PLHA and OVC with Home Based Care Evaluation andBaseline Survey 2006 Cambodia Food Support to PLHA and OVC with Home Based Care Aye Thwin Consultant September 2006This survey is made

Evaluationand Baseline Survey

2006 Cambodia

Food Support to PLHA and OVC with Home Based Care

Aye Thwin Consultant September 2006

This survey is made possible by the generous support of the American People through the United States Agency for International Development (USAID). The contents are the responsibility of KHANA and the World

Food Progarm and do not necessarily refl ect the views of USAID or the United States Government.

This survey is undertaken to assess the effectiveness of the KHANA/WFP integrated programme of food support and home based care for People Living with HIV/AIDS (PLHA) and Orphan and Vulnerable (OVC) and also to establish a baseline data for new areas in which the programme plans to start in October 2006. The author wishes to express sincere appreciation to the Khmer HIV/AIDS NGO Alliance (KHANA) and World Food Programme (WFP) Cambodia for offering the opportunity to perform this exciting job.

Thanks must also go to Dr. Tith Khimuy, Dr. Leng Kuoy, Dr. Mak Munint, and Mr. Sem Peng Sean for team formation, training, logistical arrangements, fi eld supervision, feedback and overall coordination. Without their contributions, the survey could not have been up to this quality. Thanks are also due to the survey teams for their enthusiasm, tireless effort and devotion to data collection, to Mr. Kim San and his team for timely and good quality data entry and processing, and to village leaders, community volunteers, NGOs and families in the survey villages for their kind cooperation and sparing of time to participate in the survey.

Grateful acknowledgements are due to all the administrative and support staff of KHANA for facilitating the consultant’s job and necessities during his stay in Cambodia.

Invaluable support and guidance from WFP is also thankfully acknowledged.

Last, but not least, sincere thanks must go to Dr. Oum Sopheap, KHANA Executive Director, without whose sincere devotion and tireless support, this type of large scale research would not have been accomplished.

Acknowledgements

ANOVA Analysis of Variance

BCC Behavioral Change in Communities

BMI Body Mass Index

CBOs Community Based Organizations

CED Chronic Energy Defi ciency

FGD Focus Group Discussion

HAZ Height-for-age Z-score

KHANA Khmer HIV/AIDS NGO Alliance

MSG Mono-sodium glutamate

NCHADS National Center for HIV/AIDS, Dermatology and STD

NCHS National Center for Health Statistics

N.S. Not Signifi cant

PLHA People Living with HIV/AIDS

PPS Probability Proportionate to Size

OVC Orphans and Vulnerable Children

Sig. Signifi cant

SPSS Statistical Package of the Social Science

Under-fi ves 6-59 months old children

VAM Vulnerability Analysis and Mapping

WAZ Weight-for age Z-score

WFP World Food Programme

WHO World Health Organization

WHZ Weight-for-height Z-score

ACRONYMS

I. Introduction to Survey .........................................................................................................................6 1 Introduction ...............................................................................................................................................6 2 Methodology .............................................................................................................................................7

II. Results .....................................................................................................................................................12

1. Surveyed population – measurement units ............................................................................................12 2. Socio-economic and demographic situation ......................................................................................16 3. Preventing and mitigating the impact of HIV/AIDS on coping mechanisms .........................................23 4. Preventing and mitigating the impact of HIV/AIDS on food security, nutrition and health ....................31 5. Preventing and mitigating the impact of HIV/AIDS on schooling ..........................................................45 6. Integrating with development activities and improving livelihoods .......................................................49 7. Integrating with development activities. Behavioural change in communities, operational performance of KHANA partners, and challenges and opportunities for future programming .........52 8. Discussion and recommendations .........................................................................................................55 Conclusion .............................................................................................................................................56 Bibliography ...........................................................................................................................................57

Annex 1. Operational defi nitions ...............................................................................................................58

Annex 2. Sample size calculation .............................................................................................................59

Annex 3. Sampling ..........................................................................................................................................60

Annex 4. Questionnaires ...............................................................................................................................63

Annex 5. Survey Teams .................................................................................................................................65

KHANA/WFP - FOOD SUPPORT AND HOME BASED CARE OF PLHA AND OVC, CAMBODIA ...66

1 HOUSEHOLD INTERVIEW IDENTIFICATION ............................................................................................66 2 HOUSEHOLD DEMOGRAPHY .................................................................................................................673 EDUCATION STATUS OF CHILDREN OF PLHA HOUSEHOLDS ...........................................................684 LIVELIHOOD OF PLHA ............................................................................................................................695 PLHA HEALTH STATUS ..........................................................................................................................706 HOUSEHOLD BORROWING AND CREDIT ...........................................................................................717 ASSETS SOLD .........................................................................................................................................728 HOUSEHOLD EXPENDITURE .................................................................................................................739 FOOD SECURITY AND FOOD SHORTAGE ..........................................................................................7410 DIETARY DIVERSITY OF PLHA .................................................................................................................7511 MEALS CONSUMED BY PLHA AND HIS/HER HOUSEHOLD ..............................................................7612 ANTHROPOMETRIC MEASUREMENT .....................................................................................................77

KHANA/WFP - FOOD SUPPORT TO HOME BASED CARE OF PLHA AND OVC, CAMBODIA ....78

1 HOUSEHOLD INTERVIEW IDENTIFICATION .........................................................................................782 HOUSEHOLD DEMOGRAPHY .................................................................................................................793 EDUCATION STATUS OF OVC AND CHILDREN IN OVC HOUSEHOLDS .......................................804 LIVELIHOOD OF OVC ..............................................................................................................................815 OVC HEALTH STATUS ...............................................................................................................................826 HOUSEHOLD BORROWING AND CREDIT ...........................................................................................837 ASSETS SOLD ..........................................................................................................................................848 HOUSEHOLD EXPENDITURE ..................................................................................................................859 FOOD SECURITY AND FOOD SHORTAGE .............................................................................................8610 DIETARY DIVERSITY OF OVC ................................................................................................................8711 MEALS CONSUMED BY OVC AND HOUSEHOLD ................................................................................8812 ANTHROPOMETRIC MEASUREMENT .....................................................................................................89

Table of Contents

Cambodia has the highest HIV prevalence in Southeast Asia. According to the HIV Sentinel Surveillance (HSS) conducted by the National Centre for HIV/AIDS, Dermatology and Sexual Transmitted Disease

(NCHADS) in 2003, 123,100 adults are infected with HIV, of which 57,500 are women. The same survey estimated that there were 19,814 AIDS cases, of which 8,344 were women1. By 2000, it was estimated that 30,000 children had been orphaned by AIDS and that number was expected to quadruple in the next fi ve years. The HIV/AIDS epidemic nature is changing. Everyday, more people with HIV/AIDS are becoming sick and joining the ranks of those needing medical care and social support. Family livelihood is severely affected2 .

Since its launch in 1996, KHANA has established partnerships with local NGOs and CBOs to combat the epidemic. At the end of 2005, KHANA was providing technical and fi nancial support to 70 NGOs and 12 Community Based Organizations (CBOs) in 14 provinces and 3 municipalities, implementing projects on integrated care and preven-tion, focused prevention, support networks and income generation. KHANA supports 149 Home Care Teams in 11 Home Care networks and combines home-based care with prevention, impact mitigation and IEC and community education services in a comprehensive package of services3 .

In an attempt to improve food security in HIV-affected families and to help meet nutritional needs of PLHA and OVC, KHANA, WFP and MoH, started a partnership in 2003, to integrate food support into the comprehensive service package of Home-based Care. The long-term objective of the food support programme is to contribute to the mitigation of the impacts of HIV/AIDS on affected households.

The programme supports PLHA and OVC households with a monthly ration of:

(1) Rice: 30 kg (2) Fortifi ed Vegetable Oil 1 kg (3) Iodized salt 0.50 kg

This standard monthly food ration is given regardless of the number of household members or number of PLHA and/or OVC per household.

The programme is implemented in the framework of a tripartite partnership between the Government (MOH), WFP and KHANA’s network of partner NGOs. The activities at the community level are carried out by the Home Care Teams each of which consists of NGO staff, Home Care volunteers, health center staff and village volunteers.

As of July 2006, 29 NGOs are implementing integrated food support and HBC, in 193 health center-based areas in 14 provinces, covering 4,327 PLHA households and 3,903 OVC households. Furthermore, three partner NGOs are planning to start the programme in eight new health centre areas in three provinces to benefi t 257 PLHA households and 175 OVC households.

Although the monitoring process, various observations, and small-scale qualitative assessments show better results of the programme, no proper base line or evaluation study has been done during the three years since the programme was implemented in 2003.

This study was conducted in July and August 2006, to evaluate the three-year old integrated food support and home care project as well as to establish the baseline for both existing and newly planned areas.

1 NCHADS, HSS, 20032 Strategic Plan 2004-2008, KHANA3 Annual Report 2005, KHANA

I. Introduction to Survey1. Introduction

6

Immediate objectives of the programme are to:

Support an increase in the awareness, education and behavior change related to HIV/AIDS and

Preserve assets and mitigate the impact of HIV/AIDS on schooling of AIDS-affected family members and OVC by:

1. preventing and mitigating the negative impact of HIV/AIDS

2. ensuring REGULAR school attendance

3. serving income transfer to ensure stable food intake in the family

4. avoiding harmful coping mechanisms (such as selling of productive assets, school drop-out)

5. integrating with development activities such as education and vocational training based on gender-specifi c priority needs

Based on some related studies on Intervention for PLHA and OVC in the international arena4 and taking into account the guidelines in WFP’s indicators compendium and USAID guidelines5 and FAO/WHO recommenda-tions6 , the indicators to be assessed were developed based on the set objectives, and confi rmed by senior management of both KHANA and WFP. Indicators were identifi ed in fi ve broad categories:

1. Negative impact of HIV/AIDS on coping mechanisms and livelihood;

2. Negative impact on food security and nutrition and health;

3. Negative impact on schooling;

4. Ability of participation in ARV treatment, education, vocational training; and

5. Behavioral change in community and HBC teams, challenges and opportunities for future programming.

The aim of the survey was to evaluate the 2003-programme areas using these indicators as well as to provide information for possible programme adjustment and initiatives as necessary. The methodology allows an evaluation of the ongoing programme and also produces information statistically suitable as a base-line to be utilized for future evaluation of the response to food assistance, for both ongoing Intervention areas and newly planned expansion areas.

2.1 Survey DesignThe KHANA/WFP programme of food support to PLHA and OVC started in October 2003. The number of benefi ciaries increased so as of July 2006, 5,291 PLHA households and 8,539 OVC households in 14 provinces were benefi ting from the programme.

Project areas are identifi ed in WFP target communes based on three criteria (1) overlap with WFP priority areas with a high concentration of food-insecure people; (2) overlap with areas with a high concentration of PLHA and OVC requiring care and support; and (3) overlap with existence of MOH partners.

Since there has been no baseline survey, this study attempts to assess the programme effectiveness by comparing two areas; “Intervention” and “Control”. Sampling universe of Intervention area includes 113 HBC team areas in 14 provinces in which food support Intervention is ongoing. Sampling universe of Control area includes 8 HBC team areas in 3 provinces where the PLHA and OVC have never received food support, but selected for future

2. Methodology

4 Assessments on HIV/AIDS Interventions; Reports of Tanzania, Lesotho, Thailand, India5 USAID6 Living Well with HIV/AIDS, FAO/WHO

7

programme expansion. The above mentioned criteria for selecting programme areas assure the comparison, the possible confounding factors being similar; poverty, food insecurity and general socio-economic conditions, which are the main indicators used in identifying WFP priority areas as VAM analysis7 (see section 4). Moreover PLHA and OVC in both areas receive ongoing service packages of comprehensive HBC.

The effect of additional NGO programmes is also taken into consideration. The only difference between the two groups can be regarded as the food support to PLHA and OVC.

The study conducted a cross-sectional cluster survey on separate performances of PLHA and OVC in both ar-eas. Representative sample sizes of PLHA and OVC were separately calculated for each area using the formula “Sample size required for selected combination of P1 and changes or comparison-group differences to be de-tected” (see Annex 2).

Clusters were defi ned as health center areas to which each HBC team was attached. Measurement units were; PLHA and OVC for nutrition, health and livelihood indicators and households of PLHA and OVC for food security and coping indicators. Thus fi nal selection of measurement units in clusters was the random selection of house-holds of PLHA and OVC based on the benefi ciary lists of the HBC teams. The number of clusters was decided to be 20.

Although sampling was required for a large benefi ciary population widely dispersed in the Intervention areas, the small number of clusters in Control areas (total nine in three provinces), allowed selection of all clusters and still obtained the required number of measurement units by intra cluster random sampling.

The sampling procedure in Intervention areas followed the multi-stage cluster sampling utilizing PPS design to select fi nal clusters and random sampling to select intra cluster households, so as to obtain the results that are representative of each area (see Annex 2).

The fi rst stage included stratifi cation of programme areas into three broad strata, according to WFP sub-offi ce areas, namely, Kampong Cham, Kampong Speu and Siem Reap and their neighbouring provinces, in each of which the variation in the benefi ciary characteristics (see indicators) was supposed to be small.

In the second stage, two provinces from the Siem Reap stratum and one province each from the Kampong Cham and Kampong Speu strata were selected, in order to give the benefi ciaries in the strata the probability of participating in the study proportionate to the benefi ciary population size of stratum they belong to.

The third stage consisted of the allocation of the number of clusters (HCs) to each of the four provinces based on the population of the benefi ciaries in each province.

In the fourth stage, an allocated number of clusters were selected in each of the four sampled provinces by using the PPS technique.

In the fi fth stage, intra-cluster random sampling of households were conducted and each cluster was assigned the constant number of measurement units (households) to make sure that target members were suffi ciently well spread across enough clusters that survey estimates are not unduly infl uenced by a handful of clusters. Eleven PLHA and eight OVC were assigned to each cluster totaling 220 PLHA and 144 OVC in 20 clusters, which allowed 95% confi dence limit, 80% statistical power and design effect of 1.5.

7 Poverty based on income and cost of food for 2100 Cal, Stunting, Underweight, Family head education, Primary Education of children, disaster proneness: Draught or Flood by communes; Final selection also considered rapid assessment of the Implementing Partners, NGOs.

8

2.2 Survey ToolsQuestionnairesQuantitativeQuestionnaires were developed based on the indicators identifi ed. For quantitative analysis, fi ve broad categories of indicators were further categorized into 12 groups in order to make it simpler for enumerators, data entry and data analysis. Questionnaires were tested to ascertain fast and reliable data entry in Statistical Package of the Social Science (SPSS), with least error. Each questionnaire was tested by dummy analysis design to ensure that each question generates the desired information for each indicator (see Annex 4).

QualitativeA qualitative study was also conducted to obtain behavioral change, perception and programme performance information and also to weigh and/or supplement the quantitative analysis. A total of 12 Focus Group Discussion (FGD) and 16 Key Informant Interview (KII) were held; eight FGD and eight KII in Intervention areas and four FGD and eight KII in Control areas were conducted. Two KIIs were also conducted at KHANA and WFP programme offi ces.

Questionnaires were translated into Khmer by Dr. Mak Munit, programme offi cer for M&E and Food Support at KHANA, and checked by the consultant with the assistance of Dr. Leng Kuoy, Team leader of M&E and Mr. Meas Kimsan, Programme Assistant of M&E at KHANA.

All questionnaires were pre-tested in the fi eld in Takeo Province, revised and fi nalized in compliance with local culture, understandability, and feasibility in form fi lling.

AnthropometryThe anthropometry measurements were taken by trained team members assigned specifi cally for anthropometry. The body weight of the PLHA and OVC over 5 years of age were measured using standardized bathroom scales measuring up to a maximum of 120 kg with increments of 100 grammes. Those under fi ve years of age were weighed using Salter spring scales. Weight measurements were taken with the child in light clothing.

The standing height was measured of children two years of age or older. Supine length was measured for children less than two years of age using the portable length measuring board. Two assigned measurers took the height or length measurements ensuring that the child’s legs were fully extended and that the child’s head touched the vertical headboard.

2.3 Survey TeamsSurvey team members were recruited by KHANA based on their qualifi cations and experience in both quantitative and qualitative research. All members selected were university graduates. Five survey teams were assigned to fi ve broad areas by provinces. A total of 25 team members, 19 enumerators and six facilitators/team leaders were divided according to the workload of each team (see Annex 5). The team leaders were selected based on their performance during training and planning sessions, observed by trainers. The teams collected data from 20 to 28 July 2006.

9

2.4 TrainingThe training was conducted by the consultant and Dr. Leng Kuoy, from 11 to 14 of July, and assisted by Mr. Sem Peng Sean and Mr. Meas Kimsan. Anthropometry training emphasized practice and standardization. Field testing was conducted in Takeo province on 17 July, on both quantitative and qualitative data collection, including anthropometric measurements. Feed-back, discussion, revision and fi nalization of the questionnaire were done on 18 July and survey planning and random selection of intra-cluster households from the list obtained from HBC teams were conducted on 19 July.

2.5 SupervisionTwo supervisors, Mr. Sem Peng Sean for Battambang, and Dr. Mak Munit for Prey Veng were assigned to the teams which had highest workload and potential of facing constraints in the fi eld. A mobile supervision unit was established which then visited each team and assessed interview techniques and accuracy of equipment. They also randomly sampled recently completed forms, checked for errors, discussed the mistakes with enumerators and the team leaders, shared positive techniques and common mistakes among teams, and held evening meetings to discuss problems faced in the fi eld. Twenty-four hour communication was maintained by cell phones among the teams, and there was also assistance from Dr Leng Kuoy, the M&E team leader from KHANA.

2.6 Database Design & Data EntryData entry started on 29 July and was carried out by a data entry team qualifi ed for SPSS. Data was entered using a form created in SPSS version 12. Work were divided and assigned to fi ve data entry operators with their own laptops and checked two times per day, once mid-way through the data-entry process and once at the end of the working day. The completed data set in SPSS format was handed over to the consultant on 7 August. The consultant carried out data cleaning with assistance from Mr. Kimsan.

2.7 Data QualityThe data collected by the survey teams was generally of a good quality. All the team members have qualifi ca-tions and experience in social science research. Team members were accustomed to working with each other. They applied lessons learned from their previous experiences to collect higher quality, more accurate data. All participated seriously in the training, winding-up and feedback sessions as well as in supervision fi eld discus-sions. Communication channels allowed immediate solutions to be found for unforeseen problems in the fi eld. Practice and standardization procedures assessing precision and accuracy of survey teams in anthropometric training ensured the correct measurements. Age data for children (OVC or PLHA) are recorded by birth dates. The data entry format was well prepared and established to meet the requirements for data analysis. The main strength of the survey is the use of PPS sampling methodology and strictly following the sampled clusters as much as possible. The weakness is the multiple stage sampling and thus the fi nal data set needed to be weighted. Detailed analysis of data quality is presented in the following chapter.

10

2.8 Data Analysis and Final ReportAfter data cleaning, the consultant conducted the data analysis by using CDC’s EPI Info2000 software to calcu-late the anthropometric results for OVC and PLHA. The remaining data cleaning/data analysis process uses the statistical analysis software program SPSS, version 12.0. The confi dence interval was set to 95% and results are considered signifi cant at the p <0.05 level. Signifi cance for comparisons among representative results of Control and Interventions areas are determined by using Chi Square analysis for proportions and Analysis of Variance (ANOVA) / Post-hoc test for means.

The analysis stresses the comparability of the two data sets (Intervention and Control), each of which is repre-sentative of the respective group/area by sample size as well as survey design. It follows the statistical principle of ability to determine signifi cance test in comparison as long as the data set is normally distributed data (i.e. randomly selected as in simple random sampling or its simulated PPS sampling). To ensure normal distribution, allowing each measurement unit equal probability of selection in multiple stage sampling, all data were weighted using the formula recommended for weighting data resultant of sampling that are not based on probability of population size.

No attempt is made to compare the data between the provinces since it is not the objective of survey and nor does the sampling design possess the adequate statistical strength to present the data that are representative of either provinces or communes.

The preliminary report was submitted on 23 August 2006. The fi nal report was submitted on 12 September 2006.

11

Table 1 Number of clusters and number of populations interviewed and measured by surveyed areas

II. Results1. Surveyed population – measurement units

Area # of clusters

# of households interviewed # of PLHA measured

# of OVC measured

PLHA OVC

Intervention 20 208 157 208 158

Control 9 177 142 173 138

There were only nine health center areas, which can be identifi ed as Control areas, in which KHANA/partners’ Home Care Teams are supporting PLHA and OVC without food support. Thus all the PLHA and OVC in Control areas, identified and available as measurement units were interviewed and their weight and height were measured.

