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Household Microbial Water Quality Testing in a Peruvian Demographic and Health Survey: Evaluation of the Compartment Bag Test for Escherichia coli

ajtmhThe Joint Monitoring Program relies on household surveys to classify access to improved water sources instead of measuring microbiological quality. The aim of this research was to pilot a novel test for  quantification of household drinking water in the 2011 Demographic and Health Survey (DHS) in Peru. In the Compartment Bag Test (CBT), a 100-mL water sample is supplemented with chromogenic medium to support the growth of , poured into a bag with compartments, and incubated. A color change indicates  growth, and the concentration of /100 mL is estimated as a most probable number. Triplicate water samples from 704 households were collected; one sample was analyzed in the field using the CBT, another replicate sample using the CBT was analyzed by reference laboratories, and one sample using membrane filtration (MF) was analyzed by reference laboratories. There were no statistically significant differences in  concentrations between the field and laboratory CBT results, or when compared with MF results. These results suggest that the CBT for  is an effective method to quantify fecal bacteria in household drinking water. The CBT can be incorporated into DHS and other national household surveys as a direct measure of drinking water safety based on microbial quality to better document access to safe drinking water.

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The Importance of Gender in Data on Orphans and Vulnerable Children

gender-ovcAddressing gender when monitoring and evaluating projects for orphans and vulnerable children (OVC) helps ensure equity in access and benefits for boys and girls. This brief explores the importance of gender in monitoring and evaluation activities and suggests indicators to reveal and explain gender gaps in OVC outcomes.

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Barriers to and Facilitators of Sex- and Age-Disaggregated Data – Kenya

tr-17-163The availability of sex- and age-disaggregated data allows program managers and decision makers to examine service delivery, treatment, and health outcome data in depth. This helps them detect differences between the sexes, age groups, and key populations, which can lead to better understanding of the health needs of each of these groups and populations. Access to these data can also ensure that health systems do not perpetuate inequities associated with negative health outcomes. Despite the importance of examining gender and age differences, sex and age disaggregation are not always included or maintained in routine data collection practices and national HIS databases, such as the DHIS 2. Collection and use of gender-related data are increasing globally, but information gaps still prevent full understanding of the factors that facilitate or discourage helpful data disaggregation and use.

To enhance the availability and use of gender data, MEASURE Evaluation—funded by the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—explored factors that contribute to collection and use of sex- and age-disaggregated data in Kenya. Our study used a two-pronged approach: (1) a desk review of key documents and literature, and (2) key informant interviews (KIIs) with national-level data producers and decision makers.

Many variables have an impact on when and how data are disaggregated, but we found common barriers and facilitators around the availability, production, and use of sex- and age-disaggregated data. The most common barriers to producing disaggregated data were low demand and the view that disaggregation was unnecessary. These barriers influenced data-collection tool design. We found that the availability of data by sex and age depended on the tool that was used and what type of data was collected. HIV data were generally disaggregated by sex and age, but there was variation in which age bands were used. Key informants (KIs) for this study said that registers at the facility were disaggregated by sex. This was confirmed by review of data collection tools. However, when aggregated into summary tools, the male and female fields were often aggregated into number of people, as programs did not require disaggregated summary reporting.

We also found that the production of disaggregated data was limited by the availability of resources and the added burden of reporting this type of data. Key informants strongly believed that data being collected should be used, or else it should not be collected. The KIs explored successes and challenges in analyzing and using disaggregated data. They were not sure who was responsible for ensuring disaggregation and providing technical support. Key informants working with PEPFAR data cited successes and supportive strategies more frequently than KIs in other health areas that also had implications for HIV (such as tuberculosis, malaria, and immunizations).

Our desk review revealed that a majority of Kenya’s HIV reports include sex and age disaggregation in their data presentations and discussions. Kenya’s progress in gender integration and sex and age disaggregation should be applauded. Kenya has shown substantial progress and has lessons to share with other countries, as it continues to strengthen data collection, analysis, and use of disaggregated data. Nevertheless, significant challenges remain that will require continued support to address.

