Lot Quality Research Articles

An Integrated Approach to Harmonize Nutrition Knowledge across Sectors in the Upper Manya Krobo District of Ghana

Determinants of nutrition are addressed by multiple service delivery platforms, including government sectors such as agriculture, education, finance, and health, in addition to community members and volunteers. Consistent messages must be integrated across these platforms to make education efforts more effective, particularly among vulnerable communities. As part of the Building Capacity for Sustainable Livelihoods and Health in Ghana (Nutrition Links) project, a needs assessment was conducted to identify knowledge gaps among service providers in the Upper Manya Krobo District. An integrated, multi‐level approach was subsequently developed to address these needs: (i) training workshops (e.g., Community‐Based Growth Promotion, Mother‐to‐Mother Support Group) for health sector staff and community volunteers; (ii) workshops to harmonize nutrition promotion messages (e.g., Essential Nutrition Actions) for non‐health sector (agriculture and finance institutions) staff; and (iii) Lots Quality Assurance Sampling and data analysis workshops for staff from all government sectors (health, agriculture, education, social development, environmental health, and governance) and finance institutions. These training sessions allowed participants to interact with multiple sectors and use local data to examine specific district‐wide nutrition concerns. Each session had on average 26 people in attendance and ranged from 4 to 7 days in duration. A questionnaire was administered before and after each training session and the results were compared to determine if participant knowledge had improved. All pre‐ and post‐training comparisons demonstrated an increase in participants' knowledge (p<0.0001). Training sessions with the greatest improvement included Mother‐to‐Mother Support Group for community members (mean increase = 70 ± 11 %), Essential Nutrition Actions for staff from the agriculture sector and finance institutions (mean increase = 60 ± 15 %), and Lots Quality Assurance Sampling (mean increase = 50 ± 14 %). Integrated, multi‐sector training sessions can be useful in harmonizing nutrition knowledge and may provide opportunities for improving communication and coordination of services across sectors.Support or Funding InformationGlobal Affairs Canada, McGill University, World Vision

Quality and compliance with Clinical Practice Guidelines of Chronic Noncommunicable Diseases in primary care

To assess the quality and compliance of clinical practice guidelines (CPG) applicable to chronic non-communicable diseases (CNCD) in primary healthcare (CS), and views of staff on the barriers, facilitators and their use. 18 valued CPG with AGREEII, 3 are selected to develop indicators and assess compliance using lot quality acceptance sample (LQAS, standard 75 / 95% threshold 40 / 75% respectively, α:0. 05, β:0. 10) on 5 CS. 70 professionals surveyed about knowledge and use of CPG. Average quality of the CPG was 57.2%; low rating in domains: "Applicability" (<25%), "Stakeholder involvement" (43.5%) and "Rigour of development" (55.0%). Compliance in CS ranges from 39 to 53.4%. Professionals show uneven knowledge of CPG; 44 to 45% (according to CPG), they declare that they are not used, they identify as main barriers the lack of training, and their difficult accessibility and management. The quality and implementation of evaluated CPG is deficient constituting an opportunity of improvement in health services.

Predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the Remote and Poorest Rural Communities of Zambia: A Multilevel Analysis.

