Evaluationand Baseline Survey
2006 Cambodia
Food Support to PLHA and OVC with Home Based Care
Aye Thwin Consultant September 2006
This survey is made possible by the generous support of the American People through the United States Agency for International Development (USAID). The contents are the responsibility of KHANA and the World
Food Progarm and do not necessarily refl ect the views of USAID or the United States Government.
This survey is undertaken to assess the effectiveness of the KHANA/WFP integrated programme of food support and home based care for People Living with HIV/AIDS (PLHA) and Orphan and Vulnerable (OVC) and also to establish a baseline data for new areas in which the programme plans to start in October 2006. The author wishes to express sincere appreciation to the Khmer HIV/AIDS NGO Alliance (KHANA) and World Food Programme (WFP) Cambodia for offering the opportunity to perform this exciting job.
Thanks must also go to Dr. Tith Khimuy, Dr. Leng Kuoy, Dr. Mak Munint, and Mr. Sem Peng Sean for team formation, training, logistical arrangements, fi eld supervision, feedback and overall coordination. Without their contributions, the survey could not have been up to this quality. Thanks are also due to the survey teams for their enthusiasm, tireless effort and devotion to data collection, to Mr. Kim San and his team for timely and good quality data entry and processing, and to village leaders, community volunteers, NGOs and families in the survey villages for their kind cooperation and sparing of time to participate in the survey.
Grateful acknowledgements are due to all the administrative and support staff of KHANA for facilitating the consultant’s job and necessities during his stay in Cambodia.
Invaluable support and guidance from WFP is also thankfully acknowledged.
Last, but not least, sincere thanks must go to Dr. Oum Sopheap, KHANA Executive Director, without whose sincere devotion and tireless support, this type of large scale research would not have been accomplished.
Acknowledgements
ANOVA Analysis of Variance
BCC Behavioral Change in Communities
BMI Body Mass Index
CBOs Community Based Organizations
CED Chronic Energy Defi ciency
FGD Focus Group Discussion
HAZ Height-for-age Z-score
KHANA Khmer HIV/AIDS NGO Alliance
MSG Mono-sodium glutamate
NCHADS National Center for HIV/AIDS, Dermatology and STD
NCHS National Center for Health Statistics
N.S. Not Signifi cant
PLHA People Living with HIV/AIDS
PPS Probability Proportionate to Size
OVC Orphans and Vulnerable Children
Sig. Signifi cant
SPSS Statistical Package of the Social Science
Under-fi ves 6-59 months old children
VAM Vulnerability Analysis and Mapping
WAZ Weight-for age Z-score
WFP World Food Programme
WHO World Health Organization
WHZ Weight-for-height Z-score
ACRONYMS
I. Introduction to Survey .........................................................................................................................6 1 Introduction ...............................................................................................................................................6 2 Methodology .............................................................................................................................................7
II. Results .....................................................................................................................................................12
1. Surveyed population – measurement units ............................................................................................12 2. Socio-economic and demographic situation ......................................................................................16 3. Preventing and mitigating the impact of HIV/AIDS on coping mechanisms .........................................23 4. Preventing and mitigating the impact of HIV/AIDS on food security, nutrition and health ....................31 5. Preventing and mitigating the impact of HIV/AIDS on schooling ..........................................................45 6. Integrating with development activities and improving livelihoods .......................................................49 7. Integrating with development activities. Behavioural change in communities, operational performance of KHANA partners, and challenges and opportunities for future programming .........52 8. Discussion and recommendations .........................................................................................................55 Conclusion .............................................................................................................................................56 Bibliography ...........................................................................................................................................57
Annex 1. Operational defi nitions ...............................................................................................................58
Annex 2. Sample size calculation .............................................................................................................59
Annex 3. Sampling ..........................................................................................................................................60
Annex 4. Questionnaires ...............................................................................................................................63
Annex 5. Survey Teams .................................................................................................................................65
KHANA/WFP - FOOD SUPPORT AND HOME BASED CARE OF PLHA AND OVC, CAMBODIA ...66
1 HOUSEHOLD INTERVIEW IDENTIFICATION ............................................................................................66 2 HOUSEHOLD DEMOGRAPHY .................................................................................................................673 EDUCATION STATUS OF CHILDREN OF PLHA HOUSEHOLDS ...........................................................684 LIVELIHOOD OF PLHA ............................................................................................................................695 PLHA HEALTH STATUS ..........................................................................................................................706 HOUSEHOLD BORROWING AND CREDIT ...........................................................................................717 ASSETS SOLD .........................................................................................................................................728 HOUSEHOLD EXPENDITURE .................................................................................................................739 FOOD SECURITY AND FOOD SHORTAGE ..........................................................................................7410 DIETARY DIVERSITY OF PLHA .................................................................................................................7511 MEALS CONSUMED BY PLHA AND HIS/HER HOUSEHOLD ..............................................................7612 ANTHROPOMETRIC MEASUREMENT .....................................................................................................77
KHANA/WFP - FOOD SUPPORT TO HOME BASED CARE OF PLHA AND OVC, CAMBODIA ....78
1 HOUSEHOLD INTERVIEW IDENTIFICATION .........................................................................................782 HOUSEHOLD DEMOGRAPHY .................................................................................................................793 EDUCATION STATUS OF OVC AND CHILDREN IN OVC HOUSEHOLDS .......................................804 LIVELIHOOD OF OVC ..............................................................................................................................815 OVC HEALTH STATUS ...............................................................................................................................826 HOUSEHOLD BORROWING AND CREDIT ...........................................................................................837 ASSETS SOLD ..........................................................................................................................................848 HOUSEHOLD EXPENDITURE ..................................................................................................................859 FOOD SECURITY AND FOOD SHORTAGE .............................................................................................8610 DIETARY DIVERSITY OF OVC ................................................................................................................8711 MEALS CONSUMED BY OVC AND HOUSEHOLD ................................................................................8812 ANTHROPOMETRIC MEASUREMENT .....................................................................................................89
Table of Contents
Cambodia has the highest HIV prevalence in Southeast Asia. According to the HIV Sentinel Surveillance (HSS) conducted by the National Centre for HIV/AIDS, Dermatology and Sexual Transmitted Disease
(NCHADS) in 2003, 123,100 adults are infected with HIV, of which 57,500 are women. The same survey estimated that there were 19,814 AIDS cases, of which 8,344 were women1. By 2000, it was estimated that 30,000 children had been orphaned by AIDS and that number was expected to quadruple in the next fi ve years. The HIV/AIDS epidemic nature is changing. Everyday, more people with HIV/AIDS are becoming sick and joining the ranks of those needing medical care and social support. Family livelihood is severely affected2 .
Since its launch in 1996, KHANA has established partnerships with local NGOs and CBOs to combat the epidemic. At the end of 2005, KHANA was providing technical and fi nancial support to 70 NGOs and 12 Community Based Organizations (CBOs) in 14 provinces and 3 municipalities, implementing projects on integrated care and preven-tion, focused prevention, support networks and income generation. KHANA supports 149 Home Care Teams in 11 Home Care networks and combines home-based care with prevention, impact mitigation and IEC and community education services in a comprehensive package of services3 .
In an attempt to improve food security in HIV-affected families and to help meet nutritional needs of PLHA and OVC, KHANA, WFP and MoH, started a partnership in 2003, to integrate food support into the comprehensive service package of Home-based Care. The long-term objective of the food support programme is to contribute to the mitigation of the impacts of HIV/AIDS on affected households.
The programme supports PLHA and OVC households with a monthly ration of:
(1) Rice: 30 kg (2) Fortifi ed Vegetable Oil 1 kg (3) Iodized salt 0.50 kg
This standard monthly food ration is given regardless of the number of household members or number of PLHA and/or OVC per household.
The programme is implemented in the framework of a tripartite partnership between the Government (MOH), WFP and KHANA’s network of partner NGOs. The activities at the community level are carried out by the Home Care Teams each of which consists of NGO staff, Home Care volunteers, health center staff and village volunteers.
As of July 2006, 29 NGOs are implementing integrated food support and HBC, in 193 health center-based areas in 14 provinces, covering 4,327 PLHA households and 3,903 OVC households. Furthermore, three partner NGOs are planning to start the programme in eight new health centre areas in three provinces to benefi t 257 PLHA households and 175 OVC households.
Although the monitoring process, various observations, and small-scale qualitative assessments show better results of the programme, no proper base line or evaluation study has been done during the three years since the programme was implemented in 2003.
This study was conducted in July and August 2006, to evaluate the three-year old integrated food support and home care project as well as to establish the baseline for both existing and newly planned areas.
1 NCHADS, HSS, 20032 Strategic Plan 2004-2008, KHANA3 Annual Report 2005, KHANA
I. Introduction to Survey1. Introduction
6
Immediate objectives of the programme are to:
Support an increase in the awareness, education and behavior change related to HIV/AIDS and
Preserve assets and mitigate the impact of HIV/AIDS on schooling of AIDS-affected family members and OVC by:
1. preventing and mitigating the negative impact of HIV/AIDS
2. ensuring REGULAR school attendance
3. serving income transfer to ensure stable food intake in the family
4. avoiding harmful coping mechanisms (such as selling of productive assets, school drop-out)
5. integrating with development activities such as education and vocational training based on gender-specifi c priority needs
Based on some related studies on Intervention for PLHA and OVC in the international arena4 and taking into account the guidelines in WFP’s indicators compendium and USAID guidelines5 and FAO/WHO recommenda-tions6 , the indicators to be assessed were developed based on the set objectives, and confi rmed by senior management of both KHANA and WFP. Indicators were identifi ed in fi ve broad categories:
1. Negative impact of HIV/AIDS on coping mechanisms and livelihood;
2. Negative impact on food security and nutrition and health;
3. Negative impact on schooling;
4. Ability of participation in ARV treatment, education, vocational training; and
5. Behavioral change in community and HBC teams, challenges and opportunities for future programming.
The aim of the survey was to evaluate the 2003-programme areas using these indicators as well as to provide information for possible programme adjustment and initiatives as necessary. The methodology allows an evaluation of the ongoing programme and also produces information statistically suitable as a base-line to be utilized for future evaluation of the response to food assistance, for both ongoing Intervention areas and newly planned expansion areas.
2.1 Survey DesignThe KHANA/WFP programme of food support to PLHA and OVC started in October 2003. The number of benefi ciaries increased so as of July 2006, 5,291 PLHA households and 8,539 OVC households in 14 provinces were benefi ting from the programme.
Project areas are identifi ed in WFP target communes based on three criteria (1) overlap with WFP priority areas with a high concentration of food-insecure people; (2) overlap with areas with a high concentration of PLHA and OVC requiring care and support; and (3) overlap with existence of MOH partners.
Since there has been no baseline survey, this study attempts to assess the programme effectiveness by comparing two areas; “Intervention” and “Control”. Sampling universe of Intervention area includes 113 HBC team areas in 14 provinces in which food support Intervention is ongoing. Sampling universe of Control area includes 8 HBC team areas in 3 provinces where the PLHA and OVC have never received food support, but selected for future
2. Methodology
4 Assessments on HIV/AIDS Interventions; Reports of Tanzania, Lesotho, Thailand, India5 USAID6 Living Well with HIV/AIDS, FAO/WHO
7
programme expansion. The above mentioned criteria for selecting programme areas assure the comparison, the possible confounding factors being similar; poverty, food insecurity and general socio-economic conditions, which are the main indicators used in identifying WFP priority areas as VAM analysis7 (see section 4). Moreover PLHA and OVC in both areas receive ongoing service packages of comprehensive HBC.
The effect of additional NGO programmes is also taken into consideration. The only difference between the two groups can be regarded as the food support to PLHA and OVC.
The study conducted a cross-sectional cluster survey on separate performances of PLHA and OVC in both ar-eas. Representative sample sizes of PLHA and OVC were separately calculated for each area using the formula “Sample size required for selected combination of P1 and changes or comparison-group differences to be de-tected” (see Annex 2).
Clusters were defi ned as health center areas to which each HBC team was attached. Measurement units were; PLHA and OVC for nutrition, health and livelihood indicators and households of PLHA and OVC for food security and coping indicators. Thus fi nal selection of measurement units in clusters was the random selection of house-holds of PLHA and OVC based on the benefi ciary lists of the HBC teams. The number of clusters was decided to be 20.
Although sampling was required for a large benefi ciary population widely dispersed in the Intervention areas, the small number of clusters in Control areas (total nine in three provinces), allowed selection of all clusters and still obtained the required number of measurement units by intra cluster random sampling.
The sampling procedure in Intervention areas followed the multi-stage cluster sampling utilizing PPS design to select fi nal clusters and random sampling to select intra cluster households, so as to obtain the results that are representative of each area (see Annex 2).
The fi rst stage included stratifi cation of programme areas into three broad strata, according to WFP sub-offi ce areas, namely, Kampong Cham, Kampong Speu and Siem Reap and their neighbouring provinces, in each of which the variation in the benefi ciary characteristics (see indicators) was supposed to be small.
In the second stage, two provinces from the Siem Reap stratum and one province each from the Kampong Cham and Kampong Speu strata were selected, in order to give the benefi ciaries in the strata the probability of participating in the study proportionate to the benefi ciary population size of stratum they belong to.
The third stage consisted of the allocation of the number of clusters (HCs) to each of the four provinces based on the population of the benefi ciaries in each province.
In the fourth stage, an allocated number of clusters were selected in each of the four sampled provinces by using the PPS technique.
In the fi fth stage, intra-cluster random sampling of households were conducted and each cluster was assigned the constant number of measurement units (households) to make sure that target members were suffi ciently well spread across enough clusters that survey estimates are not unduly infl uenced by a handful of clusters. Eleven PLHA and eight OVC were assigned to each cluster totaling 220 PLHA and 144 OVC in 20 clusters, which allowed 95% confi dence limit, 80% statistical power and design effect of 1.5.
7 Poverty based on income and cost of food for 2100 Cal, Stunting, Underweight, Family head education, Primary Education of children, disaster proneness: Draught or Flood by communes; Final selection also considered rapid assessment of the Implementing Partners, NGOs.
8
2.2 Survey ToolsQuestionnairesQuantitativeQuestionnaires were developed based on the indicators identifi ed. For quantitative analysis, fi ve broad categories of indicators were further categorized into 12 groups in order to make it simpler for enumerators, data entry and data analysis. Questionnaires were tested to ascertain fast and reliable data entry in Statistical Package of the Social Science (SPSS), with least error. Each questionnaire was tested by dummy analysis design to ensure that each question generates the desired information for each indicator (see Annex 4).
QualitativeA qualitative study was also conducted to obtain behavioral change, perception and programme performance information and also to weigh and/or supplement the quantitative analysis. A total of 12 Focus Group Discussion (FGD) and 16 Key Informant Interview (KII) were held; eight FGD and eight KII in Intervention areas and four FGD and eight KII in Control areas were conducted. Two KIIs were also conducted at KHANA and WFP programme offi ces.
Questionnaires were translated into Khmer by Dr. Mak Munit, programme offi cer for M&E and Food Support at KHANA, and checked by the consultant with the assistance of Dr. Leng Kuoy, Team leader of M&E and Mr. Meas Kimsan, Programme Assistant of M&E at KHANA.
All questionnaires were pre-tested in the fi eld in Takeo Province, revised and fi nalized in compliance with local culture, understandability, and feasibility in form fi lling.
AnthropometryThe anthropometry measurements were taken by trained team members assigned specifi cally for anthropometry. The body weight of the PLHA and OVC over 5 years of age were measured using standardized bathroom scales measuring up to a maximum of 120 kg with increments of 100 grammes. Those under fi ve years of age were weighed using Salter spring scales. Weight measurements were taken with the child in light clothing.
The standing height was measured of children two years of age or older. Supine length was measured for children less than two years of age using the portable length measuring board. Two assigned measurers took the height or length measurements ensuring that the child’s legs were fully extended and that the child’s head touched the vertical headboard.
2.3 Survey TeamsSurvey team members were recruited by KHANA based on their qualifi cations and experience in both quantitative and qualitative research. All members selected were university graduates. Five survey teams were assigned to fi ve broad areas by provinces. A total of 25 team members, 19 enumerators and six facilitators/team leaders were divided according to the workload of each team (see Annex 5). The team leaders were selected based on their performance during training and planning sessions, observed by trainers. The teams collected data from 20 to 28 July 2006.
9
2.4 TrainingThe training was conducted by the consultant and Dr. Leng Kuoy, from 11 to 14 of July, and assisted by Mr. Sem Peng Sean and Mr. Meas Kimsan. Anthropometry training emphasized practice and standardization. Field testing was conducted in Takeo province on 17 July, on both quantitative and qualitative data collection, including anthropometric measurements. Feed-back, discussion, revision and fi nalization of the questionnaire were done on 18 July and survey planning and random selection of intra-cluster households from the list obtained from HBC teams were conducted on 19 July.
2.5 SupervisionTwo supervisors, Mr. Sem Peng Sean for Battambang, and Dr. Mak Munit for Prey Veng were assigned to the teams which had highest workload and potential of facing constraints in the fi eld. A mobile supervision unit was established which then visited each team and assessed interview techniques and accuracy of equipment. They also randomly sampled recently completed forms, checked for errors, discussed the mistakes with enumerators and the team leaders, shared positive techniques and common mistakes among teams, and held evening meetings to discuss problems faced in the fi eld. Twenty-four hour communication was maintained by cell phones among the teams, and there was also assistance from Dr Leng Kuoy, the M&E team leader from KHANA.
2.6 Database Design & Data EntryData entry started on 29 July and was carried out by a data entry team qualifi ed for SPSS. Data was entered using a form created in SPSS version 12. Work were divided and assigned to fi ve data entry operators with their own laptops and checked two times per day, once mid-way through the data-entry process and once at the end of the working day. The completed data set in SPSS format was handed over to the consultant on 7 August. The consultant carried out data cleaning with assistance from Mr. Kimsan.
2.7 Data QualityThe data collected by the survey teams was generally of a good quality. All the team members have qualifi ca-tions and experience in social science research. Team members were accustomed to working with each other. They applied lessons learned from their previous experiences to collect higher quality, more accurate data. All participated seriously in the training, winding-up and feedback sessions as well as in supervision fi eld discus-sions. Communication channels allowed immediate solutions to be found for unforeseen problems in the fi eld. Practice and standardization procedures assessing precision and accuracy of survey teams in anthropometric training ensured the correct measurements. Age data for children (OVC or PLHA) are recorded by birth dates. The data entry format was well prepared and established to meet the requirements for data analysis. The main strength of the survey is the use of PPS sampling methodology and strictly following the sampled clusters as much as possible. The weakness is the multiple stage sampling and thus the fi nal data set needed to be weighted. Detailed analysis of data quality is presented in the following chapter.
10
2.8 Data Analysis and Final ReportAfter data cleaning, the consultant conducted the data analysis by using CDC’s EPI Info2000 software to calcu-late the anthropometric results for OVC and PLHA. The remaining data cleaning/data analysis process uses the statistical analysis software program SPSS, version 12.0. The confi dence interval was set to 95% and results are considered signifi cant at the p <0.05 level. Signifi cance for comparisons among representative results of Control and Interventions areas are determined by using Chi Square analysis for proportions and Analysis of Variance (ANOVA) / Post-hoc test for means.
The analysis stresses the comparability of the two data sets (Intervention and Control), each of which is repre-sentative of the respective group/area by sample size as well as survey design. It follows the statistical principle of ability to determine signifi cance test in comparison as long as the data set is normally distributed data (i.e. randomly selected as in simple random sampling or its simulated PPS sampling). To ensure normal distribution, allowing each measurement unit equal probability of selection in multiple stage sampling, all data were weighted using the formula recommended for weighting data resultant of sampling that are not based on probability of population size.
No attempt is made to compare the data between the provinces since it is not the objective of survey and nor does the sampling design possess the adequate statistical strength to present the data that are representative of either provinces or communes.
The preliminary report was submitted on 23 August 2006. The fi nal report was submitted on 12 September 2006.
11
Table 1 Number of clusters and number of populations interviewed and measured by surveyed areas
II. Results1. Surveyed population – measurement units
Area # of clusters
# of households interviewed # of PLHA measured
# of OVC measured
PLHA OVC
Intervention 20 208 157 208 158
Control 9 177 142 173 138
There were only nine health center areas, which can be identifi ed as Control areas, in which KHANA/partners’ Home Care Teams are supporting PLHA and OVC without food support. Thus all the PLHA and OVC in Control areas, identified and available as measurement units were interviewed and their weight and height were measured.
1.1 Age and gender distribution of PLHA and family members
Table 1.1.a. Age and gender distribution of family members of PLHA households by areas
12
Age group
Intervention Areas Control Areas
Male Female Total Male Female Total
N % N % N % N % N % N %
0-4 38 52.8 34 47.2 72 100 32 51.6 30 49.4 62 100
5- 17 187 49.7 189 50.3 376 100 115 45.3 139 54.7 254 100
18 + 209 40.2 307 59.4 517 100 171 37.7 281 62 452 100
Total 434 45 530 54.9 965 100 318 41.4 450 58.5 768 100
Children below fi ve years of age are most vulnerable. WHO defi nes 10-19 years as “adolescents.” The United Nations defi nes 15-24 years as “youth”. WFP defi nes OVC as aged below 18 years of age, and at risk of exclu-sion from school and a possibility of having to work for money. This survey analyzed these age groups separately to describe the different characteristics. The gender distribution and age group distribution in Intervention and Control areas are found similar.
Age grouping of PLHA was done by anthropometric analysis and reported with consideration of the following facts (6):
Children under-fi ve years are most vulnerable and have different characteristics;
The available reference data base for weight-for-height Z-score is most reliable only up to the age of 10 years in the currently available internationally recommended nutrition data base of Epi-Info8 ; Age group of OVC is defi ned by WFP as under-eighteen (up to 17) years; and
For the age group of 10-24 years, Body Mass Index (BMI) for age is recommended to present the nutritional status. The reference data base to compute BMI for age (cut-off being BMI for age 5th percentile) for the age group of 10-19 years is different by each one year age; and Expert committee on physical status has recommended that 18-24 years age group should be examined separately from age group of 25-49 years, because the difference of mean BMI between these two groups is more variable. Due to the above distribution, comparisons between Intervention and Control for both genders combined can not be performed in all except the 25-49 age group. Comparison can only be seen by separate gender in the other age groups.
