Annex 5: Results of SQUEAC Investigation in Augie LGA

Annex 5: Results of SQUEAC Investigation in Augie LGA

Figure 8: Monthly Admissions in Augie LGA

Figure 9: Exit data for Augie CMAM

Figure 10: Spatial Distribution of Admissions and Defaulters in Augie LGA

Table 4: Results of the Mind Mapping exercise in Augie LGA

On Outreach

Knowledge and Understanding of CMAM
Augie North
-  Good (both Men & Women)
Augie: Tungan Dade
-  No awareness
Garu: Yola
-  Good (both Men and Women)
Birnin Tudu
-  Good (both Men & Women)
Birnin Tudu: Yarbudda
- Only Women are aware
Bayawa North:
-  Good / Communication Channels
Augie North:
-  Community Volunteers,
-  Beneficiaries
-  Traditional Leaders
Augie: Tungan Dade
-  No Community Volunteer
-  No Beneficiary
Garu:
-  Community Volunteers
-  Beneficiaries
Birnin Tudu
-  Leaders
-  Beneficiaries
-  Community Volunteers
Bayawa North:
-  Beneficiaries
Use of Key People
Augie North
-  Announcement through town criers
-  Leaders
Augie: Tungan Dade
- The leader is not aware
Garu:
-  Leaders
Birnin Tudu
-  Leaders
-  Community Volunteers
Bayawa North: Assarara
-  Not aware / Volunteers
Augie North
-  Not active, Poor Selection & Motivation Problem
Augie Tungan Dade
-  No Volunteer
Augie Tungan Noma
- Not active because he is not within
the Town
Garu:
-  Not active
Birnin Tudu: Yarbudda
-  No Volunteers
Bayawa North: Assarara
-  No Community Volunteer

On Barriers

Physical (Distance, Topography, Animal, Security)
Augie
-  The OTP Clinic is far is not a major barrier for most
-  Mother Sick
-  No Access roads during raining season
-  Long Waiting
-  Cost of Transport due to Distance
Garu
-  Distance
Birnin Tudu:
-  Distance / Human (Social, Religious, Political, Ethnic)
Augie
-  Husband refusal
Garu
-  Husband refusal
Birnin Tudu
-  Husband refusal
High Opportunity cost
-  Men are in involved in farming through out the year and only take children to the Clinic when the sickness is worst
/ Rejection
Augie
-  High number of rejections and no time to explain
Garu
-  Children not considered eligible, mothers not happy
-  RUTF called Madara!
Bayawa North: Yarbudda
-  Discouraged because of rejection but suspects low prevalence

On Community Barriers

Understanding of Malnutrition
Augie
-  Recognise symtoms but do not know the cause
Augie Tungan Dade
-  Recognise Symptoms do not know the cause
Augie Tungan Noma
-  Recognise symptoms link it with Shan Ciki
Garu
-  Recognise symptoms link it with Shan Ciki i.e. breast feeding while the Mother is Pregnant
Birnin Tudu
-  Recognise Symptoms link it with Yarmarainiya i.e. Evil Spirit.
Bayawa North: Assarara
-  Women recognise the symptoms and link it with Shan ciki; while men do not
-  / Health-Seeking Behaviour
-  Complex; Traditional Medicine, Chemist, Hospital
-  1st line is Herbs; 2nd line is Chemist;
3rd line Hospital
-  But now going to OTP Clinic for ‘Shan Ciki’, ‘Yarmarainiya’ and ‘Chiwonciki’
Community Structure
Mothers take the children to the Clinic only when there is Emergency;
Men may also take child to clinic
-  Self-referral / Perception of CMAM
-  Positive, very effective and madaran tamowa is free and they have seen results
-  Programme should continue

On Standard of Service/Follow-up

OTP Service
Augie
-  Manpower adequate
-  Long Waiting
-  CMAM not fully integrated activity
Birnin Tudu
-  Good Communication Staff – Beneficiaries (fewer Patients)
-  Shortage of Manpower
-  More Information needed on prevention on discharge
Garu: Yola
-  Good Communication Staff – Beneficiaries (fewer Patients)
-  Shortage of Manpower
-  Mixing BP100 to avoid shortage
Shafarma
-  Long Waiting
-  Shortage of Manpower
-  CMAM not fully Integrated / Follow-up of referrals/Defaulters
-  No means of checking if cases actually present when referred
-  No systematic follow-up of defaulters
Referrals OTP-SC-OTP
-  Two way referral system in Augie OTP is a bit okay but others None
-  No communication from SC on outcomes / Support to OTP Staff/Volunteers
-  Volunteers Pay their own transport
-  Staff expect money because it’s a special programme
-  Good support from State/UNICEF and Augie LGA
-  In-charge pays for transport of RUTF