1.1 Age and gender distribution of PLHA and family members

Table 1.1.a. Age and gender distribution of family members of PLHA households by areas

12

Age group

Intervention Areas Control Areas

Male Female Total Male Female Total

N % N % N % N % N % N %

0-4 38 52.8 34 47.2 72 100 32 51.6 30 49.4 62 100

5- 17 187 49.7 189 50.3 376 100 115 45.3 139 54.7 254 100

18 + 209 40.2 307 59.4 517 100 171 37.7 281 62 452 100

Total 434 45 530 54.9 965 100 318 41.4 450 58.5 768 100

Children below fi ve years of age are most vulnerable. WHO defi nes 10-19 years as “adolescents.” The United Nations defi nes 15-24 years as “youth”. WFP defi nes OVC as aged below 18 years of age, and at risk of exclu-sion from school and a possibility of having to work for money. This survey analyzed these age groups separately to describe the different characteristics. The gender distribution and age group distribution in Intervention and Control areas are found similar.

Age grouping of PLHA was done by anthropometric analysis and reported with consideration of the following facts (6):

Children under-fi ve years are most vulnerable and have different characteristics;

The available reference data base for weight-for-height Z-score is most reliable only up to the age of 10 years in the currently available internationally recommended nutrition data base of Epi-Info8 ; Age group of OVC is defi ned by WFP as under-eighteen (up to 17) years; and

For the age group of 10-24 years, Body Mass Index (BMI) for age is recommended to present the nutritional status. The reference data base to compute BMI for age (cut-off being BMI for age 5th percentile) for the age group of 10-19 years is different by each one year age; and Expert committee on physical status has recommended that 18-24 years age group should be examined separately from age group of 25-49 years, because the difference of mean BMI between these two groups is more variable. Due to the above distribution, comparisons between Intervention and Control for both genders combined can not be performed in all except the 25-49 age group. Comparison can only be seen by separate gender in the other age groups.

1.2 Age and gender distribution of OVC and family members

8 Epi-Info 2000, Center for Disease Control, USA

Table 1.1.b. Age and gender distribution of studied PLHA by area

Age group



N % N % N % N % N % N %

0-4 0 0 0 0 0 0 0 0 0 0 0 0

5-10 0 0 1 0 1 100 0 0 0 0 0 0

11-17 3 60 2 40 5 100 0 0 0 0 0 0

18-19 0 0 1 100 1 100 0 0 0 0 0 0

20-24 3 50 3 50 6 100 0 0 5 100 5 100

25-49 66 36.9 113 63.1 179 100 61 37 103 62.4 164 100

50 & above 3 18.8 13 81.3 16 100 2 50 2 50 4 100

Total 75 36.1 133 63.9 208 100 63 36.2 110 63.2 173 100

13

Table 1.2.a. Age and gender distribution of the family members of OVC households by area

Age group



N % N % N % N % N % N %

0-4 27 55.1 22 44.9 49 100 24 57.1 18 42.9 42 100

5- 17 179 47.5 198 52.5 377 100 157 53.8 135 46.2 292 100

18 + 140 36.8 240 63.2 380 100 120 36 212 63.7 332 100

Total 346 42.9 460 57.1 806 100 301 45.1 365 54.7 666 100

14

From the above age and gender distribution, it is clear that OVC under-fi ve can not be compared if the genders are combined. Comparison should be performed only by separate gender. For other age groups, because dis-tribution is similar in both areas, comparison can be performed by combined gender as well as by separate gender.

1.3 Assessment of data quality Missing and Improbable ValuesThe proportion of measurements that are missing or biologically implausible is a helpful index for data quality assessment. Such extreme values indicate the errors in the anthropometric measurement itself or in the reported age. For the purpose of analysis the following exclusion criteria are used for each anthropometric index based on WHO-CDC recommendations9.

Values beyond the maximum and minimum cut-off are likely to be errors and thus treated as missing values.

Index Minimum Maximum

Height-for-Age Z Score -6.00 +6.00

Weight-for-Height Z Score -4.00 +6.00

Weight-for-Age Z Score -6.00 +6.00

9 Epi-Info 2000, CDC, USA

Table 1.3.a. Missing values-anthropometry- OVC of 0 – 10 year age group

Survey Group

Weight-for-agez-score

Height-for-ageZ-score

Weight-for-heightZ-score

measured missing % measured missing % measured missing %

Intervention 60 0 0 60 1 0.017 60 1 0.017

Control 65 1 0.015 65 1 0.015 65 1 0.015

Table 1.2.b. Age and gender distribution of OVC by area

Age group



N % N % N % N % N % N %

0-4 4 66.7 2 33.3 6 100 3 33.3 6 66.7 9 100

5- 10 33 61.1 21 38.9 54 100 34 60.7 22 39.3 56 100

11-17 40 41.2 57 58.8 97 100 34 44.2 43 55.8 77 100

Total 77 49 80 51 157 100 71 50 71 50 142 100

Reference <1% (0.01)

15

Most reliable reference data base for weight-for-height Z score is available only for 0-10 year age group. Thus all three anthropometric indices were checked for missing values and were found to be around 1%. Because missing values for HAZ and WHZ scores are found more than 1%, they were re-checked by Means and Standard Deviations (SD), as follows:

Table 1.3.b. Mean and Standard Deviation of weight-for-age, height-for age and weight-for-height Z-scores among OVC of 0-10 year age group.

Survey group

weight-for-age Z-score height-for age Z-score weight-for-height Z-score

Mean SD Mean SD Mean SD

Intervention -1.88 1.05 -2.05 1.33 -0.89 1.19

Control -1.97 1.31 -1.81 1.371 -1.35 1.11

The standard deviation of an anthropometric index refl ects the intrinsic variability of the index in the population and the variability due to measurement error. With accurate age estimates and anthropometric measurements, the SD of the observed Z-score distribution should be relatively constant and close to the expected value of 1.0 for the reference distribution. World Health Organization-1995 has reported usual ranges for the standard deviations of anthropometric indices observed in a large number of surveys, which serve as a guide to assess the quality of anthropometric data. The majority of the survey populations ranged within approximately 0.2 units of the expected value: 1.00 to 1.20 for weight-for-age, 1.10 to 1.30 for height-for-age, and 0.85 to 1.10 for weight-for-height. Survey data with standard deviation values higher than these values implies there may be errors with the age or anthro-pometric data. Values less than these imply a population with little intrinsic variation and no problems with age or anthropometric data.

The observed values in both Intervention and Control areas are found to be consistent with the reference range of Standard Deviations for all three indicators. This fi nding indicates the accuracy and profound quality of age estimates and anthropometric measurements by the survey teams.

There was only one PLHA in the 0-10 year age group, thus quality analysis could not be performed. For adoles-cent and adult anthropometry, data quality was checked visually by multiple and sub-set measurements.

16

2. Socio-economic and demographic situation

Socio-economic characteristics of Intervention and Control areas are analyzed to decide whether the two areas are statistically comparable for the analysis of difference attributed to the food support Intervention. In other words, in was tested whether possible confounding factors of basic socio-economic situation, is well controlled in case-Control analysis, as follows.

Table 2. Average vulnerability analysis and mapping scores in two areas

Areas mean VAM score frequency of communes signifi cance test

Intervention 0.44 20 Not Signifi cant P: 0.699Control 0.45 8

According to VAM score as the result of multiple indicator analysis including poverty and nutrition status conducted in 2004, by communes, mean VAM scores are apparently similar and difference is statistically not signifi cant between two areas.

Further analysis of socio-economic indicators in the current survey also reveals the similarity in both areas as shown below.

2.1 Household size

Table 2.1.a. Household size – PLHA households

Household members Intervention Control

Frequency Percent Frequency Percent

1 ~ 4 members 107 51.4 105 59

5 ~ 7 members 80 38.5 55 39.9

>=8 members 21 10.1 18 10.1

Total 208 100 178 100

Mean family size 4.7 4.3

Table 2.1.b. Household size - OVC households

Household members Intervention Control

Frequency Percent Frequency Percent

1 ~ 4 members 53 33.3 74 52.1

5 ~ 7 members 83 52.2 51 35.9

>=8 members 23 14.5 17 12

Total 159 100 142 100

Mean family size 5.4 4.7

17

Mean family sizes are different for OVC and PLHA households, ranging from 4.3 to 5.4. The fi nding is consistent with the national data. The Cambodia Socio-economic Survey-2004 reported in its projection analysis, the declining trend of total fertility rate from 3.99 in 1998, to 3.46 in 2002 to 3.12 in 2005. Rapid community appraisal by the consultant revealed that the education and support for family planning by NGOs through the government structure of Health Centers in rural areas contribute to this effect.

Difference between Intervention and Control areas shows no signifi cance.

2.2 Education status of family members

Table 2.2.a. Education status of PLHA household members (Five years and above)

Education level Intervention areas Control areas

frequency percent frequency percent

Non-schooling 182 20.5 186 26.3

Functional literate 8 0.9 7 1

Primary school level 461 51.9 383 54.2

Secondary school level 179 20.2 98 13.9

High school level 56 6.3 24 3.4

University level 2 0.2 8 1.1

Total 888 706

18

Educational status of PLHA family members shows similar pattern in Intervention and Control groups. Around half of them, have primary education, followed by a quarter with no schooling. 10-20% have secondary education and only around 1% go up to university level.

Table 2.2.b. Education status of OVC household members (Five years and above)

Education level Intervention areas Control areas

frequency percent frequency percent

Non-schooling 204 23.8 206 30.7

Functional literate 6 0.7 8 1.2

Primary school level 478 55.8 337 50.2

Secondary school level 136 15.9 96 14.3

High school level 31 3.6 23 3.4

University level 1 0.1 1 0.1

Total 856 100 671 100

The education status of OVC family members shows the same pattern with those of PLHA and is similar in both Intervention and Control areas; more than half of them have primary schooling, around a quarter are illiterate, less than 20% have secondary level education and only about 0.1% reach university level.

19

2.3 Employment status

Table 2.3.a. Employment status – PLHA households

Households Intervention areas Control areas

Frequency % Frequency %

Farmer 17 16 8 17.7

Wage-labor-salary 10 9.4 3 8.6

Wage-labor (incentive) 8 7.5 3 8.6

Petty trade 8 7.5 2 5.7

Student 36 34 10 28.6

Out-of-school child 4 3.8 3 8.6

Housewife 3 2.8 0 0

Retired 1 0.9 1 2.9

Unemployed 12 11.3 4 11.4

Not known 7 6.6 1 2.9

Total 106 35

Figure 2.3.a

Among PLHA households in Intervention areas, only 35% have regular income as farmers, salaried labor or incentive labor. Out of 65% who are dependent, only 8% are engaged in petty trade.

The employment phenomenon is similar in Intervention and Control areas among PLHA households. Around two-thirds have little or no income.

Around two-thirds of the members of OVC house-holds in Intervention areas are unemployed, children, students, hous-ewives, or retired. Only 6% are engaged in petty trade and 35% have regular income. Of those, the majority are working in farms.

Figure 2.3.b

A similar pattern is found in OVC households of Control areas. 37% regu-larly earn income, and 63% have little or no income.

20

Households Intervention areas Control areas

Frequency % Frequency %

Farmer 18 18.6 8 26.7

Wage-labor-salary 7 7.2 1 3.3

Wage-labor (incentive) 8 8.2 2 6.7

Petty trade 6 6.2 1 3.3

Student 37 38.1 9 30

Out-of-school child 5 5.2 4 13.3

Housewife 2 2.1 0 0

Retired 1 1 1 3.3

Unemployed 9 9.3 4 13.3

not known 9 4.1 0 0

Table 2.3.b. Employment status – OVC households

21

Table 2.4.a. Gender of household heads – PLHA households

Areas Male Female Total Number

Number Percent Number Percent

Intervention 90 43.7 117 56.5 207

Control 77 45 93 54.4 171

2.4 Gender and education of household heads

* No statistical signifi cance (p: 0.512)

Areas Male Female Total Number

Number Percent Number Percent

Intervention 53 34.9 99 65.1 152

Control 47 34.3 89 65 136

Table 2.4.b. Gender of household heads – OVC households

More than half of the PLHA and OVC household are headed by females in both Intervention and Control areas.

Areas Years of education

Mean N Signifi cance

Intervention 7.82 158 Not Sig.

Control 5.29 105

Table 2.4.c. Education of household heads –PLHA households



Intervention 6.87 89 Not Sig.

Control 6.07 70

Table 2.4.d. Education of household heads –OVC households

Mean school attainment years of the household heads are not signifi cantly different between the two areas in both PLHA and OVC households. However, all of them are below eight years (the average age primary school attendance).

* No statistical signifi cance

Table 2.4.f. Education of primary care giver of children –OVC households



Intervention 4.33 95 Not sig

Control 4.53 80

Mean years of educational attainment by primary care giver of children in the households are found to be very low in both PLHA and OVC households (below 6 years). There is no signifi cant difference between two areas in both PLHA and OVC households.

22

Table 2.4.e. Education of primary care giver of children –PLHA households



Intervention 5.10 144 Not sig.

Control 4.79 99

23

3. Preventing and mitigating the impact of HIV/AIDS on coping mechanisms.

3.1 PLHA households

3.1.1 Assets

Table 3.1.1.a. Productive assets- ownership of agricultural means among PLHA households

Areas Percentage of households own at least one agricultural tool or animal

Number of households examined

Intervention 65.2% 208

Control 55.6% 182

Areas Percentage of households own land or building



Control 96.6% 178

Table 3.1.1.b. Productive assets- ownership of land or building

Table 3.1.1.c. Assets sold of owned properties – Agricultural means

Ownership of agricultural and land assets are similar in both areas. This is another factor that supports the comparison between the two areas on the effect of food assistance.

Areas Percentage of households sold at least one agricultural tool or animal


Intervention 0% 136

Control 0% 101

Table 3.1.1.d. Assets sold of owned properties– land or building

Areas Percentage of households sold land or building



Control 14.3% 170

* Difference not signifi cant



The proportion of households which sold their assets of land or buildings are the same in both areas at 14.3% each, while none of the households sold their agricultural assets. The reason is examined in the qualitative analysis; ten out of 12 FGD and all in-depth interviews reveal that selling agricultural assets is the last resort people seek as a coping strategy. Observations also show that various NGOs in the Control areas are already supporting income-generation activities and micro-fi nancing mechanisms. Moreover, safe water supplies and

24

Table 3.1.2.a. Loans by households

Areas Percentage of households receiving a loan in past 12 months



Control 87.5% 174


Areas Mean frequency of total loans

during past 12 months


Intervention 2.3 179

Control 10.3 152

Table 3.1.2.b. Loans by frequency

sanitation are also observed in many communes where NGOs are active. These areas have become the Control areas during the current survey. The effect of those development activities on coping mechanisms could not have been differentiated from the effect of food support. Those NGOs are offering their services to provide food support and planning for future integration of food support into their development efforts.

3.1.2 Loans

Figure 3.1.2.b


Table 3.1.2.c Loans by amount

Areas Mean of total amount of

most recent loan (Riels in

million)


Intervention 0. 43 9

Control 1.55 2


Although proportions of households taking loans during past 12 months seems to be a little bit higher in Intervention areas, the food support in Intervention areas has proved its ability to reduce the need for loans. This is demonstrated in the analysis of the average frequency of loans during the past year (signifi cantly lower at p value of 0.032 in Intervention areas) and amount of most recent loan (apparently, although not evidenced by statistical signifi cance, this is lower in Intervention areas, at 0.43 million Riels, compared with 1.55 million in Control areas).

Further analysis would allow more understanding of how the food support programme works towards positive changes in those households and communities.

25

Table 3.1.2.d. Loans by single source – percent of households

Areas Neighbors Money lender

Community fund or

NGO

Private bank

Credit from shop

keeper

Cow bank

Government bank

No. Examined

Intervention 55% 19% 61.9% 3.4% 3.4% 0% 0% 179

Control 71.4% 20% 0% 20% 0% 0% 0% 152

* Differences: Not signifi cant

Analysis of the different sources of loans suggests that community development activities are more active in Intervention areas and also that the PLHA and their families in these areas gain skills for less negative coping even in seeking sources of loans. Even though differences are not statistically signifi cant, it is apparent that PLHA households seek their loans less from high-risk sources (such as money-lenders, neighbors, private banks), and more from low-risk sources such as community funds or NGOs, in comparison with their counterparts in Control areas.

Table 3.1.2.e Loan by sources: more than one source

Areas double sources; neighbor & money lender

double sources; neighbor & private bank

Numbers examined

Intervention 5% 0.3% 179

Control 16.7% 2.8% 152


PLHA households in Intervention areas have taken loans more to invest in income generation activities (55%) and less because of illness (24%), while reasons for loans in Control areas are more for illness (83.5%) and less for investment (25%).

Figure 3.1.2.f Reasons for most recent loan – overall % of households

Table 3.1.2.f. Reasons for most recent loan – overall % of households

Areas Illness Business/Income

generation -

Intervention 23.7 54.92

Control 83.5 25

26

3.1.3. Household expenditure

Table 3.1.3.a. Division of household expenditure

Areas Food expenditure as percent of total

expenditure

Health expenditure as percent of total

expenditure

Education expenditure as percent of total

expenditure

Agricultural/Busi-ness expenditure as percent of total

expenditure

Number households examined

Intervention 40.7% 1.7% 30.7% 1.7% 199

Control 55.6% 5.5% 15.5% 1.6% 170


Figure 3.1.3.a.i Figure 3.1.3.a.ii

Although the statistical test shows no signifi cance, the differences are obvious. Less expenditure on food and health (40.7% and 1.7% respectively of total expenditure) in Intervention areas compares with more expenditure on food and health in Control areas (55.6% and 5.5% respectively). This demonstrates better food security and health status in food support programme areas.

Similarly, more expenditure on productive investment, in terms of education (30.7%) and agriculture (1.7%) in Intervention areas, compares with less investment in Control areas, in terms of education (15.5%) and agriculture (1.6%). This demonstrates an improvement in positive behavior towards longer term development and self-reliance in food productivity in programme areas.

Agricultural/Business

27

Areas Past unemployment after blood test Current joblessness No. PLHA

examinedMean

monthsreason as illness

% PLHAMean

monthsreason as

illness % PLHA

Intervention 6 80% 9.5 82% 112

Control 7 100% 9.6 100% 60

Table 3.1.4.a. Employment status

* Differences not signifi cant

Some PLHA cannot work for a wage because of illness. There is no other reason mentioned for not being able to work. On average, PLHA become unemployed 6-7 months after diagnosis and of those who are currently not working because of illness, they have been unemployed for an average of nine months. However the inability to work is less likely to be the main reason in Intervention areas than in Control areas (80% vs100%).

3.1.4 Livelihoods

3.2 OVC and households

3.2.1 Assets

Table 3.2.1.a. Productive assets- ownership of agricultural means among OVC households

Areas Percentage of households own at least one agricultural tool or animal



Control 71.4 142


Table 3.2.1.b. Productive assets- ownership of land or building

Areas Percentage of households own land or building



Control 71.4% 142


Ownership of agricultural and land assets are similar in both areas as in PLHA. There is no signifi cant difference between the two areas.

28

Table 3.2.1.d. Assets sold of owned properties - land or building

Areas Percentage of households that sold land or building



Control 11.9% 109


Proportion of households which sold their assets of land or buildings are the same in both areas (around 10-11% each), while none of the households sold their agricultural assets. The reason for this, as identifi ed in qualitative analysis, is that the selling of agricultural assets is the seen as the last resort for a coping strategy. Various NGOs are also supporting income- generation activities and micro-fi nance mechanisms, as well as safe water supplies and sanitary latrines. The effect of these development activities on coping mechanisms can not be differentiated from the effect of food support.

3.2.2 Loans

Table 3.2.1.c. Assets sold of owned properties - Agricultural means

Areas Percentage of households that sold at least one agricultural tool or animal


Intervention 0% 96

Control 0% 101


Tables 3.2.2.b/c. Size and frequency of loans in foster households

Areas Mean total amount of most recent loan (in

million Riel)



Control 1.6 104

Areas Mean frequency of loans during

past 12 months


Intervention 2 118

Control 2 104


Areas Percentage of household borrowing in past 12 months


Intervention 77% 154

Control 75% 139

Table 3.2.2.a. Loans by percentage of OVC households



29

The percentage of households taking loans is similar in the two areas, which can be explained by the fact that 89% of OVC in Intervention and 90% in Control areas have been fostered by the households interviewed. It means that OVC households are not necessarily affected by the loss of OVC’s parents because the majority of OVC are fostered by other households. Among the OVC households where OVC are not fostered, mean frequencies are similar but amount loans are even higher in Intervention areas. For OVCs who lost parents and are not fostered, the effect of food support is not clearly seen.

