Survey Report by DR Akm Version 2

EVALUATION REPORT BASED ON A SURVEY CONDUCTED AT WA SPECIAL REGION (2)
Dr. Aung Kyaw Myint External Surveyor AMI CONTENTS 1. Summary 2. Introduction 3. Objectives 4. Research Methodology 5. Findings 6. Discussion and Conclusion 7. Recommendations 8. References
Dr.Aung Kyaw Myint | AMI survey report
EXECUTIVE SUMMARY One month survey was done in order to explore the social, demographic, and economic profile of the locality in Wa Special Administrative Region (2). A total of 268 respondents from 27 villages among four townships and 91 school children from three schools were interviewed by pre-structured, pre-tested interview questionnaires. It was found that majority of local people had lack of formal education, insufficient hygienic practice, and are not available, accessible and affordable for government provided formalized health services. Unqualified health providers such as quacks, traditional birth attendants are their health care providers and too high out-of-pocket payments for treatment of illnesses with those non-professionals may lead to catastrophic health expenditures and that may sink them deeper into poverty. Although the respondents know and eager to follow healthy habits and hygienic means, the reverse is true for their practice i.e. their practices were very unhygienic and leading towards unhealthy behaviors and diseases. But the story was different in school children. School children know very well about healthy habits, had positive attitude and also had good practices. In order to improve the standard of living of that local community, just supporting and strengthening community health network seemed to be not sufficient. Health infrastructures and strategies should be revised with the aid of local authorities and community participation should be appraised in order to fulfill the desired objectives.
INTRODUCTION AMI is a European international non-profit organization providing humanitarian assistance in developing countries and currently runs projects in 2 regions in Myanmar: South Yangon Region in Dala, Seikkyi and Twantay Townships and Wa Special Administrative Region of Shan State
With the general objective to improve the live standard of the former displaced people and their host communities in Wa Special Administrative Region (2) by supporting and strengthening the community health network and to reinforce the involvement of the community in the local health system since 2001. In order to access the fulfillment of this objective, a baseline survey was conducted by survey team lead by an external surveyor on December 2011 to January 2012 (one month). An internal evaluation report was prepared by external surveyor and was submitted to the responsible authorities.
OBJECTIVES General Objective To study social and health related characteristics and the knowledge, attitude and practice of community in Wa SAR 2 on health and hygiene Specific Objectives 1. To describe the socio-demographic characteristics, environmental sanitation status, health service utilization and opinion on willingness to pay for health services of respondents 2. To determine the level of knowledge, attitude and practice of respondents and school children on health and hygiene 3. To find out the association between knowledge, attitude and practice of respondents and school children on health and hygiene
RESEARCH METHODOLOGY Study Design Community based cross-sectional descriptive study. Study Population Household representative (age above 18 years of both sexes) of community residing in Wa SAR 2 Sample size determination The following formula will use used for sample size determination. n = z2 pq d2 n z p = = = Minimum required Sample size reliability coefficient proportion of persons with a good knowledge on health & hygiene
(assumption: 0.75) q d n = = = 1-p (0.25) precision error (0.05) (1.96)2 x 0.75 x 0.25 (0.05)2 = 288.12 300 households
Sampling Plan Three-stage random sampling procedure was expected to be practiced as follows: 1st stage- 3 townships from Wa SAR 2 will be chosen at random by fishbowl draw method 2nd stage- among 3 randomly selected townships, 5 villages in each township will be randomly chosen to get a total of 15 villages 3rd stage- 20 households from each village will be randomly chosen to get a total of 300 household samples. Actual Sampling Procedure Although planned to conduct three stage random sampling method to be practiced in order to avoid selection bias, information bias and confounding bias, the difficulties in actual survey were unfortunately paramount to encounter. First, Wa local authorities did not permit the survey team to go to the assigned villages in Man Man Hseing (because local authorities were not at office when survey team ask for permission) Secondly, many assigned villages did not have enough households for sampling (there were so many villages with only 10 or 11 households). Thirdly, survey team itself was in difficult situation. Most of the staffs contracts with AMI were ended and not refreshed yet. So they were not able to go to survey sites without signed contracts and survey was delayed. At last, instead of 3 townships, survey team rushed to collect data from 4 townships, 27 villages. Finally, it is just a convenient sampling due to above uncontrollable factors and variety of reasons. Study Area Townships surveyed Township Man Man Hseing Naung Khit Mong Phen Mong Pawk Villages 3 villages 1 village 3 villages 20 villages Households 30 9 29 200 Ethnicity Wa Wa Lahu & Akha Lahu
Actual number of household surveyed Schools surveyed 1. Wei Kao Myanmar School 2. Wei Kao Chinese School 3. Mong Pawk Wa Orphan School Detailed surveyed sites
- 268
20 students - 40 students - 30 students
No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Sr No 1-9 10-19 20-29 30-38 39-48 49-58 59-68 69-79 80-88 89-98 99-108 109-118 119-128 129-138 139-148 149-158 159-168 169-178 179-188 189-198 199-208 209-218 219-228 229-238 239-248 249-258 259-268
Name of village Man Long Nam Par Khar Par San Kya Par Khu Pan Hai Kaung Pet Nam Tim Law Kaw Hwe Lone Nam Maung Tai Nan Par Kal Pa Shan Tong Ka Pway Pan Fone Paw Nar Noo Ar Koo Day Mar Lar Dee Tong Ji Mon Khan Hou Mong Pouk new village Wang Kaung Nar Naw Po Pay Paw Kway Nar Mar Day Ohm Lone Yaung Ou Kaung Lone
Village tract Man Long Kon Hein Wa Pang Par San Kya Mong Pouk Mong Pouk Bar Kaw Tong Fa Mong Pouk Tong Fa Tong Fa Tong Fa Yaung Het Wan Kaung Nan Maung Wan Kaung Nam Eu Nam Eu Mong Pouk Mong Pouk Bar Kaw Mong Pouk Mong Pouk Bar Kaung Man Phan Man Man Hseing Man Kar
Township Naung Khit Mong Phen Mong Phen Mong Phen Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Mong Pouk Man Man Hseing Man Man Hseing Man Man Hseing
HH 9 10 10 9 10 10 10 11 9 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
supervised survey Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No No No No No No
Study period From December 2nd week 2011 to January 2nd week 2012
Data collection method, tools and technique External surveyor and AMI staffs (including driver) interviewed the respondents with preformed and pre-tested structured interview questionnaire. Before data collection, first the team obtained the valid consent from respective respondent for interview. Data analysis Data were analyzed by surveyor himself after data entry by Microsoft Excel Spreadsheet. Then using SPSS version 16.0 and Microsoft Excel, Descriptive analysis was done on socioeconomic and demographic characteristics of respondents by using tables and graphs. KAP data were described by frequency distribution tables and graphs as necessary. Association between knowledge, attitude and practice of the respondents as well as school children were determined by chi-square test with p value <0.05 for significant level. Overview on Knowledge, Attitude and Practice (KAP) Survey There are various models and approaches in health behavior research. The most frequently used studies in health-seeking behavior research is Knowledge, Attitudes and Practices (KAP) surveys. Knowledge is usually assessed in order to see how far community knowledge corresponds to biomedical concepts. Typical questions include knowledge about causes and symptoms of the illness under study. Attitudes form a more complicated issue. Attitude had been defined by Ribeaux and Poppleton in 1978 as a learned predisposition to think, feel and act in a particular way towards a given object or class of objects3. As such, attitudes result from a complex interaction of beliefs, feelings, and values. They are important in designing health promotion campaigns which aim to change attitude. Attitude may be inferred from a variety of statements and answers, but direct
Dr.Aung Kyaw Myint | AMI survey report 8
asking is usually problematic since people often respond in terms of what they think is the correct answer. Therefore attitudes are not easy to obtain. However, attitudes are central to understand behavior, an element which is better acknowledged in cognitive models. Questions related to practices in KAP surveys usually enquire about the use of preventive measures or different health care options. Since majority of practice questions are hypothetical, they therefore hardly permit statements about actual practices. Practice questions usually yield information on peoples normative behaviors or on what they know should be done or they expect the interviewer wants to hear4. KAP surveys yield highly descriptive data but without providing an explanation for why people do what they do. Many KAP studies are based on the underlying assumption that there is a direct relationship between knowledge and action. Researchers using this tool assume that by changing knowledge, behavior is automatically changed as well. This is overtly over-simplistic becomes clear if one considers that there are many other factors which influence health-seeking behavior. Although knowledge about an illness may be high, illness recognition during an actual episode is much less clear. KAP surveys do not consider motivational factors and stigma which may influence health-seeking behavior. Neglected are other factors like treatment expectations, satisfaction with health care services, decision making for health care, and external barriers. All this makes clear that knowledge is just one element in a broad array of factors which determine health seeking behavior5. However, on the whole, KAP surveys are very useful for assessing distribution of community knowledge in large-scale projects and for evaluating changes in knowledge after education and media campaigns. They permit rapid assessments, yielding quantitative data, and are therefore a cheap way to gain quick insights into main knowledge data.
FINDINGS The analysis was based on the primary source information on knowledge, attitudes and practices on health and hygiene of community residing in four townships of Wa Special Administrative Region (2) and school children at three schools by structured interview questionnaires. A total of 268 respondents and 91 school children participated in this study. I. DESCRIPTIVE SURVEY 1. Socio-demographic profile of the respondents 1.1. Age of the household heads The age of the household heads of respective respondents were classified into six age groups. Frequency and percent distribution of the household heads according to age groups were described in table 1.
Table 1. Frequency and percent distribution of household heads according to age group Age group 18-30 31-43 44-56 57-69 70-82 83-95 Total Frequency 63 82 81 24 5 2 257 Percent 24.51 31.91 31.52 9.34 1.95 0.78 100.00
257 out of 268 respondents answered the question and the response rate is 95.9%. Age of the household head ranged between 18 to 90 years with the mean of 42.2 years. About two third of household heads aged between 31 to 56 years.
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1.2. Gender of the household heads The number and percentage of household heads according to their gender was described in table 2. Table 2. Gender of the household heads Gender Male Female Total Frequency 202 60 262 Percent 77.10 22.90 100.00
262 out of 268 respondents answered the question and the response rate is 97.7%. More than three-forth of the household heads were male and the remainders were female household heads.
1.3. Ethnicity of the household heads Table 3. Frequency and percent distribution of household heads according to ethnicity Race Bamar Wa Lahu Akha Total Frequency 1 34 215 12 262 Percent 0.38 12.98 82.06 4.58 100.00
Since 20 out of 27 villages were from Mong Pawk township and are Lahu villages. So more than 80% of the household heads were Lahu tribes and the remainders were Wa, Akha and Bamar respectively.
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1.4. Education status of the household heads Educational status was classified into six groups. The results were as follows. Table 4. Frequency and percent distribution of household heads according to education Education Illiterate 29 Just read & write 25 Monastery education 3 Primary school 2 Secondary school 1 High school 1 College/university 261 Total 100.0 0.4 0.4 0.8 1.1 9.6 11.1 Frequency 200 Percent 76.6
Figure 1. Bar chart of household heads educational status
Colleage/university High school Secondary school Primary school
0.4 0.4 0.8 1.1
Monestry education
Just read & write Illiterate 0.0
9.6
11.1 76.6 20.0 40.0 60.0 80.0 100.0
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More than three-fourths of household heads were illiterates and total of seven household heads out of 261 had formal school experiences. 11% of household heads confessed that they were merely literates but just able to read and write but the source of their education was unknown. 1.5. Occupation of the household heads Occupations of the household heads were declared by the respondents by their own words. Those were categorized and presented in table 5 and figure 2 respectively. Table 5. Frequency and percent distribution of household head according to occupation Occupation Farmer Rubber plant worker Soldier Preacher Policeman Total Frequency 243 10 4 4 1 262 Percent 92.75 3.82 1.53 1.53 0.38 100.00
Figure 2. Bar chart showing occupation of household heads

