This study was sponsored by Save the Children

International/Ethiopia, October 2013, Addis Ababa

A cluster-randomized control

trial of Community-based

Interventions for Newborn

Health in Ethiopia

(COMBINE): End-line

Assessment

MELA RESEARCH

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_____________________________________________________________

Additional information about this study may be obtained from:

Mela Research PLC

P.O. Box 34422

Addis Ababa, Ethiopia

Telephone: +251-11-8688765

E-mail: melainfo@melaresearch.com

Internet: http://www.melaresearch.com.

Suggested citation:

Mela Research. 2013. A cluster-randomized control trial of Community-

based Interventions for Newborn Health in Ethiopia (COMBINE): End-

line Assessment. Addis Ababa, Ethiopia

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TABLE OF CONTENTS

EXECUTIVE SUMMARY ................................................................................................ 4

EXECUTIVE SUMMARY ................................................................................................ 4

I. INTRODUCTION ........................................................................................................ 8

1.1. Neonatal mortality in Ethiopia ........................................................................................... 8

1.2. Background of the COMBINE study .................................................................................... 9

1.3. Objectives of the endline assessment .............................................................................. 11

II. SURVEY ORGANIZATION, LOGISTICS AND PRE-FIELDWORK ACTIVITIES ................... 12

2.1. Survey organizational structure ........................................................................................ 12

2.2. Survey facilitation .............................................................................................................. 12

2.3. Survey Logistics ................................................................................................................. 13

2.4. Pre-fieldwork activities ..................................................................................................... 15 2.4.1. The questionnaires (Modules): ..................................................................................................15 2.4.2. Reviewing and finalizing the questionnaires..............................................................................17 2.4.3. Survey manuals and forms .........................................................................................................18 2.4.4. Recruitment of survey teams .....................................................................................................20 2.4.5. Training of trainers .....................................................................................................................21 2.4.6. Training of survey teams ............................................................................................................21 2.4.7. Survey teams formation and site assignments ..........................................................................23 2.4.8. Deployment of survey teams .....................................................................................................23

III. SURVEY DESIGN AND METHODOLOGY .................................................................. 25

3.1. Household listing ............................................................................................................... 25

3.2. Target respondents ........................................................................................................... 27

3.3. Data collection procedures ............................................................................................... 29 3.3.1. Assigning interviewers to gashas/geres and households...........................................................29 3.3.2. Identifying respondents and conducting the interview .............................................................30 3.3.3. Making callbacks ........................................................................................................................30 3.3.4. Handling refusals and incomplete interviews ............................................................................31 3.3.5. Keeping information confidential ..............................................................................................31 3.3.6. Checking completed questionnaires ..........................................................................................31 3.3.7. Returning work assignments to the supervisor .........................................................................32

3.4. Ethical aspects of the survey ............................................................................................. 32

3.5. Challenges .......................................................................................................................... 33

IV. SUPERVISION AND DATA QUALITY ASSURANCE .................................................... 37

4.1. On-spot observation of interviews ................................................................................... 38

4.2. Re-interviews ..................................................................................................................... 38

4.3. Review meetings ............................................................................................................... 39

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4.4. Questionnaire review and editing .................................................................................... 39

4.5. Hand tally of selected indicators ...................................................................................... 40

4.6. General review/feedback meeting ................................................................................... 40

4.7. Progress reports and data sharing .................................................................................... 41

V. DATA PROCESSING ................................................................................................ 43

5.1. Questionnaires administration and office editing ........................................................... 43

5.2. Data entry .......................................................................................................................... 44

5.3. Data verification and cleaning .......................................................................................... 45

5.4. Data feedback and review meetings ................................................................................ 46

5.5. Intermediate indicators .................................................................................................... 47

VI. RESULT OF INTERVIEWS AND KEY PROGRAM INDICATORS ................................... 48

6.1. Number of interviews and response rates ....................................................................... 48

6.2. Census population age and sex structure ......................................................................... 50

6.3. Selected key survey indicators .......................................................................................... 52 6.3.1. Fertility characteristics ...............................................................................................................52 6.3.2. Neonatal death ..........................................................................................................................53 6.3.3. Selected program indicators ......................................................................................................54

REFERENCES AND DOCUMENTED CONSULTED ........................................................... 57

ANNEX 1. LIST OF ENDLINE SURVEY PARTICIPANTS .................................................... 59

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EXECUTIVE SUMMARY Background: The Saving Newborn Lives program (SNL) of Save the Children in collaboration with JSI Research &Technology, Inc. and the Federal Ministry of Health (FMoH), has been implementing the Community-based Interventions for Newborn Health in Ethiopia (COMBINE) cluster-randomized control trial to strengthen and evaluate the effect of a well-implemented Health Extension Program (HEP) as laid out in current government policy, alone and in combination with community-based treatment of neonatal infections by Health Extension Workers (HEWs). The COMBINE has been implemented in Sidama Zone in Southern Nations, Nationalities, and People’s Region (SNNPR), and East Shoa and West Arsi Zones of Oromia Region. COMBINE works closely with and through the FMoH, Regional Health Bureaus (RHB), Zonal Health Offices (ZoHOs), and Woreda Health Offices (WorHOs). Collaborating institutions include the London School of Hygiene and Tropical Medicine, Johns Hopkins University Bloomberg School of Public Health, UNICEF, the Ethiopian Pediatric Society, and WHO. Objective of the endline survey: A census-based survey of rural households in 131 Kebeles of East Shoa and West Arsi Zones in Oromia; and Sidama zone in SNNP was conducted during January 1-June 26, 2013 with the aim of producing evidence of the additional benefit, in terms of newborn lives saved of delivering community-based sepsis management in addition to high- quality implementation of existing interventions as per government policy. The survey also aimed at measuring changes, if any, from baseline in associated caretaker knowledge, practice and use of key newborn care household behaviors. Survey Organization and facilitation: Mela Research PLC (Mela) was contracted by Save the Children International (SCI) to conduct this endline survey. The Oromia and SNNP regional Health bureaus and the Woreda and Kebele health offices in the survey areas assisted in the facilitation of the field data collection. Survey design and methodology: This census-based survey rested on two interlinked methodologies i.e. (1) Listing of all households in the Kebeles and (2) One-on-one interview of all households and eligible respondents using structured questionnaires (modules). Four types of questionnaires modules were implemented as per the type of respondents. The survey respondents were: (1) household head or, if not, any other adult member of the household present in the household during the interview; (2) women in the age group 15-49 years; (3) Women who delivered (live birth) less than 60 days ago; (4) mothers who had a dead neonate (death within 28 days after birth) that occurred more than 60 days and less than 12 months from the date of the survey (Verbal autopsy). The questionnaire

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modules were used in the baseline survey but minor modifications such as wording and formatting were made following pre-testing. Twenty-one data collection teams were involved in the entire fieldwork; each team composed of 5-6 interviewers and 1 supervisor. One regional coordinator was also assigned per region. The overall conduct of the fieldwork was monitored by the project leader, the lead survey coordinator, COMBINE staff and the external survey monitors. The survey received IRB clearance from the National Ethical Clearance Committee of the Ethiopia Science and Technology Commission. Oral informed consent was obtained from each participant prior to conducting the actual interview. Survey monitoring and quality assurance: The survey implemented a stringent survey monitoring and supervision as well as data quality assurance procedures that were guided by several tailor-made manuals and checklists. Supervision of the endline survey data collection process and survey undertakings took various layers. At the field level the survey quality assurance procedures consisted of on-spot observation of interviews, re-interview, conducting review meetings, questionnaire editing and hand tally of selected indicators. Another layer of quality control came from the office editing and data processing that verified filled questionnaires for their completeness, legibility of responses, linkage and consistency across different modules. Two Satellite offices were opened in Hawassa and Ziway towns where manual edits of filled questionnaires and verifications were done before the data were sent to the central Mela office in Addis Ababa for data entry. Data processing: The data processing activities of this survey involved manual and automatic processes that encompassed a number of steps including receipt of completed questionnaires, office checking/editing, data entry, data verification, cleaning and generation of intermediate indicators. Data processing was performed concomitantly with the data collection; with the first set of data arrived in the satellite offices about two weeks after the start of data collection and data entry was launched about three weeks after the start of data collection. The data processing activities were carried out by a team of data editors, questionnaire administrators, data entry clerks, assistant data manager and the data manager. At the central office 16 full-time data entry clerks computerized the questionnaire data using EPI-INFO. Each terminal was connected to a central Server via local area network (LAN) that allowed automatic storage of the data entered by each clerk onto the Server. After verifying the completeness of the entered data, the data were regularly exported to STATA 11 for consistency checking and generation of intermediate indicators.

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Number of interviews achieved and response rates: In the 131 Kebeles a total of 143,964 households were visited but interviews were conducted in 130,405 households giving a response rate of 90.6%. The largest number of the households were interviewed in Sidama (n=73,245; 56.2%) followed by East Shoa (n=34,301; 26.3%) and West Arsi (n=22,859; 17.5%) zones. In the entire survey Kebeles a total of 134,064 women aged 15-49 years were identified who were eligible for interview. Of these women, the survey achieved a 98.6% response rate by interviewing 132,152 of them. By design, the survey focused on interviewing women who had a delivery in the 60 days prior to the date of interview. In total, 2950 such women were interviewed out of 3008 who were eligible for this interview. This resulted in a high response rate at 98%. Three-hundred Ninety two (n=392) mothers who had a dead neonate that occurred more than 60 days and less than 12 months from the date of the survey were interviewed in the entire survey Kebeles . The response rate for this particular interview was 97.2%. Census population age and sex structure The de facto mid-year population was 685,785 persons. Of these the majority (55.8%) were from Sidama and this was followed by East Shoa (24.9%) and West Arsi (19.3%). Of note, 99% of the persons included in the census were usual residents of the households. The mean age of the population was 21.6 years and compares well across the three zones. About 14% were under the age of 5 years. Women in the reproductive age (15-49 years) constitute a fifth of the population and this was comparable across zones. The population was nearly equally divided by sex. Average household size was 5.2 persons. Fertility characteristics of the population: About 42% of the women in the reproductive age reported to have had at least one pregnancy in the previous three years. About a tenth of the women in the entire survey have given birth in the year preceding the survey and this varied significantly by zone - ranging from 8.8% in Sidama to 15.1% in West Arsi. The survey found that 2.2% of the women had delivery in the previous 60 days. These indicators varied significantly by zone due to difference in fertility behaviors of the women in the zones. In general women in West Arsi appeared to have notably high fertility rate as compared to women in the other zones. Neonatal Death Rate (NDR): Overall, the NDR was estimated at 24.1 per 1000 and varies significantly by zone from a low of 18 per 1000 in Sidama to 28.8 and 32.3 per 1000, respectively, in West Arsi and East Shoa. The data show that the very early neonatal mortality was notably high at