Tables 3.2.2.d/e. Size and frequency of loans for OVC who have not been fostered

Areas Mean total amount of most recent loan (in

million Riel)



Control 1.94 94

Areas Mean frequency of loans during

past 12 months



Control 6.5 94


Table 3.2.2.f. Loans by single source - percent of households

Areas Neighbors Money lender

community fund or NGO*

private bank

credit cow bank

government bank

No. Examined

Intervention 53% 19% 41% 7.1% 0 3.8% 0 133

Control 67% 28% 7.3% 16.7% 0 9.0% 0 112

* Difference in loan from Community source is signifi cant at P: 0.000* Other differences: Not signifi cant

Sources of loans to OVC households suggest a similar pattern as found in PLHA households, suggesting active community development activities in Intervention areas. It is apparent that OVC households in Intervention areas seek their loans less from high-risk sources (i.e. money-lenders, neighbors, private banks), and more from low-risk sources such as community funds or NGOs, in comparison with their counterparts in Control areas.

Table 3.2.2.g. Main reasons for loan

Reasons Intervention Control

Illness 10.5 36.0

School 0.7 11.0

Agriculture 41.6 15.2

Daily expenses 25.6 20.8

Petty cash more small business 4.2 0.0

Buy food 0.0 12.5

30

Table 3.2.3.a. Division of household expenditure

Areas Food expenditure as percent of total

expenditure*

Health expenditure as percent of total

expenditure

Education expenditure as percent of total

expenditure

Agricultural/ Busi-ness expenditure as percent of total

expenditure

Number households examined

Intervention 33% 6% 27% 3% 159

Control 57% 12% 7% 0.8% 117

* Difference of food expenditure between two areas is signifi cant at P<0.1

Less expenditure on food and health (33% and 6% respectively of total expenditure) in Intervention areas compares with greater expenditure on food and health in Control areas (57% and 12% respectively). This demonstrates better food security and health status in food support programme areas. More expenditure on productive investment; education (27%) and agriculture (3%) in Intervention areas compares with less investment in Control areas; education (7%) and agriculture (0.8%). This demonstrates an improvement in positive behavior for longer term development and self-reliant food productivity in programme areas. It shows the same pattern as in PLHA households.

Key fi ndings Statistically signifi cant effects of the food support programme in mitigating the impact of HIV/AIDS on coping mechanisms is seen in Intervention areas as:

lower frequency of loans to PLHA households;

loans from more community sources by OVC households; and

lower food expenditure as proportion of total expenditure.

Assets are not much affected in both Intervention and Control areas. Active development and income-generation activities of some NGOs are improving the situation in both areas.

Although statistically not signifi cant, positive changes in both PLHA and OVC households are quite apparent in Intervention areas as:

loans from low-risk sources like community fund or NGO;

loans are more for agricultural investment in programme areas, compared with more loans for illness in Control areas (potentially showing improved nutrition leading to improved health); and

less expenditure on food and medicine, and more expenditure on agriculture and schooling.

As with PLHA households, OVC households in Intervention areas also takes loans more to invest in income generation activities (42%) and less because of illness (10.5%), while reasons for loans in Control areas are more for illness (36%) and for food (12.5%) and less for investment (15%).

3.2.3 Household expenditure

31

4.1 PLHA and PLHA households

4.1.1 Food security

The assessment utilizes four proxy indicators for food security: consumption of diverse food groups, food shortage, meal frequency and food expenditure.

4.1.1.1 Consumption of diverse food groupsBased on the major nutritional content of each food item and the requirements of a nutritionally-balanced diet, the survey studies the food consumed by PLHA and OVC and their families, by fi ve gross categories of group:

1. Major energy-yielding staple foods; mainly rice, maize, other cereals, wheat (noodles and others), potato, cassava, other roots and tubers;

2. Energy condensed food; oil and fats;

3. Major protein-yielding food; animal protein sources such as poultry and meats, milk and milk products, eggs, fi sh and seafood including dried fi sh and fermented fi sh paste;

4. Vegetable protein; mainly nuts, legumes, beans; and

5. Source of vitamins and minerals and electrolytes such as vegetables and fruits

4. Preventing and mitigating the impact of HIV/AIDS on food security, nutrition and health.

Areas Less than 3 groups

3 groups 4 groups 5 groups number examined

Intervention 0 14.3 62.0 23.8 193

Control 0 25.0 50.0 25.0 161

Table 4.1.1.1.a. Food groups consumed by PLHA and family members during past 24 hours – percent of households

* Differences - not signifi cant

No households in either area consumed less than three food groups. Observations shows that rice, vegetable and fi sh paste are common one day meals for poor families. Consumption patterns are found to be similar in both areas; only one quarter of households consumed all fi ve groups and the majority consumed four groups in one day. More households in Control areas consumed fewer food groups.

Table 4.1.1.1.b. Proportion of households which consumed animal protein and oil

Areas Animal protein in addition to fi sh-paste Oil Number examined

Intervention 90.9 81.8 193

Control 87.5 62.5 161


32

As fi sh paste cannot be consumed up to the amount that can provide a substantial nutrition value of protein, and oil serves as the main energy condenser in a poor family’s daily meal, the consumption of those two food items are carefully considered in analysis. More households are found to consume animal protein (in addition to fi sh-paste) and oil in Intervention areas than in Control areas.

4.1.1.2 Shortage of food Shortage of three major foods; rice, maize as a substitute for rice in scarce seasons, and oil are examined. None of the households in either area experienced shortage of all these three food items together continuously for at least one month, during the past year. However, there have been shortages of individual food items.

Areas Rice Maize Oil Numbers examined

Intervention 3.32 0.95 0.26 193

Control 4.74 1.03 1.64 161

Table 4.1.1.2.a. Average number of months experiencing shortage of food items during the last year


For each major food item, individual shortages during the past year, in terms of average number of months, reveals a better food security situation (i.e. shorter duration of shortage) in Intervention areas.

Areas at leastone month

1-3 m 4-6 m more than 6 m

Numbers examined

Intervention 50 23.5 9.5 14.3 193

Control 75 37.5 25 12.5 161

Table 4.1.1.2.b. Extent of rice shortage as proportion of households experiencing various duration of shortage


Apparently more households in Control areas have experienced rice shortage from shorter to longer periods of duration than those in Intervention areas.

As the result of shortage, households tend to cope with reducing the frequency of consumption. Control-area households consumed food less frequently.

4.1.1.3 Meal Frequency

Areas Average meal frequency Numbers examined


Control 3.9 161

Table 4.1.1.3. Meal frequency


33

Table 4.1.1.4. Proportion of PLHA households by extent of food expenditure

Areas less than 50% of total

51-69% of total

70-79% of total

80-89% of total

90% and more

No. households examined

Intervention 61.9 14.3 4.8 4.8 4.3 199

Control 50 12.5 12.5 12.5 12.5 170

* Differences- not signifi cant

Further analysis of the extent of food expenditure as proportion of total expenditure reveals that PLHA house-holds in Intervention areas with food assistance are less likely to be in serious need of food to purchase from out side and thus have ability to transfer their income to other development assets, as has been described in the previous chapter.

4.1.1.4 Food Expenditure

4.1.2 Nutrition

Nutritional status of PLHA was analyzed by anthropometric indices with the reference database from World Health Organization/National Center for Health Statistic (WHO/NCHS) utilizing Epi-Info-2000 software. All PLHA in this study appear in the age range of 5 years and above. The majority are in the range of 25 years and above (195). The 5-10 year group consists only of two people, there are fi ve in the 11-17 year group, and seven in the 18-24 year group. There were no identifi ed PLHA under 20 years of age in the Control group to compare. Therefore the nutritional status of PLHA is analyzed mainly by adult Body Mass Index (BMI) for the population of 20 years and over following the principles stated below.

Figure 4.1.1.4

34

Low weight for height in the adults is defi ned as “Chronic Energy Defi ciency” (CED) categorized on the basis of Body Mass Index (BMI). BMI is described as a unit of the result of weight in kilograms divided by the square of height in meters. Low BMI (below 18.5) is defi ned also as “thinness” and classifi ed as below, according to the WHO expert committee on physical status (1995).

For the age group of 11-24 years, Body Mass Index (BMI) for age is recommended to present the nutritional status.

The reference data base to compute BMI for age (cut-off being BMI for age 5th percentile) for the 10-19 age group is different by each one year age.

It has been recommended that the 18-24 years age group should be examined separately from the age group of 25-49 years, because differences of the mean BMI between these two groups are signifi cantly variable.

Expert committee on physical status, WHO, Geneva, 1995

Public Health Problem %Population with BMI <18.5

Low-Warning Sign, Monitoring Required 5-9%

Medium – poor Situation 10-19%

High – Serious Situation 20-39%

Very High – Critical Situation > 40%

WHO classifi cation of adult BMI Thinness or CED

BMI is an important means of objectively assessing the degree of nutritional or other socioeconomic deprivation in a population. The distribution of low BMI as a public health problem in a population indicates the presence of food insecurity or the catabolic consequences of widespread infectious diseases, such as AIDS and tuberculosis. It points to the vulnerability of certain members of the population with marginal energy reserves, in the event of drought, seasonal food shortages or epidemics. Mean adult BMI and BMI distribution (CED prevalence) are very responsive to social, health or agricultural interventions including food supplementation. To evaluate the impact of the project, the survey assessed the BMI status of PLHA who are targeted benefi ciaries of the Intervention. The population distribution of BMI can provide valuable guidance for the planning of development programmes especially in those aiming to improve total food supply.

Table 4.1.2.a. Mean BMI of adult PLHA

Area Male Female Both genders Number PLHA examined

Intervention 20.02 20.36 20.24 200

Control 19.06 19.82 19.55 170


35

Although there is no statistical signifi cance, the mean BMI of adult PLHA in general shows higher in Intervention areas, in both genders. To be more accurate the analysis needs to be done in more age group divisions.

Many studies have indicated that the difference in mean BMI of women in the younger age group (18-25 years) from those aged 26-40 years is more variable. An expert committee on physical status has recommended that this younger age group be examined separately from older cohorts and that results are subjected to prudent interpretation. Because of the diffi culty in establishing appropriate limits of BMI in young adults, it is noted that particular care is needed to avoid the misclassifi cation of a large portion of people in this age group as mildly or moderately thin. When the BMI of these groups is analyzed separately, the results change as shown below. The actual situation of the population is more accurately refl ected in the 26-49 year age group.

Table 4.1.2.b. Mean BMI by recommended age groups

Area Male Female Both genders

Number PLHA

examined

Intervention 19.02 20.06 19.54 6

Control 0 19.93 19.93 5

Area Male Female Both genders

Number PLHA

examined

Intervention 20.2 20.18 20.26 188

Control 19.55 19.53 19.54 165

20-24 year age group 25 year and over

* Difference not signifi cant * Difference not signifi cant

Even after break-down into more specifi c age groups, mean BMI of PLHA in both age groups in Intervention areas are higher than those of Control areas.

Area Male Female Number PLHA examined

Intervention 16.3% 15.4% 188

Control 33.3% 25% 165


Table 4.1.2.c. Prevalence of thinness (BMI below 18.5) among adult PLHA (age 25 and over)

Although statistically not signifi cant, a greater prevalence of adult thinness among PLHA is observed in Control areas where there has not been food support.

36

Figure 4.1.2.c

4.1.3 Health

Although the food support in the current programme assists mainly to improve household food adequacy, it also encourages the reduction of opportunistic infections due to improvement of the immune system through better food and nutrition. As expected, the likelihood of getting a superimposed infection is apparently signifi -cantly lower among PLHA in Intervention areas.

Table 4.1.3.a. Percent of PLHA who got at least one infection during past two weeks

Areas % PLHAs Infected

Number PLHA

examined


Control 90.4% 170

Figure 4.1.3.a.

* Statistically signifi cant, P<0.00

When analyzing the pattern of infections, PLHA in Intervention areas appear to have fewer infections across the spectrum. PLHA in Control areas suffer from more severe infections, so fewer people reported small minor illness under the question “others”.

37

Table 4.1.3.b. Percent of PLHA by various infections

Areas Skin infection

Respiratory infection

Diarrhea fever others numbers examined

Intervention 11.4 8 9 19.4 30.8 201

Control 12.1 18.5 10.2 29.9 18.5 170

4.2 OVC and OVC households

4.2.1 Food security

4.2.1.1 Consumption of diverse food groups

Areas Less than 3 groups

3 groups 4 groups 5 groups number examined

Intervention 6.0 17.0 52.28 29.6 159

Control 10.5 32.2 35.3 21.7 143

Table 4.2.1.1.a. Food groups consumed by OVC and family members during past 24 hours – percent of households

* Differences - Signifi cant at P<0.00

Unlike PLHA households, OVC households in Control areas are signifi cantly more adversely affected by food insecurity. More households in Control areas are consuming fewer food groups than those in Intervention areas and differences are statistically signifi cant.

Figure 4.2.1.1.a.

38

Areas animal protein in addition to fi sh-paste* Oil** number examined


Control 91.6 58.7 143

Table 4.2.1.1.b. Proportion of households which consumed animal protein and oil

* Differences - Statistically signifi cant; P<0.05

** Differences - Statistically signifi cant; P<0.00

More OVC households are found to consume animal protein (in addition to fi sh-paste) and oil in Intervention areas than in Control areas. Food support (although only rice, oil, and salt) is apparently enabling the households to consume food of high nutritional value indirectly by means of income transfer (i.e. income that would have been used to purchase rice, is now being used to purchase other food items). Improvement in food security as the result of the programme, evidenced by this proxy indicator is statistically signifi cant.

4.2.1.2 Shortage of food

Table 4.2.1.2.a. Average number of months experiencing shortage of food items during the last year

Areas Rice Maize Oil Numbers examined

Intervention 1.4 1.05 0.3 159

Control 3.7 0.86 1.5 143


Shortages of major food items during the past year are worse in Control areas although the differences are not statistically signifi cant.

Table 4.2.1.2.b. Extent of rice-shortage as proportion of households experiencing various durations of shortages

Areas at least one month 1-3 m* 4-6 m** more than 6 m*** Numbers examined

Intervention 36.4 23.1 13.5 11.5 159

Control 71.4 37.7 21.5 22.3 143

* Differences - Statistically signifi cant at P<0.05

** Differences - Statistically signifi cant at P<0.10

*** Differences - Statistically signifi cant at P<0.05

More households in Control areas have experienced rice shortage from shorter to longer periods of duration than those in Intervention areas. Differences are statistically signifi cant.

39

4.2.1.3 Meal Frequency

Table 4.2.1.3. Meal frequency

Areas Average meal frequency Numbers examined


Control 3.6 143


4.2.1.4 Food Expenditure

Table 4.2.1.4. Proportion of OVC households by extent of expenditure on food

Areas less than 50% of total

51-69% of total

70-79% of total

80-89% of total

90% and more

No. households examined

Intervention 72.2 11.1 5.6 5.6 5.6 159

Control 42.9 28.6 14.3 0 14.3 117


Further analysis of the extent of expenditure on food as a proportion of total expenditure reveals that like PLHA households, OVC households in Intervention areas appear less likely to be in serious need of food to purchase from outside.

4.2.2 Nutrition

Nutritional status of OVC was analyzed by anthropometric indices with the reference database from WHO/NCHS utilizing Epi-Info-2000 software. According to the selection criteria, all OVC under this study are in the age range of below 18 years. According to the anthropometric reference data bases for analysis and interpre-tation, nutrition status of OVC over the age of 10 year was analyzed by BMI. The nutrition indices for the most vulnerable age group, under-fi ves, are separately analyzed from the 5-10 year age group.

OVC have two distinct characteristics; prolonged suffering from food-insecurity and poverty (identifi ed by VAM analysis of WFP). When they become OVC they become vulnerable to lack of care and additional food shortage. Food support programmes to OVC aim to mitigate those negative impacts. To measure the effectiveness of this programme, the study uses three anthropometric indicators.

For OVC age 0-10 years: 1. Wasting or weight for height Z score, which refl ects the current food and nutrition deprivation situation and infections (6),(11);

2. Stunting or height for age Z score which is sensitive to prolonged food assistance, especially among 6-23 months children. The effect can be measured among the 24 to 59 months age group after 2-3 years of Intervention (11) ; and

40

For those 11-17 years: 3. BMI

4.2.2.1 Weight-for height

Low weight-for-height is generally defi ned as thinness. It can be interpreted as weight signifi cantly below the weight expected of a child of the same length or height. For those populations in which prevalence of thinness substantially exceeds the 2-3% expected on the basis of normal distribution, it can be defi ned as “wasting”.

High prevalence of low weight-for-height or wasting is indicative of severe recent or current events, acute starvation and/or severe disease resulting in failure to gain weight or actual weight loss. Causes include inadequate food intake, incorrect feeding practices, disease and infection or combination of all.

The weight-for-height indicator is appropriate for examining short-term effects such as seasonal changes in food supply, disaster or shot-term nutritional stress brought about by illness. In emergency situations like famine, the wasting prevalence among children under-fi ve years of age is strongly predictive of concurrent short-term crude mortality of the population.

For targeting food supplementation in areas where wasting is common, weight-for-height is the ideal indicator for selecting those communities likely to gain most from a proposed Intervention. This recommendation is appropriate for current WFP-MCH programmes in Cambodia.

In non-emergency situations weight-for-height is the poorest predictor of mortality within the following year. However, determinants of low weight-for-height may be identified by comparing wasted and non-wasted children or weight-for-height Z-scores as a continuous variable, in non-disaster situation. Because of its very sensitive response to short-term infl uences, wasting is not advised as a measurement of change in non-emergency situations since it is highly susceptible to seasonality.

The situation of OVC in WFP targeted areas with the current deprivation of food and proneness to infections calls for the need to be tested by the weight-for height indicator.

The normal reference value of the population mean of weight-for-height Z score is regarded as Zero and any value below zero is regarded as below normal or malnourished.

41

Table 4.2.2.1.a. Mean weight-for-height Z scores of OVC under fi ve year of age

Area Boys Girls Both Number OVC

examined

Intervention -1.3 -1.55 -1.39 6

Control -1.0 -1.25 -0.47 9

Area Boys* Girls** Both*** Number OVC

examined

Intervention -0.87 -0.48 -0.72 54

Control -1.54 -0.90 -1.25 56

Table 4.2.2.1.b. Mean weight-for-height Z scores of OVC aged 5-10 years

* Not signifi cant * Statistically signifi cant at P<0.05

** Statistically signifi cant at P<0.05

*** Statistically signifi cant at P<0.01

The mean weight-for-height Z score which is the sensitive indicator for current deprivation of food and/or existence of severe infection reveals that the food support programme has positive nutritional impact on OVC aged between 5-10 years. The statistical signifi cance test proves that the impact is solely attributable to programme’s input.

Among the under-fi ves children, the indicator does not show any improvement. Instead, it visibly appears to be worse in Intervention areas although statistically not approved. This pattern can be due to the complex nature of the age group; psychologically fragile and very much in need of psychological, as well as physical care (such as care in feeding), particularly at the time of loss of parents or care person.

Figure 4.2.2.1.b

Table 4.2.2.1.c Body mass Index of OVC age 11-17 years

Area Male Female Both* Number OVC examined

Intervention 16.6 17.7 17.21 97

Control 15.7 17.03 16.46 77

* Statistically signifi cant at P<0.1

42

Elder OVC in Intervention areas are also benefi ting from the programme signifi cantly more than those in non-programme Control areas. Improvement in Body Mass Index can also be soley attributed to the programme as its nutritional impact.

4.2.2.2 Height-for-age - Stunting

Low height for age (length for age in 6-24 months children) is identifi ed as stunting. Stunting refl ects a slowing in the growth of the fetus and the child and a resulting failure to achieve the expected length as compared to a healthy, well-nourished child of the same age. It is associated with a number of long-term factors including chronic insuffi cient protein and energy intake, frequent infection, sustained inappropriate feeding practices and poverty. Stunting data is not recommended for monitoring as it does not change in the short term such as 6-12 months (16), and is an indicator of past growth failure. However stunting in the younger age group also indicates a continuing effect of these inadequacies (6).

In analysis of stunting, the aggregation of data for children less than 24 months with those over 24 months is not recommended. For evaluation purposes the presentation of stunting data for children less than 24 months is useful. An Intervention among children under 24 months is likely to be more effective than among children of 24-59 months. This is because: 1) the determinants of stunting in older children are more varied: and 2) stunting in older children may refl ect historical nutritional or health stress and can be “permanent” i.e. not responsive to any intervention (16).

Presentation of the stunting data for children less than 24 months in the two communities (Intervention and Control) is intended for use in problem analysis and in designing interventions. Data for older children (24-59 months age group) will be used for evaluation purposes.

In comparing before and after Intervention, or Intervention and Control, it is intended to see the effect of Intervention. In the case of stunting, the effect of Intervention on children under 24 months of age in preventing growth retardation will refl ect in the stature of children 24-59 months age at the time of evaluation. Thus for comparison purposes, the 24-59 month age group is selected to capture the cumulative and lagged effect that the food assistance project would have on stunting.

The situation of OVC in WFP targeted areas (high poverty level as defi ned by VAM) with the chronic long term deprivation of food, points out the need to be tested by height-for-age indicator as well.

