of children under 5 years who report accessing RH services in the 6 months prior to the survey
	% of mothers of children under 5 years receiving RH services who report satisfaction with support provided
ANC visits	% of mothers of children under two years of age who had at least 4 comprehensive antenatal visits when they were pregnant with their youngest child
	% mothers of children aged 0-23 months who had their first ANC visit within the first 3 months of pregnancy
	% mothers of children aged 0-23 months who had their last ANC visit less than 1 month before delivery
Delivery	% of mothers of children under 5 years who delivered their youngest child at hospital
	% of mothers of children under 5 years who delivered by caesarian section
	% of mothers of children aged 0-23 months who received a health booklet during their stay at hospital
	% of mothers of children aged 0-23 months who stayed at 24h in the hospital after delivery
Postnatal Care (PNC)	% of mothers of children under two years of age who received a post-partum visit from an appropriate trained health worker within two weeks after birth of their youngest child
	% of children under two years of age who were examined by an appropriately trained health worker 3 days after delivery
	% of mothers of children under two years of age who received at least 3 post-partum visits within 40 days after delivery
(Exclusive) breastfeeding	% of infants 0-6 months who are exclusively breastfed (calculation method 1)
	% of infants 0-6 months who are exclusively breastfed (calculation method 2)
	% of mothers of children 7-23 months who breastfed their child within 1 hour after delivery
Family Planning (FP)	% of mothers of children under 5 years who report discussing FP with a trained service provider in the 12 months preceding the survey
	% of mothers of children 0-23 months who are using a modern contraceptive method
	% of mothers of children 0-23 months who know at least one risk of getting pregnant within 2 years of last delivery
	% of women of children 0-23 months who know what is the best birth spacing
Vaccinations	% of children aged 12 months- 5 years who are vaccinated for measles in clinics’ coverage area
	% of children aged 1- 5 years who are vaccinated for polio in clinics’ coverage area
	% of children aged 1- 5 years who are vaccinated for Diphtheria and Pertussis and Tetanus (DPT) in clinics coverage area
	% of children age 12-23 months who received age appropriate vaccination at time of survey
Treatment of sick child	% of children under 5 years that had fast or difficult breathing in the last 2 weeks
Treatment of sick child	% of children under 5 years with fast or difficult breathing for whom advice or treatment was sought after more than 24h of fast or difficult breathing, in the last 2 weeks
Treatment of children with Acute Respiratory Infection (ARI)	% of children under 5 years with fast or difficult breathing for whom advice or treatment was sought from an appropriate health facility or provider in the last 2 weeks
	% of children under 5 years with fast or difficult breathing or cough by type of treatment in the last 2 weeks (inclusive of antibiotics)
Treatment of children with diarrhea	% of children under 5 years with diarrhea receiving ORS and zinc supplementation
Prevalence of diarrhea	% of children under 5 years that experienced diarrhea in the last 2 weeks
Non Communicable Diseases (NCD)	% of mothers of children under 5 years who reported having at least one HH member with NCD
Non Communicable Diseases (NCD)	% of women who know 2 or more ways to reduce the risk of NCDs
Psycho Social Support (PSS) services	% women in the targeted communities who correctly identify available PSS services
	% women in the targeted communities who correctly report where to access PSS services
	% of mothers of children under 5 years who report discussing PSS with a trained service provider in the 12 months preceding the survey
	% women in the targeted communities who report that they would be comfortable and able to access these (PSS) services as needed
	% of mothers of children under 5 years who report accessing PSS support services in the 6 months prior to the survey
	% of mothers of children under 5 years receiving PSS services who report satisfaction with support provided
Child registration	% of children under 5 years officially registered in their country (for Syrians)
Child registration	% of children under 5 years without birth certificate
Mortality related to pregnancy	% of women’s sisters who died due to problems related to pregnancy

SURVEY METHODOLOGY

The surveys to be conducted will use a cluster survey design to achieve 95% confidence interval point estimates with an acceptable degree of precision.

*Target population*	Clusters x cluster respondents	Planned household respondents
Syrian refugees (in Informal Settlements)	60 x 25	1500
Vulnerable Lebanese	30 x 25	750
TOTAL		2250

The sampling frames are Syrian refugees (made up of those living in informal settlements only) and vulnerable Lebanese in the catchment areas of the 6 Medair-supported SDCs (Talia, Brital, Marj, Kabelias, Jib Janine and Rafid). For further details on the clusters selected, see the Annex below. The respondents will be women of child bearing age with children under the age of 5, or their care givers. The data will be collected by approximately 70 enumerators, trained and supervised by Medair staff, using tablets and ODK (Open Data Kit) data collection software. A total of 2250 questionnaires are planned to be completed.