1.2 Age and gender distribution of OVC and family members
8 Epi-Info 2000, Center for Disease Control, USA
Table 1.1.b. Age and gender distribution of studied PLHA by area
Age group
Intervention Areas Control Areas
Male Female Total Male Female Total
N % N % N % N % N % N %
0-4 0 0 0 0 0 0 0 0 0 0 0 0
5-10 0 0 1 0 1 100 0 0 0 0 0 0
11-17 3 60 2 40 5 100 0 0 0 0 0 0
18-19 0 0 1 100 1 100 0 0 0 0 0 0
20-24 3 50 3 50 6 100 0 0 5 100 5 100
25-49 66 36.9 113 63.1 179 100 61 37 103 62.4 164 100
50 & above 3 18.8 13 81.3 16 100 2 50 2 50 4 100
Total 75 36.1 133 63.9 208 100 63 36.2 110 63.2 173 100
13
Table 1.2.a. Age and gender distribution of the family members of OVC households by area
Age group
Intervention Areas Control Areas
Male Female Total Male Female Total
N % N % N % N % N % N %
0-4 27 55.1 22 44.9 49 100 24 57.1 18 42.9 42 100
5- 17 179 47.5 198 52.5 377 100 157 53.8 135 46.2 292 100
18 + 140 36.8 240 63.2 380 100 120 36 212 63.7 332 100
Total 346 42.9 460 57.1 806 100 301 45.1 365 54.7 666 100
14
From the above age and gender distribution, it is clear that OVC under-fi ve can not be compared if the genders are combined. Comparison should be performed only by separate gender. For other age groups, because dis-tribution is similar in both areas, comparison can be performed by combined gender as well as by separate gender.
1.3 Assessment of data quality Missing and Improbable ValuesThe proportion of measurements that are missing or biologically implausible is a helpful index for data quality assessment. Such extreme values indicate the errors in the anthropometric measurement itself or in the reported age. For the purpose of analysis the following exclusion criteria are used for each anthropometric index based on WHO-CDC recommendations9.
Values beyond the maximum and minimum cut-off are likely to be errors and thus treated as missing values.
Index Minimum Maximum
Height-for-Age Z Score -6.00 +6.00
Weight-for-Height Z Score -4.00 +6.00
Weight-for-Age Z Score -6.00 +6.00
9 Epi-Info 2000, CDC, USA
Table 1.3.a. Missing values-anthropometry- OVC of 0 – 10 year age group
Survey Group
Weight-for-agez-score
Height-for-ageZ-score
Weight-for-heightZ-score
measured missing % measured missing % measured missing %
Intervention 60 0 0 60 1 0.017 60 1 0.017
Control 65 1 0.015 65 1 0.015 65 1 0.015
Table 1.2.b. Age and gender distribution of OVC by area
Age group
Intervention Areas Control Areas
Male Female Total Male Female Total
N % N % N % N % N % N %
0-4 4 66.7 2 33.3 6 100 3 33.3 6 66.7 9 100
5- 10 33 61.1 21 38.9 54 100 34 60.7 22 39.3 56 100
11-17 40 41.2 57 58.8 97 100 34 44.2 43 55.8 77 100
Total 77 49 80 51 157 100 71 50 71 50 142 100
Reference <1% (0.01)
15
Most reliable reference data base for weight-for-height Z score is available only for 0-10 year age group. Thus all three anthropometric indices were checked for missing values and were found to be around 1%. Because missing values for HAZ and WHZ scores are found more than 1%, they were re-checked by Means and Standard Deviations (SD), as follows:
Table 1.3.b. Mean and Standard Deviation of weight-for-age, height-for age and weight-for-height Z-scores among OVC of 0-10 year age group.
Survey group
weight-for-age Z-score height-for age Z-score weight-for-height Z-score
Mean SD Mean SD Mean SD
Intervention -1.88 1.05 -2.05 1.33 -0.89 1.19
Control -1.97 1.31 -1.81 1.371 -1.35 1.11
The standard deviation of an anthropometric index refl ects the intrinsic variability of the index in the population and the variability due to measurement error. With accurate age estimates and anthropometric measurements, the SD of the observed Z-score distribution should be relatively constant and close to the expected value of 1.0 for the reference distribution. World Health Organization-1995 has reported usual ranges for the standard deviations of anthropometric indices observed in a large number of surveys, which serve as a guide to assess the quality of anthropometric data. The majority of the survey populations ranged within approximately 0.2 units of the expected value: 1.00 to 1.20 for weight-for-age, 1.10 to 1.30 for height-for-age, and 0.85 to 1.10 for weight-for-height. Survey data with standard deviation values higher than these values implies there may be errors with the age or anthro-pometric data. Values less than these imply a population with little intrinsic variation and no problems with age or anthropometric data.
The observed values in both Intervention and Control areas are found to be consistent with the reference range of Standard Deviations for all three indicators. This fi nding indicates the accuracy and profound quality of age estimates and anthropometric measurements by the survey teams.
There was only one PLHA in the 0-10 year age group, thus quality analysis could not be performed. For adoles-cent and adult anthropometry, data quality was checked visually by multiple and sub-set measurements.
16
2. Socio-economic and demographic situation
Socio-economic characteristics of Intervention and Control areas are analyzed to decide whether the two areas are statistically comparable for the analysis of difference attributed to the food support Intervention. In other words, in was tested whether possible confounding factors of basic socio-economic situation, is well controlled in case-Control analysis, as follows.
Table 2. Average vulnerability analysis and mapping scores in two areas
Areas mean VAM score frequency of communes signifi cance test
Intervention 0.44 20 Not Signifi cant P: 0.699Control 0.45 8
According to VAM score as the result of multiple indicator analysis including poverty and nutrition status conducted in 2004, by communes, mean VAM scores are apparently similar and difference is statistically not signifi cant between two areas.
Further analysis of socio-economic indicators in the current survey also reveals the similarity in both areas as shown below.
2.1 Household size
Table 2.1.a. Household size – PLHA households
Household members Intervention Control
Frequency Percent Frequency Percent
1 ~ 4 members 107 51.4 105 59
5 ~ 7 members 80 38.5 55 39.9
>=8 members 21 10.1 18 10.1
Total 208 100 178 100
Mean family size 4.7 4.3
Table 2.1.b. Household size - OVC households
Household members Intervention Control
Frequency Percent Frequency Percent
1 ~ 4 members 53 33.3 74 52.1
5 ~ 7 members 83 52.2 51 35.9
>=8 members 23 14.5 17 12
Total 159 100 142 100
Mean family size 5.4 4.7
17
Mean family sizes are different for OVC and PLHA households, ranging from 4.3 to 5.4. The fi nding is consistent with the national data. The Cambodia Socio-economic Survey-2004 reported in its projection analysis, the declining trend of total fertility rate from 3.99 in 1998, to 3.46 in 2002 to 3.12 in 2005. Rapid community appraisal by the consultant revealed that the education and support for family planning by NGOs through the government structure of Health Centers in rural areas contribute to this effect.
Difference between Intervention and Control areas shows no signifi cance.
2.2 Education status of family members
Table 2.2.a. Education status of PLHA household members (Five years and above)
Education level Intervention areas Control areas
frequency percent frequency percent
Non-schooling 182 20.5 186 26.3
Functional literate 8 0.9 7 1
Primary school level 461 51.9 383 54.2
Secondary school level 179 20.2 98 13.9
High school level 56 6.3 24 3.4
University level 2 0.2 8 1.1
Total 888 706
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Educational status of PLHA family members shows similar pattern in Intervention and Control groups. Around half of them, have primary education, followed by a quarter with no schooling. 10-20% have secondary education and only around 1% go up to university level.
Table 2.2.b. Education status of OVC household members (Five years and above)
Education level Intervention areas Control areas
frequency percent frequency percent
Non-schooling 204 23.8 206 30.7
Functional literate 6 0.7 8 1.2
Primary school level 478 55.8 337 50.2
Secondary school level 136 15.9 96 14.3
High school level 31 3.6 23 3.4
University level 1 0.1 1 0.1
Total 856 100 671 100
The education status of OVC family members shows the same pattern with those of PLHA and is similar in both Intervention and Control areas; more than half of them have primary schooling, around a quarter are illiterate, less than 20% have secondary level education and only about 0.1% reach university level.
19
2.3 Employment status
Table 2.3.a. Employment status – PLHA households
Households Intervention areas Control areas
Frequency % Frequency %
Farmer 17 16 8 17.7
Wage-labor-salary 10 9.4 3 8.6
Wage-labor (incentive) 8 7.5 3 8.6
Petty trade 8 7.5 2 5.7
Student 36 34 10 28.6
Out-of-school child 4 3.8 3 8.6
Housewife 3 2.8 0 0
Retired 1 0.9 1 2.9
Unemployed 12 11.3 4 11.4
Not known 7 6.6 1 2.9
Total 106 35
Figure 2.3.a
Among PLHA households in Intervention areas, only 35% have regular income as farmers, salaried labor or incentive labor. Out of 65% who are dependent, only 8% are engaged in petty trade.
The employment phenomenon is similar in Intervention and Control areas among PLHA households. Around two-thirds have little or no income.
Around two-thirds of the members of OVC house-holds in Intervention areas are unemployed, children, students, hous-ewives, or retired. Only 6% are engaged in petty trade and 35% have regular income. Of those, the majority are working in farms.
Figure 2.3.b
A similar pattern is found in OVC households of Control areas. 37% regu-larly earn income, and 63% have little or no income.
20
Households Intervention areas Control areas
Frequency % Frequency %
Farmer 18 18.6 8 26.7
Wage-labor-salary 7 7.2 1 3.3
Wage-labor (incentive) 8 8.2 2 6.7
Petty trade 6 6.2 1 3.3
Student 37 38.1 9 30
Out-of-school child 5 5.2 4 13.3
Housewife 2 2.1 0 0
Retired 1 1 1 3.3
Unemployed 9 9.3 4 13.3
not known 9 4.1 0 0
Table 2.3.b. Employment status – OVC households
21
Table 2.4.a. Gender of household heads – PLHA households
Areas Male Female Total Number
Number Percent Number Percent
Intervention 90 43.7 117 56.5 207
Control 77 45 93 54.4 171
2.4 Gender and education of household heads
* No statistical signifi cance (p: 0.512)
Areas Male Female Total Number
Number Percent Number Percent
Intervention 53 34.9 99 65.1 152
Control 47 34.3 89 65 136
Table 2.4.b. Gender of household heads – OVC households
More than half of the PLHA and OVC household are headed by females in both Intervention and Control areas.
Areas Years of education
Mean N Signifi cance
Intervention 7.82 158 Not Sig.
Control 5.29 105
Table 2.4.c. Education of household heads –PLHA households
Areas Years of education
Mean N Signifi cance
Intervention 6.87 89 Not Sig.
Control 6.07 70
Table 2.4.d. Education of household heads –OVC households
Mean school attainment years of the household heads are not signifi cantly different between the two areas in both PLHA and OVC households. However, all of them are below eight years (the average age primary school attendance).
* No statistical signifi cance
Table 2.4.f. Education of primary care giver of children –OVC households
Areas Years of education
Mean N Signifi cance
Intervention 4.33 95 Not sig
Control 4.53 80
Mean years of educational attainment by primary care giver of children in the households are found to be very low in both PLHA and OVC households (below 6 years). There is no signifi cant difference between two areas in both PLHA and OVC households.
22
Table 2.4.e. Education of primary care giver of children –PLHA households
Areas Years of education
Mean N Signifi cance
Intervention 5.10 144 Not sig.
Control 4.79 99
23
3. Preventing and mitigating the impact of HIV/AIDS on coping mechanisms.
3.1 PLHA households
3.1.1 Assets
Table 3.1.1.a. Productive assets- ownership of agricultural means among PLHA households
Areas Percentage of households own at least one agricultural tool or animal
Number of households examined
Intervention 65.2% 208
Control 55.6% 182
Areas Percentage of households own land or building
Number of households examined
Intervention 93.8% 208
Control 96.6% 178
Table 3.1.1.b. Productive assets- ownership of land or building
Table 3.1.1.c. Assets sold of owned properties – Agricultural means
Ownership of agricultural and land assets are similar in both areas. This is another factor that supports the comparison between the two areas on the effect of food assistance.
Areas Percentage of households sold at least one agricultural tool or animal
Number of households examined
Intervention 0% 136
Control 0% 101
Table 3.1.1.d. Assets sold of owned properties– land or building
Areas Percentage of households sold land or building
Number of households examined
Intervention 14.3% 195
Control 14.3% 170
* Difference not signifi cant
* Difference not signifi cant
* Difference not signifi cant
The proportion of households which sold their assets of land or buildings are the same in both areas at 14.3% each, while none of the households sold their agricultural assets. The reason is examined in the qualitative analysis; ten out of 12 FGD and all in-depth interviews reveal that selling agricultural assets is the last resort people seek as a coping strategy. Observations also show that various NGOs in the Control areas are already supporting income-generation activities and micro-fi nancing mechanisms. Moreover, safe water supplies and
24
Table 3.1.2.a. Loans by households
Areas Percentage of households receiving a loan in past 12 months
Number of households examined
Intervention 90.5% 198
Control 87.5% 174
* Difference not signifi cant
Areas Mean frequency of total loans
during past 12 months
Number of households examined
Intervention 2.3 179
Control 10.3 152
Table 3.1.2.b. Loans by frequency
sanitation are also observed in many communes where NGOs are active. These areas have become the Control areas during the current survey. The effect of those development activities on coping mechanisms could not have been differentiated from the effect of food support. Those NGOs are offering their services to provide food support and planning for future integration of food support into their development efforts.
3.1.2 Loans
Figure 3.1.2.b
* Difference not signifi cant
Table 3.1.2.c Loans by amount
Areas Mean of total amount of
most recent loan (Riels in
million)
Number of households examined
Intervention 0. 43 9
Control 1.55 2
* Difference not signifi cant
Although proportions of households taking loans during past 12 months seems to be a little bit higher in Intervention areas, the food support in Intervention areas has proved its ability to reduce the need for loans. This is demonstrated in the analysis of the average frequency of loans during the past year (signifi cantly lower at p value of 0.032 in Intervention areas) and amount of most recent loan (apparently, although not evidenced by statistical signifi cance, this is lower in Intervention areas, at 0.43 million Riels, compared with 1.55 million in Control areas).
Further analysis would allow more understanding of how the food support programme works towards positive changes in those households and communities.
25
Table 3.1.2.d. Loans by single source – percent of households
Areas Neighbors Money lender
Community fund or
NGO
Private bank
Credit from shop
keeper
Cow bank
Government bank
No. Examined
Intervention 55% 19% 61.9% 3.4% 3.4% 0% 0% 179
Control 71.4% 20% 0% 20% 0% 0% 0% 152
* Differences: Not signifi cant
Analysis of the different sources of loans suggests that community development activities are more active in Intervention areas and also that the PLHA and their families in these areas gain skills for less negative coping even in seeking sources of loans. Even though differences are not statistically signifi cant, it is apparent that PLHA households seek their loans less from high-risk sources (such as money-lenders, neighbors, private banks), and more from low-risk sources such as community funds or NGOs, in comparison with their counterparts in Control areas.
Table 3.1.2.e Loan by sources: more than one source
Areas double sources; neighbor & money lender
double sources; neighbor & private bank
Numbers examined
Intervention 5% 0.3% 179
Control 16.7% 2.8% 152
* Differences: Not signifi cant
PLHA households in Intervention areas have taken loans more to invest in income generation activities (55%) and less because of illness (24%), while reasons for loans in Control areas are more for illness (83.5%) and less for investment (25%).
Figure 3.1.2.f Reasons for most recent loan – overall % of households
Table 3.1.2.f. Reasons for most recent loan – overall % of households
Areas Illness Business/Income
generation -
Intervention 23.7 54.92
Control 83.5 25
26
3.1.3. Household expenditure
Table 3.1.3.a. Division of household expenditure
Areas Food expenditure as percent of total
expenditure
Health expenditure as percent of total
expenditure
Education expenditure as percent of total
expenditure
Agricultural/Busi-ness expenditure as percent of total
expenditure
Number households examined
Intervention 40.7% 1.7% 30.7% 1.7% 199
Control 55.6% 5.5% 15.5% 1.6% 170
* Differences: Not signifi cant
Figure 3.1.3.a.i Figure 3.1.3.a.ii
Although the statistical test shows no signifi cance, the differences are obvious. Less expenditure on food and health (40.7% and 1.7% respectively of total expenditure) in Intervention areas compares with more expenditure on food and health in Control areas (55.6% and 5.5% respectively). This demonstrates better food security and health status in food support programme areas.
Similarly, more expenditure on productive investment, in terms of education (30.7%) and agriculture (1.7%) in Intervention areas, compares with less investment in Control areas, in terms of education (15.5%) and agriculture (1.6%). This demonstrates an improvement in positive behavior towards longer term development and self-reliance in food productivity in programme areas.
Agricultural/Business
27
Areas Past unemployment after blood test Current joblessness No. PLHA
examinedMean
monthsreason as illness
% PLHAMean
monthsreason as
illness % PLHA
Intervention 6 80% 9.5 82% 112
Control 7 100% 9.6 100% 60
Table 3.1.4.a. Employment status
* Differences not signifi cant
Some PLHA cannot work for a wage because of illness. There is no other reason mentioned for not being able to work. On average, PLHA become unemployed 6-7 months after diagnosis and of those who are currently not working because of illness, they have been unemployed for an average of nine months. However the inability to work is less likely to be the main reason in Intervention areas than in Control areas (80% vs100%).
3.1.4 Livelihoods
3.2 OVC and households
3.2.1 Assets
Table 3.2.1.a. Productive assets- ownership of agricultural means among OVC households
Areas Percentage of households own at least one agricultural tool or animal
Number of households examined
Intervention 61.1 157
Control 71.4 142
* Difference not signifi cant
Table 3.2.1.b. Productive assets- ownership of land or building
Areas Percentage of households own land or building
Number of households examined
Intervention 83.3% 157
Control 71.4% 142
* Difference not signifi cant
Ownership of agricultural and land assets are similar in both areas as in PLHA. There is no signifi cant difference between the two areas.
28
Table 3.2.1.d. Assets sold of owned properties - land or building
Areas Percentage of households that sold land or building
Number of households examined
Intervention 10.4% 134
Control 11.9% 109
* Difference not signifi cant
Proportion of households which sold their assets of land or buildings are the same in both areas (around 10-11% each), while none of the households sold their agricultural assets. The reason for this, as identifi ed in qualitative analysis, is that the selling of agricultural assets is the seen as the last resort for a coping strategy. Various NGOs are also supporting income- generation activities and micro-fi nance mechanisms, as well as safe water supplies and sanitary latrines. The effect of these development activities on coping mechanisms can not be differentiated from the effect of food support.
3.2.2 Loans
Table 3.2.1.c. Assets sold of owned properties - Agricultural means
Areas Percentage of households that sold at least one agricultural tool or animal
Number of households examined
Intervention 0% 96
Control 0% 101
* Difference not signifi cant
Tables 3.2.2.b/c. Size and frequency of loans in foster households
Areas Mean total amount of most recent loan (in
million Riel)
Number of households examined
Intervention 1.6 118
Control 1.6 104
Areas Mean frequency of loans during
past 12 months
Number of households examined
Intervention 2 118
Control 2 104
* Difference not signifi cant
Areas Percentage of household borrowing in past 12 months
Number of households examined
Intervention 77% 154
Control 75% 139
Table 3.2.2.a. Loans by percentage of OVC households
* Difference not signifi cant
* Difference not signifi cant
29
The percentage of households taking loans is similar in the two areas, which can be explained by the fact that 89% of OVC in Intervention and 90% in Control areas have been fostered by the households interviewed. It means that OVC households are not necessarily affected by the loss of OVC’s parents because the majority of OVC are fostered by other households. Among the OVC households where OVC are not fostered, mean frequencies are similar but amount loans are even higher in Intervention areas. For OVCs who lost parents and are not fostered, the effect of food support is not clearly seen.
Tables 3.2.2.d/e. Size and frequency of loans for OVC who have not been fostered
Areas Mean total amount of most recent loan (in
million Riel)
Number of households examined
Intervention 4.09 106
Control 1.94 94
Areas Mean frequency of loans during
past 12 months
Number of households examined
Intervention 6.5 106
Control 6.5 94
* Difference not signifi cant
Table 3.2.2.f. Loans by single source - percent of households
Areas Neighbors Money lender
community fund or NGO*
private bank
credit cow bank
government bank
No. Examined
Intervention 53% 19% 41% 7.1% 0 3.8% 0 133
Control 67% 28% 7.3% 16.7% 0 9.0% 0 112
* Difference in loan from Community source is signifi cant at P: 0.000* Other differences: Not signifi cant
Sources of loans to OVC households suggest a similar pattern as found in PLHA households, suggesting active community development activities in Intervention areas. It is apparent that OVC households in Intervention areas seek their loans less from high-risk sources (i.e. money-lenders, neighbors, private banks), and more from low-risk sources such as community funds or NGOs, in comparison with their counterparts in Control areas.
Table 3.2.2.g. Main reasons for loan
Reasons Intervention Control
Illness 10.5 36.0
School 0.7 11.0
Agriculture 41.6 15.2
Daily expenses 25.6 20.8
Petty cash more small business 4.2 0.0
Buy food 0.0 12.5
30
Table 3.2.3.a. Division of household expenditure
Areas Food expenditure as percent of total
expenditure*
Health expenditure as percent of total
expenditure
Education expenditure as percent of total
expenditure
Agricultural/ Busi-ness expenditure as percent of total
expenditure
Number households examined
Intervention 33% 6% 27% 3% 159
Control 57% 12% 7% 0.8% 117
* Difference of food expenditure between two areas is signifi cant at P<0.1
Less expenditure on food and health (33% and 6% respectively of total expenditure) in Intervention areas compares with greater expenditure on food and health in Control areas (57% and 12% respectively). This demonstrates better food security and health status in food support programme areas. More expenditure on productive investment; education (27%) and agriculture (3%) in Intervention areas compares with less investment in Control areas; education (7%) and agriculture (0.8%). This demonstrates an improvement in positive behavior for longer term development and self-reliant food productivity in programme areas. It shows the same pattern as in PLHA households.