100.00 90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00 92.75
3.82 Farmer Rubber plant worker
1.53 Soldier
1.53 Preacher
0.38 Policeman
More than 90% of household heads were said-to-be farmers. Minority of the household heads were rubber plantation workers, local soldiers, policeman and preachers.
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1.6. Age of the respondents Ages of the respondents were also categorized into six groups. Age range between 18 to 90 years and mean age was 39.8 years. Table 6. Frequency and percent distribution of respondents according to age group Respondent age group 18-30 31-43 44-56 57-69 70-82 83-95 Total Frequency 84 78 79 17 5 1 264 Percent 31.82 29.55 29.92 6.44 1.89 0.38 100.00
Nearly one-third of the respondents aged between 18 to 30 years and almost all were in working age group (18 to 56 years). 1.7. Gender of the respondents Table 7. Frequency and percent distribution of respondents according to gender Respondent gender Male Female Total Frequency 127 141 268 Percent 47.39 52.61 100.00
Male respondents accounted for 47% whereas female respondents were 53%.
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Figure 3. Pie chart showing sex distribution among respondents
47.39 52.61
Male Female
1.8. Ethnicity of the respondents Table 8. Frequency and percent distribution of respondents according to ethnicity Respondent ethnicity Wa Lahu Shan Akha Total Frequency 40 218 1 9 268 Percent 14.93 81.34 0.37 3.36 100.00
Like their household heads, majority of the respondents were Lahu tribes and there was no bamar among the respondents.
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1.9. Education of the respondents Table 9. Frequency and percent distribution of respondents according to their education Respondents' education Illiterate 30 Just read & write 24 Monastery education 2 Primary school 8 Secondary school 2 High school 1 College/university 268 Total Figure 4. Bar chart of respondents education 100.0 0.4 0.7 3.0 0.7 9.0 11.2 Frequency 201 Percent 75.0
Colleage/university High school Secondary school Primary school Monestry education Just read & write
0.4 0.7 3.0 0.7 9.0 11.2 75.0 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0
Illiterate
75% of the respondents were illiterates. Nearly 20% were just able to read and/or just had experiences of monastery education.
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1.10. Occupation of the respondents Current occupation of the respondents was asked and self declared occupations were recorded. The results were as follows; Table 10. Frequency and percent distribution of respondents by their occupation Respondents' occupation Farmer Rubber plant worker Teacher No response Total Frequency 250 10 1 7 268 Percent 93.28 3.73 0.37 2.61 100.00
More than 90% of the respondents answered that they are farmers. The vast minority were rubber plant workers and a teacher. But about 3% of the respondents refused to answer the question. Figure 5. Bar diagram for respondents occupation
No response 2.61
Teacher 0.37
Rubber plant worker 3.73
Farmer
93.28
0.00
20.00
40.00
60.00
80.00
100.00
1.11. Household size Average household size of respondent was 5.8 members per household with averages of male 1.64, female 1.6 and children 2.8 members.
2. Environmental Sanitation 2.1. Type of housing Housing pattern of the respondents were observed & recorded by survey team. Table 11 and figure 6 showed the results. Table 11. Frequency distribution of housing patterns Type of house Brick Wood with zinc roof Wood with palm roof Bamboo houses with palm roof Bamboo houses with plastic sheet roof Total Frequency 1 116 43 107 1 268 Percent 0.37 43.28 16.04 39.93 0.37 100.00
Figure 6. Housing patterns
Bamboo house with plastic sheet roof Bamboo house with palm roof Wood with palm roof Wood with zinc roof
0.37 39.93 16.04 43.28
Brick
0.37
0.00 10.00 20.00 30.00 40.00 50.00
43% of houses were wooden houses with zinc roofs. Nearly 40% were bamboo houses (huts) with palm roofs.
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2.2. Water 2.2.1. Sources of drinking water Table 12. Frequency distribution of respondent according to their drinking water sources Drinking water source Mountain stream Lake water Well Artificial water reservoir River water Total Frequency 226 19 11 10 2 268 Percent 84.33 7.09 4.10 3.73 0.75 100.00
Figure 7. Diagrammatic presentation of table 12