TIMEFRAME / SCHEDULE:

Survey questionnaire pre-testing – August 2019

Enumerator training – September 2019

Field data collection: 16^th – 27^th September2019

Consultant: Data analysis and report writing: October – November 2019

Review of draft report – November 2019

SECURITY

Medair will liaise closely with the local authorities and Municipalities for security information across Bekaa.

PERSONS TO CONTACT

Survey focal point: Farah Darwiche (Medair Health Project Manager: healthco-leb@medair.org

M&E focal point: Alastair Punch (Assessments, Monitoring and Evaluation Manager): monitoring-leb@medair.org

FUNDING

Funding for this consultancy will come from Medair donor, EU-Madad. The other costs of the survey are also supported by Medair donor Global Affairs Canada-IHA

ANNEX: Sampling approach

General cluster selection procedure:

Syrian refugees:
1. Using IAMP 63, the number of Syrian refugee households living in Informal Tented Settlements (ITS) within the coverage area of the 6 Medair-supported SDCs (23 Cadasters) was broken down by Cadaster and ITS, and a cumulative population list was made.
2. Based on the total household population, and the required sample size, an interval was calculated for 60 clusters, the starting point for which was selected by a random number.
3. The cluster locations (ITS/Pcodes) were then selected using the interval through systematic random sampling.
4. At the field level, the 25 household respondents will be chosen firstly from within the selected ITS. Where there are not enough households with mothers (or care givers) with children under 5, the next nearest ITS will be located in order to reach the required cluster sample size.

Vulnerable Lebanese:
1. In the same way that IAMP 65 was used for Syrian refugees in ITS, a cumulative population list of Lebanese was made by household per Cadaster. Starting with the 2018 KPC survey Municipality statistics on the number of Lebanese living in the Cadaster and the proportion of vulnerable Lebanese among them, additional sources were used to verify these numbers. These included a) updated Municipality data (through a phone survey), b) Wikipedia statistics, and c) staff local knowledge. The revised list was then used to conclude a final 2019 version of Cadaster populations of Lebanese and vulnerable Lebanese.
2. Based on the total vulnerable Lebanese household population (from across the 23 Cadasters), an interval was calculated for 30 clusters, the starting point for which was selected by a random number.
3. The cluster locations (Cadasters) were then selected using the interval through systematic random sampling.
4. At the field level, where there is only one cluster in the Cadaster, the enumerator teams will be directed either by the Medair-supported CBO, or by the Municipality, to a starting point in the Cadaster that contains high numbers of vulnerable Lebanese. After the first household has been identified, snowball sampling will be used to reach the 25 required households per cluster.
5. Where there is more than one cluster in the Cadaster, the same approach will be used, but the Cadaster will be delineated into the number of clusters through natural geographical boundaries, such as roads, rivers or urban areas.