Key fi ndings Statistically signifi cant effects of the food support programme in mitigating the impact of HIV/AIDS on coping mechanisms is seen in Intervention areas as:
lower frequency of loans to PLHA households;
loans from more community sources by OVC households; and
lower food expenditure as proportion of total expenditure.
Assets are not much affected in both Intervention and Control areas. Active development and income-generation activities of some NGOs are improving the situation in both areas.
Although statistically not signifi cant, positive changes in both PLHA and OVC households are quite apparent in Intervention areas as:
loans from low-risk sources like community fund or NGO;
loans are more for agricultural investment in programme areas, compared with more loans for illness in Control areas (potentially showing improved nutrition leading to improved health); and
less expenditure on food and medicine, and more expenditure on agriculture and schooling.
As with PLHA households, OVC households in Intervention areas also takes loans more to invest in income generation activities (42%) and less because of illness (10.5%), while reasons for loans in Control areas are more for illness (36%) and for food (12.5%) and less for investment (15%).
3.2.3 Household expenditure
31
4.1 PLHA and PLHA households
4.1.1 Food security
The assessment utilizes four proxy indicators for food security: consumption of diverse food groups, food shortage, meal frequency and food expenditure.
4.1.1.1 Consumption of diverse food groupsBased on the major nutritional content of each food item and the requirements of a nutritionally-balanced diet, the survey studies the food consumed by PLHA and OVC and their families, by fi ve gross categories of group:
1. Major energy-yielding staple foods; mainly rice, maize, other cereals, wheat (noodles and others), potato, cassava, other roots and tubers;
2. Energy condensed food; oil and fats;
3. Major protein-yielding food; animal protein sources such as poultry and meats, milk and milk products, eggs, fi sh and seafood including dried fi sh and fermented fi sh paste;
4. Vegetable protein; mainly nuts, legumes, beans; and
5. Source of vitamins and minerals and electrolytes such as vegetables and fruits
4. Preventing and mitigating the impact of HIV/AIDS on food security, nutrition and health.
Areas Less than 3 groups
3 groups 4 groups 5 groups number examined
Intervention 0 14.3 62.0 23.8 193
Control 0 25.0 50.0 25.0 161
Table 4.1.1.1.a. Food groups consumed by PLHA and family members during past 24 hours – percent of households
* Differences - not signifi cant
No households in either area consumed less than three food groups. Observations shows that rice, vegetable and fi sh paste are common one day meals for poor families. Consumption patterns are found to be similar in both areas; only one quarter of households consumed all fi ve groups and the majority consumed four groups in one day. More households in Control areas consumed fewer food groups.
Table 4.1.1.1.b. Proportion of households which consumed animal protein and oil
Areas Animal protein in addition to fi sh-paste Oil Number examined
Intervention 90.9 81.8 193
Control 87.5 62.5 161
* Differences - not signifi cant
32
As fi sh paste cannot be consumed up to the amount that can provide a substantial nutrition value of protein, and oil serves as the main energy condenser in a poor family’s daily meal, the consumption of those two food items are carefully considered in analysis. More households are found to consume animal protein (in addition to fi sh-paste) and oil in Intervention areas than in Control areas.
4.1.1.2 Shortage of food Shortage of three major foods; rice, maize as a substitute for rice in scarce seasons, and oil are examined. None of the households in either area experienced shortage of all these three food items together continuously for at least one month, during the past year. However, there have been shortages of individual food items.
Areas Rice Maize Oil Numbers examined
Intervention 3.32 0.95 0.26 193
Control 4.74 1.03 1.64 161
Table 4.1.1.2.a. Average number of months experiencing shortage of food items during the last year
* Differences - not signifi cant
For each major food item, individual shortages during the past year, in terms of average number of months, reveals a better food security situation (i.e. shorter duration of shortage) in Intervention areas.
Areas at leastone month
1-3 m 4-6 m more than 6 m
Numbers examined
Intervention 50 23.5 9.5 14.3 193
Control 75 37.5 25 12.5 161
Table 4.1.1.2.b. Extent of rice shortage as proportion of households experiencing various duration of shortage
* Differences - not signifi cant
Apparently more households in Control areas have experienced rice shortage from shorter to longer periods of duration than those in Intervention areas.
As the result of shortage, households tend to cope with reducing the frequency of consumption. Control-area households consumed food less frequently.
4.1.1.3 Meal Frequency
Areas Average meal frequency Numbers examined
Intervention 4.21 193
Control 3.9 161
Table 4.1.1.3. Meal frequency
* Differences - not signifi cant
33
Table 4.1.1.4. Proportion of PLHA households by extent of food expenditure
Areas less than 50% of total
51-69% of total
70-79% of total
80-89% of total
90% and more
No. households examined
Intervention 61.9 14.3 4.8 4.8 4.3 199
Control 50 12.5 12.5 12.5 12.5 170
* Differences- not signifi cant
Further analysis of the extent of food expenditure as proportion of total expenditure reveals that PLHA house-holds in Intervention areas with food assistance are less likely to be in serious need of food to purchase from out side and thus have ability to transfer their income to other development assets, as has been described in the previous chapter.
4.1.1.4 Food Expenditure
4.1.2 Nutrition
Nutritional status of PLHA was analyzed by anthropometric indices with the reference database from World Health Organization/National Center for Health Statistic (WHO/NCHS) utilizing Epi-Info-2000 software. All PLHA in this study appear in the age range of 5 years and above. The majority are in the range of 25 years and above (195). The 5-10 year group consists only of two people, there are fi ve in the 11-17 year group, and seven in the 18-24 year group. There were no identifi ed PLHA under 20 years of age in the Control group to compare. Therefore the nutritional status of PLHA is analyzed mainly by adult Body Mass Index (BMI) for the population of 20 years and over following the principles stated below.
Figure 4.1.1.4
34
Low weight for height in the adults is defi ned as “Chronic Energy Defi ciency” (CED) categorized on the basis of Body Mass Index (BMI). BMI is described as a unit of the result of weight in kilograms divided by the square of height in meters. Low BMI (below 18.5) is defi ned also as “thinness” and classifi ed as below, according to the WHO expert committee on physical status (1995).
For the age group of 11-24 years, Body Mass Index (BMI) for age is recommended to present the nutritional status.
The reference data base to compute BMI for age (cut-off being BMI for age 5th percentile) for the 10-19 age group is different by each one year age.
It has been recommended that the 18-24 years age group should be examined separately from the age group of 25-49 years, because differences of the mean BMI between these two groups are signifi cantly variable.
Expert committee on physical status, WHO, Geneva, 1995
Public Health Problem %Population with BMI <18.5
Low-Warning Sign, Monitoring Required 5-9%
Medium – poor Situation 10-19%
High – Serious Situation 20-39%
Very High – Critical Situation > 40%
WHO classifi cation of adult BMI Thinness or CED
BMI is an important means of objectively assessing the degree of nutritional or other socioeconomic deprivation in a population. The distribution of low BMI as a public health problem in a population indicates the presence of food insecurity or the catabolic consequences of widespread infectious diseases, such as AIDS and tuberculosis. It points to the vulnerability of certain members of the population with marginal energy reserves, in the event of drought, seasonal food shortages or epidemics. Mean adult BMI and BMI distribution (CED prevalence) are very responsive to social, health or agricultural interventions including food supplementation. To evaluate the impact of the project, the survey assessed the BMI status of PLHA who are targeted benefi ciaries of the Intervention. The population distribution of BMI can provide valuable guidance for the planning of development programmes especially in those aiming to improve total food supply.
Table 4.1.2.a. Mean BMI of adult PLHA
Area Male Female Both genders Number PLHA examined
Intervention 20.02 20.36 20.24 200
Control 19.06 19.82 19.55 170
* Differences not signifi cant
35
Although there is no statistical signifi cance, the mean BMI of adult PLHA in general shows higher in Intervention areas, in both genders. To be more accurate the analysis needs to be done in more age group divisions.
Many studies have indicated that the difference in mean BMI of women in the younger age group (18-25 years) from those aged 26-40 years is more variable. An expert committee on physical status has recommended that this younger age group be examined separately from older cohorts and that results are subjected to prudent interpretation. Because of the diffi culty in establishing appropriate limits of BMI in young adults, it is noted that particular care is needed to avoid the misclassifi cation of a large portion of people in this age group as mildly or moderately thin. When the BMI of these groups is analyzed separately, the results change as shown below. The actual situation of the population is more accurately refl ected in the 26-49 year age group.
Table 4.1.2.b. Mean BMI by recommended age groups
Area Male Female Both genders
Number PLHA
examined
Intervention 19.02 20.06 19.54 6
Control 0 19.93 19.93 5
Area Male Female Both genders
Number PLHA
examined
Intervention 20.2 20.18 20.26 188
Control 19.55 19.53 19.54 165
20-24 year age group 25 year and over
* Difference not signifi cant * Difference not signifi cant
Even after break-down into more specifi c age groups, mean BMI of PLHA in both age groups in Intervention areas are higher than those of Control areas.
Area Male Female Number PLHA examined
Intervention 16.3% 15.4% 188
Control 33.3% 25% 165
* Difference not signifi cant
Table 4.1.2.c. Prevalence of thinness (BMI below 18.5) among adult PLHA (age 25 and over)
Although statistically not signifi cant, a greater prevalence of adult thinness among PLHA is observed in Control areas where there has not been food support.
36
Figure 4.1.2.c
4.1.3 Health
Although the food support in the current programme assists mainly to improve household food adequacy, it also encourages the reduction of opportunistic infections due to improvement of the immune system through better food and nutrition. As expected, the likelihood of getting a superimposed infection is apparently signifi -cantly lower among PLHA in Intervention areas.
Table 4.1.3.a. Percent of PLHA who got at least one infection during past two weeks
Areas % PLHAs Infected
Number PLHA
examined
Intervention 79.6% 201
Control 90.4% 170
Figure 4.1.3.a.
* Statistically signifi cant, P<0.00
When analyzing the pattern of infections, PLHA in Intervention areas appear to have fewer infections across the spectrum. PLHA in Control areas suffer from more severe infections, so fewer people reported small minor illness under the question “others”.
37
Table 4.1.3.b. Percent of PLHA by various infections
Areas Skin infection
Respiratory infection
Diarrhea fever others numbers examined
Intervention 11.4 8 9 19.4 30.8 201
Control 12.1 18.5 10.2 29.9 18.5 170
4.2 OVC and OVC households
4.2.1 Food security
4.2.1.1 Consumption of diverse food groups
Areas Less than 3 groups
3 groups 4 groups 5 groups number examined
Intervention 6.0 17.0 52.28 29.6 159
Control 10.5 32.2 35.3 21.7 143
Table 4.2.1.1.a. Food groups consumed by OVC and family members during past 24 hours – percent of households
* Differences - Signifi cant at P<0.00
Unlike PLHA households, OVC households in Control areas are signifi cantly more adversely affected by food insecurity. More households in Control areas are consuming fewer food groups than those in Intervention areas and differences are statistically signifi cant.
Figure 4.2.1.1.a.
38
Areas animal protein in addition to fi sh-paste* Oil** number examined
Intervention 96.9 82.4 159
Control 91.6 58.7 143
Table 4.2.1.1.b. Proportion of households which consumed animal protein and oil
* Differences - Statistically signifi cant; P<0.05
** Differences - Statistically signifi cant; P<0.00
More OVC households are found to consume animal protein (in addition to fi sh-paste) and oil in Intervention areas than in Control areas. Food support (although only rice, oil, and salt) is apparently enabling the households to consume food of high nutritional value indirectly by means of income transfer (i.e. income that would have been used to purchase rice, is now being used to purchase other food items). Improvement in food security as the result of the programme, evidenced by this proxy indicator is statistically signifi cant.
4.2.1.2 Shortage of food
Table 4.2.1.2.a. Average number of months experiencing shortage of food items during the last year
Areas Rice Maize Oil Numbers examined
Intervention 1.4 1.05 0.3 159
Control 3.7 0.86 1.5 143
* Differences - not signifi cant
Shortages of major food items during the past year are worse in Control areas although the differences are not statistically signifi cant.
Table 4.2.1.2.b. Extent of rice-shortage as proportion of households experiencing various durations of shortages
Areas at least one month 1-3 m* 4-6 m** more than 6 m*** Numbers examined
Intervention 36.4 23.1 13.5 11.5 159
Control 71.4 37.7 21.5 22.3 143
* Differences - Statistically signifi cant at P<0.05
** Differences - Statistically signifi cant at P<0.10
*** Differences - Statistically signifi cant at P<0.05
More households in Control areas have experienced rice shortage from shorter to longer periods of duration than those in Intervention areas. Differences are statistically signifi cant.
39
4.2.1.3 Meal Frequency
Table 4.2.1.3. Meal frequency
Areas Average meal frequency Numbers examined
Intervention 4.0 159
Control 3.6 143
* Differences - not signifi cant
4.2.1.4 Food Expenditure
Table 4.2.1.4. Proportion of OVC households by extent of expenditure on food
Areas less than 50% of total
51-69% of total
70-79% of total
80-89% of total
90% and more
No. households examined
Intervention 72.2 11.1 5.6 5.6 5.6 159
Control 42.9 28.6 14.3 0 14.3 117
* Differences - not signifi cant
Further analysis of the extent of expenditure on food as a proportion of total expenditure reveals that like PLHA households, OVC households in Intervention areas appear less likely to be in serious need of food to purchase from outside.
4.2.2 Nutrition
Nutritional status of OVC was analyzed by anthropometric indices with the reference database from WHO/NCHS utilizing Epi-Info-2000 software. According to the selection criteria, all OVC under this study are in the age range of below 18 years. According to the anthropometric reference data bases for analysis and interpre-tation, nutrition status of OVC over the age of 10 year was analyzed by BMI. The nutrition indices for the most vulnerable age group, under-fi ves, are separately analyzed from the 5-10 year age group.
OVC have two distinct characteristics; prolonged suffering from food-insecurity and poverty (identifi ed by VAM analysis of WFP). When they become OVC they become vulnerable to lack of care and additional food shortage. Food support programmes to OVC aim to mitigate those negative impacts. To measure the effectiveness of this programme, the study uses three anthropometric indicators.
For OVC age 0-10 years: 1. Wasting or weight for height Z score, which refl ects the current food and nutrition deprivation situation and infections (6),(11);
2. Stunting or height for age Z score which is sensitive to prolonged food assistance, especially among 6-23 months children. The effect can be measured among the 24 to 59 months age group after 2-3 years of Intervention (11) ; and
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For those 11-17 years: 3. BMI
4.2.2.1 Weight-for height
Low weight-for-height is generally defi ned as thinness. It can be interpreted as weight signifi cantly below the weight expected of a child of the same length or height. For those populations in which prevalence of thinness substantially exceeds the 2-3% expected on the basis of normal distribution, it can be defi ned as “wasting”.
High prevalence of low weight-for-height or wasting is indicative of severe recent or current events, acute starvation and/or severe disease resulting in failure to gain weight or actual weight loss. Causes include inadequate food intake, incorrect feeding practices, disease and infection or combination of all.
The weight-for-height indicator is appropriate for examining short-term effects such as seasonal changes in food supply, disaster or shot-term nutritional stress brought about by illness. In emergency situations like famine, the wasting prevalence among children under-fi ve years of age is strongly predictive of concurrent short-term crude mortality of the population.
For targeting food supplementation in areas where wasting is common, weight-for-height is the ideal indicator for selecting those communities likely to gain most from a proposed Intervention. This recommendation is appropriate for current WFP-MCH programmes in Cambodia.
In non-emergency situations weight-for-height is the poorest predictor of mortality within the following year. However, determinants of low weight-for-height may be identified by comparing wasted and non-wasted children or weight-for-height Z-scores as a continuous variable, in non-disaster situation. Because of its very sensitive response to short-term infl uences, wasting is not advised as a measurement of change in non-emergency situations since it is highly susceptible to seasonality.
The situation of OVC in WFP targeted areas with the current deprivation of food and proneness to infections calls for the need to be tested by the weight-for height indicator.
The normal reference value of the population mean of weight-for-height Z score is regarded as Zero and any value below zero is regarded as below normal or malnourished.
41
Table 4.2.2.1.a. Mean weight-for-height Z scores of OVC under fi ve year of age
Area Boys Girls Both Number OVC
examined
Intervention -1.3 -1.55 -1.39 6
Control -1.0 -1.25 -0.47 9
Area Boys* Girls** Both*** Number OVC
examined
Intervention -0.87 -0.48 -0.72 54
Control -1.54 -0.90 -1.25 56
Table 4.2.2.1.b. Mean weight-for-height Z scores of OVC aged 5-10 years
* Not signifi cant * Statistically signifi cant at P<0.05
** Statistically signifi cant at P<0.05
*** Statistically signifi cant at P<0.01
The mean weight-for-height Z score which is the sensitive indicator for current deprivation of food and/or existence of severe infection reveals that the food support programme has positive nutritional impact on OVC aged between 5-10 years. The statistical signifi cance test proves that the impact is solely attributable to programme’s input.
Among the under-fi ves children, the indicator does not show any improvement. Instead, it visibly appears to be worse in Intervention areas although statistically not approved. This pattern can be due to the complex nature of the age group; psychologically fragile and very much in need of psychological, as well as physical care (such as care in feeding), particularly at the time of loss of parents or care person.
Figure 4.2.2.1.b
Table 4.2.2.1.c Body mass Index of OVC age 11-17 years
Area Male Female Both* Number OVC examined
Intervention 16.6 17.7 17.21 97
Control 15.7 17.03 16.46 77
* Statistically signifi cant at P<0.1
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Elder OVC in Intervention areas are also benefi ting from the programme signifi cantly more than those in non-programme Control areas. Improvement in Body Mass Index can also be soley attributed to the programme as its nutritional impact.
4.2.2.2 Height-for-age - Stunting
Low height for age (length for age in 6-24 months children) is identifi ed as stunting. Stunting refl ects a slowing in the growth of the fetus and the child and a resulting failure to achieve the expected length as compared to a healthy, well-nourished child of the same age. It is associated with a number of long-term factors including chronic insuffi cient protein and energy intake, frequent infection, sustained inappropriate feeding practices and poverty. Stunting data is not recommended for monitoring as it does not change in the short term such as 6-12 months (16), and is an indicator of past growth failure. However stunting in the younger age group also indicates a continuing effect of these inadequacies (6).
In analysis of stunting, the aggregation of data for children less than 24 months with those over 24 months is not recommended. For evaluation purposes the presentation of stunting data for children less than 24 months is useful. An Intervention among children under 24 months is likely to be more effective than among children of 24-59 months. This is because: 1) the determinants of stunting in older children are more varied: and 2) stunting in older children may refl ect historical nutritional or health stress and can be “permanent” i.e. not responsive to any intervention (16).
Presentation of the stunting data for children less than 24 months in the two communities (Intervention and Control) is intended for use in problem analysis and in designing interventions. Data for older children (24-59 months age group) will be used for evaluation purposes.
In comparing before and after Intervention, or Intervention and Control, it is intended to see the effect of Intervention. In the case of stunting, the effect of Intervention on children under 24 months of age in preventing growth retardation will refl ect in the stature of children 24-59 months age at the time of evaluation. Thus for comparison purposes, the 24-59 month age group is selected to capture the cumulative and lagged effect that the food assistance project would have on stunting.
The situation of OVC in WFP targeted areas (high poverty level as defi ned by VAM) with the chronic long term deprivation of food, points out the need to be tested by height-for-age indicator as well.
The normal reference value of the population mean of height-for-age Z score is regarded as Zero and any value below zero is regarded as below normal or malnourished.
Table 4.2.2.2. Height-for-age Z score of children age 24-59 months
Area Boys Girls Both Number OVC examined
Intervention -0.06 -1.51 -0.55 6
Control -0.20 -1.59 -1.24 8
* Not signifi cant
The benefi ciaries of the programme and the most sensitive age group to programme input on long standing food support, 6-23 months old OVC in Intervention areas, show improvement compared with those in Control areas, as refl ected in height-for age Z score among the 24-59 months age group. Nevertheless, statistical tests do not show signifi cance for this indicator in this age group. This can be partly explained by an insuffi cient number of variables for proper statistical tests in this age group.
43
4.2.3 Health
One of the survey’s objectives was to examine the infections OVC have experienced during the past two weeks and the care provided to them. Since all OVC were experiencing at least one infection during that time, the survey examined the number of OVC who got more than one infection. Control areas are more prone to infection.
Areas % OVC infected
OVC examined Number
Intervention 12.5% 157
Control 18.8% 142
Table 4.2.3.a. Percent of OVC who get more than one infection during the past two weeks
Areas mean duration each episode
days
mean frequency of
infections
Number OVC
examined
Intervention 3.62 1.99 157
Control 4.47 2.12 142
Table 4.2.3.b. Infection episodes
* Not signifi cant * Not signifi cant
Frequency of infections and duration of each episode show a worse situation in Control areas although the differences are not signifi cant.
Table 4.2.3.c. Care during illness
Areas attended by health personnel
reason for not attended by H personnel
-HC far away*
reason for not attended by H personnel -other
work to do*
Number OVC examined
Intervention 54% 25% 75% 157
Control 50% 7% 93% 142
* Statistically signifi cant at P<0.05
The proportions of OVC who receive care by health personnel are not signifi cantly different between the two areas; however, the reasons for not getting proper treatment are signifi cant. Compared to Intervention areas, other commitments (and not the distance) are the main reason for a signifi cantly higher number of OVC in Control areas not receiving care by health professionals. Care for OVC is obviously more appreciated in Intervention areas.