The normal reference value of the population mean of height-for-age Z score is regarded as Zero and any value below zero is regarded as below normal or malnourished.

Table 4.2.2.2. Height-for-age Z score of children age 24-59 months

Area Boys Girls Both Number OVC examined

Intervention -0.06 -1.51 -0.55 6

Control -0.20 -1.59 -1.24 8

* Not signifi cant

The benefi ciaries of the programme and the most sensitive age group to programme input on long standing food support, 6-23 months old OVC in Intervention areas, show improvement compared with those in Control areas, as refl ected in height-for age Z score among the 24-59 months age group. Nevertheless, statistical tests do not show signifi cance for this indicator in this age group. This can be partly explained by an insuffi cient number of variables for proper statistical tests in this age group.

43

4.2.3 Health

One of the survey’s objectives was to examine the infections OVC have experienced during the past two weeks and the care provided to them. Since all OVC were experiencing at least one infection during that time, the survey examined the number of OVC who got more than one infection. Control areas are more prone to infection.

Areas % OVC infected

OVC examined Number


Control 18.8% 142

Table 4.2.3.a. Percent of OVC who get more than one infection during the past two weeks

Areas mean duration each episode

days

mean frequency of

infections

Number OVC

examined


Control 4.47 2.12 142

Table 4.2.3.b. Infection episodes

* Not signifi cant * Not signifi cant

Frequency of infections and duration of each episode show a worse situation in Control areas although the differences are not signifi cant.

Table 4.2.3.c. Care during illness

Areas attended by health personnel

reason for not attended by H personnel

-HC far away*

reason for not attended by H personnel -other

work to do*

Number OVC examined

Intervention 54% 25% 75% 157

Control 50% 7% 93% 142


The proportions of OVC who receive care by health personnel are not signifi cantly different between the two areas; however, the reasons for not getting proper treatment are signifi cant. Compared to Intervention areas, other commitments (and not the distance) are the main reason for a signifi cantly higher number of OVC in Control areas not receiving care by health professionals. Care for OVC is obviously more appreciated in Intervention areas.

Key fi ndings The statistically signifi cant effect of the programme in mitigating the impact of HIV/AIDS on food security, nutrition and health is evidenced by the following fi ndings in Intervention areas compared with Control areas:

more food groups consumed in OVC households;

more animal protein and oil consumption by OVC households;

less OVC households experience rice shortages;

higher mean weight-for-height Z score of OVC in the 5-10 year age group;

44

Higher BMI of 11-17 years old OVC; and

fewer secondary infections in PLHA

Though statistically not signifi cant, the following indicators apparently shows the better performance in programme areas:

More food groups consumed by PLHA households;

Less food shortages in PLHA households;

Higher BMI of PLHA:

Higher height-for-age Z score in OVC in the 5-10 year age group; and

Fewer infections and of less frequency and shorter duration among OVC.

No difference in weight-for-height Z score in under-fi ves can be explained because of the insuffi cient number of cases for statistical analysis; a total of fi ve for both areas.

45

Table 5.1.a. Schooling status of the children in PLHA households

5.1 PLHA households

5. Preventing and mitigating the impact of HIV/AIDS on schooling

Areas ever attend school % Current enroll % Numbers examined

Male Female Male Female

Intervention 86.4 86.4 80 80 402

Control 80.3 85.7 80 83 275

More than three quarters of the children in both areas and of both genders have ever attended school and are also currently enrolled. In both areas and for both genders, the children start kindergarten late around, 7.5 years of age

* Not signifi cant

Table 5.1.b. Mean number of school years missed among children who are not currently enrolled

Areas mean years missed numbers examined

male female*


Control 3.57 3.1 55

*Statistically signifi cant at P<0.05

Among children who are not currently enrolled in school, the average number of years they have missed is signifi cantly higher among females in Control areas (compared to Intervention).

Even among the children currently enrolled in school, those who have missed school, have missed an average of 2-3 months. There is no signifi cant difference between areas or genders.

Around 85% of the children are planning to enroll next term. The fi gures are similar in both areas and regardless of gender.

The mean number of repeated classes by children in Intervention and Control areas, regardless of gender, is similar in both areas at around 0.5 classes.

For most of the schooling indicators, there are no signifi cant differences between genders and between areas. Only the mean length of time that has been missed from school (in years) is signifi cantly longer in Control areas and among females.

46

5.2 OVC and OVC households

Table 5.2.a. Percent of OVC currently enrolled in school by gender

Areas Currently enrolled Numbers examinedBoys Girls*


Control 79.8 75.3 141

Figure 5.2.a


The food support programme proves its positive impact on schooling of OVC, especially for girls. The proportion of girl OVC currently enrolled in school is signifi cantly higher in Intervention areas. This fact becomes clear in FGD with communities:-

« Now she does not need to work for money, she is strong enough to go to school. She is happy at school because she does not need to worry about home and her Mom. »

FGD at Kraing Ampil, Kampot and Snoa village, Battambong

Table 5.2.b. Mean number of years that classes have been repeated by OVC

Areas Mean class repeated Numbers examinedBoys Girls*


Control 0.43 0.71 141

* Not signifi cant

Even though statistically not signifi cant, class repetition among girls is much lower in Intervention than in Control areas, while among boys it is the opposite, but with a smaller difference.

47

Table 5.2.c Years of school missed among OVC who are not currently enrolled

Areas Mean years of school missed

Numbers examined

Boys Girls*


Control 2.6 5.9 17

Figure 5.2.c

Among the OVC who are not currently enrolled in school, girls in Control areas have missed school for a signifi cantly longer period than girls in Intervention areas. This is evidence of the Programme’s impact.

5.3. Children in OVC households

Table 5.3.a. Schooling status of children in OVC households

Areas ever attend school % Current enroll % Numbers examinedMale Female Male Female

Intervention 85.7 91.3 85 81.8 393

Control 75 85.7 71.4 66.7 306

* Not signifi cant

The pattern is similar to PLHA households. More than three quarters of the children have ever attended school and are also currently enrolled. There is a similar pattern in both areas across both genders. In both areas and in both genders, the children start kindergarten late, at around 7.5 years of age.

Areas mean years missed numbers examinedmale* female*


Control 8.8 5.05 71

Table 5.3.b. Mean number of years missed among children of OVC householdswho are not currently enrolled

*statistically signifi cant at P<0.05

48

The children who are not currently enrolled in the schools have missed some years. The mean number of years missed is signifi cantly higher in Control areas for both male and female OVC. OVC in Intervention areas have missed fewer months before they enroll

Table 5.3.c. Mean number of months missed among children of OVC householdswho are currently enrolled

Areas mean months missed numbers examined

male* female**


Control 2.58 4.32 235

* statistically signifi cant at P<0.1

** statistically signifi cant at P<0.05

The pattern is clearer when looking at the children who are currently enrolled in schools but are still missing some months. Children of OVC households in Intervention areas have missed less months and the difference is signifi cant.

Table 5.3.d. Children of OVC households who plan to enroll and class repeated

Areas Plan to enroll next term %

Mean number of class repeated

Numbers examined

Male Female Male Female

Intervention 90% 86.4% 0.44 0.39 393

Control 85.7% 71.4% 0.47 0.70 306

* Not signifi cant

A large percentage of children are planning to enroll in school next term. However, these percentages are lower in Control areas and among females. Among females there is larger difference between Control and Intervention areas.

Approximately half a term has been repeated by male students in both areas. Female students are apparently repeating more classes in Control areas. None is signifi cant statistically.

Key fi ndings The achievement in preventing and mitigating the negative impact of HIV/AIDS on schooling is evidenced as the sole attribute of the programme by statistically signifi cant improvement of the following indicators in Intervention areas:-

Shorter duration of missing schooling in years in children of PLHA and OVC households;

More OVC girls currently enrolled; and

Shorter duration of missing schools in years by OVC girls.

49

6. Integrating with development activities, and improving livelihoods. Ability to participate in ARV treatment, education, and vocational training.

6.1 PLHA

One of the objectives of the food support programme is to attract PLHA to proper treatment regimes, and to give them the time and resources to enable them to stick to those regimes, as well, the time and resources of PLHA to enable them to regularly participate in proper treatment regimes.

Although all PLHA in both areas are currently receiving ARV treatment, more PLHA under the food support programme are regularly attending ARV treatment regimes for longer durations than their counterparts in the Control areas.

Areas Mean duration of ARV treatment months

% PLHA who regularly attend treatment

Number PLHA examined

Intervention 17.28 94.6% 201

Control 4.98 93.3% 170

Table 6.1. ARV treatment regimes

* Not signifi cant

6.1.2 Life skills training

Areas personal hygiene

food & nutrition

health care income generation

coping with community*

No. PLHA examined

Intervention 96.7 91.3 95.7 78.3 78.3 112

Control 75 62.5 75 50 37.5 60

Table 6.1.2.a. Proportion of PLHA who have obtained life skills trainings in

* Different to training in coping strategies: Signifi cant P<0.05

* Others not signifi cant

Apparently more PLHA in Intervention areas have participated and obtained training on all identifi ed categories than those in Control areas.

Areas KHANA staff HBC staff health staff Community group Friends family

Intervention 2.4% 44.3% 11.4% 40.6% 0.4% 0.9%

Control 0.74% 35.81% 25.05% 36.55% 1.11% 0.74%

Table 6.1.2.b. Sources of life skills training provision

The life skills trainings mentioned above are provided mostly by Home Care teams and community groups in both areas. Notably, training by health staff is much more evident in Control areas. The overall picture shows more activities in life skills trainings by community and HBC teams in Intervention areas

50

6.2 OVC

Areas Percent OVC fostered by households Number examined

Male female*

Intervention 76.9 75 154

Control 71.4 66.7 142

Table 6.2.a. OVC who have been fostered

* Statistically signifi cant P<0.05

With food support, the livelihood of OVC apparently improves. More OVC are fostered in Intervention areas. Difference is statistically signifi cant among girls between Intervention and Control areas at P<0.05 level.

Table 6.2.b. OVC status of studying

Areas % OVC attending school

% OVC attending vocational school

% OVC assisting in household work

No. of OVC examined

Intervention 72.2% 47% 54.8% 154

Control 42.9% 25% 39.3% 141


More OVC in programme areas are attending school, vocational training and assisting in household work (the latter point indicates that the OVC are not away from home, working) than in Control areas and they are also studying more hours per day as shown in the following table.

Areas Mean hours per day attending school

Mean hours per day attending vocational training

No. of OVC examined


Control 1.9 0.78 141

Table 6.2.c. Mean hours of studying per day by OVC

* Not signifi cant

Table 6.2.d. Proportion of OVC who have obtained life skills trainings in

Areas personal hygiene

food & nutrition

health care

Income generation

coping with community*

No. OVC examined

Intervention 77.8 72.4 72.7 32.7 32.1 154

Control 28.6 21.8 26.8 6.3 8.5 141

* Differences in all livelihood trainings are signifi cant at P<0.00

51

More OVC in Intervention areas are participating and completing various livelihood trainings than their counter-parts in Control areas, and differences are statistically signifi cant in all trainings.

Key fi ndings Programme’s significant impact on improving livelihood in Intervention areas is as follows:

So more OVC girls are fostered, and

more OVC are participating in all variety of livelihood trainings.

Although statistically not significant:

more PLHA in Intervention areas are regularly attending ARV treatment for longer duration;

more PLHA are participating in all livelihood trainings;

more OVC are attending school and vocational trainings and assisting in household work; and

OVC are studying more hours per day.

52

7. Integrating with development activities Behavioral changes in communities, operational performance of KHANA partners, and challenges and opportunities for future programming

To assess the behavioral change in the community and HBC teams and to further explore the challenges and opportunities of the programme operation, the survey team conducted a qualitative study; in-depth interviews, focus group discussions and observations, and analyzed them by triangulation techniques.

7.1 StudyA total of 12 FGD and 16 in-depth interviews were conducted. Four FGD were held for research topic 1, and eight in-depth interviews for combined topics 1 and 2 were conducted with the HBC teams and community leaders in Intervention areas. For research topic two; four FGD in Intervention areas and four FGD in Control areas were held, in addition to eight in-depth interviews in Control areas, with benefi ciaries, community members and volunteers.

Each focus group includes a mix of male and female participants. All participants reflect the diversity of the programme’s benefi ciaries as PLHA, OVC, care giver, ordinary community member and community volunteer (e.g support group member).

Observations are made during visits and also during quantitative data collection to assess the situation of households, food storage and kitchen condition, development activities in the community, and community interaction in the village.

The assessment conducts the triangulation analysis to verify and balance the fi ndings.

7.2 Key FindingsResearch Topic 1: Problems and constraints encountered by KHANA and HBC teams in monitoring and managing of food distribution.

Regular and refresher trainings for most NGO partners have been conducted on food management and reporting on the logistical aspects of food distribution. The training has been conducted by KHANA and WFP.

Despite clear criteria from KHANA, the selection of food support benefi ciaries has, on occasion, been problematic. This has occurred when the NGO partners attempt to follow the criteria but are misled by the complexity of the situation at household level. For example, there is evidence that some households are receiving double rations because the wife chose to live separately from her husband when he tested positive for HIV and then returned to him when she also tested positive for HIV. By this time, both parties have become eligible, applied for and received food support but have not informed the NGO that they are once again living under the same roof.

Stakeholders involved at all levels of the Intervention require further capacity building in some issues that would further enhance the effectiveness of the programme, such as: clear instructions and training in participatory planning, selection criteria and rationale, and an increase in the basic knowledge of Home Based Care Teams and programme staff on food and nutrition with special reference to HIV/AIDS.

The communities have an appreciative perception of the work of the HBC teams with no evidence of negative attitudes towards team members or their work.

“In 2000, the organization started to come and help people with HIV. After that, food support came and it has really improved the lives of those people. Neighbors are also starting to help them.”

Community leader, Bromol Bdom village, Kmong Kanggerg commune, Prey Veng

53

Together with the fi ndings of research topic 2, it is apparent that regular and timely information fl ow is required for programme management. If actual practices and occurrences at the ground level (such as incomplete practice of information dissemination to communities, welfare support with nutritionally controversial items, and discrepancies in the selection process), were known to management in time, then, consequently, analysis, feed back and programme adjustments could have been made in a timely manner.

Summary

Food management trainings have been conducted;

Selection of benefi ciaries has been a constraint at fi eld level;

Clear operational guidelines and basic training on nutrition and BCC are required;

The communities have an appreciative perception of the work of the HBC teams; and

There is a need for monitoring mechanisms with regular and timely information fl ows.

Research Topic 2: Changes in benefi ciary and community perception towards food support programme.

The qualitative data suggests that information about the programme has not been fully disseminated to the communities by most of the NGO partners. Eighty-three percent of participants did not know which organizations were involved in the assistance and what were the aims of the assistance. Sixty-seven percent stated that they were instructed to get a blood test and after that, they would get a food ration. Around 70% of community leaders were informed of the food support and the selection criteria but it was not discussed with them in detail. It was apparent that the communities did not expect to participate in the planning of the programme, although they did want to be fully informed and clear about the project.

Participatory planning of the selection of benefi ciaries, food distribution sites and monitoring has been partially practiced by some partners. Thirty percent of community leaders and FGD participants stated that there were regular meetings at the NGO sites. As a result, food distribution sites were selected and adjusted to the need of benefi ciaries.

“We choose the middle point to distribute. This was suggested by PLHA during the meeting.”

A community volunteer, Norea 2 village, Norea commune, Battambang district.

The food quality and type is culturally acceptable and appropriate.

There are no problems of storage, especially for large families of six or more. Current rations are adequate for small families of four or fi ve. For large families the monthly rations last for approximately two weeks.

The livelihood trainings have been widely participated, in programme areas and many basic life skills have been conveyed to the benefi ciaries.

“We have been trained how to take care of our health, and the importance of clean bodies.”

PLHA in Roveang commune, Takeo province

However, little knowledge has been gained on food and nutrition. The communities (i.e. leaders, volunteers and benefi ciaries) can not explain about the nutritional advantage of food especially for PLHA and OVC, the importance of food for HIV-affected persons, and nutritional requirements. They regard food only as a means of preventing hunger and as a means of income transfer.

“Benefi t of food is relieving hunger, and better life. Now she (OVC) can go to school because she does not need to work to earn money for food.”

Community leader, Roveang commune, Takeo province

54

The HBC team leaders are aware of the nutritional requirements, the side effects of drugs on food intake (during ART) and the advantages of good nutrition for combating drugs’ side effects. Yet nobody in the community can repeat this knowledge, i.e. the nutritional needs of PLHA, food and drug interactions, care in food consumption during ARV treatment, and preparation of nutritionally-balanced food etc. Furthermore, some NGO partners were distributing controversial items like MSG (Mono-Sodium Glutamate) as part of their welfare activities. A need of proper training on food and nutrition is apparent.

Community members feel that other poor families with young children should also get food support and that PLHA and OVC households need additional support, such as shelter, because all their assets were sold before the HBC programme started.

Sitha was so shy when she found out that she was infected with HIV, that she did not even tell the HBC team. Her parents sold everything including their house and land to pay for Sitha’s medicines and health care. Now they don’t have any shelter, even in the rainy season.

Too much appreciation on food and other material support is observed as potential for developing dependency. However, six FGD (50%) revealed the communities’ desire for self-reliance.

“We want to establish a community fund so that we can help those in need.”

Community member,Tourl Ta Ek village, Battambang

Achievements in development activities like income-generation and small loans for businesses, contributing to behavior change and livelihood status, have been observed in some Intervention areas but not all.

OVC and PLHA were outcasts before the Intervention but social stigma has been decreasing since the HBC teams and their community support groups became active in counseling and psychosocial support to PLHA and OVC, and community education.

Since the start of the Intervention, the PLHA who have been denied jobs have been denied only on the basis of skill or strength. They indicated that jobs were not denied on the basis of discrimination.

Summary

Although participatory planning, especially in benefi ciary selection and feasibility of food collection by beneficiaries, has been practiced in some areas, information dissemination to communities about the programme has not been fully accomplished in most areas.

Food quality and type is culturally acceptable and appropriate.

There is no problem of storage, but the monthly ration is not enough for large families

Life skills training has been conveyed to benefi ciaries on self-health care, hygiene etc, but further training on nutrition for PLHA and OVC is required.

The communities would like other forms of social support in addition to food

The success of development activities in some areas are seen as an essential part of reducing the risk of dependency on food aid.

Social stigma has been decreasing since the start of the programme

No case of employment denied on the basis of discrimination.

55

Food rations to PLHA and OVC households in conjunction with existing home based care activities is an appropriate approach. Positive trends have been achieved. The objective to mitigate the impact of HIV/AIDS on PLHA and OVC in terms of food security, and livelihoods, is generally achieved. Moreover, contributing to education (i.e. assisting access to formal, informal, and vocational education) for longer-term development, security and self-reliance is indicative of an effective exit strategy. It is also providing urgent resources of food and nutrition to those poverty-stricken, HIV-infected families, and therefore contributing to better health, livelihoods and more earning opportunities.

Some important indicators have strongly proved the impact of the programme on food security, nutrition and better involvement of benefi ciaries in development programmes. Other indicators, while showing an improved situation in Intervention areas, can not statistically prove the impact of the programme. In these cases, the improvement can be also be attributed to existing home care activities and other development programmes implemented in the areas by community organizations.

In-depth qualitative studies and triangulation analysis (i.e. observation, in-depth interviews and FGD) reveal the fact that although the livelihood trainings have been much participated in, in programme areas, little knowledge has been gained. Participants cannot recall the nutritional needs of PLHA and OVC, food and drug interactions, self-care in food consumption during ARV treatment, or preparation methods for nutritionally-balanced food etc. Some HBC teams and NGO partners are distributing some controversial items like MSG and noodles by using welfare cash from KHANA.

Food and other support should be continued and other options are to be explored. Achievement in development activities like income-generation and small loans for business are contributing to behavior change and livelihood status in some areas, which in turn leads to communities placing a value on self-reliance.

The implementation of a participatory planning mechanism is strongly recommended for the food support programme. This would enable KHANA and WFP to become more visible among the communities and beneficiaries involved in the programme and would enable those communities to have a greater understanding of the purpose, criteria and impact of the food programme.

It is also necessary for the selection criteria of benefi ciaries receiving food support to be reviewed with KHANA’s partners so that there is no misunderstanding or neglect of the guidelines related to benefi ciary selection.

These fi ndings also suggest that KHANA should review its monitoring and information processes from the fi eld to head offi ce, so that problems can be more effectively addressed and that the data collected from the fi eld is complete, accurate and useful.

8. Discussion and Recommendations

56

Conclusion

The food support programme should continue as it clearly has a positive impact on food security, nutrition and livelihoods, and is essential for PLHA and OVC. However, food support must be provided in a comprehensive manner as part of a longer-term development strategy. KHANA and its partners have already begun to do this but more intensive development activities that integrate proper IEC and BCC strategies, now need to take place. Integrated HBC with food support, although the primary aim is care and support, has great potential to link with wider development activities that will help vulnerable communities. If the capacities of current operating partners are not suffi cient enough, KHANA should try to seek additional partners who engage in wider development activities (income-generation, water supplies and sanitation), and have experience and expertise in these fi elds.

