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Base de données d'évaluation

Evaluation report

PAK 1999/010: The Bond of Care: Dera Ismail Khan District 1998

Author: Massoud, N.; Shaukat, P.; Mahal, Z.; Andersson, N.; CIET International

Executive summary


The Government of NWFP, UNICEF, and UNDP are collaborating with CIET International - an international non governmental organisation devoted to building the community voice in planning - to introduce CIET methods (also referred as Sentinel Community Surveillance, SCS) in the province. The rationale for UNICEF is the Master Plan of Operation of the Government of Pakistan-UNICEF Country Programme of Cooperation 1996-1998. The overall objective of planning, monitoring, and evaluation, according to this Programme of Cooperation, is to stimulate dialogue on the situation of children and women. This dialogue should be based on evidence of trends and programme impact, ultimately leading to improved allocation and utilization of financial, human and organisational resources for children and women. UNDP joined the SCS project in May 1997 in the context of the institutional reform project in NWFP. One part of this project is devoted to building development management capacity in the districts of Mardan and Dera Ismail Khan.

Purpose / Objective

- To learn about the communities' perceptions and practices on care for women and children
- To identify actionable interventions for the care of the mother that can change the care for her child, ultimately leading to improved child survival, protection, and development
- To identify care resources at household and community levels (including time, energy, knowledge or money) that are necessary to bring about change in care practices
- To continue building provincial and district level capacities to conduct inquiries of this nature in the future

This survey makes use of new methodology, Sentinel Community Surveillance (or CIET method). The aim of the Community Voice in Planning Initiative is to strengthen capacities for community-based assessment and analysis at the provincial, district and community levels, while producing actionable data on priority problems rapidly and at low cost.


A survey of 1,703 households from 10 sites was carried out; 82% of the households were in rural areas. 15 health facilities were reviewed. A total of 1,319 women with children under three years were interviewed. Respondents reported on 1,497 children under three. Interviews were also conducted with 39 Traditional Birth Attendants and 12 Lady Health Visitors. Ten focus groups were held with mothers, ten focus groups with husbands, and ten focus groups with mothers-in-law.

Key Findings and Conclusions

About 44% of children aged 6-36 months are chronically malnourished. A rural child is 72% more likely to be chronically malnourished than an urban child. Some 19% of children aged 6-36 months were reported to have low weight-for-height, this percentage being higher among boys than girls.

About 27.5% of household respondents reported that their children are not well grown for their age. There is an association between their perception and anthropometry; however, mothers tend to underestimate malnutrition, especially chronic malnutrition. Among children thought by their mothers to be well grown for their age, 42.5% were chronically malnourished and 14.5% were acutely malnourished.

Some 17% reported having taken iron/folate supplements during their last pregnancy, and 19% of those took the tablets for three months or more. Some 26% said they had less food during their pregnancy than before their pregnancy and 6.5% indicated not having enough food.

Asked how many antenatal check-ups they had during their last pregnancy, about 80% of women said they received no formal antenatal care. The average number of visits is higher in urban 5.2 than rural areas 2.8. Among the main reasons given for not going for check-ups are: local traditions 34%, lack of necessity 26%, and lack of awareness 14%.

A woman who has received some education is 9 times more likely to attend antenatal care compared with an uneducated woman. A woman who received help during her last pregnancy or reduced her heavy work at a certain stage of the pregnancy is more likely to receive antenatal care [or vice versa]. A woman who received formal antenatal care is 8.4 times more likely to take iron/folate tablets and 11 times more likely to report having had enough food during her last pregnancy. Among those who did receive formal antenatal care, 3% reported not having been satisfied at all, 79% were somewhat satisfied and 18% were very satisfied.

Focus groups with mothers were also asked whether men maltreated or even beat women in the area. In five of the groups, women said they were very well treated by their husbands who were reported to fulfill every justified demand of their wives. In the other five groups, women were complaining of very bad treatment from their husbands. Common reasons for beating and maltreatment are: instigation by mother-in-law, women arguing with their husbands, or suspicion about affairs.

Breastfeeding is almost universal; only 1.3% of children were said not to have been breastfed at all. For 57% of children, breastfeeding started within the first day. Exclusive breastfeeding does not last long after birth, with liquid or solid complements given by 58% on the first day.


Suggested interventions:

Mother care
To take iron-folate tablets more than three months
To increase food intake
To attend antenatal care check-ups
To avoid quarrels in the household
To provide adequate care to mothers during pregnancy

Child care
To give colostrum to the newborns
To avoid giving prelacteal feeds
To initiate breastfeeding within the first two hours after birth

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Report information





ECD - Family & Community Practices

UNDP, Government of NWFP


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