Key fi ndings The statistically signifi cant effect of the programme in mitigating the impact of HIV/AIDS on food security, nutrition and health is evidenced by the following fi ndings in Intervention areas compared with Control areas:
more food groups consumed in OVC households;
more animal protein and oil consumption by OVC households;
less OVC households experience rice shortages;
higher mean weight-for-height Z score of OVC in the 5-10 year age group;
44
Higher BMI of 11-17 years old OVC; and
fewer secondary infections in PLHA
Though statistically not signifi cant, the following indicators apparently shows the better performance in programme areas:
More food groups consumed by PLHA households;
Less food shortages in PLHA households;
Higher BMI of PLHA:
Higher height-for-age Z score in OVC in the 5-10 year age group; and
Fewer infections and of less frequency and shorter duration among OVC.
No difference in weight-for-height Z score in under-fi ves can be explained because of the insuffi cient number of cases for statistical analysis; a total of fi ve for both areas.
45
Table 5.1.a. Schooling status of the children in PLHA households
5.1 PLHA households
5. Preventing and mitigating the impact of HIV/AIDS on schooling
Areas ever attend school % Current enroll % Numbers examined
Male Female Male Female
Intervention 86.4 86.4 80 80 402
Control 80.3 85.7 80 83 275
More than three quarters of the children in both areas and of both genders have ever attended school and are also currently enrolled. In both areas and for both genders, the children start kindergarten late around, 7.5 years of age
* Not signifi cant
Table 5.1.b. Mean number of school years missed among children who are not currently enrolled
Areas mean years missed numbers examined
male female*
Intervention 3.54 1.5 80
Control 3.57 3.1 55
*Statistically signifi cant at P<0.05
Among children who are not currently enrolled in school, the average number of years they have missed is signifi cantly higher among females in Control areas (compared to Intervention).
Even among the children currently enrolled in school, those who have missed school, have missed an average of 2-3 months. There is no signifi cant difference between areas or genders.
Around 85% of the children are planning to enroll next term. The fi gures are similar in both areas and regardless of gender.
The mean number of repeated classes by children in Intervention and Control areas, regardless of gender, is similar in both areas at around 0.5 classes.
For most of the schooling indicators, there are no signifi cant differences between genders and between areas. Only the mean length of time that has been missed from school (in years) is signifi cantly longer in Control areas and among females.
46
5.2 OVC and OVC households
Table 5.2.a. Percent of OVC currently enrolled in school by gender
Areas Currently enrolled Numbers examinedBoys Girls*
Intervention 87.5 89.8 154
Control 79.8 75.3 141
Figure 5.2.a
* Statistically signifi cant at P<0.05
The food support programme proves its positive impact on schooling of OVC, especially for girls. The proportion of girl OVC currently enrolled in school is signifi cantly higher in Intervention areas. This fact becomes clear in FGD with communities:-
« Now she does not need to work for money, she is strong enough to go to school. She is happy at school because she does not need to worry about home and her Mom. »
FGD at Kraing Ampil, Kampot and Snoa village, Battambong
Table 5.2.b. Mean number of years that classes have been repeated by OVC
Areas Mean class repeated Numbers examinedBoys Girls*
Intervention 0.52 0.43 154
Control 0.43 0.71 141
* Not signifi cant
Even though statistically not signifi cant, class repetition among girls is much lower in Intervention than in Control areas, while among boys it is the opposite, but with a smaller difference.
47
Table 5.2.c Years of school missed among OVC who are not currently enrolled
Areas Mean years of school missed
Numbers examined
Boys Girls*
Intervention 2.7 1.2 19
Control 2.6 5.9 17
Figure 5.2.c
Among the OVC who are not currently enrolled in school, girls in Control areas have missed school for a signifi cantly longer period than girls in Intervention areas. This is evidence of the Programme’s impact.
5.3. Children in OVC households
Table 5.3.a. Schooling status of children in OVC households
Areas ever attend school % Current enroll % Numbers examinedMale Female Male Female
Intervention 85.7 91.3 85 81.8 393
Control 75 85.7 71.4 66.7 306
* Not signifi cant
The pattern is similar to PLHA households. More than three quarters of the children have ever attended school and are also currently enrolled. There is a similar pattern in both areas across both genders. In both areas and in both genders, the children start kindergarten late, at around 7.5 years of age.
Areas mean years missed numbers examinedmale* female*
Intervention 3.3 2.0 85
Control 8.8 5.05 71
Table 5.3.b. Mean number of years missed among children of OVC householdswho are not currently enrolled
*statistically signifi cant at P<0.05
48
The children who are not currently enrolled in the schools have missed some years. The mean number of years missed is signifi cantly higher in Control areas for both male and female OVC. OVC in Intervention areas have missed fewer months before they enroll
Table 5.3.c. Mean number of months missed among children of OVC householdswho are currently enrolled
Areas mean months missed numbers examined
male* female**
Intervention 0.53 0.93 308
Control 2.58 4.32 235
* statistically signifi cant at P<0.1
** statistically signifi cant at P<0.05
The pattern is clearer when looking at the children who are currently enrolled in schools but are still missing some months. Children of OVC households in Intervention areas have missed less months and the difference is signifi cant.
Table 5.3.d. Children of OVC households who plan to enroll and class repeated
Areas Plan to enroll next term %
Mean number of class repeated
Numbers examined
Male Female Male Female
Intervention 90% 86.4% 0.44 0.39 393
Control 85.7% 71.4% 0.47 0.70 306
* Not signifi cant
A large percentage of children are planning to enroll in school next term. However, these percentages are lower in Control areas and among females. Among females there is larger difference between Control and Intervention areas.
Approximately half a term has been repeated by male students in both areas. Female students are apparently repeating more classes in Control areas. None is signifi cant statistically.
Key fi ndings The achievement in preventing and mitigating the negative impact of HIV/AIDS on schooling is evidenced as the sole attribute of the programme by statistically signifi cant improvement of the following indicators in Intervention areas:-
Shorter duration of missing schooling in years in children of PLHA and OVC households;
More OVC girls currently enrolled; and
Shorter duration of missing schools in years by OVC girls.
49
6. Integrating with development activities, and improving livelihoods. Ability to participate in ARV treatment, education, and vocational training.
6.1 PLHA
One of the objectives of the food support programme is to attract PLHA to proper treatment regimes, and to give them the time and resources to enable them to stick to those regimes, as well, the time and resources of PLHA to enable them to regularly participate in proper treatment regimes.
Although all PLHA in both areas are currently receiving ARV treatment, more PLHA under the food support programme are regularly attending ARV treatment regimes for longer durations than their counterparts in the Control areas.
Areas Mean duration of ARV treatment months
% PLHA who regularly attend treatment
Number PLHA examined
Intervention 17.28 94.6% 201
Control 4.98 93.3% 170
Table 6.1. ARV treatment regimes
* Not signifi cant
6.1.2 Life skills training
Areas personal hygiene
food & nutrition
health care income generation
coping with community*
No. PLHA examined
Intervention 96.7 91.3 95.7 78.3 78.3 112
Control 75 62.5 75 50 37.5 60
Table 6.1.2.a. Proportion of PLHA who have obtained life skills trainings in
* Different to training in coping strategies: Signifi cant P<0.05
* Others not signifi cant
Apparently more PLHA in Intervention areas have participated and obtained training on all identifi ed categories than those in Control areas.
Areas KHANA staff HBC staff health staff Community group Friends family
Intervention 2.4% 44.3% 11.4% 40.6% 0.4% 0.9%
Control 0.74% 35.81% 25.05% 36.55% 1.11% 0.74%
Table 6.1.2.b. Sources of life skills training provision
The life skills trainings mentioned above are provided mostly by Home Care teams and community groups in both areas. Notably, training by health staff is much more evident in Control areas. The overall picture shows more activities in life skills trainings by community and HBC teams in Intervention areas
50
6.2 OVC
Areas Percent OVC fostered by households Number examined
Male female*
Intervention 76.9 75 154
Control 71.4 66.7 142
Table 6.2.a. OVC who have been fostered
* Statistically signifi cant P<0.05
With food support, the livelihood of OVC apparently improves. More OVC are fostered in Intervention areas. Difference is statistically signifi cant among girls between Intervention and Control areas at P<0.05 level.
Table 6.2.b. OVC status of studying
Areas % OVC attending school
% OVC attending vocational school
% OVC assisting in household work
No. of OVC examined
Intervention 72.2% 47% 54.8% 154
Control 42.9% 25% 39.3% 141
* Differences not signifi cant
More OVC in programme areas are attending school, vocational training and assisting in household work (the latter point indicates that the OVC are not away from home, working) than in Control areas and they are also studying more hours per day as shown in the following table.
Areas Mean hours per day attending school
Mean hours per day attending vocational training
No. of OVC examined
Intervention 2.9 0.93 154
Control 1.9 0.78 141
Table 6.2.c. Mean hours of studying per day by OVC
* Not signifi cant
Table 6.2.d. Proportion of OVC who have obtained life skills trainings in
Areas personal hygiene
food & nutrition
health care
Income generation
coping with community*
No. OVC examined
Intervention 77.8 72.4 72.7 32.7 32.1 154
Control 28.6 21.8 26.8 6.3 8.5 141
* Differences in all livelihood trainings are signifi cant at P<0.00
51
More OVC in Intervention areas are participating and completing various livelihood trainings than their counter-parts in Control areas, and differences are statistically signifi cant in all trainings.
Key fi ndings Programme’s significant impact on improving livelihood in Intervention areas is as follows:
So more OVC girls are fostered, and
more OVC are participating in all variety of livelihood trainings.
Although statistically not significant:
more PLHA in Intervention areas are regularly attending ARV treatment for longer duration;
more PLHA are participating in all livelihood trainings;
more OVC are attending school and vocational trainings and assisting in household work; and
OVC are studying more hours per day.
52
7. Integrating with development activities Behavioral changes in communities, operational performance of KHANA partners, and challenges and opportunities for future programming
To assess the behavioral change in the community and HBC teams and to further explore the challenges and opportunities of the programme operation, the survey team conducted a qualitative study; in-depth interviews, focus group discussions and observations, and analyzed them by triangulation techniques.
7.1 StudyA total of 12 FGD and 16 in-depth interviews were conducted. Four FGD were held for research topic 1, and eight in-depth interviews for combined topics 1 and 2 were conducted with the HBC teams and community leaders in Intervention areas. For research topic two; four FGD in Intervention areas and four FGD in Control areas were held, in addition to eight in-depth interviews in Control areas, with benefi ciaries, community members and volunteers.
Each focus group includes a mix of male and female participants. All participants reflect the diversity of the programme’s benefi ciaries as PLHA, OVC, care giver, ordinary community member and community volunteer (e.g support group member).
Observations are made during visits and also during quantitative data collection to assess the situation of households, food storage and kitchen condition, development activities in the community, and community interaction in the village.
The assessment conducts the triangulation analysis to verify and balance the fi ndings.
7.2 Key FindingsResearch Topic 1: Problems and constraints encountered by KHANA and HBC teams in monitoring and managing of food distribution.
Regular and refresher trainings for most NGO partners have been conducted on food management and reporting on the logistical aspects of food distribution. The training has been conducted by KHANA and WFP.
Despite clear criteria from KHANA, the selection of food support benefi ciaries has, on occasion, been problematic. This has occurred when the NGO partners attempt to follow the criteria but are misled by the complexity of the situation at household level. For example, there is evidence that some households are receiving double rations because the wife chose to live separately from her husband when he tested positive for HIV and then returned to him when she also tested positive for HIV. By this time, both parties have become eligible, applied for and received food support but have not informed the NGO that they are once again living under the same roof.
Stakeholders involved at all levels of the Intervention require further capacity building in some issues that would further enhance the effectiveness of the programme, such as: clear instructions and training in participatory planning, selection criteria and rationale, and an increase in the basic knowledge of Home Based Care Teams and programme staff on food and nutrition with special reference to HIV/AIDS.
The communities have an appreciative perception of the work of the HBC teams with no evidence of negative attitudes towards team members or their work.
“In 2000, the organization started to come and help people with HIV. After that, food support came and it has really improved the lives of those people. Neighbors are also starting to help them.”
Community leader, Bromol Bdom village, Kmong Kanggerg commune, Prey Veng
53
Together with the fi ndings of research topic 2, it is apparent that regular and timely information fl ow is required for programme management. If actual practices and occurrences at the ground level (such as incomplete practice of information dissemination to communities, welfare support with nutritionally controversial items, and discrepancies in the selection process), were known to management in time, then, consequently, analysis, feed back and programme adjustments could have been made in a timely manner.
Summary
Food management trainings have been conducted;
Selection of benefi ciaries has been a constraint at fi eld level;
Clear operational guidelines and basic training on nutrition and BCC are required;
The communities have an appreciative perception of the work of the HBC teams; and
There is a need for monitoring mechanisms with regular and timely information fl ows.
Research Topic 2: Changes in benefi ciary and community perception towards food support programme.
The qualitative data suggests that information about the programme has not been fully disseminated to the communities by most of the NGO partners. Eighty-three percent of participants did not know which organizations were involved in the assistance and what were the aims of the assistance. Sixty-seven percent stated that they were instructed to get a blood test and after that, they would get a food ration. Around 70% of community leaders were informed of the food support and the selection criteria but it was not discussed with them in detail. It was apparent that the communities did not expect to participate in the planning of the programme, although they did want to be fully informed and clear about the project.
Participatory planning of the selection of benefi ciaries, food distribution sites and monitoring has been partially practiced by some partners. Thirty percent of community leaders and FGD participants stated that there were regular meetings at the NGO sites. As a result, food distribution sites were selected and adjusted to the need of benefi ciaries.
“We choose the middle point to distribute. This was suggested by PLHA during the meeting.”
A community volunteer, Norea 2 village, Norea commune, Battambang district.
The food quality and type is culturally acceptable and appropriate.
There are no problems of storage, especially for large families of six or more. Current rations are adequate for small families of four or fi ve. For large families the monthly rations last for approximately two weeks.
The livelihood trainings have been widely participated, in programme areas and many basic life skills have been conveyed to the benefi ciaries.
“We have been trained how to take care of our health, and the importance of clean bodies.”
PLHA in Roveang commune, Takeo province
However, little knowledge has been gained on food and nutrition. The communities (i.e. leaders, volunteers and benefi ciaries) can not explain about the nutritional advantage of food especially for PLHA and OVC, the importance of food for HIV-affected persons, and nutritional requirements. They regard food only as a means of preventing hunger and as a means of income transfer.
“Benefi t of food is relieving hunger, and better life. Now she (OVC) can go to school because she does not need to work to earn money for food.”
Community leader, Roveang commune, Takeo province
54
The HBC team leaders are aware of the nutritional requirements, the side effects of drugs on food intake (during ART) and the advantages of good nutrition for combating drugs’ side effects. Yet nobody in the community can repeat this knowledge, i.e. the nutritional needs of PLHA, food and drug interactions, care in food consumption during ARV treatment, and preparation of nutritionally-balanced food etc. Furthermore, some NGO partners were distributing controversial items like MSG (Mono-Sodium Glutamate) as part of their welfare activities. A need of proper training on food and nutrition is apparent.
Community members feel that other poor families with young children should also get food support and that PLHA and OVC households need additional support, such as shelter, because all their assets were sold before the HBC programme started.
Sitha was so shy when she found out that she was infected with HIV, that she did not even tell the HBC team. Her parents sold everything including their house and land to pay for Sitha’s medicines and health care. Now they don’t have any shelter, even in the rainy season.
Too much appreciation on food and other material support is observed as potential for developing dependency. However, six FGD (50%) revealed the communities’ desire for self-reliance.
“We want to establish a community fund so that we can help those in need.”
Community member,Tourl Ta Ek village, Battambang
Achievements in development activities like income-generation and small loans for businesses, contributing to behavior change and livelihood status, have been observed in some Intervention areas but not all.
OVC and PLHA were outcasts before the Intervention but social stigma has been decreasing since the HBC teams and their community support groups became active in counseling and psychosocial support to PLHA and OVC, and community education.
Since the start of the Intervention, the PLHA who have been denied jobs have been denied only on the basis of skill or strength. They indicated that jobs were not denied on the basis of discrimination.
Summary
Although participatory planning, especially in benefi ciary selection and feasibility of food collection by beneficiaries, has been practiced in some areas, information dissemination to communities about the programme has not been fully accomplished in most areas.
Food quality and type is culturally acceptable and appropriate.
There is no problem of storage, but the monthly ration is not enough for large families
Life skills training has been conveyed to benefi ciaries on self-health care, hygiene etc, but further training on nutrition for PLHA and OVC is required.
The communities would like other forms of social support in addition to food
The success of development activities in some areas are seen as an essential part of reducing the risk of dependency on food aid.
Social stigma has been decreasing since the start of the programme
No case of employment denied on the basis of discrimination.
55
Food rations to PLHA and OVC households in conjunction with existing home based care activities is an appropriate approach. Positive trends have been achieved. The objective to mitigate the impact of HIV/AIDS on PLHA and OVC in terms of food security, and livelihoods, is generally achieved. Moreover, contributing to education (i.e. assisting access to formal, informal, and vocational education) for longer-term development, security and self-reliance is indicative of an effective exit strategy. It is also providing urgent resources of food and nutrition to those poverty-stricken, HIV-infected families, and therefore contributing to better health, livelihoods and more earning opportunities.
Some important indicators have strongly proved the impact of the programme on food security, nutrition and better involvement of benefi ciaries in development programmes. Other indicators, while showing an improved situation in Intervention areas, can not statistically prove the impact of the programme. In these cases, the improvement can be also be attributed to existing home care activities and other development programmes implemented in the areas by community organizations.
In-depth qualitative studies and triangulation analysis (i.e. observation, in-depth interviews and FGD) reveal the fact that although the livelihood trainings have been much participated in, in programme areas, little knowledge has been gained. Participants cannot recall the nutritional needs of PLHA and OVC, food and drug interactions, self-care in food consumption during ARV treatment, or preparation methods for nutritionally-balanced food etc. Some HBC teams and NGO partners are distributing some controversial items like MSG and noodles by using welfare cash from KHANA.
Food and other support should be continued and other options are to be explored. Achievement in development activities like income-generation and small loans for business are contributing to behavior change and livelihood status in some areas, which in turn leads to communities placing a value on self-reliance.
The implementation of a participatory planning mechanism is strongly recommended for the food support programme. This would enable KHANA and WFP to become more visible among the communities and beneficiaries involved in the programme and would enable those communities to have a greater understanding of the purpose, criteria and impact of the food programme.
It is also necessary for the selection criteria of benefi ciaries receiving food support to be reviewed with KHANA’s partners so that there is no misunderstanding or neglect of the guidelines related to benefi ciary selection.
These fi ndings also suggest that KHANA should review its monitoring and information processes from the fi eld to head offi ce, so that problems can be more effectively addressed and that the data collected from the fi eld is complete, accurate and useful.
8. Discussion and Recommendations
56
Conclusion
The food support programme should continue as it clearly has a positive impact on food security, nutrition and livelihoods, and is essential for PLHA and OVC. However, food support must be provided in a comprehensive manner as part of a longer-term development strategy. KHANA and its partners have already begun to do this but more intensive development activities that integrate proper IEC and BCC strategies, now need to take place. Integrated HBC with food support, although the primary aim is care and support, has great potential to link with wider development activities that will help vulnerable communities. If the capacities of current operating partners are not suffi cient enough, KHANA should try to seek additional partners who engage in wider development activities (income-generation, water supplies and sanitation), and have experience and expertise in these fi elds.
Although the programme has made a difference in terms of improved nutrition, the general nutritional status of PLHA and OVC is still relatively lower and requires special attention. A nutritionally-targeted programme (i.e. not simply the provision of rations, but nutrient support to target benefi ciaries and integrated nutrition education BCC approach) is highly recommended for future planning.
NGO partners should have clear guidelines for multiplier training (i.e. ToT training downwards), participatory planning and information dissemination to communities. Standard guidelines should be developed with the participation of the NGO partners.
The basic food and nutrition training for HBC teams as outlined in the KHANA training manuals need to be expanded, developed and combined with BCC skills training, emphasizing the particular needs of PLHA (and OVC). A food and nutrition training curriculum should be developed expanded and edited by means of sharing feedback among knowledgeable professionals before use at fi eld level.
Capacity building for NGO and KHANA staff in terms of knowledge of basic food and nutrition for PLHA and OVC, participatory approaches and BCC is essential.
A monitoring system needs to be established with regular and timely information fl ows between every level, from senior management to programme level to NGO partners at operational level. The required information may include essential programme components; such as information dissemination to communities, participatory planning, any discrepancies in benefi ciary selection, and gaps between support, knowledge and needs of benefi ciaries (such as knowledge on food, ART and nutrition, transportation etc). The means of information collection may include appropriate reporting, regular fi eld monitoring with check lists, and regular meetings with partner NGOs. The monitoring system should include analysis using specifi c formats, which can translate the data into information for planners and managers, and regular and participatory feed-back and problem solving mechanisms at all levels.
Currently, the food support programme is manned by a manager and assisted by a programme assistant from the Monitoring and Evaluation Unit at KHANA. Their responsibilities are mainly to collect and compile the quarterly reports according to WFP’s guidelines and report to WFP. However, other programmes/teams at KHANA have better man power and conduct regular fi eld visits for their own programmes. Little dialogue has been seen between food support and other teams. A checklist to gather essential information for management support should be developed in a cross-cutting way among the programmes/teams. The food support programme needs to be part of KHANA’s integrated M&E system.
Exit criteria for food support and nutritionally-targeted support should be clearly set up through a careful participatory planning process as part of the development package, to avoid dependency and to aim at sustained development.