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15.5 per 1000, suggesting that neonatal mortality is heavily clustered in the first two days after delivery. The data also revealed that 78% of the neonatal deaths occurred in the first week of life. On the other hand, a relatively small portion of the neonatal deaths (22%) had happened after the first week and the late neonatal death rate estimated at 5.3 per 1000. Key program indicators: The proportion of women who had home visit by a volunteer during their most recent pregnancy that ended in the previous two months was reported at 37%. Twenty-nine (29%) of the women reported to have had home postnatal visit in the same period by a volunteer. Both indicators did not vary significantly by zone. A tenth of the women reported to have received home visit by HEWs during the same period. The coverage for this indicator was the lowest in West Arsi at 5.3% while the highest in Sidama (12.7%). Similarly, postnatal home visit by HEWs was low at 15.1% and varied by zone - from 6.8% in West Arsi to 19.9% in Sidama. Coverage for at least one antenatal care (ANC) visit in health facility reported to be fairly high at 75.8%. Only 17% of the women attended their most recent deliveries (previous 2 months) in health facilities. Nevertheless, institutional delivery appeared notably high in East Shoa at 30.1%. The corresponding coverage in West Arsi and Sidama was 19.6% and 10.3%, respectively.

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I. INTRODUCTION

1.1. Neonatal mortality in Ethiopia

Neonatal mortality, amounting to an estimated 4 million deaths worldwide each year,

constitutes 40 percent of under-5 Mortality and approximately 57 percent of Infant

Mortality [1] . The vast majority of neonatal deaths arise in low-income and middle

income countries, and about half occur at home [2] . In the past two to three decades

neonatal mortality rates have shown a slow decline in developing countries whereas

infant and under-5 mortality rates have declined significantly [1, 3-6] .

With a population of nearly 83 million in 2010 [7], Ethiopia is the second most populous

country in Africa next to Nigeria. The population grows at a rate of 2.6 percent per

annum. The vast majority of the people (84 percent) resides in rural areas, agriculture

being the major source of livelihood [8]. High mortality, high fertility and low life

expectancy characterize the demography of Ethiopia as in most sub-Saharan African

countries. In the past decade, however, the country witnessed an unprecedented

decline in under-5 mortality from 166 per 1000 in 2000 to 88 per 1000 live births in 2011

[9], which can be translated to an average decline of 47%.

About 42% of the under-5 mortality in Ethiopia is attributable to neonatal deaths [9]. According to the 2011 Ethiopia DHS, the country is experiencing a notably high neonatal mortality rate at 37 per 1000 live births, which is comparable to the average rate of 35.9 per 1000 live births for the Africa region [10]. Although the causes of neonatal mortality are not well documented in the country, several factors can play their parts including low coverage of maternal and neonatal care services, high levels of unassisted and unskilled delivery attendance and low levels of postnatal care for mothers and newborns, lack of recognition and swift care-seeking for maternal and newborn danger signs, and inadequate treatment of complications, including infection. It is also estimated that neonatal infection accounts for nearly half (47%) of all neonatal mortality in Ethiopia.

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Over the last decade the neonatal deaths have gained an increasing importance on the

world wide policy agenda because the Millennium Development Goal (MDG) for child

survival cannot be met without substantial reductions in neonatal mortality. It is

estimated that reduction of under-five child mortality by two thirds by 2015, as called

for by the MDGs, will require a reduction in neonatal mortality of at least 50% [4]. A

recent analysis of the Ethiopia DHS (2000-2011) concluded that the current declining

trend in neonatal mortality in the country appears inadequate to achieve the MDG #4

target of reducing under-five mortality rates by two-thirds by the year 2015. A much

faster decline in neonatal mortality is warranted in order to decisively meet the MDG #4

target. The study also underscores that strategies to address neonatal survival in the

country requires a multifaceted approach that encompasses health-related measures as

well as several other community-based measures of considerable importance [11].

1.2. Background of the COMBINE study

The Saving Newborn Lives program (SNL) of Save the Children in collaboration with JSI

Research &Technology, Inc. and the Federal Ministry of Health (FMoH), has been

implementing the Community-based Interventions for Newborn Health in Ethiopia

(COMBINE) cluster-randomized control trial to strengthen and evaluate the effect of a

well-implemented Health Extension Program (HEP) as laid out in current government

policy, alone and in combination with community-based treatment of neonatal

infections by Health Extension Workers (HEWs).

The National HEP presents important opportunities to access antenatal care during

pregnancy, improve essential newborn care practices in the home, and increase

caretaker awareness and care-seeking for danger signs in sick neonates. The HEWs

under the HEP are paid community-level government workers who promote

environmental sanitation but also are increasingly charged with delivering high-impact

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interventions in the community like immunization, antenatal and postnatal visits, family

planning, and more recently Integrated Community Case Management (iCCM). At the

present time, however, treatment of neonatal infections is not authorized at the health

post (HP) level. In order to build on HEP achievements and address a primary cause of

neonatal death, the COMBINE trial was designed to test and evaluate a strategy for

bringing neonatal infection treatment closer to communities.

The COMBINE has been implemented within a population of more than 640,000 in

Sidama Zone in Southern Nations, Nationalities, and People’s Region (SNNPR), and East

Shoa and West Arsi Zones of Oromia Region. COMBINE works closely with and through

the FMoH, Regional Health Bureaus (RHB), Zonal Health Offices (ZoHOs), and Woreda

Health Offices (WorHOs). Collaborating institutions include the London School of

Hygiene and Tropical Medicine, Johns Hopkins University Bloomberg School of Public

Health, UNICEF, the Ethiopian Pediatric Society, and WHO.

The primary objectives of COMBINE are to Strengthen and evaluate the implementation

of HEP according to existing policy; and, assess the effectiveness and feasibility of

integrating community-based management of infections in neonates by HEWs when

supported by volunteer Community Health Promoters (vCHPs).

The COMBINE is a two arm, cluster randomized control trial. The Health center (HC)

catchment area is the unit of randomization for the trial. Of 22 HCs, 11 were

randomized to the home-based counseling and referral for neonatal infection arm

(control arm), and the remaining eleven to home-based counseling and management of

neonatal infection by Health Extension Workers (HEWs) when referral is not possible

(Intervention/trial arm). Since May 2008, Save the Children has supported the HEP in

both the intervention and control arms of the COMBINE study. Community-based

treatment of neonatal infections in the intervention arm began in July 2011.

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1.3. Objectives of the endline assessment

This endline assessment survey aimed to provide evidence of the additional benefit, in

terms of newborn lives saved and cost effectiveness, of delivering community-based

sepsis management in addition to high- quality implementation of existing interventions

as per government policy. In order to quantify the additional impact of neonatal

infection management by HEWs on survival, the primary outcome of interest under

COMBINE is thus neonatal mortality after the first day of life. The study will also

measure changes from baseline in associated caretaker knowledge, practice and use of

key newborn care household behaviors.

The endline assessment employed a census-based survey of rural households in 131

Kebeles of East Shoa and West Arsi Zones in Oromia; and Sidama zone in SNNP. It was

fielded during the period January 1-June 26, 2013.

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II. SURVEY ORGANIZATION, LOGISTICS AND PRE-FIELDWORK ACTIVITIES

2.1. Survey organizational structure

Mela Research PLC (Mela) was contracted by Save the Children International (SCI) to

conduct the COMBINE study endline survey (Contract Reference Number:

021/SCI/NO/12). The endline survey by design was a census of rural households in 131

Kebeles of the three study zones. Due to the vast nature of the assignment that required

large manpower and logistics inputs Mela setup an ad-hoc organizational structure

within its mandate to help facilitate proper implementation of the survey.

Figure 1 presents the survey organizational structure and the different personnel

participated at various levels of the survey. Mela also setup two satellite offices in the

towns of Hawassa and Ziway, respectively, for the Sidama and Oromia surveys. The

survey was staffed by several positions including: (1) Project leader (2) Lead fieldwork

coordinator (3) Administrative and finance officer (4) Data manager (5) Training

coordinator (6) Trainers (7) Supervisors (8) Interviewers (9) Data entry clerks (10)

Assistant data manager (11) Office data editors/questionnaire demonstrators and (12)

Kebele guiders. Annex 1 shows the list of individuals participated in the different

positions in the survey.

2.2. Survey facilitation The survey was facilitated by the Oromia and SNNP regional Health bureaus as well as

the Woreda and Kebele offices in the survey areas. In particular, the regional health

bureaus of both regions were quite instrumental in the successful implementation of

the survey as they dispatched formal letters of survey facilitation/support to each of the

study Woredas ahead of the fieldwork. Subsequently, the Woreda offices also wrote

similar letters of support to the respective Kebeles. Each region also assigned one survey

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focal person who assisted during the training and fieldwork. These coordinated efforts

should be emphasized among the most important inputs for the success of the field

data collection.

Figure 1. COMBINE endline survey organizational structure

2.3. Survey Logistics

Satellite and central offices

Given the amount of data to be collected and the vast nature of the field operation,

Mela opened two satellite offices in Oromia and SNNP. The Oromia office was located in

the town of Ziway - located at almost equal distance between the two Oromia study

zones of East Shoa and West Arsi. The office at the town of Hawassa served the Sidama

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survey. These offices were staffed by 5-6 office editors/questionnaire administrators

and furnished with important office furniture and desk top computers. The satellite

offices received, reviewed and recorded filled questionnaires from the survey teams on

regular basis. They also transferred edited and verified questionnaires and other survey

forms to the central Mela office in Addis Ababa. A feedback mechanism was put in place

between the satellite offices and the survey teams and between the central office and

the satellite offices. In addition, the Satellite offices kept stock of blank questionnaires

and forms to be transferred the survey teams.