84.33
90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00
7.09
4.10
3.73
0.75 River water
Mountain stream
Lake water
Well
Artificial water reservoir
Majority of the respondents used mountain streams as their drinking water and the remainders used lake water, well water, water from artificial reservoirs and river water as well.
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2.2.2. Sources of domestic (usable) water Table 13. Frequency distribution of respondent according to their domestic water sources Domestic water source Mountain stream Lake water Well River water Artificial water reservoir Total Frequency 225 19 11 8 5 268 Percent 83.96 7.09 4.10 2.99 1.87 100.00
Figure 8. Sources of domestic water
90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00
83.96
7.09
4.10
2.99 River water
1.87 Artifical water reservoir
Mountain stream
Lake water
Well
It was found that there is no significant difference among drinking water and domestic water sources. Almost all respondents answered that their domestic and drinking water source was mountain stream water. The answer was almost the same in every villages regardless of different townships.
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2.2.3. Purification of drinking water The respondents were asked whether they purified the drinking water or not. The results were as follows; Table 14. Frequency distribution table for drinking water purification Water purification Purified before drink No purified before drink Total Frequency Percent 36 13.43 232 86.57 268 100.00
Figure 9. Donut chart showing drinking water purification status
13%
Purified before drink No purified before drink
87%
Very small proportion of respondents answered that they purified their drinking water and the majority remainders never purified their drinking water by any means. But water purification methods among the purifiers were not explored.
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2.3. Excreta The respondents were asked as well as the survey team observed whether their household had latrine or not. Table 15. Frequency and percent distribution of household according to their latrine status Latrine Latrine present Latrine absent Total Frequency 99 169 268 Percent 36.94 63.06 100.00
Figure 10. Pie chart for latrine status
37% Latrine present Latrine absent 63%
Only one-third of the household surveyed possessed the latrine and two-thirds of the household had no latrine. Among the households with latrine, type and sanitary status of their latrine had been observed by survey team and the results were shown as follow: Table 16. Type of latrine Type of latrine Indirect pit latrine Direct pit latrine Total Frequency Percent 68 68.69 31 31.31 99 100.00
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Figure 11. Donut diagram for table 16
31.31 Indirect pit latrine Direct pit latrine 68.69
Table 17. Sanitary status of the latrine Sanitary status of latrine Sanitary Non-sanitary Total Frequency 57 42 99 Percent 57.58 42.42 100.00
Figure 12. Pie chart for sanitary status of the latrine
42% 58% Sanitary Non-sanitary
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57% of latrines were sanitary and the remainders were non-sanitary according to the criteria of fly proof, odour free and privacy standards. The respondents without latrine were again asked for the reasons of absentee. Their answers were complied as follows; Table 18. Reasons for absence of latrine Reasons for absence of latrine Used to open air defecation No money for latrine Lack of space Use public toilet No time to build No response Total Frequency 91 60 6 3 3 6 169 Percent 53.85 35.50 3.55 1.78 1.78 3.55 100.00
Figure 13. Reasons for absence of latrine
No response No time to build Use public toilet Lack of space No money for latrine Used to open air defecation 0.00
3.55 1.78 1.78 3.55 35.50 53.85 10.00 20.00 30.00 40.00 50.00 60.00
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2.4. Pest activity Pest is a troublesome animals or things those can deteriorate human health such as mosquitoes, flies, flees, bugs, ticks and mites. The survey team asked the respondents about pest activity in their houses but no time to observe the actual pest activity among the households. The answers were categorized and were presented in table 19 and figure 14. Table 19. Pest activity Pest activity Absent Mild Moderate Plenty No response Total Frequency 24 165 70 5 4 268 Percent 8.96 61.57 26.12 1.87 1.49 100.00
Figure 14. Bar chart showing pest activity
70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00 Absent 8.96
61.57
26.12
1.87 Mild Moderate Plenty
1.49 No response
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3. Maternal and Child Health Table 20. Frequency and percent distribution of current pregnancies in the households of the respondents Current pregnancy in family Present Absent No response Total Frequency 16 250 2 268 Percent 5.97 93.28 0.75 100.00
Table 21. Township analysis regarding current pregnancy Township Naung Khit Mong Phen Man Man Hseing Mong Pawk Current pregnancy Present 1 (11.1%) 0 (0%) 4 (13.3%) 11 (5.5%) Current Pregnancy Absent 8 (88.9%) 48 (100%) 26 (86.7%) 189 (94.5%)
About 6 % of the respondents answered that there were pregnant women currently present in their families. Proportions of pregnancy per townships are shown in above table. Then the respondents were asked furthermore about maternal death in their family. Table 22. Frequency and percent distribution of maternal death within 1 year Maternal death in family Present Absent No response Total Frequency 9 253 6 268 Percent 3.36 94.40 2.24 100.00
Academically maternal death is defined as the death of mother during pregnancy, delivery or in puerperium (6 weeks after delivery) due to either direct or indirect obstetric related causes among their families. However the question here was just asking is there any maternal death within your family? and there are no further clarification in the question. So it was not
appropriate to calculate maternal mortality rate based on this finding. Here 3.36% of the respondents answered that there were maternal death in their families within the past 12 months but it cannot be interpreted like MMR in surveyed area was found to be 33.6 per 1000 live births. The respondents were asked also about any death of under 5 children in their households within one year and their answers were as follows. Table 23. Frequency and percent distribution of under 5 death within 1 year Under 5 death in family Present Absent No response Total Frequency 98 168 2 268 Percent 36.57 62.69 0.75 100.00
One-third of the respondents admitted that there were deaths of under 5 children within their families. Those respondents were asked again about the causes of those deaths. Table 24. Frequency and percent distribution of causes of under 5 death Causes of U5MR Fever & ARI Unknown cause Neonatal death Vomiting & diarrhea Starving Malaria Generalized spasm (tetanus?) Chronic disease Measles Accident Anaphylactic shock Drowning Worm infestation Oedema Premature birth Total Frequency 26 18 17 13 6 3 3 4 2 1 1 1 1 1 1 98 Percent 26.53 18.37 17.35 13.27 6.12 3.06 3.06 4.08 2.04 1.02 1.02 1.02 1.02 1.02 1.02 100.00
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It was found that ARI, diarrhea and starving (malnutrition) accounted for most frequent causes of death of under five children. Regarding Ante-Natal Care (ANC), the respondents were asked about any ANC for pregnant women in their families and households. Table 25. Frequency and percent distribution of ANC ANC during pregnancy ANC received ANC not received No response Total Frequency Percent 140 52.24 101 37.69 27 10.07 268 100.00
Figure 15. Bar diagram for percent distribution of ANC
60.00 50.00
52.24
37.69 40.00 30.00 20.00 10.00 0.00 ANC received ANC not received No response 10.07
According to their response, only 52% of pregnant women received Ante-Natal Care and about 37% had no ANC during their pregnancies. The respondents who answered yes to ANC were asked again for identification of service provider in ANC. The results were:
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Table 26. Service provider of ANC Service provider for ANC AMI health personals AMW MCH mobile teams VHV Hospital Private Clinic No response Total Frequency 89 28 8 6 4 2 3 140 Percent 63.57 20.00 5.71 4.29 2.86 1.43 2.14 100.00
Figure 16. Service provider of ANC
No response
Private Clinic Hospital VHV MCH mobile teams AMW AMI health personals 0.00
2.14
1.43 2.86 4.29 5.71 20.00 63.57 10.00 20.00 30.00 40.00 50.00 60.00 70.00
63% responded that ante-natal service provider was AMI health personals. They just said AMI health personals and no further clarification about that statement. Another 20% admitted that their ANC provider was auxiliary mid-wife (Also AMI trained). Others ANC providers were AMI mobile MCH teams, village health volunteers, hospital and private clinic respectively. So it can be said that almost all ante-natal care in that locality were covered by AMI. But when the respondents were asked about the accuchers who delivered the last baby in the family, the responses were varied.
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Table 27. Type of accuchers in last child birth Accuchers in last child birth TBA Neighbors Husband Self Relatives Parents Hospital VHV Doctor Total Frequency 74 41 39 36 11 8 4 2 1 216 Percent 34.26 18.98 18.06 16.67 5.09 3.70 1.85 0.93 0.46 100.00
Figure 17. Type of accuchers