57
1 Measuring Change in Nutritional Status, World Health Organization, Geneva, 1983
2 Robert Magnani. Sampling Guide. Food and nutrition Technical assistance Series, USAID, 1987
3 Rothenberg, R.B., Lobanov, A., Singh, K.B., and Stroh, Jr., G.,: Observations on the application of EPI cluster survey methods for estimating disease incidence, Bulletin of the World Health Organization 63 (1), 93-99, 1985
4 Developing and applying national guidelines for Nutrition and HIV/AIDS, UNICEF, FANTA-UAAID, March 2003
5 Measuring the Effect of Targeted Food Assistance on Benefi ciaries with Chronic Illness: S. Strasser RN, MS, MPH and Kari Egge MPH, PhD, International Conference on HIV/AIDS and Food and Nutrition Security, International Food Policy Research Institute Durban, South Africa 14-16 April 2005
6 Physical Status: The Use and Interpretation of Anthropometry, Report of a WHO Expert Committee, Geneva, 1995; page 217
7 Brownie C, Habicht, J-P, Cogill, B. Comparing indicators of health or nutritional status. American journal of epidemiology, 1966,124:1031-1044
8 Armitage, P, Berry G. Statistical Methods in medical research, 2nd ed. Oxford, Blackwell, 1987
9 Suggested Core Indicators for Monitoring Food Security Status. Committee on World Food Security, 26th
session, Rome, September 2000
10 Anne Swindale, Punam Ohri-Vachaspati, Measuring Household Food Consumption: A Technical Guide. USAID, December 1999
11 Frank Riely, Nancy Mock, Bruce Cogill, Laura Bailey, and Eric Kenefick. Food Security Indicators and Framework for Use in the Monitoring and Evaluation of Food Aid Programs. USAID, January 1999
12 Kari Egge MPH, PhD and Susan Strasser RN, MS, MPH. Measuring the impact of targeted food assistance on HIV/AIDS-related benefi ciary groups; M& E indicators for consideration, C-SAFE, November 2005
13 A guide to monitoring and evaluating HIV/AIDS care and support, WHO, 2004
14 Sheik Iliayas at el. Impact of nutritional Intervention on weight and body mass index of HIV positive individuals in Tamil Nadu, South India
15 Food and nutrition needs in emergency, UNHCR,UNICEF,WFP,WHO, 2002
16 Anthropometric indicators measurement guide 2003 edition, Food and nutrition Technical assistance Series, USAID, 2004
17 Aviva Must, at el. Reference data for obesity: 85th and 95th percentiles of body mass index and triceps skinfold thickness, Am J Clin Nutr, 1991
18 Profi le of Food Aid programme, KHANA, 2006-2007, Cambodia
19 Protracted Relief and Recovery Operation- Cambodia 10305.0 (2004-2006), WFP.
20 Strategic Plan 2006-2009, WFP
21 Keeping up with the changing epidemic, Annual Report 2005, Khmer HIV/AIDS NGO Alliance, Cambodia
22 Strategic Plan 2004-2005, KHANA, Cambodia
Bibliography
58
Annex 1WFP Operational Defi nitions (for eligibility for food support)
Eligible PLHA households refer to the PLHA households which suffer from food and food income shortage during their illness and/or have children who are unable to attend school etc. Their living standard should be poor in order to qualify for food assistance.
PLHA refers a person who self-identifi es as HIV+ and who is known to be HIV+ by community leaders and/or health center staff.
OVC; Orphans and Vulnerable children. Orphans are generally considered as children who do not have a living parent (either father or mother) and whose age is under 18. Vulnerable children usually refers to those children living in a household affected by HIV. OVC also refer to children who suffer from well-founded incidences of exclusion, abuse, discrimination and social stigma.
Household refers all persons within one family, including foster families, who have lived under the same roof for the last year.
Head of household refers to the main decision-maker within a household
Primary care giver of OVC refers to the main person within an OVC household who is responsible for caring for the OVC in that household.
59
Annex 2Sample size calculation
Required sample size is calculated based on the formula described in the chapter “Calculating sample size requirement for indicators that are, means or totals” in the reference book “Sampling Guide” by Robert Magnani, Food and Nutrition Technical Assistance Series, USAID, 1987.
n=D [(Z. + Z.)2 * (sd12 + sd2
2) / (X2 - X1)2 ]
n = required minimum sample size per survey round or comparison groupD = design effect for cluster surveys (use default value of 2, as discossed in Section 3.4)X1 = the estimated level of an indicator at the time of the fi rst survey or for the Control areaX2 = the expected level of the indicator either at some future date or for the project area such that the quantity ( X2 - X1 ) is the size of the magintude of change or comparison-group differences it is desired to be able to detect
sd1 and sd2 = expected standard deviations for the indications for the respective survey round or comparison groups being compared
Z. = the z-score corresponding to the degree of confi dence with which it is desired to be able to conclude that an observed change of size ( X2 - X1 ) would not have occurred by chance ( statistical signifi cance ), andZ. = the z-score corresponding to the degree of confi dence with which it is desired to be ceretain of detecting a change of size ( X2 - X1 ) if one actually occurred ( statistical power ).
For this particular study, considering the available resources and time limits, the following values are defi ned as acceptable levels of statistical testing for the result of the study.
D = 1.5X1 = 1.93 WHZ for OVC and 17 BMI for PLHAX2 = 1.4 WHZ for OVC and 22 for PLHA
Note: X1 value is estimated referring to the Cambodia Demographic Health Survey, 2000 (CDHS-2000) as national level of mean weight-for-height Z score being 1.2, and estimating much worse situation; WFP targeted areas is already worse off as defi ned by VAM as highly vulnerable and also current OVC status of 20% infection.
To estimate X2 value, there is not enough data and experience internationally to be referred to the same situation of OVC and same type of Intervention. The estimation was made considering the most probable scenario in Intervention of similarly severe situation.
For estimating X1 and X2 for PLHA similar considerations are applied.
Ninety-fi ve percent level of confi dence and 80% statistical power, as generally recommended, was regarded as an acceptable level for this study.
The estimated required sample sizes come out as 220 for PLHA in each area and 144 for OVC in each area including a 10% non-response rate.
60
Strata No Province # of PLHA # of OVC Total Proportion
KC 1 Total 1402 2474 3876 28%
KS 2 Total 1497 2519 4016 29%
SR 3 Total 2392 3546 5938 43%
5291 8539 13830
2nd Stage: Since benefi ciaries population is nearly double in Siem Reap than that in each of remaining two strata, two provinces from Siem Reap stratum and one province each from Kampong Cham and Kampong Speu strata will be selected, in order to give the beneficiaries in the strata, the probability of participating in the study proportionate to the benefi ciary size of stratum they belong to PPS.
Annex 3Sampling
Sampling procedures consist of two parts; One comparison group selection and two representative sampling of both groups.
For comparison of Intervention and Control groups the sampling procedures follows the following guidelines (12):
“Comparison groups are normally expected to consist of populations of one or more nearby districts, municipalities, or other administrative units that have characteristics similar to those of the program being evaluated. The selection process normally consists of two stages. The fi rst involves identifying groups that meet the criteria of similarity. The choice could be made purposively ( i.e., characteristics of the group could be predefi ned and selection could be made according to the agreed- upon criteria) unless several areas have profi les similar to the program area, in which case one could be chosen randomly. Once the survey universe for the comparison area has been defi ned, it remains to select a sample of clusters and households to represent the comparison area. The sampling procedures are identical to those for general population surveys”.
Comparison groups are identifi ed as Intervention and Control areas. Intervention areas are those which have been under integrated food support and HBC for three years and Control areas are those which are planning to start food support in October and have been under implementation of HBC as the same package as in Intervention areas without food support. Socioeconomic characteristic are tested (see chapter 4 socio-economic situation) and confi rmed as comparable by VAM analysis of WFP which use the poverty and nutrition indicators.
For Intervention areas representative sampling is decided to conduct cluster sampling with 20 clusters as HBC teams (Health Centers) and follow PPS procedure in multiple stage due too the operation and geographic indications.
For Control areas, since the number of identifi ed clusters are smaller than 20 (total 9), it is decide to select all 9 clusters and to conduct random sampling of intra-cluster households if the number of households are larger than defi ned constant number of households per cluster.
Ideally, to avoid heterogeneity among clusters (i.e. Health Centre); the benefi ciary population can be divided into “Strata” (number of categories) in which the VARIATION in the benefi ciary characteristics is small relative o that in the whole population of benefi ciaries among clusters.
In this case, benefi ciary characteristics can be defi ned, as socio demographic characteristics of the community they belong to, which will infl uence the effect of the programme. KHANA food assistance-HBC programme is operating in the three broad areas administered by WFP’s operational sub-offi ces formed based on geographic and administrative characteristics.
First Stage: Thus, the survey area can be stratifi ed into three broad strata, according to WFP sub offi ce areas, namely, Kampong Cham, Kampong Speu and Siem Reap, in each of which variation in the beneficiary characteristics is supposed to be small.
61
The selection of provinces within each stratum will also based on the fact that probability of the province for participating in the study will be proportionate to the benefi ciary size of the province, PPS, i.e. larger provinces are given a greater chance of selection than smaller provinces, in terms of benefi ciaries.
Strata Stratum No Province # of PLHA # of OVC Total
KC 1 Kampong Cham 557 651 1208
KC 1 Kampong Thom 241 492 733
KC 1 Prey Veng 372 522 894
KC 1 Svay Rieng 232 809 1041
KC 1 Kampong Chnnang 47 31 78
KS 2 Kampong Speu 128 289 417
KS 2 Kampot 130 63 193
KS 2 Sihanouk Ville 310 374 684
KS 2 Takeo 882 1762 2644
SR 3 Banthey Meanchey 499 682 1181
SR 3 Battambang 716 1009 1725
SR 3 Pailin 120 238 358
SR 3 Pursat 320 737 1057
SR 3 Siem Reap 737 880 1617
Kampong Cham sub-offi ce area stratum : Kampong Cham province
Kampong Speu sub-offi ce area stratum : Takeo province
Siem Reap sub-offi ce area stratum : (1) Battambang (2) Siem Reap
3rd Stage: Since sample size for acceptable statistical strength is, for each of the Intervention and Control areas; PLHA 220 and OVC 144; cluster numbers are decided to be 20 (due to limited resource) so that number of elements (target sampled benefi ciaries) per cluster is defi ned as households of 11 PLHA and 8 OVC; this makes sure that target members are suffi ciently well spread across enough clusters that survey estimates are not unduly infl uenced by a handful of clusters.
Each health centre based by home-based care team in the selected provinces are regarded as clusters. All the clusters in selected provinces are listed with respective number of benefi ciaries and selection of 20 clusters is processed by PPS technique based on the population size of total benefi ciaries in each cluster (PLHA plus OVC).
62
Final list of sample clusters are as follows.
Sampled clusters
INTERVENTION CONTROL
Strata ProvinceName of health centers
ProvinceName of health centers
SR Battambang Kork Khmum Kampot Krin Ampil
SR Battambang Bansay Treng Kampot Kampong Kandal
SR Battambang Rokar Kampot Trey Koh
SR Battambang Samrong Knong Prey Veng Prey Pnov
SR Battambang Tourl Ta Ek Prey Veng Por Ty
KC Kampong Cham Da Prey Veng Kragnoung
KC Kampong Cham Knol Dambong Prey Veng Pean Roung
KC Kampong Cham Sandek Prey Veng Kanh Chreach
KC Kampong Cham Tomnoup Siem Reap Kampong Thkov
SR Siem Reap Siem Reap
SR Siem Reap Pouk
SR Siem Reap Dan Run
KS Takeo Prey Lear
KS Takeo Baray
KS Takeo Lum Chong
KS Takeo Cham Bork
KS Takeo Ro Veang
KS Takeo Batie
KS Takeo Chan Chum
KS Takeo Romeng
20 clusters
9 clusters
63
Annex 4Questionnaires
Qualitative Assessment of Community Perception of the KHANA/WFP Food Support Program
Methodology
Methods: Key Informant In-depth Interviews (or Community Interviews), Focus Group Discussions and Observations
1. Problems and constraints encountered by KHANA and HCT in monitoring and management of food distribution
KHANA and HCT in Intervention areas (20 HCT under study – one out of every fi ve was assessed, covering four HCT areas.
Key Informant Interviews
KII with HCT team leader: one in each of the 4 areas- 4
KII with responsible person from WFP sub-offi ce- 3
KII with KHANA team leader - 1
Total KII - 7
Focus Group Discussions
1 FGD with 2 HCT team member, 2 health staff, and 2 volunteers in each of the 4 areas- 4
Total FGD 4
Questions
1. Have you received training on receiving and distributing food, invoicing, and signing bills?
1.1 by whom?
1.2 were the trainings well conducted?
1.3 have you been well trained?
2. Do you have any difficulties in managing food distribution? What are those diffi culties at each level?
2.1 HQ level at WFP and KHANA
2.2 Field Offi ce level at HC and team HQ
2.4 Field level
2.5 Community
3. What are the possible solutions?
4. What support do you need from each level to be able to carry out food support effectively?
4.1 HQ level at WFP and KHANA
4.2 Field Offi ce level at HC and team HQ
4.3 Field level
4.4 Community level
64
5. How do you feel about interacting with PLHA and OVC?
5.1 Are you afraid of infection when you talk to them?
5.2. Do you worry about what other people think when they see you interacting with PLHA and OVC?
5.3 What other feelings do you have about working with PLHA and OVC?
6. Have your feelings and attitude towards PLHA and OVC changed since you started to help provide food support through the HCT?
6.1 What were your feelings before HBC and the provision of food support and what are your feelings now?
Observations
Report on and record quantity and quality of all trainings on all subjects covering the 20 selected HCs and KHANA staff.
1. Numbers of people trained
2. Number of people trained from each HCT
2. Major changes in benefi ciaries; community, perception of project, roles and responsibilities
Observations:At each of the selected 20 HCs (Intervention) and 13 HCs (Control)— 1. number of community groups and individuals involved in selection of benefi ciaries and provision of care and support. 2. number of community groups and individuals taking care of food distribution activities
KII: Same 4 areas in Intervention area and 3 areas in Control area with community leader, HCT team leader and health staff.
Total 12 KII in Intervention area and 9 in Control area
FGD: 4 areas in Intervention area; 3 areas in Control area 2 FGD in each area; Total 14
(1) with 2 community members from different social strata
(2) with 2 PLHA and 2 elder OVC
Questions1. Information sharing: whether community is fully informed about the project?
2. Monitoring: whether PLHA and OVC households are consulted in monitoring of food distribution?
3. Ration planning: whether community can describe the advantages, (nutritional and food security), of food rations?
4. Appropriateness and Acceptability: whether food is acceptable to those interviewed? Whether the rations are adequate for intended benefi ciaries?
5. Food handling: Any problems in storing or preparing commodities distributed?
6. Nutrition: adequacy: whether ration is enough for an entire month for intended benefi ciaries?
7. Nutrition: support to at-risk groups: whether community feels that some other at-risk groups also need the food rations under current project?
Discrimination8. Whether community see PLHA and OVC as outcasts or people to be accepted, cared for and counseled?
9. Whether PLHA and OVC can get access to jobs and equal payment that other people with same skills and capacity have access to?
65
Annex 5Survey Teams
List of Interviewees
Kampot/Takeo (1)
Nº Name Sex Responsible
01 Sok Saron F TL/Superviser
02 Ouk Sok M NT/In deep
03 Heng Kanha F Interviewer
04 Van Sodaneath F Interviewer
05 In Pongaphotra M Interviewer
06 Chea Syna F Interviewer
07 Oum Vesna F Interviewer
08 Keo Kosal M Interviewer
09 Pech Chanra M Interviewer
Battambang (2)
Nº Name Sex Responsible
10 Thorn Riguen F TL/Superviser
11 Lim Sreypech F NT/In deep
12 Pang Chhaya M Interviewer
13 Chem Vuthy M Interviewer
14 Keat Sereysophorn F Interviewer
Prey Veng (3)
Nº Name Sex Responsible
15 Ly Vandy M TL/Superviser
16 Kater Sreyan F NT/In deep
17 Kaing Vouchna F Interviewer
18 Phuon Sothea F Interviewer
19 Neang Kimhong M Interviewer
20 Nak Samnang F Interviewer
21 Ouk Ratanak M Interviewer
Siem Reap (4)
Nº Name Sex Responsible
22 Eam Thea M TL/Superviser
23 Bou Sreyna F Interviewer
Kampong Cham (5)
Nº Name Sex Responsible
24 Gnim Chandara F TL/Superviser
25 Chek Sokhin M Interviewer
66
Dat
e o
f in
terv
iew
1. P
rovi
nce
2. H
ealth
Cen
ter
3. H
ouse
hold
Typ
e
3. H
ouse
hold
ID N
umb
er
Ref
. Cod
e 1.
1
Ref
. Cod
e 1.
2
One
dig
it P
LHA
......
.1
O
VC
.....2
4 d
igit
s R
ef c
od
e 1.
3
dd
mm
yy
1. N
ame
of E
num
erat
or2.
Enu
mer
ator
ID
3. D
ate/
time
of F
irst I
nter
view
4. D
ate/
time
of S
econ
d In
terv
iew
5. N
ame
of T
eam
Lea
der
6. N
ame
of S
uper
viso
r
9. N
ame
of D
ata
Ent
ry O
per
ator
DD
MM
YY
Sta
rt T
ime
Fini
sh T
ime
Che
cked
& s
igne
d
Che
cked
& s
igne
d
Che
cked
& s
igne
d
PLHA
HOU
SEHO
LDHO
USEH
LD IN
TERV
IEW
ID
ENTI
FICA
TION
SHE
ET
KHAN
A/W
FP -
FOOD
SUP
PORT
AND
HOM
E BA
SED
CARE
OF
PLHA
AND
OVC
, CAM
BODI
ABAS
E LI
NE A
ND
EVAL
UATI
ON S
URVE
Y - 2
006
Ho
use
ho
ld Q
ues
tio
nn
aire
fold
er
67
1.2.
3.4.
5.6.
7.8.
9
Fam
ily M
emb
er ID
Nam
eW
hat i
s [N
AM
E]’s
re
latio
nshi
p to
th
e he
ad o
f the
ho
useh
old
?
Wha
t is
[NA
ME
]’s s
ex?
Wha
t is
[NA
ME
]’s a
ge
in c
omp
lete
d
year
s an
d
mon
ths?
Doe
s th
e b
enefi
cia
ry o
f foo
d
ratio
ns [
NA
ME
] in
th
is h
ouse
hold
hav
e tw
o liv
ing
par
ents
?
“Is
this
per
son
[NA
ME
] th
e p
rimar
y ca
re
giv
er o
f the
ch
ildre
n?
Wha
t is
the
hig
hest
leve
l of
year
s of
ed
uca-
tion
of th
e fa
mily
mem
ber
[N
AM
E]?
Wha
t is
the
emp
lom
ent
stat
us o
f the
fa
mily
mem
ber
[N
AM
E]?
Cod
e 1.
4 -
6 d
igits
CO
DE
AC
OD
E D
YEA
RS
MO
NTH
S
CO
DE
CC
OD
E E
SERIAL NUMBER
PLHA
HOU
SEHO
LDRE
SPON
DENT
: hou
seho
ld
head
or s
pous
e or
plh
a or
oth
er, r
espo
ndin
g fo
r all
curr
ent h
ouse
hold
m
embe
rs
HOUS
EHOL
D DE
MOG
RAPH
YFO
R AL
L HO
USHO
LD M
EMBE
RSA
SK
WH
O T
HE
HE
AD
OF
TH
E H
OU
SE
HO
LD
IS A
MO
NG
TH
OS
E C
UR
RE
NT
LY R
ES
IDIN
G IN
TH
E H
OU
SE
HO
LD
. A
SS
IGN
H
OU
SE
HO
LD
HE
AD
, ME
MB
ER
ID 1
AN
D E
NT
ER
TH
E N
AM
E IN
TH
E F
IRS
T R
OW
. A
SK
TH
E R
ES
PO
ND
EN
T T
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AL
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TH
ER
M
EM
BE
RS
OF
TH
E H
OU
SE
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LD
. AS
SIG
N A
ME
MB
ER
ID A
ND
EN
TE
R N
AM
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FO
R A
LL
OT
HE
R H
OU
SE
HO
LD
ME
MB
ER
S.
68
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
F
AM
ILY
ME
MB
ER
ID
NA
ME
“Sex
Has
[N
AM
E]
ever
at
tend
ed
scho
ol?
At w
hat
age
did
[N
AM
E]
star
t KG
?
Wha
t is
the
mai
n re
ason
[N
AM
E]
has
not
ever
at
tend
ed
scho
ol?
Is [
NA
ME
] cu
rren
tly
enro
lled
in
scho
ol?
If N
o, h
ow
man
y Y
EA
RS
ha
s [N
AM
E]
com
ple
t-ed
?
Wha
t is
the
mai
n re
ason
[N
AM
E]
is n
ot
curr
ently
en
rolle
d
in s
choo
l th
is
term
?
If Q
13 is
Y
ES
, how
m
any
year
s ha
s [N
AM
E]
mis
sed
fro
m th
e st
art o
f sc
hool
ing
to
the
cur-
rent
term
?
If [N
AM
E]
has
mis
sed
so
me
year
s w
hat i
s th
e m
ain
reas
on
for
mis
sing
sc
hool
?
Will
[N
AM
E]
enro
ll in
sc
hool
ne
xt
term
?
Wha
t is
the
mai
n re
ason
[N
AM
E]
will
not
en
roll
in
scho
ol
next
te
rm?
Wha
t cl
ass
leve
l is
[NA
ME
] cu
rren
tly
enro
lled
in
or
was
[N
AM
E]
mos
t re
cent
ly
enro
lled
in
?
How
m
any
clas
ses
has
[NA
ME
] ev
er re
-p
eate
d?
CO
DE
1.4
[6
DIG
ITS
]
AG
EC
OD
E F
B
ELO
WC
OD
E F
B
ELO
WYe
ars
CO
DE
F
BE
LOW
CO
DE
F
BE
LOW
CO
DE
CN
UM
BE
R
CO
DE
F:R
EA
SO
N F
OR
NO
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LM
EN
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ON
-AT
TE
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CE
Illne
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......