Printing of survey materials:

Printing copies of questionnaire modules and forms and availing them on timely basis to

the survey teams was the most demanding logistics activity of the survey mainly due to

the exceptionally large size of the survey. We put in place a system that maintained

sufficient stocks of blank questionnaires in the Satellite offices throughout the survey.

The regional survey coordinators, the Satellite offices and the logistic officer maintained

effective communications to print and avail blank questionnaires and forms to the

survey teams without interruption.

Completed and edited questionnaires were transported from the Satellite offices to the

central office for data entry on weekly basis, making sure that the data entry clerks had

enough stock to enter. Similarly, black questionnaires and forms were transported

regularly to the satellite offices from Addis Ababa where the printing company was

located. Cars were assigned for this purpose during the entire survey period.

Computers and accessories:

For the purpose of data entry we purchased and made available 23 Desk-Top computers

(20 for data entry, 1 for assistant data manager and 2 for the satellite offices). High

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storage hard drives were also made available for daily backups of entered data. The

computers were connected via Local Area Network (LAN) to a central server.

Cars for fieldwork:

We deployed 26 Land cruisers (21 for the data collection teams, 4 for regional

coordinators and 1 for the overall survey coordinator) and 1 additional car for the

logistic officer during the entire survey period from January 31-September 26, 2013.

2.4. Pre-fieldwork activities

The pre-fieldwork activities of this endline survey involved several interlinked steps that

broadly encompassed development/finalization of questionnaires, pretesting of

questionnaires, development of forms and checklists, recruitment of survey team

members, training, and deployment of survey teams. This section presents the various

steps in detail.

2.4.1. The questionnaires (Modules):

Four types of questionnaire modules (Modules 1-4) were used to gather information in

this endline survey as per the type of respondent. All the modules were used during the

baseline survey but minor modification such as wording and formatting were made on

some of the questions following discussions and pre-testing.

Module 1- Household Module:

Module 1 is basically an entry point for the other interviews. The respondents for this

module were the heads of the households or any adult (age 18 years or older). Apart

from area identification and consent forms, this module collected information about all

usual and non-usual members of the households, including their names, sex, age,

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relationship to the head of the household. The questionnaire served as a gateway to

identify eligible women respondents (permanent residents women age 15-49 years) for

module 2.

Module 2- Women 15-49 years:

All women who were usual residents of a household and age 15-49 were eligible for

Module 2 interview. Module 2 recorded basic area identification as in Module 1

including the name of the respondent women and her line number that was to be

transferred from Module 1. The main section of module two restricted to women who

had pregnancy in the preceding three years. It collected detailed birth history (Brass-

type questions) such as number of children ever born, living together, living elsewhere,

died and surviving including still birth. The pregnancy/birth history of Module 2

recorded the date of birth and date of death (if dead) of each birth in the preceding

three years. It also collected information on miscarriage and still birth. It recoded the

number of neonatal deaths (before 28 days) and for those deaths that occurred within 2

days detailed information on the day of the week and time of death was also collected.

Module 2 was also an entry point for Module 4 (Verbal Autopsy questionnaire) that

focused on neonates that died with the 12 months proceeding the interview excluding

those who died in the first two months prior to interview.

Module 3: Women who delivered less than 60 days ago:

This module contained more questions than the rest of the modules. It collected

information about antenatal care, delivery care, newborn care, postnatal care, child

feeding practices, among others. Facility-and home-based visits during pregnancy,

delivery and postnatal period by volunteer community health workers (vCHWs), health

extension workers (HEWs) and health workers were asked to respondent mothers in

relation to their most recent pregnancy and child birth that occurred in the previous 60

days.

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Module 4: Verbal Autopsy (VA) questionnaire for neonatal death:

The VA module asked mothers of deceased neonates who died in the past one year but

two months prior to the date of interview. The VA module contained both structured

and open ended questions. The questions included area identifiers, basic characteristics

of the deceased child, such as date of birth, sex and date of death including the day and

time of death, mother's reported lay cause of death, symptoms, health condition

immediately after birth, mother's health condition, whether the child encountered

accident, if any, whether medical care was sought for the child, among others.

Questionnaires translation:

The questionnaires/Modules were originally developed in English. They were translated

to Amharic (oficial language of Ethiopia) for use in the Sidama survey and to Oromiffa

for use in East Shoa and West Arsi zones of the Oromia region. Language experts

translated the questionnaires to the local languages. The translations were verified via

consistency checks against the English versions of the questionnaires. Local

terminologies of key terms and concepts were also recorded and used by the

interviewers during interviews.

2.4.2. Reviewing and finalizing the questionnaires

Questionnaire review meeting:

Before pretesting the questionnaire modules in an actual field setup Mela and COMBINE

teams jointly held a questionnaire review meeting to thoroughly review Modules 1-3 for

wording, clarity, language, flow/order, format, skip rules, instructions clarity, the use of

terminologies and to suggest areas for improvement. The review focused on the

Amharic modules but used the English version for verification. Several wording,

concepts, language use, formatting, instruction and other related problems were

identified in all the modules with the most critical formatting and instruction problems

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on Module 3. The findings from the questionnaire review meeting along with the

pretest (see below) results were used to revise the modules in both languages.

Pretesting of questionnaires:

The pretest aimed at determining the strengths and weaknesses of the survey

questionnaires (Modules 1, 2 & 3) concerning questions wording, clarity, language,

flow/order, format, skip rules, the use of local terminologies, among others and suggest

areas for improvement. The questionnaires were pretested in the COMBNE study zones

including East Shoa and West Arsi zones in Oromia and Sidama zones in SNNP. The

pretest was conducted in the three zones but in the Kebeles that were not targeted by

the COMBINE program intervention. Two kebeles were purposely selected per zone and

the pretest was conducted in six Kebeles. Six experienced interviewers (2 per zone) with

prior exposure to the COMBINE baseline survey as well as other similar surveys were

recruited to conduct the pretesting. The pretest interviewers were given a one and half

day orientation/training on the pretest methodology and the questionnaire modules.

The findings of the pretest concluded that the questionnaire modules were in general in

good shape. It had however identified some inconsistencies, wording problems, and

formatting issues in some of the questions in all the three modules. Following the

pretest necessary editorials and formatting were made on the modules. The pretest also

checked consistency across the questionnaires in the three languages - English, Amharic

and Oromiffa.

2.4.3. Survey manuals and forms

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This endline survey was demanding both technically and logistically due to its size and

complexity. Several survey teams were deployed for over a 5-month period.

Standardizing the survey procedure was of paramount importance and to this end we

developed several manuals and forms that were integral parts of the training and data

collection activities.

The following manuals were developed and used during the training of survey teams

and the actual data collection:

Manual 1: Interviewer's manual

Manual 2: Household listing manual

Manual 3: Supervisor's manual

Manual 4: Coordinator's manual

Manual 5: VA interviewer's manual

Manual 6: Data collection training facilitator's guide

The forms and checklists that were employed during household listing, data collection,

data transmission and editing are as follows.

Form 1: Gasha/gere listing form

Form 2: Household listing form

Form 3: Household listing summary sheet

Form 4: Interviewer assignment sheet

Form 5: Interviewer progress sheet

Form 6: Area codes - Region, Zone, Woreda and Kebele codes

Form 7: Age / Birth-date consistency chart

Form 8: Questionnaire package cover page

Form 9: Questionnaire submission sheet (from supervisors to coordinators)

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Form 10: Questionnaire submission sheet (from coordinators to satellite offices)

Form 11: Questionnaire submission sheet (from satellite offices to central office)

Form 12: Coordinators field visit schedule

Form 13: Interview observation checklist (to be used by the supervisor)

Form 14: Supervisor performance evaluation sheet (to be used by the

coordinators)

Form 15: Regional coordinators performance evaluation sheet (to be used by the

lead coordinator)

Form 16: Data collection progress sheet (for use by the coordinators)

Survey logistic forms (SLF) that were employed to facilitate the transfer of questionnaire

modules and forms include the following:

SLF 1: Blank questionnaire modules/forms transfer form (from Satellite office to

coordinators)

SLF 2: Blank questionnaire modules/forms transfer form (from coordinators to

supervisors)

SLF 3: Stock control of blank questionnaire modules and forms

2.4.4. Recruitment of survey teams

An ad-hoc recruitment committee composed of Mela and COMBINE teams

conducted the recruitment in Addis Ababa (for the Oromia teams) and

Hawassa (for the Sidama teams). Key survey positions including interviewers,

supervisors and coordinators were advertised in local newspaper as well as

in the regional health offices. Minimum qualification and experiences was set

for each position. The candidates who fulfilled the minimum criteria

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underwent through evaluations that encompassed written exams, face to face

interviews, and local language competence test. More than 900 applicants

were received for the different positions. The selection of participants was based on two

steps: (1) an initial screener based on their resume that mainly focused on their stated

language ability, minimum qualification and previous survey experiences, and (2) panel

of tests that encompassed language proficiency and interview to assess applicants'

survey experience and a written test. Finally, 151 candidate interviewers (74 for Oromia

and 7 for Sidama), 22 candidate supervisors (11 for Oromia and 12 for Sidama) and 4

coordinators (2 for Sidama and 2 for Oromia) were recruited to attend the training for

survey teams.

2.4.5. Training of trainers

Mela conducted a 4-day training of trainers (ToT) meeting in January 8-11, 2013. The

meeting was attended by four Mela trainers, four regional survey coordinators and four

COMBINE staff members. The ToT was co-facilitated by Mela and Save the Children. The

ToT aimed to equip end-line assessment survey trainers with the necessary knowledge

and tools to conduct the training as well as to standardize the training so that trainees in

different venues and with different languages were exposed to the same information

and materials. The trainers were also given orientation on how to use the training

facilitator's guide.

2.4.6. Training of survey teams

The training was held during January 14-28, 2013. Two different venues were used for

the training - Rift Valley Hotel (Shashemene) for the Oromia team and Tadessed Enjory

hotel (Hawassa) for the Sidama team. The two towns are 20 Kms away from each other.