Although the programme has made a difference in terms of improved nutrition, the general nutritional status of PLHA and OVC is still relatively lower and requires special attention. A nutritionally-targeted programme (i.e. not simply the provision of rations, but nutrient support to target benefi ciaries and integrated nutrition education BCC approach) is highly recommended for future planning.

NGO partners should have clear guidelines for multiplier training (i.e. ToT training downwards), participatory planning and information dissemination to communities. Standard guidelines should be developed with the participation of the NGO partners.

The basic food and nutrition training for HBC teams as outlined in the KHANA training manuals need to be expanded, developed and combined with BCC skills training, emphasizing the particular needs of PLHA (and OVC). A food and nutrition training curriculum should be developed expanded and edited by means of sharing feedback among knowledgeable professionals before use at fi eld level.

Capacity building for NGO and KHANA staff in terms of knowledge of basic food and nutrition for PLHA and OVC, participatory approaches and BCC is essential.

A monitoring system needs to be established with regular and timely information fl ows between every level, from senior management to programme level to NGO partners at operational level. The required information may include essential programme components; such as information dissemination to communities, participatory planning, any discrepancies in benefi ciary selection, and gaps between support, knowledge and needs of benefi ciaries (such as knowledge on food, ART and nutrition, transportation etc). The means of information collection may include appropriate reporting, regular fi eld monitoring with check lists, and regular meetings with partner NGOs. The monitoring system should include analysis using specifi c formats, which can translate the data into information for planners and managers, and regular and participatory feed-back and problem solving mechanisms at all levels.

Currently, the food support programme is manned by a manager and assisted by a programme assistant from the Monitoring and Evaluation Unit at KHANA. Their responsibilities are mainly to collect and compile the quarterly reports according to WFP’s guidelines and report to WFP. However, other programmes/teams at KHANA have better man power and conduct regular fi eld visits for their own programmes. Little dialogue has been seen between food support and other teams. A checklist to gather essential information for management support should be developed in a cross-cutting way among the programmes/teams. The food support programme needs to be part of KHANA’s integrated M&E system.

Exit criteria for food support and nutritionally-targeted support should be clearly set up through a careful participatory planning process as part of the development package, to avoid dependency and to aim at sustained development.

57

1 Measuring Change in Nutritional Status, World Health Organization, Geneva, 1983

2 Robert Magnani. Sampling Guide. Food and nutrition Technical assistance Series, USAID, 1987

3 Rothenberg, R.B., Lobanov, A., Singh, K.B., and Stroh, Jr., G.,: Observations on the application of EPI cluster survey methods for estimating disease incidence, Bulletin of the World Health Organization 63 (1), 93-99, 1985

4 Developing and applying national guidelines for Nutrition and HIV/AIDS, UNICEF, FANTA-UAAID, March 2003

5 Measuring the Effect of Targeted Food Assistance on Benefi ciaries with Chronic Illness: S. Strasser RN, MS, MPH and Kari Egge MPH, PhD, International Conference on HIV/AIDS and Food and Nutrition Security, International Food Policy Research Institute Durban, South Africa 14-16 April 2005

6 Physical Status: The Use and Interpretation of Anthropometry, Report of a WHO Expert Committee, Geneva, 1995; page 217

7 Brownie C, Habicht, J-P, Cogill, B. Comparing indicators of health or nutritional status. American journal of epidemiology, 1966,124:1031-1044

8 Armitage, P, Berry G. Statistical Methods in medical research, 2nd ed. Oxford, Blackwell, 1987

9 Suggested Core Indicators for Monitoring Food Security Status. Committee on World Food Security, 26th

session, Rome, September 2000

10 Anne Swindale, Punam Ohri-Vachaspati, Measuring Household Food Consumption: A Technical Guide. USAID, December 1999

11 Frank Riely, Nancy Mock, Bruce Cogill, Laura Bailey, and Eric Kenefick. Food Security Indicators and Framework for Use in the Monitoring and Evaluation of Food Aid Programs. USAID, January 1999

12 Kari Egge MPH, PhD and Susan Strasser RN, MS, MPH. Measuring the impact of targeted food assistance on HIV/AIDS-related benefi ciary groups; M& E indicators for consideration, C-SAFE, November 2005

13 A guide to monitoring and evaluating HIV/AIDS care and support, WHO, 2004

14 Sheik Iliayas at el. Impact of nutritional Intervention on weight and body mass index of HIV positive individuals in Tamil Nadu, South India

15 Food and nutrition needs in emergency, UNHCR,UNICEF,WFP,WHO, 2002

16 Anthropometric indicators measurement guide 2003 edition, Food and nutrition Technical assistance Series, USAID, 2004

17 Aviva Must, at el. Reference data for obesity: 85th and 95th percentiles of body mass index and triceps skinfold thickness, Am J Clin Nutr, 1991

18 Profi le of Food Aid programme, KHANA, 2006-2007, Cambodia

19 Protracted Relief and Recovery Operation- Cambodia 10305.0 (2004-2006), WFP.

20 Strategic Plan 2006-2009, WFP

21 Keeping up with the changing epidemic, Annual Report 2005, Khmer HIV/AIDS NGO Alliance, Cambodia

22 Strategic Plan 2004-2005, KHANA, Cambodia

Bibliography

58

Annex 1WFP Operational Defi nitions (for eligibility for food support)

Eligible PLHA households refer to the PLHA households which suffer from food and food income shortage during their illness and/or have children who are unable to attend school etc. Their living standard should be poor in order to qualify for food assistance.

PLHA refers a person who self-identifi es as HIV+ and who is known to be HIV+ by community leaders and/or health center staff.

OVC; Orphans and Vulnerable children. Orphans are generally considered as children who do not have a living parent (either father or mother) and whose age is under 18. Vulnerable children usually refers to those children living in a household affected by HIV. OVC also refer to children who suffer from well-founded incidences of exclusion, abuse, discrimination and social stigma.

Household refers all persons within one family, including foster families, who have lived under the same roof for the last year.

Head of household refers to the main decision-maker within a household

Primary care giver of OVC refers to the main person within an OVC household who is responsible for caring for the OVC in that household.

59

Annex 2Sample size calculation

Required sample size is calculated based on the formula described in the chapter “Calculating sample size requirement for indicators that are, means or totals” in the reference book “Sampling Guide” by Robert Magnani, Food and Nutrition Technical Assistance Series, USAID, 1987.

n=D [(Z. + Z.)2 * (sd12 + sd2

2) / (X2 - X1)2 ]

n = required minimum sample size per survey round or comparison groupD = design effect for cluster surveys (use default value of 2, as discossed in Section 3.4)X1 = the estimated level of an indicator at the time of the fi rst survey or for the Control areaX2 = the expected level of the indicator either at some future date or for the project area such that the quantity ( X2 - X1 ) is the size of the magintude of change or comparison-group differences it is desired to be able to detect

sd1 and sd2 = expected standard deviations for the indications for the respective survey round or comparison groups being compared

Z. = the z-score corresponding to the degree of confi dence with which it is desired to be able to conclude that an observed change of size ( X2 - X1 ) would not have occurred by chance ( statistical signifi cance ), andZ. = the z-score corresponding to the degree of confi dence with which it is desired to be ceretain of detecting a change of size ( X2 - X1 ) if one actually occurred ( statistical power ).

For this particular study, considering the available resources and time limits, the following values are defi ned as acceptable levels of statistical testing for the result of the study.

D = 1.5X1 = 1.93 WHZ for OVC and 17 BMI for PLHAX2 = 1.4 WHZ for OVC and 22 for PLHA

Note: X1 value is estimated referring to the Cambodia Demographic Health Survey, 2000 (CDHS-2000) as national level of mean weight-for-height Z score being 1.2, and estimating much worse situation; WFP targeted areas is already worse off as defi ned by VAM as highly vulnerable and also current OVC status of 20% infection.

To estimate X2 value, there is not enough data and experience internationally to be referred to the same situation of OVC and same type of Intervention. The estimation was made considering the most probable scenario in Intervention of similarly severe situation.

For estimating X1 and X2 for PLHA similar considerations are applied.

Ninety-fi ve percent level of confi dence and 80% statistical power, as generally recommended, was regarded as an acceptable level for this study.

The estimated required sample sizes come out as 220 for PLHA in each area and 144 for OVC in each area including a 10% non-response rate.

60

Strata No Province # of PLHA # of OVC Total Proportion

KC 1 Total 1402 2474 3876 28%

KS 2 Total 1497 2519 4016 29%

SR 3 Total 2392 3546 5938 43%

5291 8539 13830

2nd Stage: Since benefi ciaries population is nearly double in Siem Reap than that in each of remaining two strata, two provinces from Siem Reap stratum and one province each from Kampong Cham and Kampong Speu strata will be selected, in order to give the beneficiaries in the strata, the probability of participating in the study proportionate to the benefi ciary size of stratum they belong to PPS.

Annex 3Sampling

Sampling procedures consist of two parts; One comparison group selection and two representative sampling of both groups.

For comparison of Intervention and Control groups the sampling procedures follows the following guidelines (12):

“Comparison groups are normally expected to consist of populations of one or more nearby districts, municipalities, or other administrative units that have characteristics similar to those of the program being evaluated. The selection process normally consists of two stages. The fi rst involves identifying groups that meet the criteria of similarity. The choice could be made purposively ( i.e., characteristics of the group could be predefi ned and selection could be made according to the agreed- upon criteria) unless several areas have profi les similar to the program area, in which case one could be chosen randomly. Once the survey universe for the comparison area has been defi ned, it remains to select a sample of clusters and households to represent the comparison area. The sampling procedures are identical to those for general population surveys”.

Comparison groups are identifi ed as Intervention and Control areas. Intervention areas are those which have been under integrated food support and HBC for three years and Control areas are those which are planning to start food support in October and have been under implementation of HBC as the same package as in Intervention areas without food support. Socioeconomic characteristic are tested (see chapter 4 socio-economic situation) and confi rmed as comparable by VAM analysis of WFP which use the poverty and nutrition indicators.

For Intervention areas representative sampling is decided to conduct cluster sampling with 20 clusters as HBC teams (Health Centers) and follow PPS procedure in multiple stage due too the operation and geographic indications.

For Control areas, since the number of identifi ed clusters are smaller than 20 (total 9), it is decide to select all 9 clusters and to conduct random sampling of intra-cluster households if the number of households are larger than defi ned constant number of households per cluster.

Ideally, to avoid heterogeneity among clusters (i.e. Health Centre); the benefi ciary population can be divided into “Strata” (number of categories) in which the VARIATION in the benefi ciary characteristics is small relative o that in the whole population of benefi ciaries among clusters.

In this case, benefi ciary characteristics can be defi ned, as socio demographic characteristics of the community they belong to, which will infl uence the effect of the programme. KHANA food assistance-HBC programme is operating in the three broad areas administered by WFP’s operational sub-offi ces formed based on geographic and administrative characteristics.

First Stage: Thus, the survey area can be stratifi ed into three broad strata, according to WFP sub offi ce areas, namely, Kampong Cham, Kampong Speu and Siem Reap, in each of which variation in the beneficiary characteristics is supposed to be small.

61

The selection of provinces within each stratum will also based on the fact that probability of the province for participating in the study will be proportionate to the benefi ciary size of the province, PPS, i.e. larger provinces are given a greater chance of selection than smaller provinces, in terms of benefi ciaries.

Strata Stratum No Province # of PLHA # of OVC Total

KC 1 Kampong Cham 557 651 1208

KC 1 Kampong Thom 241 492 733

KC 1 Prey Veng 372 522 894

KC 1 Svay Rieng 232 809 1041

KC 1 Kampong Chnnang 47 31 78

KS 2 Kampong Speu 128 289 417

KS 2 Kampot 130 63 193

KS 2 Sihanouk Ville 310 374 684

KS 2 Takeo 882 1762 2644

SR 3 Banthey Meanchey 499 682 1181

SR 3 Battambang 716 1009 1725

SR 3 Pailin 120 238 358

SR 3 Pursat 320 737 1057

SR 3 Siem Reap 737 880 1617

Kampong Cham sub-offi ce area stratum : Kampong Cham province

Kampong Speu sub-offi ce area stratum : Takeo province

Siem Reap sub-offi ce area stratum : (1) Battambang (2) Siem Reap

3rd Stage: Since sample size for acceptable statistical strength is, for each of the Intervention and Control areas; PLHA 220 and OVC 144; cluster numbers are decided to be 20 (due to limited resource) so that number of elements (target sampled benefi ciaries) per cluster is defi ned as households of 11 PLHA and 8 OVC; this makes sure that target members are suffi ciently well spread across enough clusters that survey estimates are not unduly infl uenced by a handful of clusters.

Each health centre based by home-based care team in the selected provinces are regarded as clusters. All the clusters in selected provinces are listed with respective number of benefi ciaries and selection of 20 clusters is processed by PPS technique based on the population size of total benefi ciaries in each cluster (PLHA plus OVC).

62

Final list of sample clusters are as follows.

Sampled clusters

INTERVENTION CONTROL

Strata ProvinceName of health centers

ProvinceName of health centers

SR Battambang Kork Khmum Kampot Krin Ampil

SR Battambang Bansay Treng Kampot Kampong Kandal

SR Battambang Rokar Kampot Trey Koh

SR Battambang Samrong Knong Prey Veng Prey Pnov

SR Battambang Tourl Ta Ek Prey Veng Por Ty

KC Kampong Cham Da Prey Veng Kragnoung

KC Kampong Cham Knol Dambong Prey Veng Pean Roung

KC Kampong Cham Sandek Prey Veng Kanh Chreach

KC Kampong Cham Tomnoup Siem Reap Kampong Thkov

SR Siem Reap Siem Reap

SR Siem Reap Pouk

SR Siem Reap Dan Run

KS Takeo Prey Lear

KS Takeo Baray

KS Takeo Lum Chong

KS Takeo Cham Bork

KS Takeo Ro Veang

KS Takeo Batie

KS Takeo Chan Chum

KS Takeo Romeng

20 clusters

9 clusters

63

Annex 4Questionnaires

Qualitative Assessment of Community Perception of the KHANA/WFP Food Support Program

Methodology

Methods: Key Informant In-depth Interviews (or Community Interviews), Focus Group Discussions and Observations

1. Problems and constraints encountered by KHANA and HCT in monitoring and management of food distribution

KHANA and HCT in Intervention areas (20 HCT under study – one out of every fi ve was assessed, covering four HCT areas.

Key Informant Interviews

KII with HCT team leader: one in each of the 4 areas- 4

KII with responsible person from WFP sub-offi ce- 3

KII with KHANA team leader - 1

Total KII - 7

Focus Group Discussions

1 FGD with 2 HCT team member, 2 health staff, and 2 volunteers in each of the 4 areas- 4

Total FGD 4

Questions

1. Have you received training on receiving and distributing food, invoicing, and signing bills?

1.1 by whom?

1.2 were the trainings well conducted?

1.3 have you been well trained?

2. Do you have any difficulties in managing food distribution? What are those diffi culties at each level?

2.1 HQ level at WFP and KHANA

2.2 Field Offi ce level at HC and team HQ

2.4 Field level

2.5 Community

3. What are the possible solutions?

4. What support do you need from each level to be able to carry out food support effectively?

4.1 HQ level at WFP and KHANA

4.2 Field Offi ce level at HC and team HQ

4.3 Field level

4.4 Community level

64

5. How do you feel about interacting with PLHA and OVC?

5.1 Are you afraid of infection when you talk to them?

5.2. Do you worry about what other people think when they see you interacting with PLHA and OVC?

5.3 What other feelings do you have about working with PLHA and OVC?

6. Have your feelings and attitude towards PLHA and OVC changed since you started to help provide food support through the HCT?

6.1 What were your feelings before HBC and the provision of food support and what are your feelings now?

Observations

Report on and record quantity and quality of all trainings on all subjects covering the 20 selected HCs and KHANA staff.

1. Numbers of people trained

2. Number of people trained from each HCT

2. Major changes in benefi ciaries; community, perception of project, roles and responsibilities

Observations:At each of the selected 20 HCs (Intervention) and 13 HCs (Control)— 1. number of community groups and individuals involved in selection of benefi ciaries and provision of care and support. 2. number of community groups and individuals taking care of food distribution activities

KII: Same 4 areas in Intervention area and 3 areas in Control area with community leader, HCT team leader and health staff.

Total 12 KII in Intervention area and 9 in Control area

FGD: 4 areas in Intervention area; 3 areas in Control area 2 FGD in each area; Total 14

(1) with 2 community members from different social strata

(2) with 2 PLHA and 2 elder OVC

Questions1. Information sharing: whether community is fully informed about the project?

2. Monitoring: whether PLHA and OVC households are consulted in monitoring of food distribution?

3. Ration planning: whether community can describe the advantages, (nutritional and food security), of food rations?

4. Appropriateness and Acceptability: whether food is acceptable to those interviewed? Whether the rations are adequate for intended benefi ciaries?

5. Food handling: Any problems in storing or preparing commodities distributed?

6. Nutrition: adequacy: whether ration is enough for an entire month for intended benefi ciaries?

7. Nutrition: support to at-risk groups: whether community feels that some other at-risk groups also need the food rations under current project?

Discrimination8. Whether community see PLHA and OVC as outcasts or people to be accepted, cared for and counseled?

9. Whether PLHA and OVC can get access to jobs and equal payment that other people with same skills and capacity have access to?

65

Annex 5Survey Teams

List of Interviewees

Kampot/Takeo (1)

Nº Name Sex Responsible

01 Sok Saron F TL/Superviser

02 Ouk Sok M NT/In deep

03 Heng Kanha F Interviewer

04 Van Sodaneath F Interviewer

05 In Pongaphotra M Interviewer

06 Chea Syna F Interviewer

07 Oum Vesna F Interviewer

08 Keo Kosal M Interviewer

09 Pech Chanra M Interviewer

Battambang (2)


10 Thorn Riguen F TL/Superviser

11 Lim Sreypech F NT/In deep

12 Pang Chhaya M Interviewer

13 Chem Vuthy M Interviewer

14 Keat Sereysophorn F Interviewer

Prey Veng (3)


15 Ly Vandy M TL/Superviser

16 Kater Sreyan F NT/In deep

17 Kaing Vouchna F Interviewer

18 Phuon Sothea F Interviewer

19 Neang Kimhong M Interviewer

20 Nak Samnang F Interviewer

21 Ouk Ratanak M Interviewer

Siem Reap (4)


22 Eam Thea M TL/Superviser

23 Bou Sreyna F Interviewer

Kampong Cham (5)


24 Gnim Chandara F TL/Superviser

25 Chek Sokhin M Interviewer

66

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ab

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Prim

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Care

Giv

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: ...

....

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69

CO

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US

EH

OLD

D

EM

OG

RA

PH

Y P

AG

E

2223

2425

2627

2829

3031

3233

3435

3637

Wor

king

(as

p

aid

em

plo

yee,

em

plo

yer,

self-

emp

loye

d,

farm

ing

incl

ud-

ing

fi sh

ing

and

fo

rest

ry, a

ny

inco

me

earn

ing

jo

b)?

If w

orki

ng n

ow,

how

long

hav

e yo

u b

een

un-

emp

loye

d a

fter

bei

ng id

entifi

ed

as

PLH

A?

Why

did

you

b

ecom

e un

em-

plo

yed

at t

hat

time?

un-e

mp

loye

d

dur

atio

nW

hat i

s th

e m

ain

reas

on fo

r yo

u to

b

e un

emp

loye

d

now

?

Dis

able

d o

r lo

ng-t

erm

ill?

FAM

ILY

ME

MB

ER

IDS

EX

Mon

ths

MO

NTH

SC

ode

GM

ON

THS

Cod

e G

MO

NTH

S

coping with community

If YES By Whom

If YES By Whom

income generation

If YES By Whom

self health care

If YES By Whom

food & nutrition

If YES By Whom

personal hygiene

c o d e G1

c o d e G1

c o d e G1

c o d e G1

c o d e G1

SERIAL NUMBER

Hav

e yo

u b

een

trai

ned

in

CO

DE

G: R

EA

SO

N F

OR

UN

EM

PL

OY

ME

NT

ILL

AN

D S

ICK

....

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

1LA

CK

OF

SK

ILL

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.2E

MP

LOY

ER

DID

NO

T W

AN

T TO

EM

PLO

Y (

Dis

crim

inat

ion)

....

......

......

......

......

34.

Did

not

wan

t to

wor

k ...

......

......

......

......

......

......

......

......

......

......

......

......

......

...4

5. O

ther

---

- (s

pec

ify)

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

5

CO

DE

G1

KH

AN

A .