......
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are
for
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ling
s....
....3
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not a
fford
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ts...
......
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ung
er...
......
......
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k to
ear
n m
oney
......
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e fo
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son.
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..8S
choo
l too
far
away
......
......
......
..9
Teac
her
is n
ot g
ood
......
......
.....1
0La
ck o
f tea
cher
s....
......
......
......
11N
o b
enefi
t to
sch
ool..
......
......
..12
Mar
riag
e....
......
......
......
....1
3O
ther
s (s
pec
ify).
......
......
..14
SERIAL NUMBER
CO
PY
TH
E M
EM
BE
R ID
AN
D N
AM
E O
F E
AC
H C
HIL
D A
GE
5 T
O U
ND
ER
18
FR
OM
HH
DE
MO
GR
AP
HY,
PA
GE
2,
ON
TO T
HIS
PA
GE
, BE
FO
RE
STA
RT
ING
TH
E IN
TE
RV
IEW
Let
us
star
t th
is s
ecti
on
by
talk
ing
ab
ou
t th
e ed
uca
tio
n o
f th
e ch
ildre
n in
th
is h
ou
seh
old
. W
e w
ill t
alk
abo
ut
sch
oo
l en
rollm
ent,
and
att
end
ance
PLHA
HOU
SEHO
LDRE
SPON
DENT
S: M
othe
r or
Prim
ary
Care
Giv
er o
f chi
ldre
n ne
w-b
orn
to 1
4 ye
ars
of a
ge, o
r ch
ild, 1
5-18
yea
rsRE
SPON
DENT
-rel
atio
nshi
p to
PL
HA (C
ODE
A-2)
: ...
....
..
EDUC
ATIO
N ST
ATUS
OF
THE
CHIL
DREN
IN P
LHA
HOU
SEHO
LD
FOR
ALL
CHIL
DREN
AGE
D 5-
18 Y
EARS
OLD
69
CO
PY
ID C
OD
E A
ND
SE
X O
F P
LHA
FR
OM
HO
US
EH
OLD
D
EM
OG
RA
PH
Y P
AG
E
2223
2425
2627
2829
3031
3233
3435
3637
Wor
king
(as
p
aid
em
plo
yee,
em
plo
yer,
self-
emp
loye
d,
farm
ing
incl
ud-
ing
fi sh
ing
and
fo
rest
ry, a
ny
inco
me
earn
ing
jo
b)?
If w
orki
ng n
ow,
how
long
hav
e yo
u b
een
un-
emp
loye
d a
fter
bei
ng id
entifi
ed
as
PLH
A?
Why
did
you
b
ecom
e un
em-
plo
yed
at t
hat
time?
un-e
mp
loye
d
dur
atio
nW
hat i
s th
e m
ain
reas
on fo
r yo
u to
b
e un
emp
loye
d
now
?
Dis
able
d o
r lo
ng-t
erm
ill?
FAM
ILY
ME
MB
ER
IDS
EX
Mon
ths
MO
NTH
SC
ode
GM
ON
THS
Cod
e G
MO
NTH
S
coping with community
If YES By Whom
If YES By Whom
income generation
If YES By Whom
self health care
If YES By Whom
food & nutrition
If YES By Whom
personal hygiene
c o d e G1
c o d e G1
c o d e G1
c o d e G1
c o d e G1
SERIAL NUMBER
Hav
e yo
u b
een
trai
ned
in
CO
DE
G: R
EA
SO
N F
OR
UN
EM
PL
OY
ME
NT
ILL
AN
D S
ICK
....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
1LA
CK
OF
SK
ILL
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.2E
MP
LOY
ER
DID
NO
T W
AN
T TO
EM
PLO
Y (
Dis
crim
inat
ion)
....
......
......
......
......
34.
Did
not
wan
t to
wor
k ...
......
......
......
......
......
......
......
......
......
......
......
......
......
...4
5. O
ther
---
- (s
pec
ify)
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
5
CO
DE
G1
KH
AN
A .
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
..1H
BC
TE
AM
....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
....2
HE
ALT
H S
TAFF
....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
...3
CO
MM
UN
ITY
O
RG
AN
IZAT
ION
...
......
......
......
......
......
......
......
......
......
......
......
...4
FRIE
ND
S ..
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.....5
FAM
ILY
ME
MB
ER
....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
6
Wh
ich
of
the
follo
win
g a
ctiv
itie
s ar
e yo
u e
ng
aged
cu
rren
tly, a
nd
for
how
lon
g?
PLHA
HOU
SEHO
LDRE
SPON
DENT
: PLH
A - F
OOD
SUPP
ORT
BENE
FICI
ARY
ONLYPL
HA L
IVEL
IHOO
D ST
ATUS
70
CO
DE
H: R
EA
SO
N F
OR
NO
T G
ET
TIN
G O
R M
ISS
ING
AR
V O
R N
OT
G
ET
TIN
G T
RE
AT
ME
NT
FO
R IN
FE
CT
ION
S
WO
RK
, FA
RM
WO
RK
....
......
......
......
......
......
1 D
OM
ES
TIC
LA
BO
R .
......
......
......
......
......
......
..2N
O B
OD
Y T
O H
ELP
TP
GO
TO
HS
....
......
...3
ILLN
ES
S .
......
......
......
......
......
......
......
......
......
..4H
EA
LTH
CE
NTE
R T
OO
FA
R A
WAY
....
......
....5
LAC
K O
F M
ED
ICIN
E I
N H
S .
......
......
......
......
.6
CO
DE
I O
PP
OR
TU
NIS
TIC
INF
EC
TIO
NS
SK
IN I
NFE
CTI
ON
S .
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.1R
ES
PIR
ATO
RY
TR
AC
T IN
FEC
TIO
N I
NC
LUD
ING
TB
....
......
......
......
......
......
...2
DIA
RR
HO
EA
/dys
entr
y ...
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.3FE
VE
R .
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
...4
OTH
ER
S (
SP
EC
IFY
) ...
......
......
......
......
......
......
......
......
......
......
......
......
......
......
...5
CO
PY
ID C
OD
E A
ND
SE
X O
F P
LHA
FR
OM
HO
US
EH
OLD
D
EM
OG
RA
PH
Y P
AG
E
3839
4041
4243
4445
4647
Are
you
get
ting
A
RV
trea
tmen
t?
If so
, for
how
lo
ng?
Ff N
O, w
hat
is th
e m
ajor
re
ason
?
If yo
u ar
e cu
rren
tly ta
king
A
RV
trea
tmen
t, d
o yo
u ta
ke
treat
men
t re
gul
arly
?
If N
O, h
ow m
any
times
hav
e yo
u m
isse
d
the
treat
men
t
AN
D W
hat a
re
the
mai
n re
ason
s fo
r m
issi
ng th
e tre
atm
ent?
Do
you
had
on
e or
mor
e of
th
e fo
llow
ing
in
fect
ions
dur
ing
th
e p
ast t
wo
wee
ks?
If Y
ES
, how
lo
ng d
oes
each
in
fect
ion
last
?
How
man
y re
pea
ted
in
fect
ions
hav
e yo
u ha
d in
the
last
two
wee
ks?
Wer
e th
ey
atte
nded
to
by
heal
th
per
sonn
el-
Yes/
No
If N
O, w
hat w
as
the
mai
n re
ason
?
FAM
ILY
ME
MB
ER
IDS
EX
Mon
ths
CO
DE
HFR
QC
OD
E I
DAY
SFR
QC
OD
E H
HE
ALT
H P
ER
SO
NN
EL
AR
E N
OT
GO
OD
....
....7
N
O H
EA
LTH
PE
RS
ON
NE
L ...
......
......
......
......
...8
BE
LIE
VE
NO
BE
NE
FIT
FRO
M M
OR
E A
RV
....
.9
DO
NO
T K
NO
W A
RV
IS
AVA
ILA
BLE
....
......
10O
THE
RS
(S
PE
CIF
Y)
......
......
......
......
......
......
..11
SERIAL NUMBER
PLHA
HOU
SEHO
LDRE
SPON
DENT
: PLH
A - F
OOD
SUPP
ORT
BENE
FICI
ARY
ONLY
PLHA
HEA
LTH
STAT
US
71
1.
Did
you
or
any
hous
ehol
d m
emb
ers
bor
row
any
fund
s or
ob
tain
any
goo
ds
or s
ervi
ces
on c
red
it in
the
last
12
mon
ths?
2.
Why
did
you
NO
T b
orro
w fu
nds
or o
bta
in g
ood
s or
ser
vice
s on
cre
dit?
YE
S…
1 (>
>Q
3)N
O..2
CO
DE
J
I wo
uld
now
like
to a
sk y
ou
ab
ou
t th
e lo
ans
or
cred
its ta
ken
by
you
r h
ou
seh
old
in th
e la
st y
ear.
Ple
ase
con
sid
er a
ll lo
ans
or
cred
its ta
ken
by
all h
ou
seh
old
mem
bers
.
48.
49.
50.
51.
52.
LOA
N T
YP
ED
id a
nyon
e in
you
r ho
use-
hold
take
a [
LOA
N T
YP
E]
in th
e la
st 1
2 m
onth
s?
How
man
y tim
es in
the
pas
t 12
mon
ths
did
a
mem
ber
of y
our
HH
take
a
[LO
AN
TY
PE
]
Ple
ase
thin
k ab
out t
he m
ost r
ecen
t tim
e th
is [
LOA
N T
YP
E]
was
take
n.
Wha
t was
the
tota
l am
ount
or
valu
e of
the
[LO
AN
TY
PE
]?
Wha
t was
the
mai
n p
urp
ose
of th
is m
ost
rece
nt [
LOA
N T
YP
E]?
Has
this
mos
t rec
ent
[LO
AN
TY
PE
] b
een
pai
d b
ack
in fu
ll?
NU
MB
ER
AM
OU
NT
IN R
IEL
CO
DE
K
1C
ash
loan
from
rela
tive,
frie
nd o
r ne
ighb
or
2C
ash
loan
from
mon
ey le
nder
3Lo
an fr
om c
ow b
ank
4C
red
it fo
r g
ood
s or
ser
vice
s fro
m s
tore
keep
er/s
ervi
ce p
rovi
der
5C
ash
loan
from
gov
ernm
ent b
ank
6C
ash
loan
from
priv
ate
ban
k
7C
ash
loan
from
com
mun
ity fu
nd o
r N
GO
8[A
DD
AN
Y O
THE
R L
IKE
LY T
YP
ES
OF
LOA
NS
HE
RE
]
9[A
DD
AN
Y O
THE
R L
IKE
LY T
YP
ES
OF
LOA
NS
HE
RE
]
10O
ther
(sp
ecify
:___
____
____
____
____
____
___)
L O A N C O D E
CO
DE
J: R
EA
SO
N F
OR
NO
T T
AK
ING
LO
AN
/CR
ED
IT?
DID
N’T
NE
ED
TO
....
......
......
......
......
......
......
......
......
......
......
......
......
.....1
N
O P
LAC
E T
O G
O F
OR
LO
AN
/CR
ED
IT .
......
......
......
......
......
......
......
2 TU
RN
ED
D
OW
N/D
EN
IED
FO
R
LOA
N/C
RE
DIT
...
......
......
......
......
.....3
O
THE
R
(SP
EC
IFY
) ...
......
......
......
......
......
......
......
......
......
......
......
......
...4
CO
DE
K: P
UR
PO
SE
OF
LO
AN
/CR
ED
IT a
nd
SE
LL
ING
AS
SE
TS
ILLN
ES
S .
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.....1
S
CH
OO
LIN
G .
......
......
......
......
......
......
......
......
......
......
......
......
......
......
....2
CA
PIT
AL
FOR
B
US
INE
SS
-AG
RIC
ULT
UR
E
......
......
......
......
......
......
....3
LAC
K O
F FU
ND
S/D
AIL
Y E
XP
EN
SE
S .
......
......
......
......
......
......
......
......
4
MA
RR
IAG
E A
ND
CE
RE
MO
NIE
S .
......
......
......
......
......
......
......
......
......
.5
FUN
ER
AL
EX
PE
NS
ES
...
......
......
......
......
......
......
......
......
......
......
......
....6
P
ETT
Y T
RA
DE
/ser
vice
....
......
......
......
......
......
......
......
......
......
......
......
...7
BU
Y F
OO
D B
EFO
RE
HA
RV
ES
T--
......
......
......
......
......
......
......
......
......
.8O
THE
R (
SP
EC
IFY
) ...
......
......
......
......
......
......
......
......
......
......
......
......
....9
I wo
uld
now
like
to
ask
yo
u a
bo
ut
any
bo
rro
win
g o
r an
y lo
ans
take
n b
y h
ou
seh
old
mem
ber
s in
th
e p
ast
12 m
on
ths.
PLHA
HOU
SEHO
LDRE
SPON
DENT
: HOU
SEHO
LD H
EAD
OR S
POUS
E OR
PLH
A (R
ELAT
IONS
HIP
TO H
OUSE
HOLD
HEA
D - C
ODE
A.]..
....
....
....
..
HOUS
EHOL
D BO
RROW
ING
AND
CRED
IT
72
AS
SE
T 53
.54
.55
.56
.
Doe
s th
e ho
useh
old
ow
n an
y [A
SS
ET]
?
How
man
y [A
SS
ET]
d
oes
your
ho
useh
old
ow
n?
Did
you
sel
l th
e as
set
[NA
ME
] d
urin
g th
e la
st y
ear
How
man
y d
id y
ou s
ell?
Wha
t is
the
mai
n re
ason
fo
r se
lling
th
at a
sset
?
QU
AN
TITY
cod
e k
A S S E T C O D E
AS
SE
T 53
. (C
ON
T.)
54. (
CO
NT.
)54
. (C
ON
T.)
55. (
CO
NT.
)56
. (C
ON
T.)
Doe
s th
e ho
useh
old
ow
n an
y [A
SS
ET]
?
How
man
y [A
SS
ET]
d
oes
your
ho
useh
old
ow
n?
Did
you
sel
l th
e as
set
[NA
ME
] d
urin
g th
e la
st y
ear?
How
man
y d
id y
ou s
ell?
Wha
t is
the
mai
n re
ason
fo
r se
lling
th
at a
sset
?
QU
AN
TITY
cod
e k
A S S E T C O D E
LA
ND
AN
D B
UIL
DIN
GS
1La
nd -
Hec
ter
2B
uild
ing
s --
Bus
ines
s- U
nit
3B
uild
ing
s --
Ag
ricul
ture
-Uni
t
TR
AN
SP
OR
T E
QU
IPM
EN
T
4Ve
hicl
e (C
ar, V
an, e
tc.)
5M
otor
cycl
e
6B
icyc
le
7Tu
k-tu
k
HO
US
EH
OL
D D
UR
AB
LE
S
8R
efrig
erat
or/fr
eeze
r
9S
ewin
g m
achi
ne
10W
ashi
ng m
achi
ne
11Va
cuum
cle
aner
12E
lect
ric r
ice
cook
er
13S
team
ric
e co
oker
14Fo
od p
roce
ssor
AG
RIC
ULT
UR
E/B
US
INE
SS
15Tw
o-w
heel
ed tr
acto
r
16Fo
ur-w
heel
ed tr
acto
r
17A
gric
ultu
ral e
qui
pm
ent-
pie
ce
18To
ols
smal
l and
larg
e-p
iece
19B
oat
20Fi
shin
g n
et
21C
art
22ag
ri an
imal
TV,
RA
DIO
, PH
ON
ES
22Te
levi
sion
23R
adio
/VC
D, e
tc.
24Te
lep
hone
25M
obile
pho
ne
OT
HE
R G
OO
DS
26S
atel
lite
dis
h
27C
omp
uter
28A
ir co
nditi
oner
29Je
wel
ry
30M
osq
uito
net
31O
ther
(sp
ecify
____
)
32O
ther
(sp
ecify
____
)
33O
ther
(sp
ecify
____
)
34O
ther
(sp
ecify
____
)
CO
DE
K: P
UR
PO
SE
OF
LO
AN
/CR
ED
IT a
nd
SE
LL
ING
AS
SE
TS
ILLN
ES
S .
......
......
......
......
......
......
......
......
......
......
......
......
1S
CH
OO
LIN
G .
......
......
......
......
......
......
......
......
......
......
.....2
CA
PIT
AL
FOR
BU
SIN
ES
S-A
GR
ICU
LTU
RE
....
......
......
..3LA
CK
O
F FU
ND
S/D
AIL
Y
EX
PE
NS
ES
...
......
......
......
...4
MA
RR
IAG
E
AN
D
CE
RE
MO
NIE
S
......
......
......
..5
FUN
ER
AL
EX
PE
NS
ES
...
......
......
......
......
......
.....6
P
ETT
Y
TRA
DE
/ser
vice
...
......
......
......
......
......
....7
BU
Y
FOO
D
BE
FOR
E
HA
RV
ES
T--
......
......
......
8O
THE
R
(SP
EC
IFY
) ...
......
......
......
......
......
......
...9
GO
TO
NE
XT
CO
LU
MN
>>
You
r h
ou
seh
old
may
ow
n s
om
e as
sets
like
lan
d, v
ehic
les
or
ho
use
ho
ld g
oo
ds.
I w
ou
ld li
ke t
o a
sk y
ou
ab
ou
t th
ose
ass
ets
now
.
PLHA
HOU
SEHO
LDRE
SPON
DENT
: HOU
SEHO
LD H
EAD
OR S
POUS
E OR
PLH
A .(R
ELAT
IONS
HIP
TO H
OUSE
HOLD
HEA
D - C
ODE
A.]..
....
....
....
ASK
ABOU
T AL
L AS
SETS
THE
HOU
SEHO
LD O
WNS
AND
SOL
D DU
RING
PAS
T YE
AR
ASSE
TS S
OLD
73
57.
58.
LIN
E N
OIT
EM
“TO
TAL
CA
SH
EX
PE
ND
ITU
RE
(R
IEL
S)”
“IN
-KIN
D E
XP
EN
DIT
UR
E (
VAL
UE
IN C
AS
H -
RIE
LS
)”
1M
ain
cere
al
2S
econ
dar
y ce
real
3R
oots
/Tub
ers
4Ve
get
able
5Fi
sh o
r m
eat
6O
il
7O
ther
food
(fi s
h p
aste
, sal
t, su
gar
, leg
umes
)
8Fo
od &
drin
ks c
onsu
med
out
sid
e th
e ho
use
9Fu
el
10M
edic
al e
xpen
ses
11H
ousi
ng/re
nt
12A
lcoh
ol a
nd to
bac
co
13Tr
ansp
orta
tion
14Fi
nes
and
deb
ts
15E
qui
pm
ents
/tool
s/se
eds
16W
ater
/lig
ht/fu
el
17E
duc
atio
n/sc
hool
fees
18C
loth
ing
/sho
es
19C
eleb
ratio
n/so
cial
eve
nts
20M
icel
lane
ous/
othe
r
I wo
uld
now
like
to
ask
yo
u a
bo
ut
exp
end
itu
re b
y yo
ur
ho
use
ho
ld o
n t
he
follo
win
g e
xpen
ses.
Ple
ase
con
sid
er in
ave
rag
e p
er m
on
th, d
uri
ng
th
e p
ast
six
mo
nth
s.
PLHA
HOU
SEHO
LDRE
SPON
DENT
: HOU
SEHO
LD H
EAD
OR S
POUS
E OR
PLH
A (R
ELAT
IONS
HIP
TO H
OUSE
HOLD
HEA
D - C
ODE
A.]..
....
....
....
..
HOU
SEHO
LD E
XPEN
DITU
RE
74
No
w I w
ou
ld li
ke to
ask
yo
u a
bo
ut t
he
typ
es o
f fo
od
s th
at y
ou
or a
nyo
ne
in y
ou
r ho
use
ho
ld
ate
yest
erd
ay d
uri
ng
the
day
or
nig
ht.
If y
este
rday
was
no
t a ty
pic
al d
ay in
term
s o
f fo
od
co
nsu
mp
tio
n, p
leas
e th
ink
bac
k to
th
e m
ost
rec
ent
typ
ical
foo
d c
on
sum
pti
on
day
.
So
me
ho
use
ho
lds
hav
e p
erio
ds
wh
en o
bta
inin
g f
oo
d f
or
thei
r h
ou
seh
old
s is
har
der
an
d o
ther
per
iod
s w
hen
it
is e
asie
r. I
wo
uld
lik
e to
ask
yo
u a
bo
ut
you
r h
ou
seh
old
’s
foo
d s
up
ply
du
rin
g d
iffe
ren
t m
on
ths
of
the
year
. Wh
en r
esp
on
din
g t
o t
hes
e q
ues
tio
ns,
p
leas
e th
ink
bac
k ov
er t
he
last
12
mo
nth
s.
For
Dat
a E
ntry
59.
Did
any
one
in y
our
hous
ehol
d e
at [
FOO
D IT
EM
] ye
ster
day
? Th
is c
ould
incl
ude
food
pre
par
ed a
t hom
e th
at w
as ta
ken
to a
wor
k si
te o
r sc
hool
. Ple
ase
do
not
incl
ude
pre
par
ed fo
od p
urch
ased
aw
ay fr
om h
ome
or in
-kin
d m
eals
.”
6061
For
Dat
a E
ntry
Nam
e of
Foo
d It
emD
urin
g la
st 1
2 m
onth
s, h
ow m
any
mon
ths
you
did
not
hav
e en
oug
h fo
od [
FOO
D IT
EM
NA
ME
] to
feed
you
r fa
mily
?