34.26 35.00 30.00 25.00 20.00 18.98 18.06
16.67
15.00
10.00 5.00 0.00 5.09 3.70
1.85
0.93
0.46
Traditional Birth Attendants (TBA) delivered about one-third of the last births. TBA are the persons who are used to deliver the baby in Myanmar villages. In areas covered by formal public health sector, TBAs are trained by basic health staffs such as lady health visitors and midwives. Here the respondents just answered TBA and it was unclear that whether that TBA was trained or un-trained. It was followed by non-trained accuchers: delivered by neighbors, husband and self accounted for nearly half of the births. Neither of the respondents said that their last baby was delivered by AMW or AMI health personals.
Regarding exclusive breast feeding, the respondents answers were; Table 28. Frequency distribution of exclusive breast feeding Exclusive breast feeding EBF done EBF not done No response Total Frequency Percent 228 85.07 15 5.60 25 9.33 268 100.00
EBF is the type of breast feeding as soon as the baby born up to 6 months only breasts milk and no other fluid. 85% of the respondents answered mother practiced exclusive breast feeding habit to new born in their families. Table 29. Child morbidity in the family within one year Child Morbidity Yes No Total Frequency 251 17 268 Percent 93.66 6.34 100.00
Figure 18. Pie diagram for child morbidity
6%
Yes No 94%
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Regarding childhood illness mainly under fives illnesses, 94% of respondent said that there were varieties of childhood illnesses within their families within one year. 6% denied that. There are only question whether childhood illness present or not and no further clarification about type of illnesses. Then the respondents were asked how they response to common health problems such as diarrhea, malaria, ARI and malnutrition. The responses were then categorized and presented. Those are the chronological categorization of community responses verbatim and no technical categorizations are used here. Table 30. Community responses for diaorrhoea Treatment for diarrhea Go to VHV No idea at all Buy drug from pharmacy Go to AMW ORS Traditional medicine Go to AMI RHC Go to clinic Go to hospital Total Frequency 122 63 35 20 17 5 4 1 1 268 Percent 45.52 23.51 13.06 7.46 6.34 1.87 1.49 0.37 0.37 100.00
50.00 45.00 40.00 35.00 30.00 25.00 20.00 15.00 10.00 5.00 0.00
45.52
23.51 13.06 7.46 6.34 1.87 1.49 0.37 0.37
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Table 31. Community responses for malaria Treatment for malaria No idea at all Go to VHV Buy drug from pharmacy Go to AMW Go to HU clinic Traditional medicine Blood for MP Quack treatment Go to clinic Go to hospital Do matkalung Total Frequency 141 46 35 11 8 8 7 4 3 3 2 268 Percent 52.61 17.16 13.06 4.10 2.99 2.99 2.61 1.49 1.12 1.12 0.75 100.00
Table 20. Diagrammatic presentation of table 31
60.00 50.00 40.00 30.00 20.00 10.00 0.00
52.61
17.16
13.06
4.10 2.99 2.99 2.61 1.49 1.12 1.12 0.75
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Table 32. Community responses for ARI Treatment for ARI Go to VHV No idea at all Buy drug from pharmacy Go to AMW Matkalung Treat with Amoxicillin Traditional medicine Total Figure 21. Diagrammatic presentation of table 32
39.18
Frequency 105 88 32 18 11 9 5 268
Percent 39.18 32.84 11.94 6.72 4.10 3.36 1.87 100.00
40.00 35.00 30.00 25.00 20.00 15.00 10.00 5.00 0.00
32.84
11.94 6.72 4.10 3.36 1.87
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Table 33. Community responses for malnutrition Treatment for malnutrition No idea at all Go to VHV Go to AMW Buy drug from pharmacy Feeding Go to Chinese clinic HE Total Frequency 196 39 11 8 6 5 3 268 Percent 73.13 14.55 4.10 2.99 2.24 1.87 1.12 100.00

73.13
80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00
14.55 4.10 2.99 2.24 1.87 1.12
Regarding those health problems, most common community responses were do nothing (no idea at all) and go to VHV for some treatment and self treatment (buy drug from pharmacy). Here pharmacy means local drug stores with or without qualified pharmacist. Actually it means self medication or self treatment. And quack means local unqualified persons who treat variety of illnesses of community with some charges. Matkalung is traditional Chinese way of treatment of fever by scraping the skin with some sharp instruments.
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4. Health services and Health Care Utilization Are there any formal (permanent) health center providing reliable health services in that region? It means are there any government health services in their locality and community response for above question is as follows: Table 34. Availability of formal health services Formal HC service in your area Present Absent Total Frequency 14 254 268 Percent 5.22 94.78 100.00
Figure 23. Donut chart for availability of health services
5%
Present
Absent
95%
Only 5% of the respondent said that their locality had formalized health services. The vast majority responded that they had no formal health services in their residing areas. Then in order to know is health care accessible to them? The respondents were asked about estimated duration (distance) to access health care.
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Table 35. Access to health care Estimated duration to access HC 1-4 hour walk 4-8 hour walk 8-12 hour walk 12-24 hour walk No response Total Frequency Percent 122 45.52 62 23 10 51 268 23.13 8.58 3.73 19.03 100.00
Figure 24. Bar diagram for health care access
No response 12-24 hour walk 8-12 hour walk 4-8 hour walk 1-4 hour walk 0.00 10.00 3.73 8.58
19.03
23.13 45.52 20.00 30.00 40.00 50.00
Nearly half of the respondent answered they had to walk at least 1 to 4 hours in order to get health services and nearly 20% did not response that question. Who is your reliable health care provider? Personal opinion of the respondents in response to this question by following fashion:
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Table 36. Reliable health care provider Reliable HC provider VHV AMW Medical doctor AMI staff Traditional healer Quack Self treatment BHS Total Frequency 139 41 35 19 18 6 6 4 268 Percent 51.87 15.30 13.06 7.09 6.72 2.24 2.24 1.49 100.00
Figure 25. Bar diagram for reliable health care provider
BHS Self Quack Traditional healer AMI staff Medical doctor AMW VHV 0.00
1.49 2.24 2.24 6.72 7.09 13.06 15.30 51.87 10.00 20.00 30.00 40.00 50.00 60.00
Village health volunteers ranked first (51%). It was followed by auxiliary mid-wife (15%), medical doctors (13%), AMI medical staffs (7%). Minority still relied on traditional healers and quacks. 2% answered that self treatment is more reliable. Is there any illness episode in your household within past 12 months? The answers to those questions were as follows:
38
Table 37. Illness within past 12 months Illness during past 12 months Yes No Don't know Total Frequency Percent 188 70.15 74 27.61 6 2.24 268 100.00
Figure 26. Pie chart for illness within past 12 months
2% 28% Yes 70% No Don't know
70% of the respondents said that there were varieties of illnesses in their household (family) during past 12 months in one of their family members. How did they response to those illnesses?
39
Table 38. Response to illnesses Response to illness AMW treatment Quack treatment VHV treatment Buy drug from pharmacy (Self treatment) Private clinic treatment AMI treatment Do not treat Hospital treatment Total Frequency 73 38 29 19 13 10 5 1 188 Percent 38.83 20.21 15.43 10.11 6.91 5.32 2.66 0.53 100.00
Figure 27. Bar diagram for responses to illnesses