Syrian refugee cluster selection

PCode	PCode Name	District	Cadaster	Cluster selection
53139-01-028	Taibet Baalbek 028	Baalbek	Taibet Baalbek	1
51329-01-013	Haouch El-Ghanam 013	Zahle	Haouch El-Ghanam	2
51329-01-001	Haouch El-Ghanam 001	Zahle	Haouch El-Ghanam	3
53437-01-090	Serraaine Et-Tahta 090	Baalbek	Serraaine Et-Tahta	4
52277-01-045	Marj BG 045	West Bekaa	Marj BG	5
52237-01-014	Qaraaoun 014	West Bekaa	Qaraaoun	6
51231-01-024	Saadnayel 024	Zahle	Saadnayel	7
51231-01-016	Saadnayel 016	Zahle	Saadnayel	8
52217-01-009	Kamed El-Laouz 009	West Bekaa	Kamed El-Laouz	9
52227-01-010	Ghazzé 010	West Bekaa	Ghazzé	10
51281-01-049	Aanjar (Haouch Moussa) 049	Zahle	Aanjar (Haouch Moussa)	11
51329-01-008	Haouch El-Ghanam 008	Zahle	Haouch El-Ghanam	12
52277-01-100	Marj BG 100	West Bekaa	Marj BG	13
51267-01-048	Barr Elias 048	Zahle	Barr Elias	14
51231-01-083	Saadnayel 083	Zahle	Saadnayel	15
53419-01-036	Haouch Er-Rafqa 036	Baalbek	Haouch Er-Rafqa	16
51264-01-003	Haouch Qayssar 003	Zahle	Haouch Qayssar	17
52211-01-043	Joubb Jannine 043	West Bekaa	Joubb Jannine	18
53419-01-038	Haouch Er-Rafqa 038	Baalbek	Haouch Er-Rafqa	19
51227-01-038	Taanayel 038	Zahle	Taanayel	20
51227-01-005	Taanayel 005	Zahle	Taanayel	21
51383-01-083	Dalhamiyet Zahlé 083	Zahle	Dalhamiyet Zahlé	22
51227-01-003	Taanayel 003	Zahle	Taanayel	23
51264-01-001	Haouch Qayssar 001	Zahle	Haouch Qayssar	24
51227-01-008	Taanayel 008	Zahle	Taanayel	25
51267-01-131	Barr Elias 131	Zahle	Barr Elias	26
53139-01-005	Taibet Baalbek 005	Baalbek	Taibet Baalbek	27
51267-01-143	Barr Elias 143	Zahle	Barr Elias	28
51251-01-004	Haouch Es-Siyadé 004	Zahle	Haouch Es-Siyadé	29
51264-01-006	Haouch Qayssar 006	Zahle	Haouch Qayssar	30
52234-01-001	Khiara 001	West Bekaa	Khiara	31
52277-01-017	Marj BG 017	West Bekaa	Marj BG	32
51383-01-064	Dalhamiyet Zahlé 064	Zahle	Dalhamiyet Zahlé	33
52227-01-044	Ghazzé 044	West Bekaa	Ghazzé	34
51281-01-002	Aanjar (Haouch Moussa) 002	Zahle	Aanjar (Haouch Moussa)	35
51267-01-029	Barr Elias 029	Zahle	Barr Elias	36
53437-01-014	Serraaine Et-Tahta 014	Baalbek	Serraaine Et-Tahta	37
51231-01-076	Saadnayel 076	Zahle	Saadnayel	38
52211-01-004	Joubb Jannine 004	West Bekaa	Joubb Jannine	39
51267-01-036	Barr Elias 036	Zahle	Barr Elias	40
52277-01-004	Marj BG 004	West Bekaa	Marj BG	41
52271-01-001	Harimé Es-Soughra 001	West Bekaa	Harimé Es-Soughra	42
52227-01-011	Ghazzé 011	West Bekaa	Ghazzé	43
51267-01-017	Barr Elias 017	Zahle	Barr Elias	44
51231-01-045	Saadnayel 045	Zahle	Saadnayel	45
53419-01-040	Haouch Er-Rafqa 040	Baalbek	Haouch Er-Rafqa	46
52277-01-024	Marj BG 024	West Bekaa	Marj BG	47
51267-01-013	Barr Elias 013	Zahle	Barr Elias	48
51267-01-011	Barr Elias 011	Zahle	Barr Elias	49
51383-01-061	Dalhamiyet Zahlé 061	Zahle	Dalhamiyet Zahlé	50
52227-01-001	Ghazzé 001	West Bekaa	Ghazzé	51
53419-01-004	Haouch Er-Rafqa 004	Baalbek	Haouch Er-Rafqa	52
52227-01-003	Ghazzé 003	West Bekaa	Ghazzé	53
53139-01-006	Taibet Baalbek 006	Baalbek	Taibet Baalbek	54
52277-01-019	Marj BG 019	West Bekaa	Marj BG	55
51234-01-007	Qabb Elias 007	Zahle	Qabb Elias	56
52211-01-003	Joubb Jannine 003	West Bekaa	Joubb Jannine	57
52254-01-006	Haouch El-Harime 006	West Bekaa	Haouch El-Harime	58
51267-01-018	Barr Elias 018	Zahle	Barr Elias	59
52277-01-001	Marj BG 001	West Bekaa	Marj BG	60

Vulnerable Lebanese cluster selection

Area Code	District	Cadaster	Cadaster for MADAD Phase 1&2 Lebanese	Cluster selection
51251	Zahle	Haouch Es-Siyadé		1
52237	West Bekaa	Qaraaoun		2
51264	Zahle	Haouch Qayssar		3
52217	West Bekaa	Kamed El-Laouz	Yes	4
53419	Baalbek	Haouch Er-Rafqa	Yes	5
52211	West Bekaa	Joubb Jannine	Yes	6,7
52227	West Bekaa	Ghazzé		8
52277	West Bekaa	Marj BG	Yes	9,10
51227	Zahle	Taanayel		11
53437	Baalbek	Serraaine Et-Tahta		12,13
51231	Zahle	Saadnayel	Yes	14,15
53453	Baalbek	Brital	Yes	16,17,18,19,20
51267	Zahle	Barr Elias	Yes	21,22,23,24,25
51234	Zahle	Qabb Elias	Yes	26,27,28,29,30