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The 15-day training was organized to accommodate different methodologies including

presentation of key terms, concepts and procedures, item-by-item review of

questionnaire modules, role play (demonstration interview), mock (pair) interview,

Questions & Answers (Q&A), field practice, feedback sessions and trainees' evaluation

(tests). The training was assisted by a number of tailor-made manuals, questionnaire

modules, and forms/checklists. A training facilitator's guide was used during the

training. There were 28 training sessions that encompassed general introductory and

background information, survey methodologies, the item-by-item orientation of the

questionnaire modules, role play, mock interview, group work and field practice, survey

supervision, among others.

Mela deployed two trainers per region. The project leader was also fully involved in the

trainings in both regions. COMBINE team has played an important part in monitoring

the progress of the training as well as in providing technical inputs in the different

sessions. Field practice sites were identified and prearrangements were made with the

Kebele officials/HEWs by the COMBINE team. The logistics of the trainings in both

regions were facilitated by eight members of Mela who were present full time during

the training.

The VA training was given to the supervisors of both regions in one venue at Hawassa

Tadesse Enjory Hotel. The training was guided by the VA interviewer's manual. The VA

training did not have field practice due to its sensitive nature and locating eligible

women for a VA interview is not an easy task. But we used the baseline VA data for

Mock interview and role play, which was found to be very helpful for the trainees to

understand the possible responses in an actual interview. The supervisors were

evaluated via a test prepared for the purpose and feedback was provided by the trainer

to the group and to individual supervisors.

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Different tests, and qualitative performance evaluations were used to rate trainees'

competence. Ten of the trainees were selected for supervisors' positions and 50 for

interviewers' positions in Oromia. While five trainees were selected as reserves in

Oromia. In Sidama 11 best performing trainees were selected for the supervisors'

position and 55 were selected for the interviewers' positions. Seven trainees were

selected as reserves in Sidama.

2.4.7. Survey teams formation and site assignments

Ten teams in Oromia and 11 in Sidama were formed; in total 21. Each team composed

of five interviewers and one supervisor. In each team trainees of different caliber were

included so that each team contains the best and relatively low-graded interviewers.

The allocation of teams to the study arms was done by the COMBINE team. Each team

was assigned to survey the intervention and control Kebeles in a balanced manner in

order to rule out any possible systematic bias that could arise due to differential team

performances.

Survey data collection areas have also been prioritized. Clusters where the rainy season

likely to start earlier than June were given first priority. While clusters where the field

practices were conducted surveyed towards the end in order to avoid respondents'

fatigue.

2.4.8. Deployment of survey teams

Survey materials, including questionnaire modules, forms and checklists and other

stationeries were provided to each team. We deployed 26 Land cruisers (21 for the data

collection teams, 4 for regional coordinators and 1 for the overall coordinator) and 1

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additional car for the logistic officer. Teams travelled to their assignment Woredas on

January 31, 2013 and actual fieldwork started on February 1, 2013.

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III. SURVEY DESIGN AND METHODOLOGY

This endline census-based survey primarily rested on two interlinked methodologies -

i.e. (1) Listing of all households in the Kebeles, gashas/geres and (2) One-on-one

interview of all households and eligible respondents. These activities, the procedures

and implementation steps are presented in greater detail in the different survey

manuals - i.e. household listing, interviewer's, supervisor's and coordinator's manuals

that were prepared for the purpose. This section only presents a summary of these

activities.

3.1. Household listing

Details about the household listing procedure can be consulted in the Household Listing

manual. This section briefly summarizes the procedure.

Since all households in a Kebele were included in the interview, a complete list of

households was a prerequisite for data collection. Using the resulting household lists,

data collectors were able to locate every household. Listing was done at a gasha/gere

level in each Kebele. A Gasha in Sidama and a Gere in Oromia is a small village often

containing 25-70 households. In a Kebele there are 25-70 gashas/geres.

The first activity of a survey team upon arrival in a Kebele was to contact the Kebele

officials to introduce about the objective of the survey and identifying appropriate

guider. The survey team generated the list of gasha/gere in the Kebele and the list of

households in each gasha/gere. The listing operation involved listing of all households

(HHs) in all gashas/geres of a Kebele. The listed HHs were used to locate households for

interview. The household listings were created by transferring the information from the

Family Folders (FF) or Health Development Army (HDA) Development Team Leader (DTL)

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network Lists. The Family Folder is considered as the primary source for the household

listing in case both sources are present and accessible to a data collection team in a

Kebele.

A Family Folder is used by the health extension workers to register all households in a

Kebele. The folder contains area identification (region, Woreda, Kebele, Gote,

Gasha/Gere). It contains the name of the head of the household, family/household

number, and the date of registration. Detailed socio-demographic information of family

members including date of birth (DOB), sex, occupation, and marital status are also

included. It also records death and the date of death of family members. The Family

Folder was available in most of the Kebeles in Sidama and East Shoa zones but not in

West Arsi at the time of the survey. Therefore, in Sidama and East Shoa zones the

household listing was constructed based on a Family Folder.

The Ministry of Health introduced the Health Development Army (HDA) in order to

accelerate the achievement of several health related targets in the communities. In

West Arsi, a DTL network contains 5-7 women or men under one team leader (a woman

leader). The list contains information on area identification (region, Woreda, Kebele and

Gote) and the names of team leaders and the members of the team. Unlike the FF that

is primarily identified by the fathers' name (household head/husband), the DTL list

contains the names of women or men or any member of HH or the community. The DTL

network list doesn't contain any other information about individual members of a team

other than their names. Because most Kebeles in West Arsi did not have FF at the time

of the survey, the DTL network list served as the main source for household listing.

A household listing form was prepared for this survey. Information useful to identify the

household was copied onto this form either from the FF or DTL network list based on

availability . The HH listing form captured information including, region, Woreda, Kebele

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and gasha/gere name, name of the HH head (if FF) or name of the women (if DTL

network). It also recorded the source of the HH list (whether it is FF or DTL network).

The HH number as it appeared in the FF are transferred onto the HH listing Form. If the

source was DTL network, consecutive HH/women’s serial numbers were given by the

data collection team. The HH number were then transferred to the questionnaires

during the interview.

3.2. Target respondents

This endline survey was based on a house-to-house individual interview that focused on

respondents of different characteristics. The respondents encompassed the following:

Household head or, if not, any other adult member of the household present

in the household during the interview (Module 1)

Women in the age group 15-49 years (Module 2)

Women who delivered (live birth) less than 60 days ago (Module 3)

Mothers who had a dead neonate1 that occurred more than 60 days and less

than 12 months from the date of the survey (Module 4)

Figure 2 below presents a flowchart that depicts how target respondents were

identified and the corresponding questionnaire modules.

1 Neonatal death is defined as the death of live-born infants within 28 days after birth

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Figure 2. Flow chart of target respondents and screening for questionnaire modules

Household (HH)

Women age 15-49 years in the

HH

No women age 15-49 years in the HH

Women who had pregnancy in the last 3

years

Women who had delivery 0-59 days ago

Women who had a dead neonate that occurred more than 60 days and less than

12 months from the date of the survey

Women without neonatal death OR with neonatal death that occurred within 2 months or

beyond a year from the date of the survey

Ask Module 1

Ask Module 2

Ask Module 3

Ask Module 4

Women without pregnancy in the last 3 years

Stop & go to Next Household

Stop & go to Next Household

Notify the Supervisor! The supervisor will conduct

the interview

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3.3. Data collection procedures

This section summarizes the procedures of data collection and the various steps that

were followed during the fieldwork. Detail data collection procedures are presented in

the interviewer's manual.

The household listing operation was the perquisite for subsequent data collection.

Listings of households were prepared by gasha/gere. The survey supervisor assigned

households to each interviewer daily. Kebele guiders who were knowledgeable of the

households and boundaries of Kebeles and the gashas/geres were hired to assist during

household listing and also to help teams locate households during data collection.

3.3.1. Assigning interviewers to gashas/geres and households

A data collection team (composed of 5-6 interviewers and 1 supervisor) worked

together as a unit and moved from one gasha/gere to the next. The procedure was that

the entire team entered a gasha/gere together and then split to the assigned

households within that gasha/gere. This facilitated easy supervision and also made it

easier for the Kebele guiders to efficiently lead each interviewer to the assigned

households. Using the Interviewer's Assignment Sheet, supervisors assigned households

to interviewers based on the household lists within each gasha/gere. Interviewer’s

Assignment Sheet also served as a summary of the results of each interviewer's work in

the field for each household. At the end of each data collection day, the interviewer

recorded the final outcome for all household visits and individual interviews conducted.

The supervisor compared the results on the assignment sheet with the completed

questionnaires as a way of verification.

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3.3.2. Identifying respondents and conducting the interview

Up on arrival in a household, the interviewer first contacted the head of the household.

If the head was not at home, any other adult (18+ years old) preferably the

wife/mothers. All Ethical aspects of the data collection should be fulfilled before

embarking to the interview. Consent forms read laud to the respondent and only when

an individual respondent consents to participate should the interview continue (See

section 3.4 below for the ethical aspects of the survey). All eligible respondents to the

survey were interviewed using the appropriate questionnaire module. If a household

was eligible for the VA interview (Module 4), the interviewer immediately notified the

supervisor to conduct the interview. By design, the VA interview was administered by

the survey supervisors.

3.3.3. Making callbacks

Because each household in every gasha/gere should be covered, the interviewer must

make every effort to conduct interviews with the individuals who were identified as

eligible in that household. Sometimes a household member was not available at the

time of first visit. The interviewer had to make at least two follow-up visits at a different

time. If a household was empty at the time of the first visit, the interviewer would

continue to the next household and returned to the first household at a later time. If the

interview was unable to interview a respondent immediately, he/she scheduled a time

to return to the household when the person would be home and able to do the

interview. If the interviewer was still unable to obtain an interview after three visits,

he/she needed to record the result code on the questionnaire and the Interviewer

Assignment Sheet and shoould inform the supervisor about the situation.