A1
Ric
e
A2
Mai
ze o
r ot
her
cere
als
C1
Oil
A1
Ric
e
A2
Pot
ato
A2
Mai
ze o
r ot
her
cere
al
A2
Cas
sava
A2
Oth
er ro
ots
and
tub
ers
A3
Whe
at n
ood
le, b
read
, bis
cuit
B2
Gro
und
nuts
, leg
umes
B2
Bea
ns (
all t
ypes
)
D1
Gre
en le
afy
veg
etab
les
D2
Oth
er v
eget
able
s
D3
Frui
t (no
t jui
ce)
B1
ferm
ente
d fi
sh p
aste
B1
Fish
(fre
sh o
r d
ry)
B2
Inse
cts/
othe
r fa
rm a
nim
als
B3
Eg
gs
B3
Pou
ltry
B3
Por
k
B3
Bee
f/Buf
falo
C1
Oil/
fat
B3
Milk
C3
Milk
pro
duc
ts
C3
Oth
ers
(sug
ar, e
tc)
PLHA
HOU
SEHO
LDRE
SPON
DENT
: HOU
SEHO
LD M
EMBE
R M
OST
KNOW
LEDG
EABL
E AB
OUT
HOUS
EHOL
D FO
OD C
ONSU
MPT
ION
RESP
ONDE
NT: R
ELAT
IONS
HIP
TO H
OUSE
HOLD
HEA
D [C
ODE
A] ..
....
....
....
....
....
....
FOOD
DIV
ERSI
TY &
FOO
D SH
ORTA
GE
75
No
w I
wo
uld
like
to
ask
yo
u a
bo
ut
som
e o
f th
e fo
od
s th
at w
ere
eate
n b
y th
e o
ur
ben
efi c
iary
PL
HA
in t
his
ho
use
ho
ld y
este
rday
. If
he/
she
did
no
t co
nsu
me
a ty
pic
al d
iet
yest
erd
ay, p
leas
e th
ink
bac
k to
th
e m
ost
rec
ent
typ
ical
day
. Fo
r ea
ch o
f th
e fo
od
gro
up
s th
at I
men
tio
n, p
leas
e te
ll m
e w
het
her
th
e P
LH
A a
te a
t le
ast
on
e se
rvin
g, o
r so
me
of
that
foo
d. T
his
co
uld
incl
ud
e fo
od
pre
par
ed a
nd
eat
en a
t h
om
e, o
r el
sew
her
e su
ch a
s at
sch
oo
l, w
ith
rel
ativ
es, o
r in
a m
arke
t.
Yest
erd
ay, d
id [
NA
ME
] ea
t an
y [F
OO
D IT
EM
], ei
ther
at
ho
me
or
else
wh
ere?
CO
PY
ID C
OD
E A
ND
SE
X O
F
PL
HA
FR
OM
HO
US
EH
OL
D
DE
MO
GR
AP
HY
PA
GE
62.
62.
62.
62.
62.
62.
62.
62.
62.
62.
62.
62.
62.
62.
62.
62.
62.
62.
62.
62.
62.
62.
…ric
eP
otat
o…
mai
ze
or o
ther
ce
real
s
Cas
sava
Oth
er
root
s an
d
tub
ers
Whe
at
nood
le,
bre
ad,
bis
cuit)
Gro
und
-nu
ts,
leg
ume
bea
ns
(all
typ
es)
Gre
en
leaf
y ve
ge-
tab
les
Oth
er
veg
-et
able
s
Frui
t (n
ot
juic
e)
fi sh
pas
teFi
sh
(fre
sh
or
dry
)
In-
sect
s/ot
her
farm
an
i-m
als
Eg
gs
Pou
l-tr
yP
ork
Bee
f/B
uf-
falo
Oil/ fat
Milk
Milk
p
rod
-uc
ts
Oth
ers
(sug
-ar
, et
c)
FAM
ILY
ME
MB
ER
IDS
EX
ON
LY F
OR
DAT
A E
NTR
Y [
CO
DE
]A
1A
2A
2A
2A
2A
3B
2B
2D
1D
2D
3B
1B
1B
2B
3B
3B
3B
3C
1B
3C
3C
3
SERIAL NUMBER
PLHA
HOU
SEHO
LDRE
SPON
DENT
: PLH
A TH
EMSE
LVES
DIET
ARY
DIVE
RSIT
Y OF
PLH
A
76
MEA
LS C
ONSU
MED
BY
PLHA
AND
THE
IR H
OUSE
HOLD
No
w I
wo
uld
like
to
ask
yo
u a
bo
ut
the
nu
mb
er o
f m
eals
co
nsu
med
by
the
AN
Y M
EM
BE
R O
F T
HIS
HO
US
EH
OL
D A
ND
PL
HA
HIM
/HE
R S
EL
F, y
este
rday
. If
yes
terd
ay w
as n
ot
a ty
pic
al d
ay in
ter
ms
of
foo
d c
on
sum
pti
on
, ple
ase
thin
k b
ack
to t
he
mo
st r
ecen
t ty
pic
al fo
od
co
nsu
mp
tio
n d
ay.
63
. Y
est
erd
ay,
did
YO
U [
PL
HA
] e
at
me
al
CO
PY
ID C
OD
E A
ND
SE
X O
F P
LH
A F
RO
M
HO
US
EH
OL
D D
EM
OG
RA
PH
Y P
AG
E63
.163
.263
.363
.463
.563
.663
.7
FAM
ILY
ME
MB
ER
IDS
EX
Any
food
bef
ore
a m
orni
ng m
eal
Mor
ning
mea
lA
ny fo
od b
etw
een
mor
ning
mea
l and
m
id d
ay m
eal
Mid
day
mea
lA
ny fo
od b
etw
een
mid
day
and
eve
ning
m
eal
Eve
ning
mea
lA
ny fo
od a
fter
the
even
ing
mea
l
64. Y
este
rday
, did
any
of
you
r h
ou
seh
old
mem
ber
eat
64.1
64.2
64.3
64.4
64.5
64.6
64.7
Any
food
bef
ore
a m
orni
ng m
eal
Mor
ning
mea
lA
ny fo
od b
etw
een
mor
ning
mea
l and
m
id d
ay m
eal
Mid
day
mea
lA
ny fo
od b
etw
een
mid
day
and
eve
ning
m
eal
Eve
ning
mea
lA
ny fo
od a
fter
the
even
ing
mea
l
SERIAL NUMBER
PLHA
HOU
SEHO
LDRE
SPON
DENT
: PLH
A
77
PLHA
HOU
SEHO
LDTo
Mea
sure
ben
efi c
iary
PLH
A
65.
66.
6768
CO
PY
ID C
OD
E A
ND
SE
X O
F P
LHA
FR
OM
HO
US
EH
OLD
DE
MO
GR
AP
HY
PA
GE
b
irthd
ate
age
in c
omp
lete
d y
ears
an
d m
onth
s If
birt
h d
ate
is n
ot a
vaila
ble
ME
AS
UR
E A
ND
RE
CO
RD
WE
IGH
TM
EA
SU
RE
AN
D R
EC
OR
D H
EIG
HT
FAM
ILY
ME
MB
ER
IDS
exD
DM
MY
YY
EA
RS
MO
NTH
S
KIL
OG
RA
MS
CE
NTI
ME
TER
S
ANTH
ROPO
MET
RIC
MEA
SURE
MEN
T
78
KHAN
A/W
FP -
FOOD
SUP
PORT
TO
HOM
E BA
SE C
ARE
OF P
LHA
AND
OVC,
CAM
BODI
A-BA
SE L
INE
AND
EVAL
UATI
ON S
URVE
Y - 2
006
Dat
e o
f in
terv
iew
PL
HA
HO
US
EH
OL
D
HO
US
EH
LD
INT
ER
VIE
W ID
EN
TIF
ICA
TIO
N S
HE
ET
1. P
rovi
nce
2. H
ealth
Cen
ter
3. H
ouse
hold
Typ
e
3. H
ouse
hold
ID N
umb
er
Ref
. Cod
e 1.
1
Ref
. Cod
e 1.
2
One
dig
it P
LHA
......
.1
O
VC
.....2
4 d
igit
s R
ef c
od
e 1.
3
dd
mm
yy
1. N
ame
of E
num
erat
or2.
Enu
mer
ator
ID
3. D
ate/
time
of F
irst I
nter
view
4. D
ate/
time
of S
econ
d In
terv
iew
5. N
ame
of T
eam
Lea
der
6. N
ame
of S
uper
viso
r
9. N
ame
of D
ata
Ent
ry O
per
ator
DD
MM
YY
Sta
rt T
ime
Fini
sh T
ime
Che
cked
& s
igne
d
Che
cked
& s
igne
d
Che
cked
& s
igne
d
79
1.2.
3.4.
5.6.
7.8.
910
11
Fam
ily M
emb
er ID
Nam
eW
hat i
s
[NA
ME
]’s
rela
tions
hip
to th
e he
ad
of th
e ho
use-
hold
?
Wha
t is
[NA
ME
]’s
sex?
Wha
t is
[NA
ME
]’s
age
in c
omp
lete
d
year
s an
d
mon
ths?
For a
ge y
oung
er
than
18
year
s,
Is th
is c
hild
[NA
ME
]
iden
tifi e
d a
s
OV
C?
If Y
ES
, was
this
chi
ld
fost
ered
by
this
hous
hold
?
If Y
ES
, was
this
child
fost
ered
by
this
hous
ehol
d ?
Wha
t is
the
emp
lom
ent
stat
us o
f the
fam
ily
mem
ber
[NA
ME
]?
Wha
t is
the
hig
hest
leve
l
of y
ears
of
educ
atio
n
of th
e p
erso
n
[NA
ME
]’?
Wha
t is
the
emp
loym
ent
stat
us o
f
the
per
son
[NA
ME
]?
Cod
e 1.
4 -
6 d
igits
CO
DE
AC
OD
E D
YEA
RS
MO
NTH
S
CO
DE
CC
OD
E E
AS
K W
HO
IS T
HE
HE
AD
OF
TH
E H
OU
SE
HO
LD
AM
ON
G T
HO
SE
CU
RR
EN
TLY
RE
SID
ING
IN T
HE
HO
US
EH
OL
D.
AS
SIG
N
HO
US
EH
OL
D H
EA
D, M
EM
BE
R ID
1 A
ND
EN
TE
R T
HE
NA
ME
IN T
HE
FIR
ST
RO
W.
AS
K T
HE
RE
SP
ON
DE
NT
TO
LIS
T A
LL
OT
HE
R
ME
MB
ER
S O
F T
HE
HO
US
EH
OL
D. A
SS
IGN
A M
EM
BE
R ID
AN
D E
NT
ER
TH
E N
AM
E F
OR
AL
L O
TH
ER
HO
US
EH
OL
D M
EM
BE
RS
.
PLHA
HOU
SEHO
LDRE
SPON
DENT
: HO
USEH
OLD
HEAD
OR
SPOU
SE O
R OT
HER
, RE
SPON
DING
FOR
ALL
CUR
RENT
HO
USEH
OLD
MEM
BERS
RESP
ONDE
NT-r
elat
ions
hip
to
hous
ehol
d he
ad
(COD
E A)
: ...
....
....
....
....
..
FOR
ALL
HOUS
EHOL
D M
EMBE
RS
80
12.
1314
1516
1718
1920
2122
23
F
AM
ILY
ME
MB
ER
ID
NA
ME
“Sex
Has
[N
AM
E]
ever
at
tend
ed
scho
ol?
At w
hat
age
did
[N
AM
E]
star
t KG
?
Wha
t is
the
mai
n re
ason
[N
AM
E]
has
not
ever
at
tend
ed
scho
ol?
Is [
NA
ME
] cu
rren
tly
enro
lled
in
scho
ol?
If N
o, h
ow
man
y Y
EA
RS
has
[N
AM
E]
com
plet
ed?
Wha
t is
the
mai
n re
ason
[N
AM
E]
is n
ot
curr
ently
en
rolle
d
in s
choo
l th
is
term
?
If Q
15 is
Y
ES
, how
m
any
year
s ha
s [N
AM
E]
mis
sed
d
urin
g fr
om
the
star
t of
scho
olin
g
to th
e cu
rent
term
?
If [N
AM
E]
has
mis
sed
so
me
year
s w
hat i
s th
e m
ain
reas
on
for
mis
sing
sc
hool
?
Will
[N
AM
E]
enro
ll in
sc
hool
ne
xt
term
?
Wha
t is
the
mai
n re
ason
[N
AM
E]
will
not
en
roll
in
scho
ol
next
te
rm?
Wha
t cl
ass
leve
l is
[NA
ME
] cu
rren
tly
enro
lled
in
or
was
[N
AM
E]
mos
t re
cent
ly
enro
lled
in
?
How
m
any
clas
ses
has
[NA
ME
] ev
er
rep
eate
d?
CO
DE
1.4
[6
DIG
ITS
]
AG
EC
OD
E F
B
ELO
WC
OD
E F
B
ELO
WYe
ars
CO
DE
F
BE
LOW
CO
DE
F
BE
LOW
CO
DE
CN
UM
BE
R
CO
DE
F:R
EA
SO
N F
OR
NO
N-E
NR
OL
LM
EN
T O
R N
ON
-AT
TE
ND
AN
CE
Illne
ss ..
......
......
......
...1
Wor
k fo
r fo
od...
......
....2
C
are
for
sib
ling
s....
....3
Can
not a
fford
cos
ts...
......
.4H
ung
er...
......
......
......
......
...5
Wor
k to
ear
n m
oney
......
....6
Car
e fo
r ill
per
son.
......
......
......
....7
Unp
aid
HH
or
farm
wor
k ...
......
..8S
choo
l too
far
away
......
......
......
..9
Teac
her
is n
ot g
ood
......
......
.....1
0La
ck o
f tea
cher
s....
......
......
......
11N
o b
enefi
t to
sch
ool..
......
......
..12
Mar
riag
e....
......
......
......
....1
3O
ther
s (s
pec
ify).
......
......
..14
SERIAL NUMBER
CO
PY
TH
E M
EM
BE
R ID
AN
D N
AM
E F
OR
EA
CH
CH
ILD
AG
E 5
TO
UN
DE
R 1
8 F
RO
M D
EM
OG
RA
PH
Y, P
AG
E 2
, O
NTO
TH
IS P
AG
E, B
EF
OR
E S
TAR
TIN
G T
HE
INT
ER
VIE
W
Let
us
star
t th
is s
ecti
on
by
talk
ing
ab
ou
t th
e ed
uca
tio
n o
f ta
ll th
e ch
ildre
n in
th
is h
ou
seh
old
. W
e w
ill t
alk
abo
ut
sch
oo
l en
rollm
ent,
and
att
end
ance
PLHA
HOU
SEHO
LDRE
SPON
DENT
: Mot
her o
r Prim
ary
Care
Giv
er o
f chi
ldre
n ne
w-b
orn
to 1
4 ye
ars
of a
ge, c
hild
; 15-
18
year
sRE
SPON
DENT
-rel
atio
nshi
p to
OVC
(C
ODE
A-1)
: ...
....
....
....
....
..
EDUC
ATIO
N ST
ATUS
OF
OVC
AND
OTH
ER C
HILD
REN
IN O
VC
HOUS
EHOL
D FO
R AL
L CH
ILDR
EN A
GE 5
TO
18 Y
EARS
81
AC
TIV
ITIE
S
FAM
ILY
ME
MB
ER
ID
[CO
PY
FR
OM
HO
US
EH
OLD
D
EM
OG
RA
PH
Y-PA
GE
.
2425
2627
2829
3031
3233
3435
3637
3839
4041
atte
nd
scho
old
o ho
mew
ork
or s
tud
ying
othe
r vo
catio
nal
trai
ning
, ot
her
HB
C
pro
gra
mm
e,
Hap
py
Hap
py
pro
gra
mm
e
wor
k on
you
r ho
useh
old
’s
farm
or
othe
r b
usin
esse
s
pre
par
e fo
od fo
r th
e ho
useh
old
’s
cons
ump
tion
(incl
udin
g
cook
ing
an
d w
ashi
ng
dis
hes)
care
for
othe
r si
blin
gs
gat
her
fi rew
ood
or
buy
fu
el fo
r co
okin
g
OR
fetc
h w
ater
do
othe
r ho
useh
old
ch
ores
su
ch a
s sh
opp
ing
, w
ashi
ng
clot
hes,
m
aint
aini
ng
com
pou
nd
or y
ard
SE
XH
OU
RS
/D
AYH
OU
RS
/D
AYH
OU
RS
/DAY
Y-1,
N-2
Y-1,
N-2
Y-1,
N-2
Y-1,
N-2
Y-1,
N-2
CO
DE
G1
CO
DE
G1
CO
DE
G1
CO
DE
G1
CO
DE
G1
income generation Y/N
coping with community
If YES By Whom
self health care Y/N
If YES By Whom
food & nutrition Y/N
If YES By Whom
Hav
e yo
u b
een
trai
ned
in
CO
DE
G1
KH
AN
A ..
......
......
......
......
......
......
......
......
......
......
......
......
......
......
1H
BC
TE
AM
.....
......
......
......
......
......
......
......
......
......
......
......
......
... 2
HE
ALT
H S
TAFF
.....
......
......
......
......
......
......
......
......
......
......
......
... 3
CO
MM
UN
ITY
OR
GA
NIZ
ATIO
N ..
......
......
......
......
......
......
......
.....
4FR
IEN
DS
.....
......
......
......
......
......
......
......
......
......
......
......
......
......
5FA
MIL
Y M
EM
BE
R ..
......
......
......
......
......
......
......
......
......
......
......
.. 6
If YES By Whom
personal hygiene Y/N
If YES By Whom
WO
RK
OU
TSID
E T
HE
HO
ME
FAM
ILY
ME
MB
ER
ID42
4344
In th
e p
ast
7 d
ays,
did
[N
AM
E]
do
wor
k fo
r so
meo
ne w
ho
is n
ot a
mem
-b
er o
f you
r ho
useh
old
?
HO
UR
S/D
AY
In th
e la
st
7 d
ays,
on
aver
age,
how
m
any
hour
s p
er d
ay,
if an
y, d
id
[NA
ME
] w
ork
for
som
eone
ou
tsid
e of
you
r ho
useh
old
?
Wha
t was
[N
AM
E]’s
mai
n ac
tivity
in th
is w
ork?
FAR
MIN
G,
CA
RIN
G F
OR
AN
IMA
LS...
......
......
......
.1S
ALE
S/S
ER
VIC
ES
......
......
......
......
......
..2M
AN
UFA
CTU
RIN
G...
......
......
......
......
...3
UN
SK
ILLE
D L
AB
OR
.....
......
......
......
....4
HO
US
EW
OR
K/D
OM
ES
TIC
......
......
......
5C
HIL
D C
AR
E...
......
......
......
......
......
......
6P
RO
TEC
TIN
G P
RO
PE
RTY
......
......
......
7FE
CTH
ING
WO
OD
/WAT
ER
......
......
......
8O
THE
R (
SP
EC
IFY
)....
......
......
......
......
...9
Was
[N
AM
E]
pai
d in
cas
h,
in k
ind
or
not
at a
ll?
SE
X
Now
I’d
like
to a
sk a
bo
ut o
ther
act
iviti
es th
at [N
AM
E] m
ay h
ave
par
ticip
ated
in d
uri
ng
the
last
7 d
ays.
In t
he
last
7 d
ays,
on
ave
rag
e, w
as t
he
OV
C in
volv
ed in
th
e F
OL
LO
WIN
G [
AC
TIV
ITY
]?
PLHA
HOU
SEHO
LDRE
SPON
DENT
: PAR
ENT
OR
PRIM
ARY
CARE
GIVE
R FO
R OV
C 5-
14 Y
EARS
OLD
; SEL
F RE
SPON
SE
BY O
VC 1
5-18
YEA
RS O
LDRE
SPON
DENT
-rel
atio
nshi
p to
OVC
(C
ODE
A-1)
: ...
....
....
....
....
..
ACTI
VITI
ES -
LIVE
LIHO
OD O
F OV
C
ASK
ONLY
FOR
OVC
- BE
NEFI
CIAR
Y OF
FOO
D SU
PPOR
T
82
RE
SP
ON
DE
NT:
PA
RE
NT
OR
PR
IMA
RY
CA
RE
GIV
ER
FO
R O
VC
5-1
4 Y
EA
RS
OL
D; S
EL
F R
ES
PO
NS
E B
Y O
VC
15-
18 Y
EA
RS
OL
D
RE
SP
ON
DE
NT-
rela
tio
nsh
ip t
o O
VC
(C
OD
E A
-1):
.....
......
......
....
TRA
NS
FER
NA
ME
S A
ND
ID C
OD
ES
OF
OV
C F
RO
M H
OU
SE
HO
LD D
EM
OG
RA
PH
Y P
AG
E
4546
4748
49
Did
you
hav
e on
e or
mor
e of
the
follo
w-
ing
infe
ctio
ns
dur
ing
the
pas
t tw
o w
eeks
?
If Y
ES
, how
lo
ng d
id
each
infe
c-tio
n la
st?
AN
D h
ow
man
y re
-p
eate
d in
fec-
tions
dur
ing
th
e p
ast t
wo
wee
ks?
Wer
e th
ey
atte
nded
to
by
heal
th
per
sonn
el-
Yes/
No
If N
O, w
hat
is th
e m
ain
reas
on?
FAM
ILY
ME
MB
ER
IDN
AM
ES
EX
CO
DE
H D
AYS
FRQ
CO
DE
I
CO
DE
H O
PP
OR
TU
NIS
TIC
INF
EC
TIO
NS
SK
IN IN
FEC
TIO
NS
......
......
......
......
......
......
......
......
. 1
RE
SP
IRAT
OR
Y T
RA
CT
INFE
CTI
ON
IN
CLU
DIN
G T
B...
......
......
......
......
......
......
......
......
... 2
DIA
RR
HO
EA
/dys
entr
y....
......
......
......
......
......
......
... 3
FEV
ER
.....
......
......
......
......
......
......
......
......
......
......
.. 4
OTH
ER
S (
SP
EC
IFY
)....
......
......
......
......
......
......
......
. 5
CO
DE
H O
PP
OR
TU
NIS
TIC
INF
EC
TIO
NS
WO
RK
, FA
RM
WO
RK
......
......
......
......
......
......
......
... 1
DO
ME
STI
C L
AB
OR
......
......
......
......
......
......
......
.....
2
NO
BO
DY
TO
HE
LP T
P G
O T
O H
C...
......
......
......