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..1H

BC

TE

AM

....

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

....2

HE

ALT

H S

TAFF

....

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

...3

CO

MM

UN

ITY

O

RG

AN

IZAT

ION

...

......

......

......

......

......

......

......

......

......

......

......

...4

FRIE

ND

S ..

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....5

FAM

ILY

ME

MB

ER

....

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

6

Wh

ich

of

the

follo

win

g a

ctiv

itie

s ar

e yo

u e

ng

aged

cu

rren

tly, a

nd

for

how

lon

g?

PLHA

HOU

SEHO

LDRE

SPON

DENT

: PLH

A - F

OOD

SUPP

ORT

BENE

FICI

ARY

ONLYPL

HA L

IVEL

IHOO

D ST

ATUS

70

CO

DE

H: R

EA

SO

N F

OR

NO

T G

ET

TIN

G O

R M

ISS

ING

AR

V O

R N

OT

G

ET

TIN

G T

RE

AT

ME

NT

FO

R IN

FE

CT

ION

S

WO

RK

, FA

RM

WO

RK

....

......

......

......

......

......

1 D

OM

ES

TIC

LA

BO

R .

......

......

......

......

......

......

..2N

O B

OD

Y T

O H

ELP

TP

GO

TO

HS

....

......

...3

ILLN

ES

S .

......

......

......

......

......

......

......

......

......

..4H

EA

LTH

CE

NTE

R T

OO

FA

R A

WAY

....

......

....5

LAC

K O

F M

ED

ICIN

E I

N H

S .

......

......

......

......

.6

CO

DE

I O

PP

OR

TU

NIS

TIC

INF

EC

TIO

NS

SK

IN I

NFE

CTI

ON

S .

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.1R

ES

PIR

ATO

RY

TR

AC

T IN

FEC

TIO

N I

NC

LUD

ING

TB

....

......

......

......

......

......

...2

DIA

RR

HO

EA

/dys

entr

y ...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.3FE

VE

R .

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

...4

OTH

ER

S (

SP

EC

IFY

) ...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

...5

CO

PY

ID C

OD

E A

ND

SE

X O

F P

LHA

FR

OM

HO

US

EH

OLD

D

EM

OG

RA

PH

Y P

AG

E

3839

4041

4243

4445

4647

Are

you

get

ting

A

RV

trea

tmen

t?

If so

, for

how

lo

ng?

Ff N

O, w

hat

is th

e m

ajor

re

ason

?

If yo

u ar

e cu

rren

tly ta

king

A

RV

trea

tmen

t, d

o yo

u ta

ke

treat

men

t re

gul

arly

?

If N

O, h

ow m

any

times

hav

e yo

u m

isse

d

the

treat

men

t

AN

D W

hat a

re

the

mai

n re

ason

s fo

r m

issi

ng th

e tre

atm

ent?

Do

you

had

on

e or

mor

e of

th

e fo

llow

ing

in

fect

ions

dur

ing

th

e p

ast t

wo

wee

ks?

If Y

ES

, how

lo

ng d

oes

each

in

fect

ion

last

?

How

man

y re

pea

ted

in

fect

ions

hav

e yo

u ha

d in

the

last

two

wee

ks?

Wer

e th

ey

atte

nded

to

by

heal

th

per

sonn

el-

Yes/

No

If N

O, w

hat w

as

the

mai

n re

ason

?

FAM

ILY

ME

MB

ER

IDS

EX

Mon

ths

CO

DE

HFR

QC

OD

E I

DAY

SFR

QC

OD

E H

HE

ALT

H P

ER

SO

NN

EL

AR

E N

OT

GO

OD

....

....7

N

O H

EA

LTH

PE

RS

ON

NE

L ...

......

......

......

......

...8

BE

LIE

VE

NO

BE

NE

FIT

FRO

M M

OR

E A

RV

....

.9

DO

NO

T K

NO

W A

RV

IS

AVA

ILA

BLE

....

......

10O

THE

RS

(S

PE

CIF

Y)

......

......

......

......

......

......

..11

SERIAL NUMBER

PLHA

HOU

SEHO

LDRE

SPON

DENT

: PLH

A - F

OOD

SUPP

ORT

BENE

FICI

ARY

ONLY

PLHA

HEA

LTH

STAT

US

71

1.

Did

you

or

any

hous

ehol

d m

emb

ers

bor

row

any

fund

s or

ob

tain

any

goo

ds

or s

ervi

ces

on c

red

it in

the

last

12

mon

ths?

2.

Why

did

you

NO

T b

orro

w fu

nds

or o

bta

in g

ood

s or

ser

vice

s on

cre

dit?

YE

S…

1 (>

>Q

3)N

O..2

CO

DE

J

I wo

uld

now

like

to a

sk y

ou

ab

ou

t th

e lo

ans

or

cred

its ta

ken

by

you

r h

ou

seh

old

in th

e la

st y

ear.

Ple

ase

con

sid

er a

ll lo

ans

or

cred

its ta

ken

by

all h

ou

seh

old

mem

bers

.

48.

49.

50.

51.

52.

LOA

N T

YP

ED

id a

nyon

e in

you

r ho

use-

hold

take

a [

LOA

N T

YP

E]

in th

e la

st 1

2 m

onth

s?

How

man

y tim

es in

the

pas

t 12

mon

ths

did

a

mem

ber

of y

our

HH

take

a

[LO

AN

TY

PE

]

Ple

ase

thin

k ab

out t

he m

ost r

ecen

t tim

e th

is [

LOA

N T

YP

E]

was

take

n.

Wha

t was

the

tota

l am

ount

or

valu

e of

the

[LO

AN

TY

PE

]?

Wha

t was

the

mai

n p

urp

ose

of th

is m

ost

rece

nt [

LOA

N T

YP

E]?

Has

this

mos

t rec

ent

[LO

AN

TY

PE

] b

een

pai

d b

ack

in fu

ll?

NU

MB

ER

AM

OU

NT

IN R

IEL

CO

DE

K

1C

ash

loan

from

rela

tive,

frie

nd o

r ne

ighb

or

2C

ash

loan

from

mon

ey le

nder

3Lo

an fr

om c

ow b

ank

4C

red

it fo

r g

ood

s or

ser

vice

s fro

m s

tore

keep

er/s

ervi

ce p

rovi

der

5C

ash

loan

from

gov

ernm

ent b

ank

6C

ash

loan

from

priv

ate

ban

k

7C

ash

loan

from

com

mun

ity fu

nd o

r N

GO

8[A

DD

AN

Y O

THE

R L

IKE

LY T

YP

ES

OF

LOA

NS

HE

RE

]

9[A

DD

AN

Y O

THE

R L

IKE

LY T

YP

ES

OF

LOA

NS

HE

RE

]

10O

ther

(sp

ecify

:___

____

____

____

____

____

___)

L O A N C O D E

CO

DE

J: R

EA

SO

N F

OR

NO

T T

AK

ING

LO

AN

/CR

ED

IT?

DID

N’T

NE

ED

TO

....

......

......

......

......

......

......

......

......

......

......

......

......

.....1

N

O P

LAC

E T

O G

O F

OR

LO

AN

/CR

ED

IT .

......

......

......

......

......

......

......

2 TU

RN

ED

D

OW

N/D

EN

IED

FO

R

LOA

N/C

RE

DIT

...

......

......

......

......

.....3

O

THE

R

(SP

EC

IFY

) ...

......

......

......

......

......

......

......

......

......

......

......

......

...4

CO

DE

K: P

UR

PO

SE

OF

LO

AN

/CR

ED

IT a

nd

SE

LL

ING

AS

SE

TS

ILLN

ES

S .

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....1

S

CH

OO

LIN

G .

......

......

......

......

......

......

......

......

......

......

......

......

......

......

....2

CA

PIT

AL

FOR

B

US

INE

SS

-AG

RIC

ULT

UR

E

......

......

......

......

......

......

....3

LAC

K O

F FU

ND

S/D

AIL

Y E

XP

EN

SE

S .

......

......

......

......

......

......

......

......

4

MA

RR

IAG

E A

ND

CE

RE

MO

NIE

S .

......

......

......

......

......

......

......

......

......

.5

FUN

ER

AL

EX

PE

NS

ES

...

......

......

......

......

......

......

......

......

......

......

......

....6

P

ETT

Y T

RA

DE

/ser

vice

....

......

......

......

......

......

......

......

......

......

......

......

...7

BU

Y F

OO

D B

EFO

RE

HA

RV

ES

T--

......

......

......

......

......

......

......

......

......

.8O

THE

R (

SP

EC

IFY

) ...

......

......

......

......

......

......

......

......

......

......

......

......

....9

I wo

uld

now

like

to

ask

yo

u a

bo

ut

any

bo

rro

win

g o

r an

y lo

ans

take

n b

y h

ou

seh

old

mem

ber

s in

th

e p

ast

12 m

on

ths.

PLHA

HOU

SEHO

LDRE

SPON

DENT

: HOU

SEHO

LD H

EAD

OR S

POUS

E OR

PLH

A (R

ELAT

IONS

HIP

TO H

OUSE

HOLD

HEA

D - C

ODE

A.]..

....

....

....

..

HOUS

EHOL

D BO

RROW

ING

AND

CRED

IT

72

AS

SE

T 53

.54

.55

.56

.

Doe

s th

e ho

useh

old

ow

n an

y [A

SS

ET]

?

How

man

y [A

SS

ET]

d

oes

your

ho

useh

old

ow

n?

Did

you

sel

l th

e as

set

[NA

ME

] d

urin

g th

e la

st y

ear

How

man

y d

id y

ou s

ell?

Wha

t is

the

mai

n re

ason

fo

r se

lling

th

at a

sset

?

QU

AN

TITY

cod

e k

A S S E T C O D E

AS

SE

T 53

. (C

ON

T.)

54. (

CO

NT.

)54

. (C

ON

T.)

55. (

CO

NT.

)56

. (C

ON

T.)

Doe

s th

e ho

useh

old

ow

n an

y [A

SS

ET]

?

How

man

y [A

SS

ET]

d

oes

your

ho

useh

old

ow

n?

Did

you

sel

l th

e as

set

[NA

ME

] d

urin

g th

e la

st y

ear?

How

man

y d

id y

ou s

ell?

Wha

t is

the

mai

n re

ason

fo

r se

lling

th

at a

sset

?

QU

AN

TITY

cod

e k

A S S E T C O D E

LA

ND

AN

D B

UIL

DIN

GS

1La

nd -

Hec

ter

2B

uild

ing

s --

Bus

ines

s- U

nit

3B

uild

ing

s --

Ag

ricul

ture

-Uni

t

TR

AN

SP

OR

T E

QU

IPM

EN

T

4Ve

hicl

e (C

ar, V

an, e

tc.)

5M

otor

cycl

e

6B

icyc

le

7Tu

k-tu

k

HO

US

EH

OL

D D

UR

AB

LE

S

8R

efrig

erat

or/fr

eeze

r

9S

ewin

g m

achi

ne

10W

ashi

ng m

achi

ne

11Va

cuum

cle

aner

12E

lect

ric r

ice

cook

er

13S

team

ric

e co

oker

14Fo

od p

roce

ssor

AG

RIC

ULT

UR

E/B

US

INE

SS

15Tw

o-w

heel

ed tr

acto

r

16Fo

ur-w

heel

ed tr

acto

r

17A

gric

ultu

ral e

qui

pm

ent-

pie

ce

18To

ols

smal

l and

larg

e-p

iece

19B

oat

20Fi

shin

g n

et

21C

art

22ag

ri an

imal

TV,

RA

DIO

, PH

ON

ES

22Te

levi

sion

23R

adio

/VC

D, e

tc.

24Te

lep

hone

25M

obile

pho

ne

OT

HE

R G

OO

DS

26S

atel

lite

dis

h

27C

omp

uter

28A

ir co

nditi

oner

29Je

wel

ry

30M

osq

uito

net

31O

ther

(sp

ecify

____

)

32O

ther

(sp

ecify

____

)

33O

ther

(sp

ecify

____

)

34O

ther

(sp

ecify

____

)

CO

DE

K: P

UR

PO

SE

OF

LO

AN

/CR

ED

IT a

nd

SE

LL

ING

AS

SE

TS

ILLN

ES

S .

......

......

......

......

......

......

......

......

......

......

......

......

1S

CH

OO

LIN

G .

......

......

......

......

......

......

......

......

......

......

.....2

CA

PIT

AL

FOR

BU

SIN

ES

S-A

GR

ICU

LTU

RE

....

......

......

..3LA

CK

O

F FU

ND

S/D

AIL

Y

EX

PE

NS

ES

...

......

......

......

...4

MA

RR

IAG

E

AN

D

CE

RE

MO

NIE

S

......

......

......

..5

FUN

ER

AL

EX

PE

NS

ES

...

......

......

......

......

......

.....6

P

ETT

Y

TRA

DE

/ser

vice

...

......

......

......

......

......

....7

BU

Y

FOO

D

BE

FOR

E

HA

RV

ES

T--

......

......

......

8O

THE

R

(SP

EC

IFY

) ...

......

......

......

......

......

......

...9

GO

TO

NE

XT

CO

LU

MN

>>

You

r h

ou

seh

old

may

ow

n s

om

e as

sets

like

lan

d, v

ehic

les

or

ho

use

ho

ld g

oo

ds.

I w

ou

ld li

ke t

o a

sk y

ou

ab

ou

t th

ose

ass

ets

now

.

PLHA

HOU

SEHO

LDRE

SPON

DENT

: HOU

SEHO

LD H

EAD

OR S

POUS

E OR

PLH

A .(R

ELAT

IONS

HIP

TO H

OUSE

HOLD

HEA

D - C

ODE

A.]..

....

....

....

ASK

ABOU

T AL

L AS

SETS

THE

HOU

SEHO

LD O

WNS

AND

SOL

D DU

RING

PAS

T YE

AR

ASSE

TS S

OLD

73

57.

58.

LIN

E N

OIT

EM

“TO

TAL

CA

SH

EX

PE

ND

ITU

RE

(R

IEL

S)”

“IN

-KIN

D E

XP

EN

DIT

UR

E (

VAL

UE

IN C

AS

H -

RIE

LS

)”

1M

ain

cere

al

2S

econ

dar

y ce

real

3R

oots

/Tub

ers

4Ve

get

able

5Fi

sh o

r m

eat

6O

il

7O

ther

food

(fi s

h p

aste

, sal

t, su

gar

, leg

umes

)

8Fo

od &

drin

ks c

onsu

med

out

sid

e th

e ho

use

9Fu

el

10M

edic

al e

xpen

ses

11H

ousi

ng/re

nt

12A

lcoh

ol a

nd to

bac

co

13Tr

ansp

orta

tion

14Fi

nes

and

deb

ts

15E

qui

pm

ents

/tool

s/se

eds

16W

ater

/lig

ht/fu

el

17E

duc

atio

n/sc

hool

fees

18C

loth

ing

/sho

es

19C

eleb

ratio

n/so

cial

eve

nts

20M

icel

lane

ous/

othe

r

I wo

uld

now

like

to

ask

yo

u a

bo

ut

exp

end

itu

re b

y yo

ur

ho

use

ho

ld o

n t

he

follo

win

g e

xpen

ses.

Ple

ase

con

sid

er in

ave

rag

e p

er m

on

th, d

uri

ng

th

e p

ast

six

mo

nth

s.

PLHA

HOU

SEHO

LDRE

SPON

DENT

: HOU

SEHO

LD H

EAD

OR S

POUS

E OR

PLH

A (R

ELAT

IONS

HIP

TO H

OUSE

HOLD

HEA

D - C

ODE

A.]..

....

....

....

..

HOU

SEHO

LD E

XPEN

DITU

RE

74

No

w I w

ou

ld li

ke to

ask

yo

u a

bo

ut t

he

typ

es o

f fo

od

s th

at y

ou

or a

nyo

ne

in y

ou

r ho

use

ho

ld

ate

yest

erd

ay d

uri

ng

the

day

or

nig

ht.

If y

este

rday

was

no

t a ty

pic

al d

ay in

term

s o

f fo

od

co

nsu

mp

tio

n, p

leas

e th

ink

bac

k to

th

e m

ost

rec

ent

typ

ical

foo

d c

on

sum

pti

on

day

.

So

me

ho

use

ho

lds

hav

e p

erio

ds

wh

en o

bta

inin

g f

oo

d f

or

thei

r h

ou

seh

old

s is

har

der

an

d o

ther

per

iod

s w

hen

it

is e

asie

r. I

wo

uld

lik

e to

ask

yo

u a

bo

ut

you

r h

ou

seh

old

’s

foo

d s

up

ply

du

rin

g d

iffe

ren

t m

on

ths

of

the

year

. Wh

en r

esp

on

din

g t

o t

hes

e q

ues

tio

ns,

p

leas

e th

ink

bac

k ov

er t

he

last

12

mo

nth

s.

For

Dat

a E

ntry

59.

Did

any

one

in y

our

hous

ehol

d e

at [

FOO

D IT

EM

] ye

ster

day

? Th

is c

ould

incl

ude

food

pre

par

ed a

t hom

e th

at w

as ta

ken

to a

wor

k si

te o

r sc

hool

. Ple

ase

do

not

incl

ude

pre

par

ed fo

od p

urch

ased

aw

ay fr

om h

ome

or in

-kin

d m

eals

.”

6061

For

Dat

a E

ntry

Nam

e of

Foo

d It

emD

urin

g la

st 1

2 m

onth

s, h

ow m

any

mon

ths

you

did

not

hav

e en

oug

h fo

od [

FOO

D IT

EM

NA

ME

] to

feed

you

r fa

mily

?

A1

Ric

e

A2

Mai

ze o

r ot

her

cere

als

C1

Oil

A1

Ric

e

A2

Pot

ato

A2

Mai

ze o

r ot

her

cere

al

A2

Cas

sava

A2

Oth

er ro

ots

and

tub

ers

A3

Whe

at n

ood

le, b

read

, bis

cuit

B2

Gro

und

nuts

, leg

umes

B2

Bea

ns (

all t

ypes

)

D1

Gre

en le

afy

veg

etab

les

D2

Oth

er v

eget

able

s

D3

Frui

t (no

t jui

ce)

B1

ferm

ente

d fi

sh p

aste

B1

Fish

(fre

sh o

r d

ry)

B2

Inse

cts/

othe

r fa

rm a

nim

als

B3

Eg

gs

B3

Pou

ltry

B3

Por

k

B3

Bee

f/Buf

falo

C1

Oil/

fat

B3

Milk

C3

Milk

pro

duc

ts

C3

Oth

ers

(sug

ar, e

tc)

PLHA

HOU

SEHO

LDRE

SPON

DENT

: HOU

SEHO

LD M

EMBE

R M

OST

KNOW

LEDG

EABL

E AB

OUT

HOUS

EHOL

D FO

OD C

ONSU

MPT

ION

RESP

ONDE

NT: R

ELAT

IONS

HIP

TO H

OUSE

HOLD

HEA

D [C

ODE

A] ..

....

....

....

....

....

....

FOOD

DIV

ERSI

TY &

FOO

D SH

ORTA

GE

75

No

w I

wo

uld

like

to

ask

yo

u a

bo

ut

som

e o

f th

e fo

od

s th

at w

ere

eate

n b

y th

e o

ur

ben

efi c

iary

PL

HA

in t

his

ho

use

ho

ld y

este

rday

. If

he/

she

did

no

t co

nsu

me

a ty

pic

al d

iet

yest

erd

ay, p

leas

e th

ink

bac

k to

th

e m

ost

rec

ent

typ

ical

day

. Fo

r ea

ch o

f th

e fo

od

gro

up

s th

at I

men

tio

n, p

leas

e te

ll m

e w

het

her

th

e P

LH

A a

te a

t le

ast

on

e se

rvin

g, o

r so

me

of

that

foo

d. T

his

co

uld

incl

ud

e fo

od

pre

par

ed a

nd

eat

en a

t h

om

e, o

r el

sew

her

e su

ch a

s at

sch

oo

l, w

ith

rel

ativ

es, o

r in

a m

arke

t.

Yest

erd

ay, d

id [

NA

ME

] ea

t an

y [F

OO

D IT

EM

], ei

ther

at

ho

me

or

else

wh

ere?

CO

PY

ID C

OD

E A

ND

SE

X O

F

PL

HA

FR

OM

HO

US

EH

OL

D

DE

MO

GR

AP

HY

PA

GE

62.

62.

62.

62.

62.

62.

62.

62.

62.

62.

62.

62.

62.

62.

62.

62.

62.

62.

62.

62.

62.

62.