Optimal utilization of maternal health-care services is associated with reduction of mortality and morbidity for both mothers and their neonates. However, deficiencies and disparity in the use of key maternal health services within most developing countries still persist. We examined patterns and predictors associated with the utilization of specific indicators for maternal health services among mothers living in the poorest and remote district populations of Zambia. A cross-sectional baseline household survey was conducted in May 2012. A total of 551 mothers with children between the ages 0 and 5 months were sampled from 29 catchment areas in four rural and remote districts of Zambia using the lot quality assurance sampling method. Using multilevel modeling, we accounted for individual- and community-level factors associated with utilization of maternal health-care services, with a focus on antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). Utilization rates of focused ANC, SBA, and PNC within 48 h were 30, 37, and 28%, respectively. The mother's ability to take an HIV test and receiving test results and uptake of intermittent preventive treatment for malaria were positive predictors of focused ANC. Receiving ANC at least once from skilled personnel was a significant predictor of SBA and PNC within 48 h after delivery. Women who live in centralized rural areas were more likely to use SBA than those living in remote rural areas. Utilization of maternal health services by mothers living among the remote and poor marginalized populations of Zambia is much lower than the national averages. Finding that women that receive ANC once from a skilled attendant among the remote and poorest populations are more likely to have a SBA and PNC, suggests the importance of contact with a skilled health worker even if it is just once, in influencing use of services. Therefore, it appears that in order for women in these marginalized communities to benefit from SBA and PNC, it is important for them to have at least one ANC provided by a skilled personnel, rather than non-skilled health-care providers.

A Study to Find Out the Full Immunization Coverage of 12 to 23-month old Children and Areas of Under-Performance using LQAS Technique in a Rural Area of Tripura.

It is very important to analyze the factors which acts as obstacle in achieving 100% immunization among children. Lot Quality Assurance Sampling (LQAS) is one of the effective method to assess such barriers. To assess the full immunization coverage among 12 to 23-month old children of rural field practice area under Department of Community Medicine, Agartala Government Medical College and identify the factors for failure of full immunization. A community based cross-sectional study was conducted from November 2013 to October 2014 on children aged 12 to 23 months old of area under Mohanpur Community health centre. Using LQAS technique 330 samples were selected with multi-stage sampling, each sub-centre being one lot and two calculated to be the decision value. Data was collected using pre-designed pre-tested questionnaire during home visit and verifying immunization card and analysed by computer software SPSS version 21.0. The full immunization coverage among 12 to 23 months old children of Mohanpur area was found as 91.67%. Out of all the 22 sub-centres, 36.36% was found under performing as per pre-fixed criteria and the main reasons for failure of full immunization in those areas are unawareness of need of subsequent doses of vaccines and illness of the children. LQAS is an effective method to identify areas of under-performance even though overall full immunization coverage is high.

AUDIT (Alcohol Use Disorders Identification Test) to Estimate the Pattern and Correlates of Alcohol Consumption among the Adult Population of West Bengal, India: A Community Based Cross-sectional Study.

Pattern of alcohol consumption substantially changed in India with in last 20 to 25 years. Excessive alcohol consumption is a major risk factor for various morbidity and mortality. So, scientific study to identify alcohol consumption patterns and its correlates will be helpful to formulate preventive strategies. To estimate the pattern of alcohol consumption and to determine its correlates, among the adult population of the state of West Bengal in India. A community based cross-sectional study was conducted among the adult population of the state of West Bengal at Gram Panchayat (GP) level. Ninety-nine (n=99) adult (≥ 18 years) men and women of Guchati GP at Paschim Medinipur district, was selected using Lot Quality Assurance Sampling (LQAS) technique. The study participants were interviewed using a pre-designed and pre-tested schedule. It was estimated that the prevalence of low risk drinking or abstinence (Zone I) was 65.5% (95% CI 55.5% to 75.5%) and the prevalence of alcohol use in excess of low-risk (Zone II) was 17.6% (95% CI 7.6% to 27.6%), and the prevalence of harmful and hazardous drinking (Zone III) was 8.5% (95% CI 0% to 18.5%) and the prevalence alcohol dependence (Zone-IV) was 8.4% (0% to 18.4%). Logistic regression model shows that "gender" (p = 0.00) and "employment status" (p = 0.01) added significantly to the model with adjusted odds ratio of 82.27 (95% CI 18.17-372.58) and 0.13 (0.03-0.66). There is a need for comprehensive screening and treatment programme to deal with the problems of Alcohol Use Disorders among adults to achieve good health and well being for sustainable development.