.. 3
ILLN
ES
S ..
......
......
......
......
......
......
......
......
......
......
.. 4
HE
ALT
H C
EN
TER
TO
O F
AR
AW
AY ..
......
......
......
...5
LAC
K O
F M
ED
ICIN
E IN
HC
.....
......
......
......
......
..... 6
HE
ALT
H P
ER
SO
NN
EL
AR
E N
OT
GO
OD
......
......
... 7
NO
HE
ALT
H P
ER
SO
NN
EL.
......
......
......
......
......
......
8
BE
LIE
VE
NO
BE
NE
FIT
FRO
M M
OR
E A
RV.
......
......
9
DO
NO
T K
NO
W A
RV
IS A
VAIL
AB
LE...
......
......
......
10
OTH
ER
S (
SP
EC
IFY
)....
......
......
......
......
......
......
......
. 11
OVC
HOUS
EHOL
DRE
SPON
DENT
: PAR
ENT
OR
PRIM
ARY
CARE
GIVE
R FO
R OV
C 5-
14 Y
EARS
OLD
; SE
LF R
ESPO
NSE
BY O
VC
15-1
8 YE
ARS
OLD
RESP
ONDE
NT-
rela
tions
hip
to O
VC
(COD
E A-
1): .
....
....
..
OVC
HEAL
TH S
TATU
SAS
K ON
LY F
OR O
VC -
BENE
FICI
ARY
OF F
OOD
SUPP
ORT
83
5051
5253
54
LOA
N T
YP
ED
id a
nyon
e in
you
r ho
useh
old
take
a
[LO
AN
TY
PE
] in
the
last
12
mon
ths?
How
man
y tim
es in
th
e p
ast 1
2 m
onth
s d
id a
mem
ber
of
your
HH
take
a
[LO
AN
TY
PE
]
Ple
ase
thin
k ab
out t
he m
ost
rece
nt ti
me
this
[LO
AN
TY
PE
] w
as ta
ken.
Wha
t w
as th
e to
tal a
mou
nt o
r va
lue
of th
e [L
OA
N T
YP
E]?
Wha
t was
the
mai
n p
urp
ose
of
this
mos
t rec
ent
[LO
AN
TY
PE
]?
Has
this
mos
t re
cent
[LO
AN
TY
PE
] b
een
pai
d
bac
k in
full?
NU
MB
ER
AM
OU
NT
IN R
IEL
CO
DE
K
1C
ash
loan
from
rela
tive,
frie
nd o
r ne
ighb
or
2C
ash
loan
from
mon
ey le
nder
3Lo
an fr
om c
ow b
ank
4C
red
it fo
r g
ood
s or
ser
vice
s fro
m s
tore
keep
er/s
ervi
ce p
rovi
der
5C
ash
loan
from
gov
ernm
ent b
ank
6C
ash
loan
from
priv
ate
ban
k
7C
ash
loan
from
com
mun
ity fu
nd o
r N
GO
8[A
DD
AN
Y O
THE
R L
IKE
LY T
YP
ES
OF
LOA
NS
HE
RE
]
9[A
DD
AN
Y O
THE
R L
IKE
LY T
YP
ES
OF
LOA
NS
HE
RE
]
10O
ther
(sp
ecify
:___
____
____
____
____
____
___)
L O A N C O D E
CO
DE
J: R
EA
SO
N F
OR
NO
T T
AK
ING
LO
AN
/CR
ED
IT?
DID
N’T
NE
ED
TO
.....
......
......
......
......
......
......
......
......
....1
N
O P
LAC
E T
O G
O F
OR
LO
AN
/CR
ED
IT .
......
......
......
..2
TUR
NE
D D
OW
N/D
EN
IED
FO
R L
OA
N/C
RE
DIT
....
.....3
O
THE
R (
SP
EC
IFY
) ...
......
......
......
......
......
......
......
......
....4
CO
DE
K: P
UR
PO
SE
OF
LO
AN
/CR
ED
IT a
nd
SE
LL
ING
AS
SE
TS
ILLN
ES
S
......
......
......
......
......
......
......
......
......
......
......
....1
S
CH
OO
LIN
G .
......
......
......
......
......
......
......
......
......
......
..2C
AP
ITA
L FO
R B
US
INE
SS
-AG
RIC
ULT
UR
E .
......
......
...3
LAC
K O
F FU
ND
S/D
AIL
Y E
XP
EN
SE
S .
......
......
......
......
4
MA
RR
IAG
E A
ND
CE
RE
MO
NIE
S .
......
......
......
......
......
5 FU
NE
RA
L E
XP
EN
SE
S .
......
......
......
......
......
......
......
......
6 P
ETT
Y T
RA
DE
/ser
vice
....
......
......
......
......
......
......
......
...7
BU
Y F
OO
D B
EFO
RE
HA
RV
ES
T ...
......
......
......
......
......
.8O
THE
R (
SP
EC
IFY
) ...
......
......
......
......
......
......
......
......
...9
1.
Did
you
or
any
hous
ehol
d m
emb
ers
bor
row
any
fund
s or
ob
tain
any
goo
ds
or s
ervi
ces
on c
red
it in
the
last
12
mon
ths?
2.
Why
did
you
NO
T b
orro
w fu
nds
or o
bta
in g
ood
s or
ser
vice
s on
cre
dit?
YE
S…
1 (>
>Q
3)N
O..2
CO
DE
J
I wo
uld
now
like
to a
sk y
ou
ab
ou
t th
e lo
ans
or
cred
its ta
ken
by
you
r h
ou
seh
old
in th
e la
st y
ear.
Ple
ase
con
sid
er a
ll lo
ans
or
cred
its ta
ken
by
all h
ou
seh
old
mem
bers
.
I wo
uld
now
like
to
ask
yo
u a
bo
ut
any
bo
rro
win
g o
r an
y lo
ans
take
n b
y h
ou
seh
old
mem
ber
s in
th
e p
ast
12 m
on
ths.
OVC
HOUS
EHOL
DRE
SPON
DENT
: HOU
SEHO
LD H
EAD
OR S
POUS
E OR
OVC
(REL
ATIO
NSHI
P TO
HOU
SEHO
LD H
EAD
- COD
E A.
]....
....
....
....
..
HOUS
EHOL
D BO
RROW
ING
AND
CRED
IT
84
AS
SE
T 55
5657
58
Doe
s th
e ho
useh
old
ow
n an
y [A
SS
ET]
?
How
man
y [A
SS
ET]
d
oes
your
ho
useh
old
ow
n?
Did
you
sel
l th
e as
set
[NA
ME
] d
urin
g th
e la
st y
ear
How
man
y d
id y
ou s
ell?
Wha
t is
the
mai
n re
ason
fo
r se
lling
th
at a
sset
?
QU
AN
TITY
cod
e k
A S S E T C O D E
AS
SE
T 55
(C
ON
T.)
56 (
CO
NT.
)57
(C
ON
T.)
58 (
CO
NT.
)
Doe
s th
e ho
useh
old
ow
n an
y [A
SS
ET]
?
How
man
y [A
SS
ET]
d
oes
your
ho
useh
old
ow
n?
Did
you
sel
l th
e as
set
[NA
ME
] d
urin
g th
e la
st y
ear?
How
man
y d
id y
ou s
ell?
Wha
t is
the
mai
n re
ason
fo
r se
lling
th
at a
sset
?
QU
AN
TITY
cod
e k
A S S E T C O D E
LA
ND
AN
D B
UIL
DIN
GS
1La
nd -
Hec
ter
2B
uild
ing
s --
Bus
ines
s- U
nit
3B
uild
ing
s --
Ag
ricul
ture
-Uni
t
TR
AN
SP
OR
T E
QU
IPM
EN
T
4Ve
hicl
e (C
ar, V
an, e
tc.)
5M
otor
cycl
e
6B
icyc
le
7Tu
k-tu
k
HO
US
EH
OL
D D
UR
AB
LE
S
8R
efrig
erat
or/fr
eeze
r
9S
ewin
g m
achi
ne
10W
ashi
ng m
achi
ne
11Va
cuum
cle
aner
12E
lect
ric r
ice
cook
er
13S
team
ric
e co
oker
14Fo
od p
roce
ssor
AG
RIC
ULT
UR
E/B
US
INE
SS
15Tw
o-w
heel
ed tr
acto
r
16Fo
ur-w
heel
ed tr
acto
r
17A
gric
ultu
ral e
qui
pm
ent-
pie
ce
18To
ols
smal
l and
larg
e-p
iece
19B
oat
20Fi
shin
g n
et
21C
art T
V, R
AD
IO, P
HO
NE
S
22Te
levi
sion
23R
adio
/VC
D, e
tc.
24Te
lep
hone
25M
obile
pho
ne
OT
HE
R G
OO
DS
26S
atel
lite
dis
h
27C
omp
uter
28A
ir co
nditi
oner
29Je
wel
ry
30M
osq
uito
net
31O
ther
(sp
ecify
____
)
32O
ther
(sp
ecify
____
)
33O
ther
(sp
ecify
____
)
34O
ther
(sp
ecify
____
)
CO
DE
K: P
UR
PO
SE
OF
LO
AN
/CR
ED
IT a
nd
SE
LL
ING
AS
SE
TS
ILLN
ES
S .
......
......
......
......
......
......
......
......
......
......
......
......
1S
CH
OO
LIN
G .
......
......
......
......
......
......
......
......
......
......
.....2
CA
PIT
AL
FOR
BU
SIN
ES
S-A
GR
ICU
LTU
RE
....
......
......
..3LA
CK
O
F FU
ND
S/D
AIL
Y
EX
PE
NS
ES
...
......
......
......
...4
MA
RR
IAG
E
AN
D
CE
RE
MO
NIE
S
......
......
......
..5
FUN
ER
AL
EX
PE
NS
ES
...
......
......
......
......
......
.....6
P
ETT
Y
TRA
DE
/ser
vice
...
......
......
......
......
......
....7
BU
Y F
OO
D B
EFO
RE
HA
RV
ES
T....
......
......
......
....8
OTH
ER
(S
PE
CIF
Y)
......
......
......
......
......
......
......
...9
GO
TO
NE
XT
CO
LU
MN
>>
You
r h
ou
seh
old
may
ow
n s
om
e as
sets
like
lan
d, v
ehic
les
or
ho
use
ho
ld g
oo
ds.
I w
ou
ld li
ke t
o a
sk y
ou
ab
ou
t th
ose
ass
ets
now
.
OVC
HOUS
EHOL
DRE
SPON
DENT
: HOU
SEHO
LD H
EAD
OR S
POUS
E OR
OVC
.(RE
LATI
ONSH
IP T
O HO
USEH
OLD
HEAD
- CO
DE A
.]...
....
....
....
..AS
K AB
OUT
ALL
ASSE
TS T
HE H
OUSE
HOLD
OW
NS A
ND S
OLD
DURI
NG P
AST
YEAR
ASSE
TS S
OLD
85
5960
LIN
E N
OIT
EM
“TO
TAL
CA
SH
EX
PE
ND
ITU
RE
(R
IEL
S)”
“IN
-KIN
D E
XP
EN
DIT
UR
E (
VAL
UE
IN C
AS
H -
RIE
LS
)”
1M
ain
cere
al
2S
econ
dar
y ce
real
3R
oots
/Tub
ers
4Ve
get
able
5Fi
sh o
r m
eat
6O
il
7O
ther
food
(fi s
h p
aste
, sal
t, su
gar
, leg
umes
)
8Fo
od &
drin
ks c
onsu
med
out
sid
e th
e ho
use
9M
edic
al e
xpen
ses
10H
ousi
ng/re
nt
11A
lcoh
ol a
nd to
bac
co
12Tr
ansp
orta
tion
13Fi
nes
and
deb
ts
14E
qui
pm
ents
/tool
s/se
eds
15W
ater
/lig
ht/fu
el
16E
duc
atio
n/sc
hool
fees
17C
loth
ing
/sho
es
18C
eleb
ratio
n/so
cial
eve
nts
19M
icel
lane
ous/
othe
r
I wo
uld
now
like
to
ask
yo
u a
bo
ut
exp
end
itu
re b
y yo
ur
ho
use
ho
ld o
n t
he
follo
win
g e
xpen
ses.
Ple
ase
con
sid
er in
ave
rag
e p
er m
on
th, d
uri
ng
pas
t si
x m
on
ths.
OVC
HOUS
EHOL
DRE
SPON
DENT
: HOU
SEHO
LD H
EAD
OR S
POUS
E OR
OVC
.(RE
LATI
ONSH
IP T
O HO
USEH
OLD
HEAD
- CO
DE A
.]...
....
....
....
..
HOUS
EHOL
D EX
PEND
ITUR
E
86
No
w I
wo
uld
lik
e to
ask
yo
u a
bo
ut
the
typ
es o
f fo
od
s th
at y
ou
or
anyo
ne
in y
ou
r h
ou
seh
old
ate
yes
terd
ay d
uri
ng
th
e d
ay o
r n
igh
t. If
yes
terd
ay w
as n
ot
a ty
pic
al d
ay
in t
erm
s o
f fo
od
co
nsu
mp
tio
n,
ple
ase
thin
k b
ack
to t
he
mo
st r
ecen
t ty
pic
al f
oo
d
con
sum
pti
on
day
.
So
me
ho
use
ho
lds
hav
e p
erio
ds
wh
en o
bta
inin
g f
oo
d f
or
thei
r h
ou
seh
old
s is
har
der
an
d o
ther
per
iod
s w
hen
it
is e
asie
r. I
wo
uld
lik
e to
ask
yo
u a
bo
ut
you
r h
ou
seh
old
’s
foo
d s
up
ply
du
rin
g d
iffe
ren
t m
on
ths
of
the
year
. Wh
en r
esp
on
din
g t
o t
hes
e q
ues
tio
ns,
p
leas
e th
ink
bac
k ov
er t
he
last
12
mo
nth
s.
For
Dat
a E
ntry
61
Did
any
one
in y
our
hous
ehol
d e
at [
FOO
D IT
EM
] ye
ster
day
? Th
is c
ould
incl
ude
food
pre
par
ed a
t hom
e th
at w
as ta
ken
to a
wor
k si
te o
r sc
hool
. Ple
ase
do
not
incl
ude
pre
par
ed fo
od p
urch
ased
aw
ay fr
om h
ome
or in
-kin
d m
eals
.
For
Dat
a E
ntry
6263
Nam
e of
Foo
d It
emD
urin
g la
st 1
2 m
onth
s, h
ow m
any
mon
ths
did
you
not
hav
e en
oug
h fo
od [
FOO
D IT
EM
NA
ME
] to
feed
you
r fa
mily
?
A1
Ric
e
A2
Pot
ato
A2
Mai
ze o
r ot
her
cere
al
A2
Cas
sava
A2
Oth
er ro
ots
and
tub
ers
A3
Whe
at n
ood
le, b
read
, bis
cuit
B2
Gro
und
nuts
, leg
umes
B2
Bea
ns (
all t
ypes
)
D1
Gre
en le
afy
veg
etab
les
D2
Oth
er v
eget
able
s
D3
Frui
t (no
t jui
ce)
B1
ferm
ente
d fi
sh p
aste
B1
Fish
(fre
sh o
r d
ry)
B2
Inse
cts/
othe
r fa
rm a
nim
als
B3
Eg
gs
B3
Pou
ltry
B3
Por
k
B3
Bee
f/Buf
falo
C1
Oil/
fat
B3
Milk
C3
Milk
pro
duc
ts
C3
Oth
ers
(sug
ar, e
tc)
OVC
HOUS
EHOL
DRE
SPON
DENT
: HOU
SEHO
LD M
EMBE
R M
OST
KNOW
LEDG
EABL
E AB
OUT
HOUS
EHOL
D FO
OD C
ONSU
MPT
ION
RESP
ONDE
NT: R
ELAT
IONS
HIP
TO H
OUSE
HOLD
HEA
D [C
ODE
A] ..
....
....
....
....
....
....
FOOD
SEC
URIT
Y &
FOO
D SH
ORTA
GE
A1
Ric
e
A2
Mai
ze o
r ot
her
cere
als
C1
Oil
87
No
w I
wo
uld
like
to
ask
yo
u a
bo
ut
som
e o
f th
e fo
od
s th
at w
ere
eate
n b
y th
e b
enefi
cia
ry O
VC
of
this
ho
use
ho
ld y
este
rday
. If
he/
she
did
no
t co
nsu
me
a ty
pic
al d
iet
yest
erd
ay,
ple
ase
thin
k b
ack
to t
he
mo
st r
ecen
t ty
pic
al d
ay. F
or
each
of
the
foo
d g
rou
ps
that
I m
enti
on
, ple
ase
tell
me
wh
eth
er t
he
child
ate
at
leas
t o
ne
serv
ing
of
that
foo
d. T
his
co
uld
incl
ud
e fo
od
pre
par
ed a
nd
ea
ten
at
ho
me,
or
else
wh
ere
such
as
at s
cho
ol,
wit
h r
elat
ives
, or
in a
mar
ket.
Yest
erd
ay, d
id [
NA
ME
] ea
t an
y [F
OO
D IT
EM
], ei
ther
at
ho
me
or
else
wh
ere?
CO
PY
ID C
OD
E A
ND
SE
X O
F
PL
HA
FR
OM
HO
US
EH
OL
D
DE
MO
GR
AP
HY
PA
GE
6464
6464
6464
6464
6464
6464
6464
6464
6464
6464
6464
…ric
eP
otat
o…
mai
ze
or o
ther
ce
real
s
Cas
sava
Oth
er
root
s an
d
tub
ers
Whe
at
nood
le,
bre
ad,
bis
cuit)
Gro
und
-nu
ts,
leg
ume
bea
ns
(all
typ
es)
Gre
en
leaf
y ve
ge-
tab
les
Oth
er
veg
-et
able
s
Frui
t (n
ot
juic
e)
fi sh
pas
teFi
sh
(fre
sh
or
dry
)
In-
sect
s/ot
her
farm
an
i-m
als
Eg
gs
Pou
l-tr
yP
ork
Bee
f/B
uf-
falo
Oil/ fat
Milk
Milk
p
rod
-uc
ts
Oth
ers
(sug
-ar
, et
c)
FAM
ILY
ME
MB
ER
IDS
EX
ON
LY F
OR
DAT
A E
NTR
Y [
CO
DE
]A
1A
2A
2A
2A
2A
3B
2B
2D
1D
2D
3B
1B
1B
2B
3B
3B
3B
3C
1B
3C
3C
3
SERIAL NUMBEROVC
HOUS
EHOL
DRE
SPON
DENT
: PAR
ENT
OR P
RIM
ARY
CARE
GIVE
R FO
R OV
C 5-
14 Y
EARS
OLD
; SEL
F RE
SPON
SE B
Y OV
C 15
-18
YEAR
S OL
D
DIET
ARY
DIVE
RSIT
Y OF
OVC
88
MEA
LS C
ONSU
MED
BY
PLHA
AND
THE
IR H
OUSE
HOLD
No
w I
wo
uld
like
to
ask
yo
u a
bo
ut
the
nu
mb
er o
f m
eals
co
nsu
med
by
the
AN
Y M
EM
BE
R O
F T
HIS
HO
US
EH
OL
D A
ND
OV
C H
IM/H
ER
SE
LF,
du
rin
g y
este
ster
day
. If
yes
terd
ay
was
no
t a
typ
ical
day
in t
erm
s o
f fo
od
co
nsu
mp
tio
n, p
leas
e th
ink
bac
k to
th
e m
ost
rec
ent
typ
ical
foo
d c
on
sum
pti
on
day
.
65
. Y
est
erd
ay,
did
YO
U [
PL
HA
] e
at
me
al
CO
PY
ID C
OD
E A
ND
SE
X O
F O
VC
FR
OM
H
OU
SE
HO
LD
DE
MO
GR
AP
HY
PA
GE
65.1
65.2
65.3
65.4
65.5
65.6
65.7
FAM
ILY
ME
MB
ER
IDS
EX
Any
food
bef
ore
a m
orni
ng m
eal
Mor
ning
mea
lA
ny fo
od b
etw
een
mor
ning
mea
l and
m
id d
ay m
eal
Mid
day
mea
lA
ny fo
od b
etw
een
mid
day
and
eve
ning
m
eal
Eve
ning
mea
lA
ny fo
od a
fter
the
even
ing
mea
l
66 Y
este
rday
, did
any
of
you
r h
ou
seh
old
mem
ber
eat
66.1
66.2
66.3
66.4
66.5
66.6
66.7
Any
food
bef
ore
a m
orni
ng m
eal
Mor
ning
mea
lA
ny fo
od b
etw
een
mor
ning
mea
l and
m
id d
ay m
eal
Mid
day
mea
lA
ny fo
od b
etw
een
mid
day
and
eve
ning
m
eal
Eve
ning
mea
lA
ny fo
od a
fter
the
even
ing
mea
l
SERIAL NUMBER
OVC
HOUS
EHOL
DRE
SPON
DENT
: PAR
ENT
OR P
RIM
ARY
CARE
GIVE
R FO
R OV
C 5-
14 Y
EARS
OLD
; SEL
F RE
SPON
SE B
Y OV
C 15
-18
YEAR
S OL
D
89
6768
6970
CO
PY
ID C
OD
E A
ND
SE
X O
F O
VC
FR
OM
HO
US
EH
OLD
DE
MO
GR
AP
HY
PA
GE
b
irthd
ate
age
in c
omp
lete
d y
ears
an
d m
onth
s If
birt
h d
ate
is n
ot a
vaila
ble
ME
AS
UR
E A
ND
RE
CO
RD
WE
IGH
TM
EA
SU
RE
AN
D R
EC
OR
D H
EIG
HT
FAM
ILY
ME
MB
ER
IDS
exD
DM
MY
YY
EA
RS
MO
NTH
S
KIL
OG
RA
MS
CE
NTI
ME
TER
S
OVC
HOUS
EHOL
DTo
Mea
sure
ben
efi c
iary
OV
C
ANTH
ROPO
MET
RIC
MEA
SURE
MEN
T
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