…ric

eP

otat

o…

mai

ze

or o

ther

ce

real

s

Cas

sava

Oth

er

root

s an

d

tub

ers

Whe

at

nood

le,

bre

ad,

bis

cuit)

Gro

und

-nu

ts,

leg

ume

bea

ns

(all

typ

es)

Gre

en

leaf

y ve

ge-

tab

les

Oth

er

veg

-et

able

s

Frui

t (n

ot

juic

e)

fi sh

pas

teFi

sh

(fre

sh

or

dry

)

In-

sect

s/ot

her

farm

an

i-m

als

Eg

gs

Pou

l-tr

yP

ork

Bee

f/B

uf-

falo

Oil/ fat

Milk

Milk

p

rod

-uc

ts

Oth

ers

(sug

-ar

, et

c)

FAM

ILY

ME

MB

ER

IDS

EX

ON

LY F

OR

DAT

A E

NTR

Y [

CO

DE

]A

1A

2A

2A

2A

2A

3B

2B

2D

1D

2D

3B

1B

1B

2B

3B

3B

3B

3C

1B

3C

3C

3

SERIAL NUMBER

PLHA

HOU

SEHO

LDRE

SPON

DENT

: PLH

A TH

EMSE

LVES

DIET

ARY

DIVE

RSIT

Y OF

PLH

A

76

MEA

LS C

ONSU

MED

BY

PLHA

AND

THE

IR H

OUSE

HOLD

No

w I

wo

uld

like

to

ask

yo

u a

bo

ut

the

nu

mb

er o

f m

eals

co

nsu

med

by

the

AN

Y M

EM

BE

R O

F T

HIS

HO

US

EH

OL

D A

ND

PL

HA

HIM

/HE

R S

EL

F, y

este

rday

. If

yes

terd

ay w

as n

ot

a ty

pic

al d

ay in

ter

ms

of

foo

d c

on

sum

pti

on

, ple

ase

thin

k b

ack

to t

he

mo

st r

ecen

t ty

pic

al fo

od

co

nsu

mp

tio

n d

ay.

63

. Y

est

erd

ay,

did

YO

U [

PL

HA

] e

at

me

al

CO

PY

ID C

OD

E A

ND

SE

X O

F P

LH

A F

RO

M

HO

US

EH

OL

D D

EM

OG

RA

PH

Y P

AG

E63

.163

.263

.363

.463

.563

.663

.7

FAM

ILY

ME

MB

ER

IDS

EX

Any

food

bef

ore

a m

orni

ng m

eal

Mor

ning

mea

lA

ny fo

od b

etw

een

mor

ning

mea

l and

m

id d

ay m

eal

Mid

day

mea

lA

ny fo

od b

etw

een

mid

day

and

eve

ning

m

eal

Eve

ning

mea

lA

ny fo

od a

fter

the

even

ing

mea

l

64. Y

este

rday

, did

any

of

you

r h

ou

seh

old

mem

ber

eat

64.1

64.2

64.3

64.4

64.5

64.6

64.7

Any

food

bef

ore

a m

orni

ng m

eal

Mor

ning

mea

lA

ny fo

od b

etw

een

mor

ning

mea

l and

m

id d

ay m

eal

Mid

day

mea

lA

ny fo

od b

etw

een

mid

day

and

eve

ning

m

eal

Eve

ning

mea

lA

ny fo

od a

fter

the

even

ing

mea

l

SERIAL NUMBER

PLHA

HOU

SEHO

LDRE

SPON

DENT

: PLH

A

77

PLHA

HOU

SEHO

LDTo

Mea

sure

ben

efi c

iary

PLH

A

65.

66.

6768

CO

PY

ID C

OD

E A

ND

SE

X O

F P

LHA

FR

OM

HO

US

EH

OLD

DE

MO

GR

AP

HY

PA

GE

b

irthd

ate

age

in c

omp

lete

d y

ears

an

d m

onth

s If

birt

h d

ate

is n

ot a

vaila

ble

ME

AS

UR

E A

ND

RE

CO

RD

WE

IGH

TM

EA

SU

RE

AN

D R

EC

OR

D H

EIG

HT

FAM

ILY

ME

MB

ER

IDS

exD

DM

MY

YY

EA

RS

MO

NTH

S

KIL

OG

RA

MS

CE

NTI

ME

TER

S

ANTH

ROPO

MET

RIC

MEA

SURE

MEN

T

78

KHAN

A/W

FP -

FOOD

SUP

PORT

TO

HOM

E BA

SE C

ARE

OF P

LHA

AND

OVC,

CAM

BODI

A-BA

SE L

INE

AND

EVAL

UATI

ON S

URVE

Y - 2

006

Dat

e o

f in

terv

iew

PL

HA

HO

US

EH

OL

D

HO

US

EH

LD

INT

ER

VIE

W ID

EN

TIF

ICA

TIO

N S

HE

ET

1. P

rovi

nce

2. H

ealth

Cen

ter

3. H

ouse

hold

Typ

e

3. H

ouse

hold

ID N

umb

er

Ref

. Cod

e 1.

1

Ref

. Cod

e 1.

2

One

dig

it P

LHA

......

.1

O

VC

.....2

4 d

igit

s R

ef c

od

e 1.

3

dd

mm

yy

1. N

ame

of E

num

erat

or2.

Enu

mer

ator

ID

3. D

ate/

time

of F

irst I

nter

view

4. D

ate/

time

of S

econ

d In

terv

iew

5. N

ame

of T

eam

Lea

der

6. N

ame

of S

uper

viso

r

9. N

ame

of D

ata

Ent

ry O

per

ator

DD

MM

YY

Sta

rt T

ime

Fini

sh T

ime

Che

cked

& s

igne

d

Che

cked

& s

igne

d

Che

cked

& s

igne

d

79

1.2.

3.4.

5.6.

7.8.

910

11

Fam

ily M

emb

er ID

Nam

eW

hat i

s

[NA

ME

]’s

rela

tions

hip

to th

e he

ad

of th

e ho

use-

hold

?

Wha

t is

[NA

ME

]’s

sex?

Wha

t is

[NA

ME

]’s

age

in c

omp

lete

d

year

s an

d

mon

ths?

For a

ge y

oung

er

than

18

year

s,

Is th

is c

hild

[NA

ME

]

iden

tifi e

d a

s

OV

C?

If Y

ES

, was

this

chi

ld

fost

ered

by

this

hous

hold

?

If Y

ES

, was

this

child

fost

ered

by

this

hous

ehol

d ?

Wha

t is

the

emp

lom

ent

stat

us o

f the

fam

ily

mem

ber

[NA

ME

]?

Wha

t is

the

hig

hest

leve

l

of y

ears

of

educ

atio

n

of th

e p

erso

n

[NA

ME

]’?

Wha

t is

the

emp

loym

ent

stat

us o

f

the

per

son

[NA

ME

]?

Cod

e 1.

4 -

6 d

igits

CO

DE

AC

OD

E D

YEA

RS

MO

NTH

S

CO

DE

CC

OD

E E

AS

K W

HO

IS T

HE

HE

AD

OF

TH

E H

OU

SE

HO

LD

AM

ON

G T

HO

SE

CU

RR

EN

TLY

RE

SID

ING

IN T

HE

HO

US

EH

OL

D.

AS

SIG

N

HO

US

EH

OL

D H

EA

D, M

EM

BE

R ID

1 A

ND

EN

TE

R T

HE

NA

ME

IN T

HE

FIR

ST

RO

W.

AS

K T

HE

RE

SP

ON

DE

NT

TO

LIS

T A

LL

OT

HE

R

ME

MB

ER

S O

F T

HE

HO

US

EH

OL

D. A

SS

IGN

A M

EM

BE

R ID

AN

D E

NT

ER

TH

E N

AM

E F

OR

AL

L O

TH

ER

HO

US

EH

OL

D M

EM

BE

RS

.

PLHA

HOU

SEHO

LDRE

SPON

DENT

: HO

USEH

OLD

HEAD

OR

SPOU

SE O

R OT

HER

, RE

SPON

DING

FOR

ALL

CUR

RENT

HO

USEH

OLD

MEM

BERS

RESP

ONDE

NT-r

elat

ions

hip

to

hous

ehol

d he

ad

(COD

E A)

: ...

....

....

....

....

..

FOR

ALL

HOUS

EHOL

D M

EMBE

RS

80

12.

1314

1516

1718

1920

2122

23

F

AM

ILY

ME

MB

ER

ID

NA

ME

“Sex

Has

[N

AM

E]

ever

at

tend

ed

scho

ol?

At w

hat

age

did

[N

AM

E]

star

t KG

?

Wha

t is

the

mai

n re

ason

[N

AM

E]

has

not

ever

at

tend

ed

scho

ol?

Is [

NA

ME

] cu

rren

tly

enro

lled

in

scho

ol?

If N

o, h

ow

man

y Y

EA

RS

has

[N

AM

E]

com

plet

ed?

Wha

t is

the

mai

n re

ason

[N

AM

E]

is n

ot

curr

ently

en

rolle

d

in s

choo

l th

is

term

?

If Q

15 is

Y

ES

, how

m

any

year

s ha

s [N

AM

E]

mis

sed

d

urin

g fr

om

the

star

t of

scho

olin

g

to th

e cu

rent

term

?

If [N

AM

E]

has

mis

sed

so

me

year

s w

hat i

s th

e m

ain

reas

on

for

mis

sing

sc

hool

?

Will

[N

AM

E]

enro

ll in

sc

hool

ne

xt

term

?

Wha

t is

the

mai

n re

ason

[N

AM

E]

will

not

en

roll

in

scho

ol

next

te

rm?

Wha

t cl

ass

leve

l is

[NA

ME

] cu

rren

tly

enro

lled

in

or

was

[N

AM

E]

mos

t re

cent

ly

enro

lled

in

?

How

m

any

clas

ses

has

[NA

ME

] ev

er

rep

eate

d?

CO

DE

1.4

[6

DIG

ITS

]

AG

EC

OD

E F

B

ELO

WC

OD

E F

B

ELO

WYe

ars

CO

DE

F

BE

LOW

CO

DE

F

BE

LOW

CO

DE

CN

UM

BE

R

CO

DE

F:R

EA

SO

N F

OR

NO

N-E

NR

OL

LM

EN

T O

R N

ON

-AT

TE

ND

AN

CE

Illne

ss ..

......

......

......

...1

Wor

k fo

r fo

od...

......

....2

C

are

for

sib

ling

s....

....3

Can

not a

fford

cos

ts...

......

.4H

ung

er...

......

......

......

......

...5

Wor

k to

ear

n m

oney

......

....6

Car

e fo

r ill

per

son.

......

......

......

....7

Unp

aid

HH

or

farm

wor

k ...

......

..8S

choo

l too

far

away

......

......

......

..9

Teac

her

is n

ot g

ood

......

......

.....1

0La

ck o

f tea

cher

s....

......

......

......

11N

o b

enefi

t to

sch

ool..

......

......

..12

Mar

riag

e....

......

......

......

....1

3O

ther

s (s

pec

ify).

......

......

..14

SERIAL NUMBER

CO

PY

TH

E M

EM

BE

R ID

AN

D N

AM

E F

OR

EA

CH

CH

ILD

AG

E 5

TO

UN

DE

R 1

8 F

RO

M D

EM

OG

RA

PH

Y, P

AG

E 2

, O

NTO

TH

IS P

AG

E, B

EF

OR

E S

TAR

TIN

G T

HE

INT

ER

VIE

W

Let

us

star

t th

is s

ecti

on

by

talk

ing

ab

ou

t th

e ed

uca

tio

n o

f ta

ll th

e ch

ildre

n in

th

is h

ou

seh

old

. W

e w

ill t

alk

abo

ut

sch

oo

l en

rollm

ent,

and

att

end

ance

PLHA

HOU

SEHO

LDRE

SPON

DENT

: Mot

her o

r Prim

ary

Care

Giv

er o

f chi

ldre

n ne

w-b

orn

to 1

4 ye

ars

of a

ge, c

hild

; 15-

18

year

sRE

SPON

DENT

-rel

atio

nshi

p to

OVC

(C

ODE

A-1)

: ...

....

....

....

....

..

EDUC

ATIO

N ST

ATUS

OF

OVC

AND

OTH

ER C

HILD

REN

IN O

VC

HOUS

EHOL

D FO

R AL

L CH

ILDR

EN A

GE 5

TO

18 Y

EARS

81

AC

TIV

ITIE

S

FAM

ILY

ME

MB

ER

ID

[CO

PY

FR

OM

HO

US

EH

OLD

D

EM

OG

RA

PH

Y-PA

GE

.

2425

2627

2829

3031

3233

3435

3637

3839

4041

atte

nd

scho

old

o ho

mew

ork

or s

tud

ying

othe

r vo

catio

nal

trai

ning

, ot

her

HB

C

pro

gra

mm

e,

Hap

py

Hap

py

pro

gra

mm

e

wor

k on

you

r ho

useh

old

’s

farm

or

othe

r b

usin

esse

s

pre

par

e fo

od fo

r th

e ho

useh

old

’s

cons

ump

tion

(incl

udin

g

cook

ing

an

d w

ashi

ng

dis

hes)

care

for

othe

r si

blin

gs

gat

her

fi rew

ood

or

buy

fu

el fo

r co

okin

g

OR

fetc

h w

ater

do

othe

r ho

useh

old

ch

ores

su

ch a

s sh

opp

ing

, w

ashi

ng

clot

hes,

m

aint

aini

ng

com

pou

nd

or y

ard

SE

XH

OU

RS

/D

AYH

OU

RS

/D

AYH

OU

RS

/DAY

Y-1,

N-2

Y-1,

N-2

Y-1,

N-2

Y-1,

N-2

Y-1,

N-2

CO

DE

G1

CO

DE

G1

CO

DE

G1

CO

DE

G1

CO

DE

G1

income generation Y/N

coping with community

If YES By Whom

self health care Y/N

If YES By Whom

food & nutrition Y/N

If YES By Whom

Hav

e yo

u b

een

trai

ned

in

CO

DE

G1

KH

AN

A ..

......

......

......

......

......

......

......

......

......

......

......

......

......

......

1H

BC

TE

AM

.....

......

......

......

......

......

......

......

......

......

......

......

......

... 2

HE

ALT

H S

TAFF

.....

......

......

......

......

......

......

......

......

......

......

......

... 3

CO

MM

UN

ITY

OR

GA

NIZ

ATIO

N ..

......

......

......

......

......

......

......

.....

4FR

IEN

DS

.....

......

......

......

......

......

......

......

......

......

......

......

......

......

5FA

MIL

Y M

EM

BE

R ..

......

......

......

......

......

......

......

......

......

......

......

.. 6

If YES By Whom

personal hygiene Y/N

If YES By Whom

WO

RK

OU

TSID

E T

HE

HO

ME

FAM

ILY

ME

MB

ER

ID42

4344

In th

e p

ast

7 d

ays,

did

[N

AM

E]

do

wor

k fo

r so

meo

ne w

ho

is n

ot a

mem

-b

er o

f you

r ho

useh

old

?

HO

UR

S/D

AY

In th

e la

st

7 d

ays,

on

aver

age,

how

m

any

hour

s p

er d

ay,

if an

y, d

id

[NA

ME

] w

ork

for

som

eone

ou

tsid

e of

you

r ho

useh

old

?

Wha

t was

[N

AM

E]’s

mai

n ac

tivity

in th

is w

ork?

FAR

MIN

G,

CA

RIN

G F

OR

AN

IMA

LS...

......

......

......

.1S

ALE

S/S

ER

VIC

ES

......

......

......

......

......

..2M

AN

UFA

CTU

RIN

G...

......

......

......

......

...3

UN

SK

ILLE

D L

AB

OR

.....

......

......

......

....4

HO

US

EW

OR

K/D

OM

ES

TIC

......

......

......

5C

HIL

D C

AR

E...

......

......

......

......

......

......

6P

RO

TEC

TIN

G P

RO

PE

RTY

......

......

......

7FE

CTH

ING

WO

OD

/WAT

ER

......

......

......

8O

THE

R (

SP

EC

IFY

)....

......

......

......

......

...9

Was

[N

AM

E]

pai

d in

cas

h,

in k

ind

or

not

at a

ll?

SE

X

Now

I’d

like

to a

sk a

bo

ut o

ther

act

iviti

es th

at [N

AM

E] m

ay h

ave

par

ticip

ated

in d

uri

ng

the

last

7 d

ays.

In t

he

last

7 d

ays,

on

ave

rag

e, w

as t

he

OV

C in

volv

ed in

th

e F

OL

LO

WIN

G [

AC

TIV

ITY

]?

PLHA

HOU

SEHO

LDRE

SPON

DENT

: PAR

ENT

OR

PRIM

ARY

CARE

GIVE

R FO

R OV

C 5-

14 Y

EARS

OLD

; SEL

F RE

SPON

SE

BY O

VC 1

5-18

YEA

RS O

LDRE

SPON

DENT

-rel

atio

nshi

p to

OVC

(C

ODE

A-1)

: ...

....

....

....

....

..

ACTI

VITI

ES -

LIVE

LIHO

OD O

F OV

C

ASK

ONLY

FOR

OVC

- BE

NEFI

CIAR

Y OF

FOO

D SU

PPOR

T

82

RE

SP

ON

DE

NT:

PA

RE

NT

OR

PR

IMA

RY

CA

RE

GIV

ER

FO

R O

VC

5-1

4 Y

EA

RS

OL

D; S

EL

F R

ES

PO

NS

E B

Y O

VC

15-

18 Y

EA

RS

OL

D

RE

SP

ON

DE

NT-

rela

tio

nsh

ip t

o O

VC

(C

OD

E A

-1):

.....

......

......

....

TRA

NS

FER

NA

ME

S A

ND

ID C

OD

ES

OF

OV

C F

RO

M H

OU

SE

HO

LD D

EM

OG

RA

PH

Y P

AG

E

4546

4748

49

Did

you

hav

e on

e or

mor

e of

the

follo

w-

ing

infe

ctio

ns

dur

ing

the

pas

t tw

o w

eeks

?

If Y

ES

, how

lo

ng d

id

each

infe

c-tio

n la

st?

AN

D h

ow

man

y re

-p

eate

d in

fec-

tions

dur

ing

th

e p

ast t

wo

wee

ks?

Wer

e th

ey

atte

nded

to

by

heal

th

per

sonn

el-

Yes/

No

If N

O, w

hat

is th

e m

ain

reas

on?

FAM

ILY

ME

MB

ER

IDN

AM

ES

EX

CO

DE

H D

AYS

FRQ

CO

DE

I

CO

DE

H O

PP

OR

TU

NIS

TIC

INF

EC

TIO

NS

SK

IN IN

FEC

TIO

NS

......

......

......

......

......

......

......

......

. 1

RE

SP

IRAT

OR

Y T

RA

CT

INFE

CTI

ON

IN

CLU

DIN

G T

B...

......

......

......

......

......

......

......

......

... 2

DIA

RR

HO

EA

/dys

entr

y....

......

......

......

......

......

......

... 3

FEV

ER

.....

......

......

......

......

......

......

......

......

......

......

.. 4

OTH

ER

S (

SP

EC

IFY

)....

......

......

......

......

......

......

......

. 5

CO

DE

H O

PP

OR

TU

NIS

TIC

INF

EC

TIO

NS

WO

RK

, FA

RM

WO

RK

......

......

......

......

......

......

......

... 1

DO

ME

STI

C L

AB

OR

......

......

......

......

......

......

......

.....

2

NO

BO

DY

TO

HE

LP T

P G

O T

O H

C...

......

......

......

.. 3

ILLN

ES

S ..

......

......

......

......

......

......

......

......

......

......

.. 4

HE

ALT

H C

EN

TER

TO

O F

AR

AW

AY ..

......

......

......

...5

LAC

K O

F M

ED

ICIN

E IN

HC

.....

......

......

......

......

..... 6

HE

ALT

H P

ER

SO

NN

EL

AR

E N

OT

GO

OD

......

......

... 7

NO

HE

ALT

H P

ER

SO

NN

EL.

......

......

......

......

......

......

8

BE

LIE

VE

NO

BE

NE

FIT

FRO

M M

OR

E A

RV.

......

......

9

DO

NO

T K

NO

W A

RV

IS A

VAIL

AB

LE...

......

......

......

10

OTH

ER

S (

SP

EC

IFY

)....

......

......

......

......

......

......

......

. 11

OVC

HOUS

EHOL

DRE

SPON

DENT

: PAR

ENT

OR

PRIM

ARY

CARE

GIVE

R FO

R OV

C 5-

14 Y

EARS

OLD

; SE

LF R

ESPO

NSE

BY O

VC

15-1

8 YE

ARS

OLD

RESP

ONDE

NT-

rela

tions

hip

to O

VC

(COD

E A-

1): .

....

....

..

OVC

HEAL

TH S

TATU

SAS

K ON

LY F

OR O

VC -

BENE

FICI

ARY

OF F

OOD

SUPP

ORT

83

5051

5253

54

LOA

N T

YP

ED

id a

nyon

e in

you

r ho

useh

old

take

a

[LO

AN

TY

PE

] in

the

last

12

mon

ths?