38.83
40.00 35.00 30.00 25.00 20.00 15.00 10.00 5.00 0.00
20.21 15.43 10.11 6.91 5.32 2.66 0.53
38% were treated by auxiliary mid-wife and 15% by village health volunteers. 20% were treated by quacks and 10% were treated by buying drugs from pharmacy. Paying for health care by what mechanism? 151 respondents answered that they had to pay by themselves (out-of-pocket payment) for health care. Total costs of health care in those respondents were 191298 Chinese Yuan with an average of 1266 Yuan. The details of the cost of health care per household were shown in data master sheet. Cost groups for paying health care are as follows:
40
Table 39. Paying for health care for one episode of illness per year per household Cost group (Chinese Yuen) 10-500 550-1000 1050-2000 2050-3000 3050-4000 5000-20000 Total Frequency 77 35 15 6 11 7 151 Percent 50.99 23.18 9.93 3.97 7.28 4.64 100.00
Figure 28. Bar chart of paying for health care
5000-20000 3050-4000 2050-3000 1050-2000 550-1000 10-500 0.00
4.64 7.28 3.97 9.93 23.18 50.99 10.00 20.00 30.00 40.00 50.00 60.00
Table 40. Mortality within one year Mortality within one year Yes No Total Frequency 24 244 268 Percent 8.96 91.04 100.00
About 9% of the respondents had some mortality in their families but majority denied any mortality within one year.
41
5. Satisfaction and willingness to pay for health care Table 41. Satisfaction of currently available health services Satisfaction of current health services Satisfied Not satisfied Total Figure 29. Pie diagram for table 41. Frequency 237 31 268 Percent 88.43 11.57 100.00
12%
Satisfied Not satisfied
88%
88% of respondents satisfied the health services currently available but 12% did not. It can be said that although currently available health services are poor, the respondents satisfied it but the exact reason for this answer is unknown. Table 42. Reasons for non-satisfaction
Reason of non-satisfaction Not enough drugs Not enough services No service at all Useless VHV Not relieve symptoms Costly No comment Total Frequency 7 3 4 2 4 2 9 31 Percent 22.58 9.68 12.90 6.45 12.90 6.45 29.03 100.00
42
Figure 30. Bar diagram for table 42

29.03 30.00 25.00 20.00 15.00 10.00 5.00 0.00 9.68 6.45 6.45 22.58 12.90 12.90
Then the respondents were asked if they satisfied, are they willing to pay for the cost of health care or not. Table 43. Willingness to pay Willing to pay for health service Yes No Total Frequency Percent 252 94.03 16 5.97 268 100.00
43
Figure 31. Donut chart for willingness to pay
6%
Yes No
94%
94% of respondent willing to pay for health services if they satisfied but 6% did not have such willingness. Those respondents who willing to pay were asked again for what kind of health services they want to pay: Table 44. Type of services willing to pay Type of service willing to pay Curative Preventive Promotive Rehabilitative Transport All Total Frequency 89 84 68 1 7 3 252 Percent 35.3 33.3 27.0 0.4 2.8 1.2 100.0
44
Figure 32. Bar diagram for willingness to pay
40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0
35.3
33.3 27.0
0.4
2.8
1.2
One-third of the respondents wanted to pay for curative service. 60% wanted to pay for preventive and promotive services. About 3% responded that they wanted to pay for transport service not health services. Regarding the type of health care provider those they willing to pay, the responses were categorized in table 45 as well as in figure 33. Table 45. Type of health care provider willing to pay Type of HC provider willing to pay Doctor VHV AMW Traditional healer Any service provider Total Frequency 95 77 43 22 15 252 Percent 37.70 30.56 17.06 8.73 5.95 100.00
45
Figure 33. Bar chart for table 45
Any service provider Traditional healer AMW VHV
5.95 8.73 17.06 30.56 37.70 0.00 5.00 10.00 15.00 20.00 25.00 30.00 35.00 40.00
Doctor
37% responded that they are willing to pay doctors for their services and 5% said that they are ready to pay for any health service providers who are responsible for their health. Regard cash amount they are willing to pay for health care provider per illness episode, the respondents answers were categorized as follows; Table 46. Amount willing to pay per illness episode Amount willing to pay per illness episode (Chinese Yuen) 1-100 101-1000 As much as it cost As much as they can Half of actual cost Negotiated price Will pay if cure Will pay food not money Total Frequency 111 12 52 38 3 2 1 1 220 Percent 50.5 5.5 23.6 17.3 1.4 0.9 0.5 0.5 100.0
46
Figure 34. Amount willing to pay
60.0 50.0 40.0 30.0 20.0 10.0 0.0
50.5
23.6
17.3 1.4 0.9 0.5 0.5
5.5
Half of the respondents said that they are willing to pay up to 100 Chinese Yuen to health care provider per illness episode. 23% responded that they are ready to pay as much as it cost and 17% wanted to pay as much as they can.
47
II. KAP SURVEY A total of 268 respondents were asked about very simple questions regarding health and hygiene in order to access their knowledge, attitude and practice. There were 16 questions each for knowledge, attitude and practice. Attitude score were set as Likart Scale. Since the questions were very simplified, full scores for knowledge was 32, for attitude was 64 and for practice was 36 points. Less than 29, 46 and 29 points were assumed to be said that their knowledge, attitude and practice are risky for health and hygiene. Questionnaires for knowledge, attitude and practices are attached in the annex. Overall KAP scores can be calculated but KAP scores for each township cant neither be analyzed nor compared because of disproportionate sample size among townships. 1. Overall knowledge scores Table 47. Knowledge scoring Knowledge Low (Score 1 to 29) High (Score 30-32) Total Frequency 24 244 268 Percent 8.96 91.04 100.00
Figure 35. Pie diagram for knowledge score
9%
Low (Score 1 to 29) High (Score 30-32) 91%
48
91% of respondents were regarded as they have high (sound) knowledge about health and hygiene and only 9% of respondents had low knowledge.
2. Overall attitude scores Table 48. Attitude scoring Attitude Bad (28-46) Good (47-64) Total Frequency 96 172 268 Percent 35.82 64.18 100.00
Figure 36. Pie diagram for attitude scoring
36%
64%
Bad (28-46) Good (47-64)
64% of respondents had good (positive attitude) whereas 36% had bad or negative attitude concerning health and hygiene habit.
49
3. Overall practice scores Table 49. Practice scoring Practice Bad practice (16-29) Good practice (30-36) Total Frequency Percent 240 89.55 28 10.45 268 100.00
Figure 37. Pie chart for practice scoring
10%
Bad practice (16-29) Good practice (30-36) 90%
Contrary to knowledge and attitude, 90% of the respondents had bad practice on health and hygiene where only 10% practicing good health habits.
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4. Association between knowledge and attitude of the respondents Table 50. Association between knowledge and attitude Total knowledge score Low High Total Total attitude score Bad Good 14 (58.3%) 10 (41.7%) 82 (33.6%) 162 (66.4%) 96 (35.8%) 172 (64.2%) Total 24 (100%) 244 (100%) 268 (100%)
2= 62.270
df=1
p=0.000
Figure 38. Association between knowledge and attitude
100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0
41.7 66.4 Good attitude Bad attitude 58.3 33.6
Low knowledge
High knowledge
It was found that the respondents who had higher knowledge on health and hygiene habits had more positive attitude on health and hygiene than the respondents who had lower knowledge (there is strong association between knowledge and attitude) and the results were statistically significant.
51
5. Association between knowledge and practice of the respondents Association between knowledge and practice of the respondents was shown in following table and figure. Table 51. Association between knowledge and practice Total knowledge score Low High Total
2= 3.324
Total practice score Bad Good 23 (95.8%) 217 (88.9%) 240 (89.6%)
df=1
Total
1 (4.2%) 27 (11.1%) 28 (10.4%)
24 (100%) 244 (100%) 268 (100%)

p= 0.1
Figure 39. Association between knowledge and practice
100.0
80.0 60.0
4.2
11.1
95.8 40.0 20.0 0.0 Low knowledge
Good practice 88.9 Bad practice
High knowledge
It was found that the regardless of the respondents knowledge whether it was low or high on health and hygiene, they had bad practice on health and hygiene (there is no association between knowledge and practice).
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6. Association between attitude and practice Association between attitude and practice of the respondents was shown in following table and figure. Table 52. Association between attitude and practice Total practice score Bad Good 156 (90.7%) 16 (9.3%) 84 (87.5%) 12 (12.5%) 240 (89.6%) 28 (10.4%)
df=1
Total attitude score Good Bad Total

