Coverage Evaluation for Preventive Chemotherapy Description of the

Coverage Evaluation for Preventive Chemotherapy Description of the

Coverage Evaluation for Preventive Chemotherapy Description of the method Training Workshop Module 1 January 2017 1 Phases of a Coverage Evaluation Module 1: Planning (central level)

Survey Area, Survey Population, Sample Size, Selection of Subunits Module 2: Implementation (local level) Creating segments, enumerating households, interviewing respondents Module 3: Interpretation and Action (central level) Interpretation of results, developing action plan

COVERAGE EVALUATIONS: MODULE 1: PLANNING & LOGISTICS PHASE Selection of the Survey Area Primary purpose for coverage survey To check if the data reporting system is working well Method for selecting the survey area (e.g. district) Random

To get a better estimate of coverage where there is reason to believe that the routine reporting is incorrect: a) in areas where the denominator is suspected to be grossly incorrect or out-of-date b) highly suspect reported coverage c) on-going incidence of morbidity d) failing a transmission or impact assessment survey Evaluation of program progress

Purposeful or random, depending on the number of areas with the suspected problem To integrate a KAP survey with a coverage survey to: a) identify the reasons for low coverage b) test the effectiveness of social mobilization and communication strategies -

Random - Purposeful if testing specific low coverage areas Random if testing across the program

Selection of the Survey Area Survey Area The administrative geographic area in which MDA is conducted and PC coverage is reported; most often the district or implementation unit. Selection of the Survey Areas Complete Exercise 1.1 Determine the Survey Population

Survey Population The population for which an estimate of PC coverage is desired. Determine the Survey Population Disease Survey Population Lymphatic filariasis

Everybody living in the survey area Onchocerciasis Everybody living in the survey area Schistosomiasis May vary, based on national treatment priorities and could include: - School age children(5-14 years)

- High risk adults Soil-transmitted helminthiasis (STH) May vary, based on national treatment priorities and could include: - Preschool age children (1-4 years) - School age children (5-14 years) - Women of child-bearing age - Everybody living in the survey area at the time of MDA (for LF)

Trachoma Everybody living in the survey area Determine the Survey Population Can we include more than one survey population? Yes! When a combination of drug packages was

delivered then an integrated coverage evaluation is possible. It is important that the survey population for each drug package be clearly defined in advance. Determine the Survey Population What about school-based distributions? Coverage evaluations should strive to include all school-age children both in and out of school

Recommended that coverage surveys be conducted at the community-level Determine the Survey Population Complete Exercise 1.2 Calculate the Sample Size Complete Exercise 1.3

Calculate the Sample Size http://www.ntdsupport.org/resources/coverage -survey-builder-coverage-evaluations Calculate the Sample Size Parameter required (symbol) -default value 1. Expected coverage (p) 50% 2. Desired precision () 5%) 5%

3. Design effect (DEFF) 4 4. Significance level () 5% (Z = 1.96)) 5% (Z = 1.96) 5. Non-response rate (r) 15% = ( )( 2 /2 )()( 1 ) 2 ( 1 )

Systematic Selection of Subunits Subunit The smallest administrative unit for which population estimates are available; may corresponds to a census enumeration area, village/settlement, hamlet or locality. Systematic Selection of Subunits What subunit should we use? Census Enumeration Areas (EAs)

Villages/Wards/Localities/Hamlets Designed to be comprehensive: jointly exhaustive and mutually exclusive A household can belong to multiple villages or no village Relatively consistent, small population size

Population size can vary widely Can be used in rural, semi-urban, and urban areas Challenging to use in urban centers Maps (sketch maps) are available, typically from the same governmental office that conducts the census Requires additional time upfront

Maps may not be available May require additional time in field Systematic Selection of Subunits Systematic Selection of Subunits 30 subunits will be randomly selected from within the survey area Use Probability Proportional to Estimated Size

(PPES) sampling Give everyone in the survey population an equal probability of being selected Sampling Overview Survey area: e.g., district, province, LGA

Subunits: e.g., Village (30 chosen using PPES) Segments: one segment of ~50 HH selected

from each chosen subunit Households: set fraction sampled from each subunit

Individuals: all individuals in the survey population in the selected HHs PPES = probability proportional to estimated size; HH = household

19 Calculate the Sample Size Complete Exercise 1.4 Systematic Selection of Subunits Within each subunit (e.g. village), a segment of households will be randomly selected. Segment A grouping of households from within the

initially sampled subunit; used for sampling efficiency (typically ~ 50 household) Why do we need to use segments? Why do we need to use segments? Why do we need to use segments? Segmentation may require some extra time upfront, but

will result in significant time saving overall by reducing the distance that each team will need to cover and the time spent in the field Systematic Selection of Subunits Each segment should have ~ 50 households Village A: 116 HHs 116/50 2 segments Village B: 288 HHs 288/50 6 segments Small Subunits with <25 expected HHs should

be merged with the next subunit on the list Large subunits with >400 expected HHs should be subdivided and listed separately Systematic Selection of Subunits Complete Exercise 1.5 to learn what to do with very small and extra large subunits Systematic Selection of Subunits

Complete Exercise 1.6 Systematic Selection of Subunits CSB will perform PPES selection based on the number of segments in each subunit Possible for large subunits to be selected more than once Systematic Selection of Subunits

Complete Exercise 1.7 Generate Sampling Lists Within each selected segment it is not necessary to visit each household A set fraction of the households will need to be visited in order to reach the sample size The CSB can generate two lists (List A and List B) to facilitate the selection of households within the

segment, according to the sampling fraction Generate Sampling Lists The numbers on the list correspond to the household numbers (e.g., the 3rd, 7th, 12th households) from which all individuals in the survey population should be sampled.

Generate Sampling Lists Complete Exercise 1.8 Integrated Coverage Evaluation It is possible to conduct an integrated coverage evaluation to assess more than one drug package. For example: Zithromax + Praziquantel An integrated coverage evaluation will require the same planning

steps as a normal coverage evaluation. The only difference is in defining the survey population. Integrated Coverage Evaluation 1) Define both survey populations. For example: Everybody (for Zithromax) and children 5-14 years (for praziquantel) 2) Calculate the expected number of people per household for each coverage population. When the survey population is a subset of the total population it will be necessary to get information on the population structure by age group.

Expected # people in coverage pop. per HH = (% pop. in age group) x (fraction age group in coverage pop.) x (average HH size) 3) The expected number of people per household for both Survey Populations will need to be entered into the CSB

Generate Sampling Lists Complete Exercise 1.9 Generate lists A & B for integrated survey STOP Save and close your CSB file Checklist of Logistics for Survey

Information: Completed/Finalized MDA reports Population data: to smallest population administrative unit available (subunits: e.g. Settlements, EA) Software: Coverage Survey Sample builder (CSB), field guide, internet access Hardware: Computers (MS Excel), calculators HH Questionnaires LGA summary report forms Sample of the drug(s) for which coverage is being evaluated (to improve participants recall) Stationary, Notebooks and pencils

Lists A & B Maps of the selected subunits: formal or locally drawn maps Chalk (optional) Personnel to be involved & TORs: Survey Coordinator, Survey Supervisors, Survey enumerators, Survey Samplers, local guides, drivers Action plan template 37 Budget

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