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3.3.4. Handling refusals and incomplete interviews

Despite repeated efforts, interviewers might experience different types of problems in

obtaining an interview with an eligible person; such as a respondent might refuse to be

interviewed, interviews might be interrupted in the middle (incomplete interview), a

respondent might not be able to respond due to health or other social problem. All

these different situations would captured in the questionnaires for later computation of

completeness/response rate. In order to minimize refusals, teams were trained on

different interviewing techniques and procedures and how to make a good rapport with

a respondent.

3.3.5. Keeping information confidential

Interviewers, supervisors, coordinators and the entire survey team members were

responsible for seeing that the questionnaires were kept confidential. Interviewers were

not allowed to see the completed questionnaires for that household nor discuss the

interview results with their colleague interviewers or any other person.

3.3.6. Checking completed questionnaires

It was the primary responsibility of the interviewer to review each questionnaire when

the interview was completed. This review should be done before the interviewer left a

household so that he/she could make sure every appropriate question was asked, that

all answers were clear and that the handwriting was legible, and skip rules were well

maintained. If there questions were not asked or erroneously recorded, the interviewer

should explain to the respondent and ask the question(s) again.

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3.3.7. Returning work assignments to the supervisor

At the end of fieldwork each day, the interviewers needed to check the filled out

questionnaires carefully. For all of the interviews that were completed the interviewer

needed to write the final result on the Interviewer Assignment Sheet and made any

note that might be of help to the supervisor, such as any problems he/she experienced

in locating a household or completing a questionnaire or in conducting an interview with

an eligible respondent. Supervisor received filled questionnaires and assignment sheets

at the end of the day.

It was the primary responsibility of the supervisor to review all completed

questionnaires from a gasha/gere. The questionnaire editing procedures were explained

in greater detail in the Supervisor’s Manual, which was provided to the supervisors. The

supervisors conducted through edits of questionnaires each day and discussed with

each interviewer the errors found. Detail about the supervision and quality assurance

procedure is presented in Section IV of this report.

3.4. Ethical aspects of the survey

IRB clearance:

Save the Children International obtained IRB clearance from the National Ethical

Clearance Committee of the Ethiopia Science and Technology Commission.

Consent process:

All field staff including interviewers, supervisors, coordinators and other staff were

trained on the ethical aspects of the study as part of the training of data collection

teams. Teams were specifically oriented on the importance of obtaining informed

consents, respecting voluntary participation of respondents, their privacy and

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confidentiality of the data collected. They were trained on how to obtain appropriately

informed consent from the study participants. All interviewers always carried informed

consent forms that plainly written and describing the objectives of the study, the

selection of study participants and potential use of the data collected. The consent form

also clearly explained that participants were free to refuse to be interviewed or to

answer all or part of the questionnaires. Interviewers are required to read loud the

consent form in the respondent's local language. An oral consent was obtained from all

participants because the majority of the population under-study had no formal

schooling and use of written consent was not feasible. No payments was made to

participants for responding to the questioners.

Save the Children International Child Safeguarding Policy and Code of Conduct:

The survey teams including all interviewers, supervisors, coordinators, senior staff of

Mela were trained on Save the Children Child Safe Guarding Policy and code of conduct.

All survey staff members signed a form to assure their compliance with the policies.

3.5. Challenges

This endline survey was not without challenges and the major challenges are as follows:

Meeting the deadline for data collection:

The original data collection duration was estimated based on the assumption that an

individual interviewer would complete 13 household interviews per day. Assessment of

the data collection progress in the first 10 weeks proved this was not attainable, which

was due to tough topographies, sparsely populated households requiring long travel

between adjacent households in some Kebeles, and heavy rain in some places also

destructed the data collection. In some Kebeles the listing of households was time

consuming because the family folder and the other sources were poorly organized;

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delaying the actual start of data collection in a Kebele. In addition, contextual factors

such as two market days in some areas, the presence of women working outside home

in some areas made it difficult to find women for interview, hence repeat call backs to

the household. These elements affected survey progress and were outside the control

of the survey teams. Indeed, the 10-week progress revealed that an interviewer could

complete a maximum of 11 households per day with all the constraints. Thus, in order

to avoid further delays in completing the survey, Save the Children and Mela agreed to

add one new interviewer per team; a total of 21 additional interviewers for the 21

teams. Mela recruited, trained and deployed these additional interviewers. Five

additional interviewers were also trained to serve as reserves in the event of attrition.

Besides, the increased number of households to be visited as compared to the initial

estimate (119,000 vs. 143,964) coupled with the aforementioned challenges required

extending the data collection period for 15 days in Oromia and 20 days in Sidama.

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Tough topography:

Some survey Woredas such as Adaba in Oromia, Bensa and Yaye in Sidama have very

tough topographies for data collection.

High call backs in some Woredas and Kebeles:

In some places especially in Adulala Woreda finding women for interview was

challenging because most women work outside home in nearby plantations. This

delayed the data collection time in the Woreda as interviewers had to make 2-3

callbacks to interview the women.

Heavy rain during the survey period:

Due to heavy rain data collection was interrupted in some Kebeles and that data

collection teams had to return to such Kebeles after the rain stopped.

Presence of small and big market days:

There were Woredas and Kebeles in the survey areas that had two or more market days

per week. In such areas interviewers had to make two or more callbacks to find

respondents for the interview, which delayed the data collection process.

Challenges in household listing:

In most Kebeles family folders and other listing sources such as the DTL were

incomplete and poorly organized. As a result, teams had to spend more time to

complete the list in close consultation with Kebele guiders, HEWs and Kebele

administrators and chairpersons.

High workload on supervisors:

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Supervisors of this endline survey had several competing responsibilities that were quite

demanding including team management, assigning teams to households, making on-

spot observations, re-interviews, editing questionnaires, submitting reports to the

coordinators, organizing review meetings among others.

Attrition of survey team members:

Since the start of data collection in February 1, 2013 a total of 23

interviewers/supervisors dropped from the survey at different time due to different

reasons. Attrition can be considered modest because the survey maintained over 80% of

the interviewers/supervisors until the final day of data collection despite the challenging

nature of the field work.

Meeting the deadline for data management:

The data management aspect of this survey was initially planned based on 119,000

households and 115,000 women in the reproductive age. Nevertheless, the survey

ended up visiting over 143,000 households and over 132,000 women in the

reproductive age. This means the number of households visited increased by 20%

compared to the initial estimate. resulting in longer data editing, data entry and

cleaning time.

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IV. SUPERVISION AND DATA QUALITY ASSURANCE

Supervision of the endline survey data collection process and survey undertakings took

various layers. The main task of supervision rested on the team supervisors. At the

second level, the regional coordinators were in charge of supervising the performance

of teams including the team supervisors. The lead fieldwork coordinator was also

supervising overall survey process at the higher level. Apart from the team supervisors,

the regional coordinators and the lead fieldwork coordinators made frequent on-spot

check of interviews in the gashas/geres, randomly reviewed filled questionnaires,

performed questionnaire editing and presented in review meetings with the

interviewers and team supervisors. Save the Children assigned two external survey

monitors also monitored and supervised the progress of the fieldwork, reviewed

completed modules, and provided technical support to survey teams throughout the

data collection period.

Another layer of quality control came from the office editing process that verified filled

questionnaires for their completeness, legibility of responses, linkage and consistency

across different modules from same households. Any problem identified at this level

was communicated to the regional coordinators and, thereby, to team supervisors.

The supervision and quality assurance was done at the gasha/gere level and consisted of

the following major activities - (1) on-spot observing interviews (2) re-interview and (3)

conducting review meetings, (4) questionnaire editing and (5) hand tally of selected

indicators.

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4.1. On-spot observation of interviews

The purpose of the observation was to evaluate and improve interviewer performance

and to look for errors and misconceptions that couldn't be detected through editing.

Thus one of the major quality assurance of the field data collection was on-spot

observation of interviews by the supervisors. During the survey period each supervisor

had to make between 10 and 15 on-spot observations per week. This means each

interviewer was observed on average twice per week. The supervisor had to fill the

interview observation checklist in every observation and discuss his/her findings with

the interviewer. On spot observation was more frequent at the beginning and end of

the survey. On-spot observations of interviews were also made by the survey

coordinators and COMBINE assigned external monitors.

4.2. Re-interviews

One of the most important functions of the field supervisor was to ensure that the

information collected by the interviewers was accurate and this was assured via re-

interview of selected households and respondents. A supervisor was expected to

conduct two re-interviews per day. At the beginning of the survey this was achieved in

both regions and by almost all supervisors. However, due to other competing tasks and

time constraints for other survey activities most supervisors were able to conduct one

re-interview a day. The re-interview of households was equally distributed across the

five/six interviewers under a supervisor so that the supervisor would have the chance to

evaluate all the interviewers under him/her. To conduct the re-interview, the supervisor

used a yellow colored blank modules (the main questionnaire modules were prepared in

white papers), should fill in the identification information with a red pen, and write

clearly “REINTERVIEW” on the top of the questionnaire Modules. The supervisor would

then visit the selected household with only the re-interview questionnaire (i.e., without

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taking the original questionnaire) and interview the household and respondents. The re-

interview asked all questions on Module 1 and 2 but selected questions on Module 3.

Due to the sensitive nature of the information to be collected we did not implement re-

interview for Module 4. After completing the re-interview, the supervisor should obtain

the original questionnaire and compare the information. He or she write the results of

the comparison on the re-interview questionnaire. If problems were detected

frequently with the same interviewer, the supervisor needed to check the interviewer’s

work very closely. The re-interview questionnaires were included with the other

materials and sent back to the Satellite offices and then to the center.

4.3. Review meetings

Regular review meeting of data collection teams was one of the mechanisms to monitor

survey progress and improve performances. In the first month of the survey the review

meetings were conducted on daily basis but this was later on rescheduled to be held on

weekly basis based on recommendations from survey coordinators and COMBINE team.

The review meetings were basically feedback sessions of activities, implementation of

survey methodologies, on common errors and data quality, time management, among

others. The meetings were mostly led by the regional survey coordinators and attended

by COMBINE external monitors.