2=0.025
Total 172 (100%) 96 (100%) 268 (100%)

p=0.5
Figure 40. Association between attitude and practice
100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0
9.3
12.5
Good practice 90.7 87.5 Bad practice
Good attitude
Bad attitude
It was also found that the regardless of the respondents attitude whether it was negative or positive on health and hygiene, they had bad practice on health and hygiene (there is no association between attitude and practice).
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III. SCHOOL KAP SURVEY A total of 91 primary school children from three schools were asked about very simple questions regarding basic personal hygiene and general health in order to access their knowledge, attitude and practice. There were 10 questions each for knowledge, attitude and practice. Attitude score were set as Likart Scale. Since the questions were very simplified, full scores for knowledge was 20, for attitude was 40 and for practice was 22 points. Less than 17, 32 and 18 points were regarded as low knowledge, bad attitude (negative attitude) and bad practice for health and hygiene. 1. Overall Knowledge Table 53. Knowledge scoring Knowledge Low (Score 1 to 17) 81 High (Score 18-20) 91 Total 100.00 89.01 Frequency 10 Percent 10.99
Figure 41. Donut diagram for knowledge score
11%
Low (Score 10 to 17) High (Score 18-20)
89%
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89% of primary school children had good knowledge and only 11% had low knowledge about health and hygiene. 2. Overall attitude Table 54. Attitude scoring Attitude Bad (10-32) 57 Good (33-40) 91 Total 100.00 62.64 Frequency 34 Percent 37.36
Figure 42. Donut diagram for attitude scoring
37% Bad (10-32) Good (33-40) 63%
Regarding attitude, 63% of school children had positive attitude on health and hygiene
while 37% had negative attitude.
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3. Overall practice Table 55. Practice scoring Practice Bad practice (10-18) Good practice (19-22) Total Frequency Percent 16 17.58 75 82.42 91 100.0
Figure 43. Donut chart for practice scoring
18%
Bad practice (10-18) Good practice (19-22)
82%
82% of school children had good practice while 18% had bad practice of health and hygiene.
4. Association between knowledge and attitude Table 56. Association between knowledge and attitude Total knowledge score Low 25 (30.9%) High 34 (37.4%) Total 2 = 14.428 df=1 57 (62.6%) 91 (100%) p=0.000
Total attitude score Bad Good 9 (90%) 1 (10%) 56 (69.1%)
Total 10 (100%) 81 (100%)
Figure 44. Association between knowledge and attitude
100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0
10.0
69.1 Good attitude 90.0 Bad attitude
30.9
Low knowledge
High knowledge
It was found that the school children who had higher knowledge on health and hygiene habits had more positive attitude on health and hygiene than the respondents who had lower knowledge (there is an association between knowledge and attitude) and the results were statistically significant. 5. Association between knowledge and practice Table 57. Association between knowledge and practice Total knowledge score Total practice score Bad Good 8 (80%) Low 8 (9.9%) High 16 (17.6%) Total
2= 35.629 df=1 p=0.000
Total
2 (20%) 73 (90.1%) 75 (82.4%)
(100%) (100%) (100%)
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Figure 45. Association between knowledge and practice
100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0
20.0
90.1 80.0
Good practice Bad practice
9.9 Low knowledge High knowledge
It was clear that the school children who had higher knowledge on health and hygiene habits had good practice on health and hygiene than the respondents who had lower knowledge (there is an association between knowledge and practice) and the results were statistically significant. 6. Association between attitude and practice Table 58. Association between attitude and practice Total practice score Total attitude score Good Bad Total
2= 19.649
Bad 4 (7%) 12 (35.3%) 16 (17.6%)

df=1
Good 53 (93%) 22 (64.7%) 75 (82.4%)
Total 57 (100%) 34 (100%) 91 (100%)

p=0.000
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Figure 46. Association between attitude and practice
90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Good attitude Bad attitude 7.0 35.3 93.0 64.7 Good practice Bad practice
It was evident that the school children who had positive attitude on health and hygiene habits had good practice on health and hygiene than the respondents who had negative attitude (there is an association between attitude and practice) and the results were also statistically significant.
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DISCUSSIONS AND CONCLUSION I. Descriptive survey Since this survey was conducted among 27 villages located in four townships of Wa Special Administrative Region, overall socio-economic and demographic profiles of the respondents are not so much different. Like other areas in Myanmar, the household heads are male pre-dominant type. About four-fifths of the respondents are Lahu tribes because out of 27 villages, 20 villages are Lahu dominant villages. The most striking feature in their profile is profound proportion of illiterates. Huge amount of household heads as well as respondents never had proper education and no schooling at all. And more than ninety percents are said to be farmers harvesting something in their native lands. Majority of the respondents live in wooden and bamboo houses, drink and use mountain stream water (verbatim) without bothering to purify it and they thought that it is not necessary to purify their already clean water. Moreover, about two-thirds of the respondents did not have any latrine in their homes and they are used to open-air-defecation habits. About half of the latrines also are unsanitary. Those findings indicate the living standards of the respondents are extremely under par and they have not enough education and sanitation for healthy living status. There are so many things required to improve their living status. Regarding maternal and child health status, about three percents of the respondents claimed that there had been some maternal deaths within their family. Also more than one-thirds of the respondents confirmed that there were the deaths of children before they reached their fifth year birthday in their households with the causes of ARI, diarrhoea, malnutrition and malaria. Ante-natal coverage is only about fifty-two percents and almost all ANC were in AMI facilities. However, it was found that about one-third of the pregnancies were delivered by traditional birth attendants and more surprisingly about three-fifths of the pregnancies were delivered by nontrained accuchers such as neighbours, husbands and self respectively. In that kind of setting, maternal mortality is inevitable and seemed to be a used-to-scenario. Although majority said
exclusive breast feeding yes, more than ninety percent of children suffered some form of illness episode. Regarding knowledge for treatment of common ailments such as diaorrhoea, malaria, ARI and malnutrition, the commonest response was no idea at all. In general, it can be said that MCH status of the surveyed area is in disastrous situation. Concerning to health care services, only five percents of the respondents had regular and formal health services in their native lands. And nearly two-thirds of the respondents had to walk one to eight hours for health services and relied totally on non-professional health personals such as village health volunteers and auxiliary mid-wives. Three-fourths of them had illness episodes within one year and those illnesses were treated mainly by auxiliary mid-wives, quacks and village health volunteers. Self medications by buying drugs from pharmacies are not uncommon also. Almost all respondents with illness were treated with out-of-pocket payments and average cost per illness was about 1200 Yuan (about 150,000 Kyats or nearly 200 US dollars per episode of illness per household) and indeed it was very costly for poor quality service. But this figure was as they said and the validity of the data was not guaranteed. Generally it can be concluded that formal government health care was almost not available, inaccessible and currently available health services are too costly for them. They received costly poor health services provided by quacks and traditional birth attendants. However, 88% of the respondents satisfied the currently available health services (May be it means health services provided by AMI). Non-satisfiers gave some reasons underlying their lack of satisfaction on currently available health services that they received (provider may or may not be AMI health personnel): no drug, no services at all, no quality etc. The vast majority (94%) were very willing to pay for health care if quality services they received and the health care provider they most wanted to pay was unsurprisingly medical doctors but half of them wanted to pay just 1 Yuen (120 kyats) up to 100 Yuen (12,000 kyats) per visit. So it can be said that they want as well as demand the quality health care services those are not available and accessible for them yet.
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II. Baseline KAP survey of respondents KAP on respondents Since knowledge questions were extremely easy even for poorly educated persons, the respondents know very well which is right and what is wrong. So ninety-one percent of the respondents gained higher scores and can be classified as high (acceptable) knowledge for health and hygiene in very basic level. However knowledge alone could not grantee development of preventive behavior of diseases. So also in attitude, about two-thirds of the respondents had positive attitude on health and hygiene. And there is statistically significant association between knowledge and attitude regarding health and hygiene. But practice is a different story. Practice scores are found to be vice versa with the knowledge score. Ninety percent of respondents had bad practice while just only ten percents had good practice regarding health and hygiene. Also there are statistically significant nonassociation between knowledge and practice as well as attitude and practice. Therefore it can be said that the respondents knows very well about good health habits and they felt that they should have health habits but in reality the reverse is true and their practices run away from healthy behaviors. The main reason behind that scenario may be lack of education and unchangeable risky behaviors predispose to diseases or lack of interest in responding the questions or interviewer bias. III. School KAP survey Regarding knowledge, attitude and practice of the primary school children, there are strong associations between knowledge and attitude, knowledge and practice, attitude and practice were observed. Therefore it could be said that the higher the knowledge, the better the attitude and the stronger the good practice on healthy habits in formal school children. However, it could not be hypothesized that there is a direct relationship between knowledge and action. It is not true that by changing knowledge, behavior is automatically changed as well because there are many other factors which influence the health seeking behavior of human.
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RECOMMENDATIONS 1. 2. Health education in that locality should be encouraged. Life skill education and behavior change communication (Health promotion) should be emphasized in schools. 3. 4. Community should be well informed about currently available health care services. Health service providers should be trained to become qualified providers who can handle basic medical problem. 5. Major problem in the local community is too poor education, misconception and lack of formal health care services and health activities. In order to fulfill the objectives of humanitarian assistance, one should not focus only on health but on education, occupation and economic status of the community.
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REFERENCES 1. Ribeaux S. & Poppleton S E. (1978). Psychology and Work. An Introduction. London: Macmillan. 2. Yoder P S (1997). Negotiating relevance: belief, knowledge and practice in international health projects. Medical Anthropology Quaterly, 11 (2): 131-146. 3. Nichter M. (1993). Social Science lessons from diarrhea research and their application to ARI. Human Organization, 52 (1): 53-54. 4. Lane S D. (1997). Television minidramas: Social marketing and evaluation in Egypt. Medical Anthropology Quaterly, vol.11, n.2.
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/ date
Annex 1: Survey questionnaires