Use of Lot quality assurance sampling surveys to evaluate community health worker performance in rural Zambia: a case of Luangwa district

Use of Lot quality assurance sampling surveys to evaluate community health worker performance in rural Zambia: a case of Luangwa district

Application of Lot Quality Technique for Immunization Coverage and Quality Assessment

Application of Lot Quality Technique for Immunization Coverage and Quality Assessment

Method for determination of varietal purity (typicality), hybridity, sterility of seed lots based on the establishment of the quantitative ratio of alleles of DNA markers

Purpose. To develop a conceptually new method for determination of varietal purity (typicality), hybridity, steri­lity of seed lots. Methods of molecular biology (genomic DNA extraction, PCR with SSR markers application, capillary electrophoresis), genetic, statistical, mathematical analysis. Results. New method for determining the varietal qualities of seed lot was developed that consists of the following steps: simultaneous DNA extraction from a representative sample of aggregated seeds; PCR and further analysis of the amplification products by determination of the qualitative and quantitative composition of SSR-markers’ alleles; calculation of values of varietal seed lot quality using experimentally derived allele ratios. Conclusions. The developed method for determining varietal qualities of seed lots allows to reduce significantly the consumption of materials, time and labor during the analysis. Consistent qualification and quantification of alleles in the total sample of a seed lot is a conceptually new approach to establish varietal purity (typicality), hybridity, sterility.

Association of Frontline Worker-Provided Services with Change in Block-Level Complementary Feeding Indicators: An Ecological Analysis from Bihar, India.

BackgroundInsufficiencies in complementary feeding put infants and young children at increased risk of undernutrition. Till now, most Indian studies have looked at the individual level determinants of complementary feeding practices. We aimed to evaluate the association of frontline worker (FLW) provided nutritional counselling services, with change in community level indicators of complementary feeding practices among 9–11 month old children over time.MethodsThe study data was obtained from five rounds of ‘Lot Quality Assurance Sampling’ survey in eight districts of Bihar, an impoverished Indian state. The surveys were conducted as evaluation exercises for the ‘Integrated Family Health Initiative (IFHI)’–a multi-faceted program aimed at improving the maternal and child health outcomes in Bihar. The main outcome indicators were—current breastfeeding, age-appropriate minimum frequency of semi-solid food, age-appropriate minimum quantity of semi-solid food, initiation of complementary feeding at the right age, and dietary diversity. Repeated measures analysis was performed to determine the association of changes in the outcome indicators with coverage of FLW-provided counselling services.ResultsVisits by FLW, advices on age-appropriate frequency and handwashing were significant predictors of receiving age-appropriate frequency of feeding. The determinants of receiving age-appropriate quantity were—advices on age appropriate frequency and advices on handwashing. Receiving food support from AWC and FLW visits were significantly associated with initiating complementary feeding at the right age.ConclusionsThe present study identified the critical elements among the different types of FLW-provided services. The study findings, from an economically and socially underdeveloped region of India, would inform the relevant programs about the nutritional counselling services that need to be emphasized upon for reducing the burden of childhood malnutrition.

The use of a lot quality assurance sampling methodology to assess and manage primary health interventions in conflict-affected West Darfur, Sudan.