4.4. Questionnaire review and editing

Ensuring that questionnaires are reviewed for completeness, legibility, and consistency

was one of the most important tasks of the supervisor and coordinators. Every

questionnaire was completely checked in the field by the supervisors before submitted

to the coordinators. Any serious problem with the questionnaire was discussed with the

interviewers and re-interviews would be conducted as deemed necessary. In such a

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situation, supervisors could instruct interviewers to go back to the respondent to get the

correct information. Questionnaire editing was done on timely basis before the team

left a Kebele. Details questionnaire editing procedures and the steps were provided in

the Supervisor's manual.

The survey coordinators were also responsible to review completed questionnaires on a

random basis. Each coordinators was tasked to review and edit a minimum of 25

questionnaires per week. Another layer of questionnaire review came from the

COMBINE survey monitors who regularly checked a sample of completed questionnaires

for completeness, legibility and accuracy. The monitors reported back to the supervisors

any comments they might have concerning the questionnaires they reviewed.

4.5. Hand tally of selected indicators

Hand tallies of selected indicators were performed by the coordinators at a gasha/gere

and Kebele levels. The indicators included (1) # of module 2s to module 1s ratio (2) # of

module 3s to module 2s ratio, (3) # of module 4s to module 2s ratio and (4) % pregnant

last 3 years. Indicators number 1, 2 and 4 were reported at gasha/gere levels while

indicator number 3 at Kebele level. The expected range of valid values for these

indicators were obtained from previous surveys including the Ethiopia DHS for

comparison. Explanations were sought for the very few out of range indicator values

observed during data collection. Such findings were presented in the biweekly interim

reports.

4.6. General review/feedback meeting

A one day review/feedback meeting was held in the presence of all survey teams, Mela

and Save the children senior staff on March 8, 2013 for Oromia and March 9, 2013 for

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the Sidama. This was about six weeks after the start of data collection. The meeting

discussed and reviewed survey progresses, lessons and challenges of the six weeks

survey activities. The results of the review meeting formed the basis for several

recommendations to improve the subsequent conduct of the survey and also clarified

some misconceptions. Areas that were emphasized during the meeting included ways to

enhance data quality, standardizing and clarifying some survey procedures such as

household listing, re-interview, on interviewers assignment, and on how to balance

speed and quality. The meeting also addressed on how to improve communication

between the different layers of survey personnel and with the COMBINE monitors and

important recommendations were put foreword. The outcomes of the meeting and

recommendations were summarized and distributed to the survey teams.

4.7. Progress reports and data sharing

Questionnaire pre-test report:

The survey questionnaire modules were pretested and amended based on findings of

the pretest. A pretest report was prepared and submitted to Save the children at the

early stage of the assignment.

Training report:

The training of survey data collection teams was documented and a report was

submitted to Save.

Interim reports:

Mela submitted 13 interim reports to Save the Children every fortnights since the start

of the survey. The interim reports tracked progress of data collection, monitoring and

supervision, data editing and data entry processes. In addition, key survey monitoring

indicators as well as intermediate analysis of key program indicators were reported

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regularly. Challenges encountered and measures taken to correct problems were also

part of the biweekly interim reports.

Data sharing:

Mela shared the computerized survey data to Save the Children at different time of the

data processing in order to get timely feedback.

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V. DATA PROCESSING

The data processing activities of this survey involved manual and automatic processes

that encompassed a number of steps including receipt of completed questionnaires,

office checking/editing, data entry, data verification, cleaning and generation of

intermediate indicators. Data processing was performed concomitantly with the data

collection; with the first set of data arrived in the satellite offices about two weeks after

the start of data collection and data entry was launched about three weeks after the

start of data collection. The data processing activities were carried out by a team of data

editors, questionnaire administrators, data entry clerks, assistant data manager and the

data manager. Details about the data processing can be consulted from the data

processing manual. This section briefly describes the different data processing activities.

5.1. Questionnaires administration and office editing

The Filled questionnaires arrived at the satellite offices twice a week during the survey

data collection period. The regional coordinators submitted the filled questionnaires

and other forms to the Satellite offices using a questionnaire submission form that were

prepared for the purpose.

Office clerks at the Satellite offices performed questionnaire verifications that included

checking for completeness of filled questionnaires, legibility, proper use of codes, and

transfer of codes. In addition they assigned office identification (IDs) to the

questionnaires, packed the questionnaires by gasha/gere and sent the data to the

central Mela office in Addis Ababa. A standard operating procedure (SOP) was employed

to guide the different activities in the Satellite offices. The Satellite offices in Hawassa

and Ziway each were staffed by 5-6 office clerks. The offices were also responsible for

keeping stock of blank questionnaire modules and checklists/ forms.

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The questionnaire administrators at the central office received the filled questionnaires

and other forms that were verified and labeled by the Satellite offices using a

questionnaire receipt form. Verified and edited questionnaires were regularly (mostly

every week) transported from the Satellite offices to the central office in Addis Ababa.

The questionnaire administrators at the center assured that the questionnaires were

screened by the Satellite offices, office IDs were assigned and recorded the area

identifications of the questionnaires in an Excel file and stored the questionnaires in the

appropriate questionnaire rack.

5.2. Data entry

EPI-INFO software was used for data entry. Four separate data entry templates were

prepared for the four modules. The data entry template was designed to accommodate

three interlinked EPI-INFO system files - QES, CHK and REC files. The QES file captured

the variables as they appeared in the questionnaire modules. The CHK file was

programmed to control data entry such as skip patterns, range rules, valid values and

consistency checks. The REC file was the actual database where entered data were

stored. Data entry began about three weeks after the launching of data collection.

Sixteen data entry clerks were involved to computerize the entire survey data over a

period of five months. The data entry clerks were given orientation and training by the

data manager and the assistant data manager on the structure of the data and the data

entry templates. The data manager was in charge of the overall execution of the data

processing in the central office. Each data entry clerk was assigned to enter data from a

given gasaha/gere and the assistant data manager assigned data to each clerk using

data entry assignment sheet. Each data entry were tasked to enter one full gasha/gere

at a time. Since we implemented a double data entry procedure the data entry clerks

were paired according to their sitting arrangement. After completing a single data entry

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the paired data entry clerks exchanged the data from a gasha/gere and performed

double data entry in a separate folder. After the double data entry completed for all the

questionnaires from a gasha/gere, the data entry clerks returned the questionnaires to

the assistant data manager. The assistant data manager put a stamp (that marked

"ENTERED") on the questionnaire package and stored it in the appropriate rack.

5.3. Data verification and cleaning

The 16 data entry computer terminals were connected to a central Server via local area

network (LAN). This allowed automatic storage of the data entered by each clerk onto

the Server. The server was managed by the data manager. The data manager always

checked the completeness of the entered data against the hard copies documentation

for each gasha/gere. After verifying the completeness of the entered data, he exported

the data to STATA 11 for consistency checking and intermediate analysis of key

indicators.

In the STATA system the entered data were regularly (weekly) challenged for

reconciliation of double entry and consistency across modules. Inconsistencies were

reported back to the data entry clerks via the assistant data manager for subsequent

correction and cleaning. Data cleaning was done regularly on daily basis and all cleaning

activities were documented at a gasha/gere level.

Selected survey monitoring intermediate indicators were also generated every fortnight

and included in the biweekly interim reports. A number of STATA do files were prepared

to automatically execute the different operations on regular basis. Below a summary of

the main do files.

|46

Cleaning: The cleaning do file generated cleaning outputs for each data entry

clerk. This checked the uniqueness of each questionnaire via the coding scheme,

checks all module 2s had module 1s, checked all module 3s had module 1 and 2,

checked all module 4s had modules 1 and 2. As well, it checked for missing

responses and outliers for open ended questions. It also checked all eligible

women in Module 1 had Module 2. This do file was executed on the server by

the data manager and the project leader's computer. The cleaning do file was

divided in to separate do files based on thematic areas. The separate do files

were integrated to a master do file.

Labeling and coding: This do file generated variable and value labels for each

variable. This do file also imputed some variables such as data entry name and

code.

Append: This do file designed to append (add cases) the data set from the

different data entry clerks into one. It executed on the server by the data

manager.

Backup: This do file stored daily backups of the appended data file.

Reshape: This do file was designed to create birth/pregnancy-based data from

Module 2. The resulting birth-based data was the basis for the computation of

different neonatal mortality related indicators.

Intermediate analysis: Selected intermediate indicators were defined and

written as Do files in STATA and was executed every other week for reporting

5.4. Data feedback and review meetings

The data manager sent feedbacks to the regional coordinators regularly based on his

findings from the data quality assessment. Since data quality checks were made by

gasah/gere and by team this made it easier to give specific and timely feedback to each

team. When the data manager identified repeated errors or error patterns relating to a

|47

given team or even an individual interviewer that was communicated promptly to the

project leader as well as to the overall coordinator for actions. The data manager and

assistant data manager held weekly meetings with the project leader to discuss issues

related to data processing and data quality. A number of review meetings were also

held with the data entry clerks on how to improve quality and speed.

The data manager presented his observations and notes to the entire survey staff during

the feedback meeting that was conducted six weeks after the start of data collection.

The presentation focused on observations from the data entry process on data quality

and completeness. Important recommendations were also forwarded to the data

collection teams.

5.5. Intermediate indicators

One of the primary goal of the data processing was to produce high-quality data. On top

of the various data checking and verifications procedures described elsewhere above,

we also put in place a procedure to run intermediate frequencies and cross-tabs as part

of the data entry process to further assure data quality and completeness. The

indicators included (1) response rates for each questionnaire module, (2) proportion

pregnant in the last 3-year, (3) proportion of births in the last year, (4) proportion of

births in the last 2 months, (5) neonatal mortality rates including very early, early and

late neonatal mortality rates, (6) still birth rate, (7) proportion visited by vCHW or HEW

during pregnancy and postnatal period, (8) antenatal coverage and (9) institutional

delivery. These key program indictors were computed every other week and reported

to Save the Children as part of the interim reports.

|48

VI. RESULT OF INTERVIEWS AND KEY PROGRAM INDICATORS

6.1. Number of interviews and response rates

This endline survey was basically a census of all households in 131 Kebeles of the three

zones. It was fielded during February 1- June 26, 2013. The survey teams in the three

zones identified and visited 143,964 households but interviews were conducted in

130,405 households giving a response rate of 90.6% (Table 1). The main reasons for not

interviewing 9.4% of the "households" that were indentified in the household lists were

absence of household members for extended period, vacant dwellings or non residential

houses and dwelling destroyed. The largest number of the households were interviewed

in Sidama (n=73,245; 56.2%) followed by East Shoa (n=34,301; 26.3%) and West Arsi

(n=22,859; 17.5%) zones.