Survey questionnaire
/ no
Name of surveyor / _____________________________ . / township _________________________________________ _________________________________________ _______________________________________ SECTION (A) I. Socio-demographic characteristics head of household / _______________________________________ 1. 2. 3. / never went to school / can read and write / attended monastery education
/ village tract quarter / village
( ) / head of households age / Bamar / Wa / Lahu / Shan / Akha _________________________ / other / head of households education / head of households sex
4. 5. 6. 7. 8.
( ) / Primary school ( KG to 4th grade ) ( ) / middle school ( 5th grade to 8th grade ) ( ) / high school ( 9th grade to 10th grade) / university - college diploma / university bachelor degree /occupation _____________________________________ _______________________________________ ( ) / respondents age / respondents sex / Bamar / Wa
/ respondents name
/ Respondents ethnic group
/ Lahu / Shan / other / Akha
_________________________
/ respondents education 1. 2. 3. 4. 5. 6. 7. 8. 9. / never went to school / can read and write / attended monastery education ( ) / Primary school ( KG to 4th grade ) ( ) / middle school ( 5th grade to 8th grade ) ( ) / high school ( 9th grade to 10th grade) / university - college diploma / university bachelor degree / post graduate / highest education level within family
__________________________________ / respondents occupation ___________________________________
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() / no of family members including respondent / men / child (0-5 yr) (5-18 yr) / total II. Environmental Sanitation Status / type of household / brick house ( ) / wooden house ( tin roof, wooden wall ) ( ) / wooden house ( thatch roof, wooden wall ) ( ) / bamboo house (thatch roof, bamboo wall ) ( ) / bamboo house (tarpaulin roof, bamboo wall ) type of drinking water / water from lake / water from well / water from deep well / water from common water tank () / water from pipe / water from river/ creek / purified water ______________________________ / other type of utility water / water from lake / water from well / water from deep well / water from common water tank (>18 yr)
/ women (> 18 yr)
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() / water from pipe / water from river/ creek / purified water ______________________________ / other do you purify water before drinking? / do do not do if yes, what method ? / boil / filter with water filter / treat with chlorine __________________________________________ / other / if not purified, why ? ( ) / not necessary ( assuming it is clean ) / do not want to bother / lack of money / lack of technique ______________________________________ other / do you have your own latrine? / have / do not have / if dont have latrine, why? (Open air defecation) / lack of space / use public toilet / lack of money
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______________________________________________ other / if your house have latrine, what type of latrine? (Service type bucket latrine) (Direct pit latrine) (Indirect pit latrine) (Water sealed latrine) ______________________________________ other
(Fly proof) (Odourless) (Privacy) / is your latrine cover the criteria of fly proof, odourless and privacy? / cover / do not cover doe your house have mosquito, flies, rodents, fleas, cockroaches, and lice? / have / alittle / moderate amount / plenty
III. Household Livelihood Status ( ) ( these questions are strictly for research and must be kept confidential. ) / how many family members have income in your house? / 1 / 2 / 3
/ 4 and above / describe the occupations of family members with income _______________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ () / Is the income regular ( monthly ) ? / yes / no if the income is regular, what is the amount of monthly income? _______________________________________________________________________________________________ _______________________________________________________________________________________ / besides regular income, are there any other income? / win lottery/ thai lottery/ 2 digit lottery __________________________ / soccer betting/ win cards ________________________________
() / side income (.eg broker fees) ________________________________ / other income ________________________________
/ if no regular income, why? () / weather ( farming) () / nature of job ( labourer) / ill health _________________________________________________ other / if not good, why?
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_______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ ___________________________________________ / does your family have debts? / have / dont have / why do you have debts?
IV. Maternal and Child Health / . / do you have pregnant mother in your family? / yes / no / does your Family have maternal death? / have / not have / if yes, what is the cause of death? _______________________________________________________________________________________________ _____________________________________________________________________
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Does your family have under 5 child death? / yes / no / if there were under 5 child death, do you know the cause of death? _______________________________________________________________________________________________ _____________________________________________________________________ If there were pregnant mothers, do they take antenatal care during pregnancy? / yes / no / who gave the antenatal care? _______________________________________________________________________________________________ _____________________________________________________________________ who deliver the baby during birth? _______________________________________________________________________________________________ _____________________________________________________________________ / was the baby breastfed immediately after birth? / breastfed / not breastfed because _______________________________________________________________________________________________ ____________________________________________________________________ Do your children ever have diarrhoea, malaria and RTI? / have
/ not have What kind of treatment was received when your child have diarrhoea? _______________________________________________________________________________________________ _____________________________________________________________________ What kind of treatment was received when your child have malaria? _______________________________________________________________________________________________ _____________________________________________________________________ What kind of treatment was received when your child have RTI? _______________________________________________________________________________________________ _____________________________________________________________________ What kind of treatment was received when your child have malnutrition? _______________________________________________________________________________________________ _____________________________________________________________________
IV. Health care assess and health care cost ? / are there health care services such as hospital, dispensary, labour room, RHC, clinic in your village? 1. 2. 3. 4. / yes / dont have / dont know / dont want to answer
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. / how long does it take to reach the nearest health care center from your house / estimated time / by walking _________________ . / by car _________________
/ the person who you rely on as health care provider 1. 2. 3. 4. 5. 6. 7. 8. / doctor / HA / nurse/ women health staff/ midwife / AMW / VHV / traditional medicine/ healer () / quack AMI (.) . / AMI RHC or mobile clinic
( ) / is there any family member who got ill within one year? 1. 2. 3. / yes / dont have / dont know/ not sure
( ) / if there were sick family member, what type of disease? ( if there were more than one sick family member, ask what happened and write down) __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________
( ) when sick, what do you do? ( ask what they do mainly) 9. () / treat with quack
10. / treat with traditional medicone 11. ( ) / treat with primary health care staff 12. () / treat with doctor (private clinic) 13. / attend govt hospital 14. / attend private hospital 15. / buy drugs from pharmacy 16. / do not treat 17. AMI clinic (.) . / get treatment at AMI RHC or mobile
? / Although sick, if do not get treatment, why ? 1. 2. 3. 4. / cant afford / untreatable disease / patient refuse treatment ( ) / other reasons (record exactly as respondent say)
_______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ ___________________________________________
() / if treated, how much is the cost for those diseases? ( ) / kyat/ Yuan
( ) Cost ( total cost for getting treatment within one year)
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/ drugs
_____________________________ _____________________________ _____________________________ _____________________________
/ hospital cost / travel cost/ food cost/ living cost / other cost
/ is there any family who die within one year? 1. 2. / yes / no
() if there were deceased family member, what is the cause of death? __________________________________________________________________________ __________________________________________________________________________ V. Satisfaction & Willingness to Pay for Health Services Are you satisfied with current health care services? / yes / no if not satisfied, why?
if satisfied, are you willing to pay if the health care services will be charged? / yes / no . if not willing to pay, which changes should happen so that you are willing to pay?
_______________________________________________________________________________________________ _______________________________________________________________________________________________ ________________________________________________________ If willing to pay, what kind of health care services are you willing to pay? (Promotive services) (Preventive services)
(Curative services ) (Rehabilitative services )
. ( transport service up to the service delivery point) / who is the health care provider you are willing to pay? / doctor / traditional medicine practitioner / witch doctor / AMW / VHV ____________________________________________________ other How much are you willing to pay for the health care services in general? ___________________________________________________ / Kyat/ Yuan
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VI. Internally Displaced Person (IDP) / Are there refugees who moved from other areas for various reasons in your village/ village tract? / yes / no / dont know if there are refugees, what is their estimate numbers? ___________________ . . why do the refugees move to your village? / war / disaster / famine / lack of jobs / where is their former area?
__________________________________________________________________________________________ where are the refugees taking shelter? _______________________________________________________________________________________________ _______________________________________________________________________________________ ey Can they have problems for livelihood, education, health and social affairs? / yes, they can / no, they cant because
/ do the local people from your area help the refugees?
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/ yes - no, beacuse _______________________________________________________________________________________________ _______________________________________________________________________________________________ ________________________________________________________ / if there are organizations to help the refugees, do you agree? / agree - / do not agree because _______________________________________________________________________________________________ _______________________________________________________________________________________________ ________________________________________________________ Do you want to give the refugees necessary help? / want to give - / do not want to give because
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SECTION (B) KNOWLEDGE, ATTITUDE & PRACTICE ON HEALTH & HYGIENE
I. KNOWLEDGE
() - / for you and your family members to be healthy K.1. Complete immunization in childhood / important / not important K.2. birth spacing is / important / not important K.3. / antenatal care / important / not important K.4. / exclusive breast feeding / important / not important K.5. / avoiding smoking / important / not important K.6. / Avoiding alcohol / important / not important K.7. Being faithful to spouse
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/ important / not important K.8. Avoiding fatty food and salty food / important / not important K.9. / doing sports / important / not important K.10. / reading health knowledge / important / not important K.11. Following advice of health care provider / important / not important K.12. / using clean water / important / not important K.13. / using fly proof latrines / important / not important K.14. avoiding food that has contact with flies / important / not important
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K.15. () good hygiene (regular shower) / important / not important
K.16. washing hands after defecation / important / not important
II. ATTITUDE
Strongly agree agree Dont agree Strongly agree Breastfeeding is very good for the health of child. Getting care since pregnancy is very good for the health of mother and child. do not
Taking traditional medicine is very good for health. Health care providers such as doctor, AMW and VHV are responsible for my health. . I am responsible for my health.
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Smoking, alcohol and unprotected sexual intercourse should be avoided for good health. Sports should be practiced for good health. Environmental sanitation is important for good health. Access to clean water is important for good health. Using fly proof latrine is important for good health. Personal hygiene is important for good health. Having health knowledge is important for good health. Having good income is important for good health Annual check-up with specialists is important for health. Vitamins should be taken regularly for good health. Mosquito net should be used when sleeping to prevent malaria.
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III. PRACTICE
P.1. did you have immunization in your childhood? / yes / no P.2. Do under five children in your house have immunization? / yes / no P.3. Have you ever attended health education talk? / yes / no P.3. Have you ever watch HE programs from TV and video? / watch / do not watch P.4. Do you always wash your hands with soap before meals and after defecation? / wash / do not wash P.5. () Do you boil drinking water ( if not bottled water) ? / boil / do not boil P.6. do you treat the well with Chlorine once a year ?
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/ treat / do not treat P.7. / do you smoke? / smoke / do not smoke P.8. / do you drink? / drink / do not drink P.9. When you are sick, do you go to clinic? / always go / go when sickness gets worse / not go /treat with traditional medicine P.10. When you are sick, do you buy drugs from pharmacy without going to clinic? / always buy get treated with drugs from pharmacy / do not buy drugs go to clinic
P.11. Do you eat fatty and salty food? / always eat / eat occassionally /do not eat / avoid with care P.12. Do you do any kind of sports activities regularly?
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/ do / do not do
P.13. Does your family use mosquito net when sleeping? / always use / do not use sometimes / never use mosquito net P.14. Do you use mosquito net for children when they sleep in afternoon? / yes / no P.15. Do you put covers on the water tank after use? / yes / no P.16. Do you clean bushes and drainage channels? / yes / no
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Annex 2: Data master sheet Wa Raw Data- Excel spreadsheet
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Survey Report by DR Akm Version 2