Table 5: Hypotheses on Coverage in Augie LGA

1.  Birnin Tudu (Rural – 50% coverage target)
-  > 50% coverage
-  Good Knowledge of CMAM
-  Recognise Symptoms
-  Good perecption of CMAM
-  Wide spread of Admission
-  Few active Volunteers
-  1st line Traditional Herbs / 2.  Bayawa North (Rural – 50% coverage target)
-  > 50% Coverage
-  Good Knowledge of CMAM
-  Good perception of CMAM
-  Wide spread of Admission
-  1st line Traditional Herbs
-  In active Volunteers / 3.  Shafarma (Rural – 50% coverage target)
-  > 50% coverage
-  Good admission from every place in the ward
-  Every body is aware of the programme and of malnutrition and are bringing children to the OTP clinic
-  Good standard of service
-  Low Defaulters
-  Good Outreach
4.  Augie (Rural – 50% coverage target)
-  > 50% coverage
-  High admissions
-  Long waiting
-  Positive regarding CMAM
-  Good Perception of CMAM
-  Volunteers Outside ward
-  Admissions outside ward / 5.  Garu (Rural – 50% coverage target)
-  < 50% coverage
-  Widespread of admissions within and outside ward
-  Active volunteers
-  Good services
-  Fewer Patient
-  Good Perception of CMAM
-  Positive regarding CMAM

Table 6: Results of Small Area Survey

Location / Hypotheses on Coverage / Cases Found / Cases in the programme / Cases not in the programme / Threshold / Coverage
Classification
Birnin Tudu / > 50%; low Coverage / 15 / 4 / 11 / > 7 cases in programme / < 50%
Augie / > 50%; good coverage / 18 / 7 / 11 / > 9 cases in programme / < 50%
Garu / < 50%; good coverage / 4 / 1 / 3 / > 2 cases in programme / < 50%
Shafarma / > 50%; good coverage / 19 / 10 / 11 / > 9 cases in programme / > 50%
Totals / 56 / 22 / 36

Table 7: Results of the questionnaire for the carers of children who are not in the programme

Questions / Garu / Birnin Tudu / Augie / Tiggi
Do you think your child is malnourished? / Yes / 3 / Yes / 3 / Yes / 7 / Yes / 9
No / 0 / No / 0 / No / 3 / No / 2
Are you aware of the existence of a programme which can help malnourished children? / Yes / 3 / Yes / 3 / Yes / 10 / Yes / 9
No / 0 / No / 0 / No / 0 / No / 2
What is the programme name?
- Maganin tamowa / 3 / 2 / 2
- Tuwon leda
- Tamowa/Clinic for tamowa / 3 / 6 / 9
- Don’t know the name
- Not answered / 2
Why your child is currently not enrolled in the programme?
- Too far
10 minute walk
- No time / too busy
Father on farm and mother pounding / 1
- Mother is sick / 1
- Mother is Pregnant / 1
- Father buys medicine from the chemist for the child / 1
- The child has been rejected by the programme already. / 1 / 1 / 1
- Other parents’ children have been rejected / 1
- I do not think the programme can help my child / 3
- It is God’s will
- Mother thought the child is okay/thought that child is not malnourished / 1 / 2 / 1
- Child got sick
During fasting period so unable to come to OTP
Child had measles / 2
- Child is not eating the plumpynut
- Lost beneficiary card / 1
Discharge Cured / 2 / 2 / 2 / 3
Was your child previously admitted to the programme? / Yes / 2 / Yes / 2 / Yes / 3 / Yes / 3
No / 1 / No / 1 / No / 7 / No / 8
If yes, why is he/she not enrolled anymore?
- defaulter* / 1
- condition improved and discharged by the programme / 2 / 2 / 3 / 3
- discharged because he/she was not recovering

*Reasons for defaulting

- The beneficiary card was lost

- Mother was sick

- Mother was Pregnant

+Other reasons of defaulting from small group discussions and semi-structured interviews

§  Fear of getting reprimanded because of lost card or for absence

§  Because they start recovering so they stop going

§  Nothing done by the OTP staff because of the sheer number of defaulters

§  No systematic follow-up for defaulters

§  ‘Hidden deaths’

§  Distance

§  Long Waiting

Figure 11: Barriers to Service Uptake

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