BackgroundOrganizations working in conflict-affected areas have a need to monitor and evaluate their programs, however this is often difficult due to the logistical challenges of conflict areas. Lot quality assurance sampling may be a suitable method of assessing programs in these situations.MethodsWe conducted a secondary data analysis of information collected during Medair’s routine program management functions. Medair’s service area in West Darfur, Sudan was divided into seven supervisory areas. Using the available population information, a sampling frame was developed and interviews were conducted from randomly selected caretakers of children in each supervisory area every six months over 19 months. A survey instrument with questions related to key indicators for immunizations and maternal, newborn, and child health was used for the interviews. Based on Medair’s goals for each indicator, decision rules were calculated for the indicators; these decision rules determined which supervisory areas and indicators performed adequately in each assessment period. Pearson’s chi-squared tests, adjusted for the survey design using STATA “svy: tab” commands, were used to detect overall differences in coverage in this analysis.ResultsThe coverage of tetanus toxoid vaccination among pregnant women increased from 47.2 to 69.7 % (p value = 0.046), and births attended by a skilled health professional increased from 35.7 to 52.7 % (p value = 0.025) from the first to last assessment periods. Measles vaccinations declined from 72.0 to 54.1 % (p value = 0.046). The estimated coverage for the proportion of women receiving a postpartum dose of vitamin A (54.7 to 61.3 %, p value = 0.44); pregnant women receiving a clean delivery kit (54.6 to 47.1 %, p value = 0.49); and pentavalent vaccinations (49.7 to 42.1 %, p value = 0.28) did not significantly change.ConclusionsLot quality assurance sampling was a feasible method for Medair staff to evaluate and optimize primary health programs in a conflict-affected area. Medair managers were able to collect, analyze, and disseminate data to staff alongside the routine work of the organization. These results suggest LQAS may be used in other complex humanitarian emergencies in which there are logistical challenges and limited resources.

Flotation techniques to improve viability of Juniperus polycarpos seed lots

The germination of freshly collected Juniperus polycarpos (K. Koch) seeds is very low and attributed to the large proportion of nonviable seeds in the seed lots. Thus, the aim of this study was to improve seed lot quality by removing nonviable seeds using two flotation techniques: incubation-drying-separation (IDS) and modified specific gravity (MSG) separation. We examined different IDS conditions (the specific incubation time, subsequent drying time and sorting media) for effectively sorting out nonviable seeds; and tested the feasibility of modified SG separation, which involved soaking seeds in water for a certain period before sorting in different concentrations of sucrose solution. Viable seeds were expected to absorb and metabolically bind more water during soaking than dead seeds could, and hence be sorted effectively depending on the viscosity of the sucrose solution. The viability of the seeds that floated or sank was determined in a topographical tetrazolium chloride (TTC) test. For the IDS trial, 7 days incubation followed by 9 h of drying and sedimentation in pure water or 200 g·L−1 sucrose solution identified, respectively, 75 and 82 % of the seeds as viable (sunken) seeds. For the MSG trail, 77 % viable seeds were recovered in the sunken fraction when seeds were soaked for 48 h then immediately sorted in 600 g·L−1 sucrose solution. In both cases, the loss of viable seeds in the discarded floating fraction was only 4 %. The results demonstrate that both IDS and MSG separation techniques substantially improved seed lot viability, but MSG separation is simple and needs no modern seed handling facility, and its efficacy relies on seed mass (due to the initial soaking) and the specific density and viscosity of the flotation medium.

Selection of Sampling Inspection Plans for Life Tests Based on Lognormal Distribution

Abstract Product control is the methodology that consists of sampling inspection procedures with which acceptability or non-acceptability of a lot of finished items can be determined by examining one or more samples of items drawn randomly from the lot. Sampling inspection plans for life tests, also termed as reliability sampling plans, are the special procedures under product control that are employed for taking decisions about the lot based on tests of the lifetime of the items and on an observed number of failures of items. A specific life-test sampling plan can be devised with reference to the lifetime of the products as the quality characteristic, which is modeled by an appropriate continuous-type probability distribution. Various procedures and rules for the design and evaluation of life-test sampling plans based on the tests of sampled lifetime data have been developed and are found in the literature of reliability sampling. In this paper, evaluation of life-test sampling plans under the conditions for the application of lognormal distribution is considered. A procedure for the selection of such plans indexed by acceptable and unacceptable mean life is evolved. Three different criteria for designing life-test plans when lot quality is evaluated in terms of mean life, hazard rate, and reliability life are proposed. Factors for adapting MIL-STD-105D to life and reliability testing indexed by acceptable quality level under the assumption of lognormal distribution are also illustrated.