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EVALUATION REPORT BASED ON A SURVEY CONDUCTED AT WA SPECIAL REGION (2)

Dr.Aung Kyaw Myint | AMI survey report

Dr.Aung Kyaw Myint | AMI survey report

Dr.Aung Kyaw Myint | AMI survey report

Dr.Aung Kyaw Myint | AMI survey report

Dr.Aung Kyaw Myint | AMI survey report

Dr.Aung Kyaw Myint | AMI survey report

20 students - 40 students - 30 students

Dr.Aung Kyaw Myint | AMI survey report

Dr.Aung Kyaw Myint | AMI survey report

Dr.Aung Kyaw Myint | AMI survey report

Dr.Aung Kyaw Myint | AMI survey report

Figure 1. Bar chart of household heads educational status

Colleage/university High school Secondary school Primary school

0.4 0.4 0.8 1.1

Dr.Aung Kyaw Myint | AMI survey report

Figure 2. Bar chart showing occupation of household heads

3.82 Farmer Rubber plant worker

Dr.Aung Kyaw Myint | AMI survey report

Dr.Aung Kyaw Myint | AMI survey report

Figure 3. Pie chart showing sex distribution among respondents

Dr.Aung Kyaw Myint | AMI survey report

Dr.Aung Kyaw Myint | AMI survey report

Rubber plant worker 3.73

Figure 6. Housing patterns

0.37 39.93 16.04 43.28

Dr.Aung Kyaw Myint | AMI survey report

Figure 7. Diagrammatic presentation of table 12

0.75 River water

Artificial water reservoir

Dr.Aung Kyaw Myint | AMI survey report

Figure 8. Sources of domestic water

2.99 River water

1.87 Artifical water reservoir

Dr.Aung Kyaw Myint | AMI survey report

Figure 9. Donut chart showing drinking water purification status

Purified before drink No purified before drink

Dr.Aung Kyaw Myint | AMI survey report

Figure 10. Pie chart for latrine status

37% Latrine present Latrine absent 63%

Dr.Aung Kyaw Myint | AMI survey report

Figure 11. Donut diagram for table 16

31.31 Indirect pit latrine Direct pit latrine 68.69

Figure 12. Pie chart for sanitary status of the latrine

42% 58% Sanitary Non-sanitary

Dr.Aung Kyaw Myint | AMI survey report

Figure 13. Reasons for absence of latrine

Dr.Aung Kyaw Myint | AMI survey report

Figure 14. Bar chart showing pest activity

1.87 Mild Moderate Plenty

Dr.Aung Kyaw Myint | AMI survey report

Dr.Aung Kyaw Myint | AMI survey report

Figure 15. Bar diagram for percent distribution of ANC

Dr.Aung Kyaw Myint | AMI survey report

Figure 16. Service provider of ANC

Dr.Aung Kyaw Myint | AMI survey report

Figure 17. Type of accuchers

Figure 18. Pie diagram for child morbidity

Dr.Aung Kyaw Myint | AMI survey report

Figure 19. Diagrammatic presentation of table 30

23.51 13.06 7.46 6.34 1.87 1.49 0.37 0.37

Dr.Aung Kyaw Myint | AMI survey report