At the end of this report, we offer recommendations for increased advocacy and awareness at all levels around the importance of data disaggregation by sex and age. We call for the development of guidelines, materials, and examples of how such data should be analyzed to reveal important findings. We also recommend support from gender-mainstreaming officers throughout program cycles to ensure production and use of sex- and age-disaggregated data.

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Applying User-Centered Design to Data Use Challenges: What We Learned

tr-17-161Countries are working to improve health information systems (HIS) to produce higher quality and more timely data. However, the mere existence of these data is not enough to guarantee their use in decision making for program planning and policy development. Data-informed decision making is the outcome of complex system dynamics in which technical, organizational, and behavioral factors interact to create specific facilitators or barriers to data use.

Many different types of stakeholders and individuals are involved in the production and use of data, including health workers, managers, and policymakers. Understanding their motivations, needs, internal decision-making processes, pain points, and experiences as they interact with others and complete work tasks is critical to developing innovative solutions to support the use of data for programmatic decision making at the district level.

MEASURE Evaluation implemented a user-centered design approach to understand the experiences of data users, identify current barriers facing HIS users, and develop creative solutions for tackling these issues.

The design activity followed an iterative process, from cultivating empathy with data users to developing prototypes to address critical barriers to data use. This report describes the design process, activities, and outcomes (prototypes) from a user-centered design activity in Tanzania and South Africa.

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INSP: Talleres de Evaluación 2017

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Para registrarte en los Talleres de Evaluación 2017 debes acceder al siguiente enlace: http://encuestas.insp.mx/talleres/

The Importance of Gender in Family Planning and Reproductive Health Data

gender-fprhAddressing gender when monitoring and evaluating family planning and reproductive health (FP/RH) projects and interventions helps to ensure equity in access and benefits for men and women. This brief explores the importance of gender in monitoring and evaluation (M&E) activities and suggests indicators to reveal and explain gender gaps in FP/RH outcomes.

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Equity Trends in Ownership of Insecticide-Treated Nets in 19 sub-Saharan African Countries

ja-17-224Malaria disproportionately affects poor, rural populations, with pregnant women and young children at highest risk. The Roll Back Malaria Partnership, together with the Secretary-General of the United Nations, launched the initiative Cover The Bed Net Gap to achieve the goal of universal bed-net coverage by December 2010.

Finding that previous distribution strategies had led to inequity in insecticide-treated net (ITN) ownership among subgroups, particularly between socioeconomic subgroups, the Cover the Bed Net Gap initiative shifted the distribution of ITNs from targeted distribution to mass distribution campaigns, which aim to provide one ITN for every two household members.

This study assessed the level of equity in bed net ownership before and after the widespread implementation of national ITN distribution strategies in 19 malaria-endemic countries in sub-Saharan Africa.

The study used data from Demographic and Health Surveys as well as Malaria Indicator Surveys. Surveys conducted prior to the launch of the initiative in 2009 were assigned as baseline surveys, and those conducted between 2009 and 2014 were considered endpoint surveys. The study used both country-level and pooled multicountry analyses. Pooled analyses based on malaria transmission risk, were done by dividing geographical zones into either low- and intermediate-risk or high-risk. A calculation of the Lorenz concentration curve and concentration index (C-index) assessed changes in equity.

Out of the 19 countries this study assessed, 13 showed improved equity between the baseline and endpoint surveys, and two countries showed no change. Four countries had worsened equity, with two showing greater increases in coverage of poorer households and two showing greater increases in coverage of richer households.

Findings indicate that bed net distribution campaigns linked to the launch of the Cover The Bed Net Gap initiative, have led to improvement in coverage of ITN ownership across sub-Saharan Africa, with a significant reduction in inequity.

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