In the entire survey Kebeles a total of 134,064 women aged 15-49 years were identified

who were eligible for interview using module 2. Of these women, the survey achieved a

98.6% response rate by interviewing 132,152 of them. The response rates for both

modules 1 and 2 compare across the three zones although it was a little bit higher in

East Shoa for module 1 at 93%.

By design, the survey focused on interviewing women who had a delivery in the 60 days

prior to the date of interview using the questionnaire module 3 as described elsewhere

above. In total, 2950 such women were interviewed out of 3008 who were eligible for

this interview. This resulted in a high response rate at 98%. The distribution of such

women by zone varied in accordance with the population size and fertility patterns -

51.5% of these women came from Sidama, followed by West Arsi (27.2%) and East Shoa

(21.3%).

|49

Mothers who had a dead neonate that occurred more than 60 days and less than 12

months from the date of the survey were interviewed using module 4. We interviewed

392 such women out of 403 who were eligible for this interview. The response rate for

questionnaire module 4 was thus 97.2% and compares well across zones.

Table 1. Number of eligible respondents, interviewed and response rate by type of module and zone, COMBINE endline survey - February 1-June 26, 2013

Type of Module Type of respondent Eligible for the interview

Interviewed Response Rate (%)

Total (3 zones)

Module 1 Household 143,964 130,405 90.6

Module 2 Women age 15-49 years 134,064 132,152 98.6

Module 3 Women who had a delivery in the previous 60 days

3008 2950 98.1

Module 4 Mothers who had a dead neonate that occurred more than 60 days and less than 12 months from the date of the survey

403 392 97.2

East Shoa (Oromia)

Module 1 Household 36,804 34,301 93.2

Module 2 Women age 15-49 years 32,165 31,320 97.4

Module 3 Women who had a delivery in the previous 60 days

644 625 97.0

Module 4 Mothers who had a dead neonate that occurred more than 60 days and less than 12 months from the date of the survey

134 131 97.7

West Arsi (Oromia)

Module 1 Household 25,584 22,859 89.3

Module 2 Women age 15-49 years 24,133 23,557 97.6

Module 3 Women who had a delivery in the previous 60 days

831 804 96.7

Module 4 Mothers who had a dead neonate that occurred more than 60 days and less than 12 months from the date of the survey

129 127 98.4

Sidama (SNNP)

Module 1 Household 81,576 73,245 89.8

Module 2 Women age 15-49 years 77,766 77,275 99.4

Module 3 Women who had a delivery in the previous 60 days

1533 1521 99.2

Module 4 Mothers who had a dead neonate that occurred more than 60 days and less than 12 months from the date of the survey

149 134 95.5

|50

6.2. Census population age and sex structure

As described elsewhere above in this report this endline assessment was a census-based

survey of all households in the study area. A de facto census approach was used, i.e. all

persons who were in a household during the previous night, irrespective of their place

of usual residence were enumerated at the house where they spent the night.

Accordingly, the de facto population during the period February 1 - June 26 was 685,785

persons (Table 2). Of these the majority (55.8%) were from Sidama and this was

followed by East Shoa (24.9%) and West Arsi (19.3%). Of note, 99% of the persons

included in the census were usual residents of the households.

The age structure of this study population depicts the typical age structure of rural

Ethiopia as revealed by the national census (Figure 3). The mean age of the population

was 21.6 years and compares well across the three zones. About 14% were under 5

years of age. The proportion of under 5 children was the highest at 18% in West Arsi and

the lowest (12.4%) in Sidama. Women in the reproductive age (15-49 years) constitute a

fifth of the population and this was comparable across zones. The population was nearly

equally distributed by sex. Average household size was 5.2 persons for the entire survey

but this was the highest at 5.8 in West Arsi. The prevailing high fertility in West Arsi

explains the noted variation.

|51

Figure 3. Population pyramid - COMBINE endline survey - February 1-June 26, 2013

Pyramid Chart

Se

qu

en

ce n

um

be

r

18

16

14

12

10

8

6

4

2

Female Male

Table 2. Age-sex distribution of census population by zone, COMBINE endline survey - February 1-June 26, 2013

East Shoa N=170,631

West Arsi N=132,230

Sidama N=382,925

Total N=685,786

Age

0-4 13.9 18.1 12.5 13.9

5-9 17.8 20.6 18.9 19.0

10-14 15.8 15.1 17.5 16.6

15-19 10.7 9.9 10.7 10.5

20-24 7.2 6.5 6.3 6.6

25-29 7.2 6.4 6.8 6.8

30-34 5.3 4.8 5.9 5.5

35-39 5.3 4.7 5.6 5.4

40-44 3.6 3.2 4.0 3.7

45-49 2.7 2.3 2.6 2.6

50-54 2.5 2.1 2.5 2.4

55-59 2.3 1.9 2.0 2.1

60-64 2.0 1.8 1.8 1.8

65+ 3.9 2.7 2.8 3.0

Age missing 0.1 0.1 0.1 0.1

Mean age 19.0 20.8 20.7 21.6

Sex

Male 52.2 50.4 50.3 50.8

Female 47.8 49.6 49.7 49.2

Average Household Size 5.0 5.8 5.2 5.2

|52

6.3. Selected key survey indicators

6.3.1. Fertility characteristics

Pregnancy last 3 years:

Questionnaire Module 2 predominantly focused on pregnant women in the three years

preceding the survey. As shown in Table 3, 41.7% of the women in the reproductive age

reported to have had at least one pregnancy in the previous three years. The pregnancy

rate was reported the highest in West Arsi at 51.7%, followed by East Shoa (42.5%) and

Sidama (38.3%). The noted difference in the rate of pregnancy across the three zones

was a reflection of differential in the fertility patterns of the population studied. The

overall rate of 41.7% for this indicator compares well with other surveys including the

Ethiopia DHS. The Ethiopia DHS collected data on the proportion of women with live

births and the three-year rate was reported at 45% (Ethiopia DHS, 2011).

Birth Last Year:

About a tenth of the women in the entire survey have given birth in the year preceding

the survey and this varied significantly by zone - ranging from 8.8% in Sidama to 15.1%

in West Arsi.

Delivery (0-59 days):

Tracking this indicator was critical for this present survey because women with delivery

in the previous 60 days were among the primary respondents of this survey (module 3).

The survey found that 2.2% of the women had delivery in the previous 60 days. Due to

variation in fertility levels this particular indicator also varied significantly by zone, the

highest being in West Arsi (3.4%). The rate however was similar between Sidama and

East Shoa (2%).

|53

Table 3. Fertility behaviors of surveyed women, COMBINE endline survey - February 1-June 26, 2013

East Shoa West Arsi Sidama Total

Women 15-49 years (n) N=31,320 N=23,557 N=77,275 N=132,152

Pregnancy (last 3 yrs) %

42.5

51.7

38.3

41.7

Birth Last Year %

9.6

15.1

8.8

10.1

Delivery (0-59 days)%

2.0

3.4

2.0

2.2

6.3.2. Neonatal death Neonatal death rate (NDR) is estimated here directly as follows: NDR = # babies who died before the age of 28 days (previous 1 year)

# births in the previous 1 year The very early (<2 days), early (<7 days) and late (7-<28days) neonatal death rates are

also estimated the same way.

Overall, the NDR was estimated at 24.1 per 1000 and varies significantly from a low of

18 per 1000 in Sidama to 28.8 and 32.3 per 1000, respectively, in West Arsi and East

Shoa (Table 4). The data show that the very early neonatal mortality was notably high

at 15.5 per 1000, suggesting that neonatal mortality is heavily clustered in the first two

days after delivery.

Previous data and literature including the Ethiopia DHS confirmed the

disproportionately high accumulation of neonatal deaths in the first week of life. Our

data revealed that 78% of the neonatal deaths occurred in the first week of life and this

was similar with the 2011 Ethiopia DHS at 78% (Early NMR=29 per 1000 / NMR=37 per

1000). On the other hand, a relatively small portion of the neonatal deaths (22%) had

|54

happened after the first week and we estimated the late neonatal death rate at 5.3 per

1000 in the entire survey area.

It should be underscored that the neonatal death rates we are reporting here are not

based on probability measures and do not take account of the ages of death of the

neonates. As a result, the NDR we present here may well represent an underestimation

of the true rate when compared with a rate that can be computed by factoring in the

age of death of the child using a life table approach.

Table 4. Neonatal mortality rates by zone, COMBINE endline survey - February 1-June 26, 2013

East Shoa West Arsi Sidama Total

Live births last 1 year (n) N=3065 N=3579 N=6868 N=13512

Neonatal Mortality rate (per 1000)- 95% CI

32.3(26.0-38.6) 28.8(23.3-34.2) 18.0(14.9-21.1) 24.1 (21.5-26.7)

Very early neonatal mortality rate (per 1000)- 95% CI

23.8(18.4-29.2) 16.4(12.3-20.6)

11.3(8.8-13.8) 15.5(13.4-17.6)

Early neonatal mortality rate (per 1000)- 95% CI

27.1(21.3-32.8) 19.8(15.3-24.4) 14.5(11.7-17.4) 18.8(16.5-21.1)

Late neonatal mortality rate (per 1000)

5.2(2.7-7.8) 8.9(5.8-12.0) 3.5(2.1-4.9) 5.3(4.1-6.5)

[Early NMR /All NMR] (%) 83.9 68.7 80.5 78.0

6.3.3. Selected program indicators

We present below in Table 5 selected program indicators including the proportion of

women who had home pregnancy visit by a volunteer community health worker (vCHW)

or HEW and the proportion of women who had home postnatal visit by a vCHW or HEW.