A Study to Assess the Prevalence of Vaccination Card Retention of Children between 12 to 23 months age by their Parents in a Rural Area of Tripura.

Introduction: low card retention and utilization has been shown by different studies determining immunization coverage in developing countries. The present study aims at assessing the prevalence of vaccination card retention of children between 12 to 23 months age by their parents in a rural area of Tripura. Material and Methods: a community based cross-sectional study has been conducted among parents of 330 children of 12 to 23 months using Lot Quality Assurance Sampling (LQAS) technique in Mohanpur, the rural field practice area under Department of Community Medicine, Agartala Government Medical College. Data was collected using pre-designed semi-structured questionnaire and analysed using computer software SPSS version 20.0. Univariate analysis was done to find the factors associated with non-retention of vaccination card. Results: the prevalence of vaccination card retention is found to be 97.9%. Majority (71.4%) said that they have lost the card and rest 28.6% of the parents mentioned that the card is with the local ASHA. Card retention was higher among children with higher educational status of both the parents and those children who were delivered institutionally. Conclusion: the present study reveals that vaccination card retention byparents of thestudy children is higher than previously conducted studies elsewhere.

Can local staff reliably assess their own programs? A confirmatory test-retest study of Lot Quality Assurance Sampling data collectors in Uganda.

BackgroundData collection techniques that routinely provide health system information at the local level are in demand and needed. LQAS is intended for use by local health teams to collect data at the district and sub-district levels. Our question is whether local health staff produce biased results as they are responsible for implementing the programs they also assess.MethodsThis test-retest study replicates on a larger scale an earlier LQAS reliability assessment in Uganda. We conducted in two districts an LQAS survey using 15 local health staff as data collectors. A week later, the data collectors swapped districts, where they acted as disinterested non-local data collectors, repeating the LQAS survey with the same respondents. We analysed the resulting two data sets for agreement using Cohens’ Kappa.ResultsThe average Kappa score for the knowledge indicators was k = 0.43 (SD = 0.16) and for practice indicators k = 0.63 (SD = 0.17). These scores show moderate agreement for knowledge indicators and substantial agreement for practice indicators. Analyses confirm that respondents were more knowledgeable on retest; no evidence of bias was found for practice indicators.ConclusionThe findings of this study are remarkably similar to those produced in the first reliability study. There is no evidence that using local healthcare staff to collect LQAS data biases data collection in an LQAS study. The bias observed in the knowledge indicators was most likely due to a ‘practice effect’, whereby respondents increased their knowledge as a result of completing the first survey; no corresponding effect was seen in the practice indicators.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1655-4) contains supplementary material, which is available to authorized users.

The Influence of Seasonality and Community-Based Health Worker Provided Counselling on Exclusive Breastfeeding - Findings from a Cross-Sectional Survey in India.

BackgroundExclusive breastfeeding (EBF) during the first six months of life is considered a high impact but low-cost measure for reducing the morbidity and mortality among children. The current study investigated the association of seasonality and frontline worker(FLW) provided counselling with practice of EBF in Bihar, India.MethodsWe used the ‘Lot Quality Assurance Sampling’ technique to conduct a multi-stage sampling survey in 8 districts of Bihar. Regarding EBF, mothers of 0–5 (completed) months old children were asked if they had given only breastmilk to their children during the previous day, while mothers of 6–8 (completed) months old children were inquired about the total duration of EBF. We tested for association between EBF during the previous day with season of interview and EBF for full 6 months with nursing season. We also assessed if receiving counselling on EBF and complementary feeding had any association with relevant EBF indicators.ResultsAmong the under-6 month old children, 76% received EBF during the previous day, whereas 92% of 6–8 (completed) months old children reportedly received EBF for the recommended duration. Proportion of 0–5 (completed) month old children receiving only breastmilk (during last 24 hours) decreased significantly with increasing age and with change of season from colder to warmer months. Odds of receiving only breastmilk during the previous day was significantly higher during the winter months (Adjusted odds ratio(AOR) = 1.50; 95% CI = 1.37, 1.63) compared to summer. Also, the children nursed primarily during the winter season had higher odds of receiving EBF for 6 months (AOR = 1.90, 95% CI = 1.43, 2.52) than those with non-winter nursing. Receiving FLW-counselling was positively associated with breastfeeding exclusively, even after adjusting for seasonality and other covariates (AOR = 1.82; 95% CI = 1.67, 1.98).ConclusionsSeasonality is a significant but non-modifiable risk factor for EBF. However, FLW-counselling was found to increase practice of EBF irrespective of season. Scale-up of FLW-counselling services, with emphasis on summer months and mothers of older infants, can potentially reduce the impact of seasonality on EBF.