How

man

y tim

es in

th

e p

ast 1

2 m

onth

s d

id a

mem

ber

of

your

HH

take

a

[LO

AN

TY

PE

]

Ple

ase

thin

k ab

out t

he m

ost

rece

nt ti

me

this

[LO

AN

TY

PE

] w

as ta

ken.

Wha

t w

as th

e to

tal a

mou

nt o

r va

lue

of th

e [L

OA

N T

YP

E]?

Wha

t was

the

mai

n p

urp

ose

of

this

mos

t rec

ent

[LO

AN

TY

PE

]?

Has

this

mos

t re

cent

[LO

AN

TY

PE

] b

een

pai

d

bac

k in

full?

NU

MB

ER

AM

OU

NT

IN R

IEL

CO

DE

K

1C

ash

loan

from

rela

tive,

frie

nd o

r ne

ighb

or

2C

ash

loan

from

mon

ey le

nder

3Lo

an fr

om c

ow b

ank

4C

red

it fo

r g

ood

s or

ser

vice

s fro

m s

tore

keep

er/s

ervi

ce p

rovi

der

5C

ash

loan

from

gov

ernm

ent b

ank

6C

ash

loan

from

priv

ate

ban

k

7C

ash

loan

from

com

mun

ity fu

nd o

r N

GO

8[A

DD

AN

Y O

THE

R L

IKE

LY T

YP

ES

OF

LOA

NS

HE

RE

]

9[A

DD

AN

Y O

THE

R L

IKE

LY T

YP

ES

OF

LOA

NS

HE

RE

]

10O

ther

(sp

ecify

:___

____

____

____

____

____

___)

L O A N C O D E

CO

DE

J: R

EA

SO

N F

OR

NO

T T

AK

ING

LO

AN

/CR

ED

IT?

DID

N’T

NE

ED

TO

.....

......

......

......

......

......

......

......

......

....1

N

O P

LAC

E T

O G

O F

OR

LO

AN

/CR

ED

IT .

......

......

......

..2

TUR

NE

D D

OW

N/D

EN

IED

FO

R L

OA

N/C

RE

DIT

....

.....3

O

THE

R (

SP

EC

IFY

) ...

......

......

......

......

......

......

......

......

....4

CO

DE

K: P

UR

PO

SE

OF

LO

AN

/CR

ED

IT a

nd

SE

LL

ING

AS

SE

TS

ILLN

ES

S

......

......

......

......

......

......

......

......

......

......

......

....1

S

CH

OO

LIN

G .

......

......

......

......

......

......

......

......

......

......

..2C

AP

ITA

L FO

R B

US

INE

SS

-AG

RIC

ULT

UR

E .

......

......

...3

LAC

K O

F FU

ND

S/D

AIL

Y E

XP

EN

SE

S .

......

......

......

......

4

MA

RR

IAG

E A

ND

CE

RE

MO

NIE

S .

......

......

......

......

......

5 FU

NE

RA

L E

XP

EN

SE

S .

......

......

......

......

......

......

......

......

6 P

ETT

Y T

RA

DE

/ser

vice

....

......

......

......

......

......

......

......

...7

BU

Y F

OO

D B

EFO

RE

HA

RV

ES

T ...

......

......

......

......

......

.8O

THE

R (

SP

EC

IFY

) ...

......

......

......

......

......

......

......

......

...9

1.

Did

you

or

any

hous

ehol

d m

emb

ers

bor

row

any

fund

s or

ob

tain

any

goo

ds

or s

ervi

ces

on c

red

it in

the

last

12

mon

ths?

2.

Why

did

you

NO

T b

orro

w fu

nds

or o

bta

in g

ood

s or

ser

vice

s on

cre

dit?

YE

S…

1 (>

>Q

3)N

O..2

CO

DE

J

I wo

uld

now

like

to a

sk y

ou

ab

ou

t th

e lo

ans

or

cred

its ta

ken

by

you

r h

ou

seh

old

in th

e la

st y

ear.

Ple

ase

con

sid

er a

ll lo

ans

or

cred

its ta

ken

by

all h

ou

seh

old

mem

bers

.

I wo

uld

now

like

to

ask

yo

u a

bo

ut

any

bo

rro

win

g o

r an

y lo

ans

take

n b

y h

ou

seh

old

mem

ber

s in

th

e p

ast

12 m

on

ths.

OVC

HOUS

EHOL

DRE

SPON

DENT

: HOU

SEHO

LD H

EAD

OR S

POUS

E OR

OVC

(REL

ATIO

NSHI

P TO

HOU

SEHO

LD H

EAD

- COD

E A.

]....

....

....

....

..

HOUS

EHOL

D BO

RROW

ING

AND

CRED

IT

84

AS

SE

T 55

5657

58

Doe

s th

e ho

useh

old

ow

n an

y [A

SS

ET]

?

How

man

y [A

SS

ET]

d

oes

your

ho

useh

old

ow

n?

Did

you

sel

l th

e as

set

[NA

ME

] d

urin

g th

e la

st y

ear

How

man

y d

id y

ou s

ell?

Wha

t is

the

mai

n re

ason

fo

r se

lling

th

at a

sset

?

QU

AN

TITY

cod

e k

A S S E T C O D E

AS

SE

T 55

(C

ON

T.)

56 (

CO

NT.

)57

(C

ON

T.)

58 (

CO

NT.

)

Doe

s th

e ho

useh

old

ow

n an

y [A

SS

ET]

?

How

man

y [A

SS

ET]

d

oes

your

ho

useh

old

ow

n?

Did

you

sel

l th

e as

set

[NA

ME

] d

urin

g th

e la

st y

ear?

How

man

y d

id y

ou s

ell?

Wha

t is

the

mai

n re

ason

fo

r se

lling

th

at a

sset

?

QU

AN

TITY

cod

e k

A S S E T C O D E

LA

ND

AN

D B

UIL

DIN

GS

1La

nd -

Hec

ter

2B

uild

ing

s --

Bus

ines

s- U

nit

3B

uild

ing

s --

Ag

ricul

ture

-Uni

t

TR

AN

SP

OR

T E

QU

IPM

EN

T

4Ve

hicl

e (C

ar, V

an, e

tc.)

5M

otor

cycl

e

6B

icyc

le

7Tu

k-tu

k

HO

US

EH

OL

D D

UR

AB

LE

S

8R

efrig

erat

or/fr

eeze

r

9S

ewin

g m

achi

ne

10W

ashi

ng m

achi

ne

11Va

cuum

cle

aner

12E

lect

ric r

ice

cook

er

13S

team

ric

e co

oker

14Fo

od p

roce

ssor

AG

RIC

ULT

UR

E/B

US

INE

SS

15Tw

o-w

heel

ed tr

acto

r

16Fo

ur-w

heel

ed tr

acto

r

17A

gric

ultu

ral e

qui

pm

ent-

pie

ce

18To

ols

smal

l and

larg

e-p

iece

19B

oat

20Fi

shin

g n

et

21C

art T

V, R

AD

IO, P

HO

NE

S

22Te

levi

sion

23R

adio

/VC

D, e

tc.

24Te

lep

hone

25M

obile

pho

ne

OT

HE

R G

OO

DS

26S

atel

lite

dis

h

27C

omp

uter

28A

ir co

nditi

oner

29Je

wel

ry

30M

osq

uito

net

31O

ther

(sp

ecify

____

)

32O

ther

(sp

ecify

____

)

33O

ther

(sp

ecify

____

)

34O

ther

(sp

ecify

____

)

CO

DE

K: P

UR

PO

SE

OF

LO

AN

/CR

ED

IT a

nd

SE

LL

ING

AS

SE

TS

ILLN

ES

S .

......

......

......

......

......

......

......

......

......

......

......

......

1S

CH

OO

LIN

G .

......

......

......

......

......

......

......

......

......

......

.....2

CA

PIT

AL

FOR

BU

SIN

ES

S-A

GR

ICU

LTU

RE

....

......

......

..3LA

CK

O

F FU

ND

S/D

AIL

Y

EX

PE

NS

ES

...

......

......

......

...4

MA

RR

IAG

E

AN

D

CE

RE

MO

NIE

S

......

......

......

..5

FUN

ER

AL

EX

PE

NS

ES

...

......

......

......

......

......

.....6

P

ETT

Y

TRA

DE

/ser

vice

...

......

......

......

......

......

....7

BU

Y F

OO

D B

EFO

RE

HA

RV

ES

T....

......

......

......

....8

OTH

ER

(S

PE

CIF

Y)

......

......

......

......

......

......

......

...9

GO

TO

NE

XT

CO

LU

MN

>>

You

r h

ou

seh

old

may

ow

n s

om

e as

sets

like

lan

d, v

ehic

les

or

ho

use

ho

ld g

oo

ds.

I w

ou

ld li

ke t

o a

sk y

ou

ab

ou

t th

ose

ass

ets

now

.

OVC

HOUS

EHOL

DRE

SPON

DENT

: HOU

SEHO

LD H

EAD

OR S

POUS

E OR

OVC

.(RE

LATI

ONSH

IP T

O HO

USEH

OLD

HEAD

- CO

DE A

.]...

....

....

....

..AS

K AB

OUT

ALL

ASSE

TS T

HE H

OUSE

HOLD

OW

NS A

ND S

OLD

DURI

NG P

AST

YEAR

ASSE

TS S

OLD

85

5960

LIN

E N

OIT

EM

“TO

TAL

CA

SH

EX

PE

ND

ITU

RE

(R

IEL

S)”

“IN

-KIN

D E

XP

EN

DIT

UR

E (

VAL

UE

IN C

AS

H -

RIE

LS

)”

1M

ain

cere

al

2S

econ

dar

y ce

real

3R

oots

/Tub

ers

4Ve

get

able

5Fi

sh o

r m

eat

6O

il

7O

ther

food

(fi s

h p

aste

, sal

t, su

gar

, leg

umes

)

8Fo

od &

drin

ks c

onsu

med

out

sid

e th

e ho

use

9M

edic

al e

xpen

ses

10H

ousi

ng/re

nt

11A

lcoh

ol a

nd to

bac

co

12Tr

ansp

orta

tion

13Fi

nes

and

deb

ts

14E

qui

pm

ents

/tool

s/se

eds

15W

ater

/lig

ht/fu

el

16E

duc

atio

n/sc

hool

fees

17C

loth

ing

/sho

es

18C

eleb

ratio

n/so

cial

eve

nts

19M

icel

lane

ous/

othe

r

I wo

uld

now

like

to

ask

yo

u a

bo

ut

exp

end

itu

re b

y yo

ur

ho

use

ho

ld o

n t

he

follo

win

g e

xpen

ses.

Ple

ase

con

sid

er in

ave

rag

e p

er m

on

th, d

uri

ng

pas

t si

x m

on

ths.

OVC

HOUS

EHOL

DRE

SPON

DENT

: HOU

SEHO

LD H

EAD

OR S

POUS

E OR

OVC

.(RE

LATI

ONSH

IP T

O HO

USEH

OLD

HEAD

- CO

DE A

.]...

....

....

....

..

HOUS

EHOL

D EX

PEND

ITUR

E

86

No

w I

wo

uld

lik

e to

ask

yo

u a

bo

ut

the

typ

es o

f fo

od

s th

at y

ou

or

anyo

ne

in y

ou

r h

ou

seh

old

ate

yes

terd

ay d

uri

ng

th

e d

ay o

r n

igh

t. If

yes

terd

ay w

as n

ot

a ty

pic

al d

ay

in t

erm

s o

f fo

od

co

nsu

mp

tio

n,

ple

ase

thin

k b

ack

to t

he

mo

st r

ecen

t ty

pic

al f

oo

d

con

sum

pti

on

day

.

So

me

ho

use

ho

lds

hav

e p

erio

ds

wh

en o

bta

inin

g f

oo

d f

or

thei

r h

ou

seh

old

s is

har

der

an

d o

ther

per

iod

s w

hen

it

is e

asie

r. I

wo

uld

lik

e to

ask

yo

u a

bo

ut

you

r h

ou

seh

old

’s

foo

d s

up

ply

du

rin

g d

iffe

ren

t m

on

ths

of

the

year

. Wh

en r

esp

on

din

g t

o t

hes

e q

ues

tio

ns,

p

leas

e th

ink

bac

k ov

er t

he

last

12

mo

nth

s.

For

Dat

a E

ntry

61

Did

any

one

in y

our

hous

ehol

d e

at [

FOO

D IT

EM

] ye

ster

day

? Th

is c

ould

incl

ude

food

pre

par

ed a

t hom

e th

at w

as ta

ken

to a

wor

k si

te o

r sc

hool

. Ple

ase

do

not

incl

ude

pre

par

ed fo

od p

urch

ased

aw

ay fr

om h

ome

or in

-kin

d m

eals

.

For

Dat

a E

ntry

6263

Nam

e of

Foo

d It

emD

urin

g la

st 1

2 m

onth

s, h

ow m

any

mon

ths

did

you

not

hav

e en

oug

h fo

od [

FOO

D IT

EM

NA

ME

] to

feed

you

r fa

mily

?

A1

Ric

e

A2

Pot

ato

A2

Mai

ze o

r ot

her

cere

al

A2

Cas

sava

A2

Oth

er ro

ots

and

tub

ers

A3

Whe

at n

ood

le, b

read

, bis

cuit

B2

Gro

und

nuts

, leg

umes

B2

Bea

ns (

all t

ypes

)

D1

Gre

en le

afy

veg

etab

les

D2

Oth

er v

eget

able

s

D3

Frui

t (no

t jui

ce)

B1

ferm

ente

d fi

sh p

aste

B1

Fish

(fre

sh o

r d

ry)

B2

Inse

cts/

othe

r fa

rm a

nim

als

B3

Eg

gs

B3

Pou

ltry

B3

Por

k

B3

Bee

f/Buf

falo

C1

Oil/

fat

B3

Milk

C3

Milk

pro

duc

ts

C3

Oth

ers

(sug

ar, e

tc)

OVC

HOUS

EHOL

DRE

SPON

DENT

: HOU

SEHO

LD M

EMBE

R M

OST

KNOW

LEDG

EABL

E AB

OUT

HOUS

EHOL

D FO

OD C

ONSU

MPT

ION

RESP

ONDE

NT: R

ELAT

IONS

HIP

TO H

OUSE

HOLD

HEA

D [C

ODE

A] ..

....

....

....

....

....

....

FOOD

SEC

URIT

Y &

FOO

D SH

ORTA

GE

A1

Ric

e

A2

Mai

ze o

r ot

her

cere

als

C1

Oil

87

No

w I

wo

uld

like

to

ask

yo

u a

bo

ut

som

e o

f th

e fo

od

s th

at w

ere

eate

n b

y th

e b

enefi

cia

ry O

VC

of

this

ho

use

ho

ld y

este

rday

. If

he/

she

did

no

t co

nsu

me

a ty

pic

al d

iet

yest

erd

ay,

ple

ase

thin

k b

ack

to t

he

mo

st r

ecen

t ty

pic

al d

ay. F

or

each

of

the

foo

d g

rou

ps

that

I m

enti

on

, ple

ase

tell

me

wh

eth

er t

he

child

ate

at

leas

t o

ne

serv

ing

of

that

foo

d. T

his

co

uld

incl

ud

e fo

od

pre

par

ed a

nd

ea

ten

at

ho

me,

or

else

wh

ere

such

as

at s

cho

ol,

wit

h r

elat

ives

, or

in a

mar

ket.

Yest

erd

ay, d

id [

NA

ME

] ea

t an

y [F

OO

D IT

EM

], ei

ther

at

ho

me

or

else

wh

ere?

CO

PY

ID C

OD

E A

ND

SE

X O

F

PL

HA

FR

OM

HO

US

EH

OL

D

DE

MO

GR

AP

HY

PA

GE

6464

6464

6464

6464

6464

6464

6464

6464

6464

6464

6464

…ric

eP

otat

o…

mai

ze

or o

ther

ce

real

s

Cas

sava

Oth

er

root

s an

d

tub

ers

Whe

at

nood

le,

bre

ad,

bis

cuit)

Gro

und

-nu

ts,

leg

ume

bea

ns

(all

typ

es)

Gre

en

leaf

y ve

ge-

tab

les

Oth

er

veg

-et

able

s

Frui

t (n

ot

juic

e)

fi sh

pas

teFi

sh

(fre

sh

or

dry

)

In-

sect

s/ot

her

farm

an

i-m

als

Eg

gs

Pou

l-tr

yP

ork

Bee

f/B

uf-

falo

Oil/ fat

Milk

Milk

p

rod

-uc

ts

Oth

ers

(sug

-ar

, et

c)

FAM

ILY

ME

MB

ER

IDS

EX

ON

LY F

OR

DAT

A E

NTR

Y [

CO

DE

]A

1A

2A

2A

2A

2A

3B

2B

2D

1D

2D

3B

1B

1B

2B

3B

3B

3B

3C

1B

3C

3C

3

SERIAL NUMBEROVC

HOUS

EHOL

DRE

SPON

DENT

: PAR

ENT

OR P

RIM

ARY

CARE

GIVE

R FO

R OV

C 5-

14 Y

EARS

OLD

; SEL

F RE

SPON

SE B

Y OV

C 15

-18

YEAR

S OL

D

DIET

ARY

DIVE

RSIT

Y OF

OVC

88

MEA

LS C

ONSU

MED

BY

PLHA

AND

THE

IR H

OUSE

HOLD

No

w I

wo

uld

like

to

ask

yo

u a

bo

ut

the

nu

mb

er o

f m

eals

co

nsu

med

by

the

AN

Y M

EM

BE

R O

F T

HIS

HO

US

EH

OL

D A

ND

OV

C H

IM/H

ER

SE

LF,

du

rin

g y

este

ster

day

. If

yes

terd

ay

was

no

t a

typ

ical

day

in t

erm

s o

f fo

od

co

nsu

mp

tio

n, p

leas

e th

ink

bac

k to

th

e m

ost

rec

ent

typ

ical

foo

d c

on

sum

pti

on

day

.

65

. Y

est

erd

ay,

did

YO

U [

PL

HA

] e

at

me

al

CO

PY

ID C

OD

E A

ND

SE

X O

F O

VC

FR

OM

H

OU

SE

HO

LD

DE

MO

GR

AP

HY

PA

GE

65.1

65.2

65.3

65.4

65.5

65.6

65.7

FAM

ILY

ME

MB

ER

IDS

EX

Any

food

bef

ore

a m

orni

ng m

eal

Mor

ning

mea

lA

ny fo

od b

etw

een

mor

ning

mea

l and

m

id d

ay m

eal

Mid

day

mea

lA

ny fo

od b

etw

een

mid

day

and

eve

ning

m

eal

Eve

ning

mea

lA

ny fo

od a

fter

the

even

ing

mea

l

66 Y

este

rday

, did

any

of

you

r h

ou

seh

old

mem

ber

eat

66.1

66.2

66.3

66.4

66.5

66.6

66.7

Any

food

bef

ore

a m

orni

ng m

eal

Mor

ning

mea

lA

ny fo

od b

etw

een

mor

ning

mea

l and

m

id d

ay m

eal

Mid

day

mea

lA

ny fo

od b

etw

een

mid

day

and

eve

ning

m

eal

Eve

ning

mea

lA

ny fo

od a

fter

the

even

ing

mea

l

SERIAL NUMBER

OVC

HOUS

EHOL

DRE

SPON

DENT

: PAR

ENT

OR P

RIM

ARY

CARE

GIVE

R FO

R OV

C 5-

14 Y

EARS

OLD

; SEL

F RE

SPON

SE B

Y OV

C 15

-18

YEAR

S OL

D

89

6768

6970

CO

PY

ID C

OD

E A

ND

SE

X O

F O

VC

FR

OM

HO

US

EH

OLD

DE

MO

GR

AP

HY

PA

GE

b

irthd

ate

age

in c

omp

lete

d y

ears

an

d m

onth

s If

birt

h d

ate

is n

ot a

vaila

ble

ME

AS

UR

E A

ND

RE

CO

RD

WE

IGH

TM

EA

SU

RE

AN

D R

EC

OR

D H

EIG

HT

FAM

ILY

ME

MB

ER

IDS

exD

DM

MY

YY

EA

RS

MO

NTH

S

KIL

OG

RA

MS

CE

NTI

ME

TER

S

OVC

HOUS

EHOL

DTo

Mea

sure

ben

efi c

iary

OV

C

ANTH

ROPO

MET

RIC

MEA

SURE

MEN

T

Produced byKhmer HIV/AIDS NGO Alliance

# 33 Street 71, Sangkat Tonle Bassac, Khan Chamkar Mon

Telephone: 023 211 505 - Fax: 023 214 049 - Website: www.khana.org.kh

des

ign

and

layo

ut b

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ova:

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ign@

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Documents

PLHA and OVC with Home Based Care Evaluation andBaseline Survey 2006 Cambodia Food Support to PLHA and OVC with Home Based Care Aye Thwin Consultant September 2006This survey is made