In addition, we also report here the coverage of antenatal care and institutional

delivery.

|55

Pregnancy and postnatal home visits by vCHWs and HEWs:

As shown in Table 5, the proportion of women who had home visit by a volunteer during

their most recent pregnancy that ended in the previous two months was reported at

37%. Twenty-nine (29%) of the women reported to have had home postnatal visit in the

same period by a volunteer. Both indicators did not vary significantly by zone.

A tenth of the women reported to have received home visit by HEWs during the same

period. The coverage for this indicator was by far the lowest in West Arsi at 5.3% while

the highest in Sidama (12.7%). Similarly, postnatal home visit by HEWs was low at 15.1%

and varied by zone - from 6.8% in West Arsi to 19.9% in Sidama.

Antenatal care and institutional delivery:

Coverage for at least one antenatal care (ANC) visit in health facility reported to be fairly

high at 75.8%. Women in West Arsi reported to have had the highest ANC coverage

(84.8%) followed by those in East Shoa (78.4%) and Sidama (70%).

Institutional delivery remained low in rural Ethiopia and our survey found that only 17%

of the women attended their most recent deliveries (previous 2 months) in health

facilities. Nevertheless, institutional delivery appeared notably high in East Shoa at

30.1%. The corresponding coverage in West Arsi and Sidama was 19.6% and 10.3%,

respectively.

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Table 5. Selected program indictors of the COMBINE program intervention, COMBINE endline survey - February 1-June 26, 2013

East Shoa West Arsi Sidama Total

Program indicators (N) N=625 N=804 N=1521 N=2950

women who had home pregnancy visit by a volunteer (%)

37.1 34.1 38.6 37.0

women who had home postnatal visit by a volunteer (%)

28.3 25.0 31.9 29.2

women who had home pregnancy visit by HEW (%) 8.8 5.3 12.7 9.9

women who had home postnatal visit by HEW (%) 14.4 6.8 19.9 15.1

women who had home postnatal visit by a volunteer or HEW (%)

34.2 27.6 39.9 35.4

ANC in health facility (%) 78.4 84.8 70.0 75.8

Institutional delivery (%) 30.1 19.6 10.3 17.0

|57

REFERENCES AND DOCUMENTED CONSULTED

References:

1. World Health Organization, Estimates. In: State of the World’s Newborns.

Washington, DC: Saving Newborn Lives, Save the Children/ USA, 2001: p. 1-49.

2. Lawn, J.E., S. Cousens, and J. Zupan, 4 million neonatal deaths: when? Where?

Why? Lancet, 2005. 365(9462): p. 891-900.

3. Darmstadt, G.L., J.E. Lawn, and A. Costello, Advancing the state of the world's

newborns. 2003, SciELO Public Health. p. 224-225.

4. Hyder, A.A., S.A. Wali, and J. McGuckin, The burden of disease from neonatal

mortality: a review of South Asia and Sub-Saharan Africa. Bjog, 2003. 110(10):

p. 894-901.

5. Aggarwal, A., R. Pant, S. Kumar, P. Sharma, C. Gallagher, A.J. Tatooles, P.S.

Pappas, and G. Bhat, Incidence and management of gastrointestinal bleeding

with continuous flow assist devices. Ann Thorac Surg. 93(5): p. 1534-40.

6. Bhutta, Z.A., G.L. Darmstadt, B.S. Hasan, and R.A. Haws, Community-based

interventions for improving perinatal and neonatal health outcomes in

developing countries: a review of the evidence. Pediatrics, 2005. 115(2 Suppl):

p. 519-617.

7. http://www.worldbank.org/en/country/ethiopia.

8. Central Statistical Agency [Ethiopia], Populating and housing census of Ethiopia.

2007.

9. Central Statistical Authority and ORC Macro, Ethiopia Demographic and Health

Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA. 2011.

10. Oestergaard, M.Z., M. Inoue, S. Yoshida, W.R. Mahanani, F.M. Gore, S. Cousens,

J.E. Lawn, and C.D. Mathers, Neonatal mortality levels for 193 countries in 2009

|58

with trends since 1990: a systematic analysis of progress, projections, and

priorities. PLoS Med, 1990. 8(8): p. e1001080.

11. Yared M, Biruk T, Daniel ST, Tedbabe D, Abeba B. Neonatal mortality in Ethiopia:

trends and determinants. BMC Public Health 2013, 13:483BMC Public Health

2013, 13:483

Documents consulted:

Interim Reports (# 1-13)

Training Report

Recruitment Report

Questionnaire Pretest Report

Interviewers' Manual

Supervisor's Manual

Data processing Manual

Household listing manual

Survey Forms and checklists

Technical Proposal

Questionnaire Modules (1-4)

|59

ANNEX 1. LIST OF ENDLINE SURVEY PARTICIPANTS

Project Leader-Mela Supervisors Interviewers

Dr. Yared Mekonnen Meaza Gezu Gurmesa Delesa

Tameru Hailu Abdela Kedir

Save the Children International Kumera Dereje Sharew Alemu

Dr. Abeba Bekele Zeyneba Hussen Giazachew Chalchisa

Biruk Tensou Ashenafi Geletu Adisu Kitela

Berket Mathewos Alemtsehay Tadese Nuriya Yacob

Jeane Rusell Shifera Bekele Helil Mohammed

Muluken Amare Abu Zenebe

Lead Survey Coordinator -Mela Tesfaye Damo Fitru Getahun

Ambaye Degefa Ayalew Aklilu Gezahegn Guta

Mutahir Hussen Zemedkun Abayneh

Data management -Mela Melke Mandefro Wubeshet Abebe

Ayanaw Amogne (Data manger) Solomon Assefa Shimelis Dejene

Yonas Biruk (Assistant data manager) Tegegn Wolde Gosa Balcha

Sindu Matiyos Aneware Haji

Logistic and admin officers-Mela kefyalew Lelamo Merera Ejlta

Zekarias Bekele/Menbere H/Mariam Demissie G/Mariam Hana Teklu

Selamu Bulado Miresa Teshome

Regional Coordinators Yisak Samuel Gizachew Mulugeta

Endeshaw Wolde Marta Gebiso Mulukan Akalu

Bekana Wakweya Manaye Ekamo Sutume Befikadu

Daniel H/Mariam Seifu Shiberu Dereje Feyera

Ayele Tsegaye Damtew Tesfaye Jihad Ibrahim

Bizuayehu Desta Feleke Netera Kasahun Beneber

Abrham Shelamo Sintayehu Seyoum

Trainers Mekonnen Solomon

Mekonnen Tadesse Interviewers Abera Abdisa

Kidane Ayele Simret Dagnachew Dagnu Solomon

Seyoum Tadesse Genenew Bekele Mulugeta Leta

Bizuayehu Desta Kemal Legie Iticha Abdisa

Ambaye Degefa Weyneshet Taye Dereje Tadesse

Kasahun Mengistu Gutema Etana Bruh Alemayehu

Mohammed Jeylu Ararsa Megersa

External Monitores Melaku Alemu Damtew Feyissa

Tewodros Wuletaw Alemayehu Kelbesa Zerihun Kura

Habtamu Jigssa Fikirte Workalemahu Habib Beriso

|60

Survey participants (continued)

Interviewers Interviewers Interviewers

Firdisa Garomsa Belayneh Gessese Wondemu Gemechu

Sisay Debele Adela Feo Edelu W/Mariam

Kebede Gudisa Alemtsehay Tesfaye Markos Daimo

Mulugeta Alemayehu Tomas Toshe Habeteweld Mekonnen

Berekete Adamu Berke Wubeshet Bezabehe Belete

Amare Hailu Tigist Tesfaye Wegene Dangiso

Abiyot Tasachew Tsegaye Alemayehu Tibelets Negash

Amensisa Roro Hailu Godana Gezahegn Kifle

MekomiTafese Tseganesh Bekele Wondimu Getu

Widneh Wikaw Adisu Denise Belachew Kanafa

Takle Temesgen Kefialew Megne Bekele Harbacho

Tesfaye Dengia Lenjish Legawo Firew Hamaro

Rahel Hailu Gulilat Birhanu Kassahun Kayessa

Helen w/semayat Derje Mekonen Firew Demeke

Gitto Wakesa Buzinesh Ondo Ayele Amanuel

Dereje Keno Gemech Meta Damen Dangiso

Tades Mekonnen Tiblet Bekele Tuguma Tibo

Hana Tesfaye Emebet Alemu Temesgen Keyamo

Endrias Mohammed Teshale Kayamo Markos Ladamo

Gadissa Deressa Samuel Tekilu Degnet Haile

Zelalem Abebayehu Aklilu Zekiyo Shitaye Urgessa

Helen Haile Kasech Kifle Eyasu Ingda

Germa Tessema Sebil Mulu Mengistu Chala

Daniel Ebiso Zerihun Ayele Hailu Kumesa

Tesfaye Tadesse Henok Hareka

Demisse Benzie Medhanit Alemu

Yonas Eshetu Mesayi Abebe

Wondowsen Fanta Temesegen Tamerat

Mesfin Degefa Yitbark Yakob

Felekech Kifle Hailu Toshe

Petros Shala Tamirat Tadesse

Agegnehu Tsegaye Balay Yote

Aberash Gebiso Shiferahu Tilahun

Degife Subra Hayider Kedir

Abebe Abero Eshetu Tariku

Netsnet Mesfin Genet Sato

|61

Survey participants (continued)

Data editors Data entry clerks

Yonatan Tadesse Eyerusalem Mohammed

Amannuel Fekadu Tsion Hailu

Solomon Girma Turufat Demissie

Robel Ayele Selamawit H/Maryame

Kenaw Molla Kimiya Kemal

Abel Daniel Azeb Abreham

Kedist Worku Freselam yemane

Mahlet Siyoum Tigist Worku

Yohannes Nigatu Tsedale Belete

Getnet Mamo Fikrte Ayele

Semeret Fikadu Zinash Solomon

Addis Amelo Selamawit Tadesse

Tsehayneshe Naro Shewaye Gezahegn

Addis Gelaw

Eftu Kassahun

Melkam Adamu

Etsegenet Asfaw

Elsabet Eshetu

Azeb Getachew

Emnet Mulugeta

Yonas Melese

Meghretu Getahun

Yeworkwuha Mohammed

Sara Abera