Predictive design of single sampling attribute plans

ABSTRACTThe design of a sampling inspection plan is usually based on the properties of the operating characteristic curve. This approach ensures that the plan has adequate power to discriminate a lot of acceptable quality from a lot rejectable quality. However, the designed plan need not necessarily have adequate predictive power when the sentenced lot is re-inspected using the same sampling plan. The paper introduces a new design approach for the single sampling attributes plan ensuring the decision of acceptance or rejection is consistent for both current and any future inspection of the lot. The proposed design controls the risks of a future sample leading to a contradictory decision of acceptance or rejection of the lot. An increase in sample size is required to achieve the required predictive power if the true lot quality fails to be at very low fraction non-conforming levels. A Bayesian analysis is also provided.

Adaptive immune response to whole cell pertussis vaccine reflects vaccine quality: A possible complementation to the Pertussis Serological Potency test

Whole cell Bordetella pertussis (wP) vaccines are still used in many countries to protect against the respiratory disease pertussis. The potency of whole-cell pertussis vaccine lots is determined by an intracerebral challenge test (the Kendrick test). This test is criticized due to lack of immunological relevance of the read-out after an intracerebral challenge with B. pertussis. The alternative in vivo test, which assesses specific antibody levels in serum after wP vaccination, is the Pertussis Serological Potency test (PSPT). Although the PSPT focuses on a parameter that contributes to protection, the protective immune mechanisms after wP vaccination includes more elements than specific antibody responses only. In this study, additional parameters were investigated, i.e. circulating pro-inflammatory cytokines, antibody specificity and T helper cell responses and it was evaluated whether they can be used as complementary readout parameters in the PSPT to assess wP lot quality. By deliberate manipulation of the vaccine preparation procedure, a panel of high, intermediate and low quality wP vaccines were made. The results revealed that these vaccines induced similar IL-6 and IP10 levels in serum 4h after vaccination (innate responses) and similar antibody levels directed against the entire bacterium. In contrast, the induced antibody specificity to distinct wP antigens differed after vaccination with high, intermediate and low quality wP vaccines. In addition, the magnitude of wP-induced Th cell responses (Th17, Th1 and Th2) was reduced after vaccination with a wP vaccine of low quality. T cell responses and antibody specificity are therefore correlates of qualitative differences in the investigated vaccines, while the current parameter of the PSPT alone was not sensitive enough to distinguish between vaccines of different qualities. This study demonstrates that assessment of the magnitude of Th cell responses and the antigen specificity of antibodies induced by wP vaccination could form valuable complementary parameters to the PSPT.

Wavelet-based spectral descriptors for detection of damage in sunflower seeds

Analysis of seeds is essential for determining seed lot quality and hence its sowing value. Although not fully objective, assessing seed quality with radiographic images has been used as alternative to standard laboratory testing. Here, we applied 2D scale-mixing non-decimated wavelet transform for automatic processing of radiographic images of sunflower seeds. From the transformed images several spectral indices are derived. These descriptors involve spectral slopes which are directly connected with the degree of image regularity. A methodology paradigm was developed to analyze the images and classify each seed as damaged or undamaged (slight, full). By considering binary and multinomial supervised classification, the rate of correct classification was found to be 82% for damaged and full seeds, and 57% for damaged, slightly damaged, and full seeds. Although in principle many different transforms can serve as a basis in deriving spectral indices, this particular transform proved out to be sensitive to image anisotropy (by its scale-mixing nature), and stable in computation (by its non-decimated nature).

Assessing delivery practices of mothers over time and over space in Uganda, 2003-2012.

BackgroundIt is well known that safe delivery in a health facility reduces the risks of maternal and infant mortality resulting from perinatal complications. What is less understood are the factors associated with safe delivery practices. We investigate factors influencing health facility delivery practices while adjusting for multiple other factors simultaneously, spatial heterogeneity, and trends over time.MethodsWe fitted a logistic regression model to Lot Quality Assurance Sampling (LQAS) data from Uganda in a framework that considered individual-level covariates, geographical features, and variations over five time points. We accounted for all two-covariate interactions and all three-covariate interactions for which two of the covariates already had a significant interaction, were able to quantify uncertainty in outputs using computationally intensive cluster bootstrap methods, and displayed outputs using a geographical information system. Finally, we investigated what information could be predicted about districts at future time-points, before the next LQAS survey is carried out. To do this, we applied the model to project a confidence interval for the district level coverage of health facility delivery at future time points, by using the lower and upper end values of known demographics to construct a confidence range for the prediction and define priority groups.ResultsWe show that ease of access, maternal age and education are strongly associated with delivery in a health facility; after accounting for this, there remains a significant trend towards greater uptake over time. We use this model together with known demographics to formulate a nascent early warning system that identifies candidate districts expected to have low prevalence of facility-based delivery in the immediate future.ConclusionsOur results support the hypothesis that increased development, particularly related to education and access to health facilities, will act to increase facility-based deliveries, a factor associated with reducing perinatal associated mortality. We provide a statistical method for using inexpensive and routinely collected monitoring and evaluation data to answer complex epidemiology and public health questions in a resource-poor setting. We produced a model based on this data that explained the spatial distribution of facility-based delivery in Uganda. Finally, we used this model to make a prediction about the future priority of districts that was validated by monitoring and evaluation data collected in the next year.Electronic supplementary materialThe online version of this article (doi:10.1186/s12982-016-0049-8) contains supplementary material, which is available to authorized users.

Empowering districts to target priorities for improving child health service in Uganda using change management and rapid assessment methods

BackgroundLocal health system managers in low- and middle-income countries have the responsibility to set health priorities and allocate resources accordingly. Although tools exist to aid this process, they are not widely applied for various reasons including non-availability, poor knowledge of the tools, and poor adaptability into the local context. In Uganda, delivery of basic services is devolved to the District Local Governments through the District Health Teams (DHTs). The Community and District Empowerment for Scale-up (CODES) project aims to provide a set of management tools that aid contextualised priority setting, fund allocation, and problem-solving in a systematic way to improve effective coverage and quality of child survival interventions.DesignAlthough the various tools have previously been used at the national level, the project aims to combine them in an integral way for implementation at the district level. These tools include Lot Quality Assurance Sampling (LQAS) surveys to generate local evidence, Bottleneck analysis and Causal analysis as analytical tools, Continuous Quality Improvement, and Community Dialogues based on Citizen Report Cards and U reports. The tools enable identification of gaps, prioritisation of possible solutions, and allocation of resources accordingly. This paper presents some of the tools used by the project in five districts in Uganda during the proof-of-concept phase of the project.ResultsAll five districts were trained and participated in LQAS surveys and readily adopted the tools for priority setting and resource allocation. All districts developed health operational work plans, which were based on the evidence and each of the districts implemented more than three of the priority activities which were included in their work plans.ConclusionsIn the five districts, the CODES project demonstrated that DHTs can adopt and integrate these tools in the planning process by systematically identifying gaps and setting priority interventions for child survival.