Introduction to Save the Children and project background
Save the Children has over 20 years’ experience of supporting the health sector in Nigeria, focusing mainly on the primary health care. It has been engaged in a number of support areas ranging from providing local technical capacity at service delivery points to a broader health system strengthening at central level. At community levels, Save the Children has sound experience of working with community structures and building relationship between them and health facilities. The organization has been operational in the Northern Nigeria since 2001. The Stop Diarrhoea project is an initiative supported by Reckitt Benckiser aimed at contributing to a two third reduction in diarrhoea-related deaths among children under the age of five in Somolu, Lagos State, Nigeria.
Incidence, risk factors and treatment of diarrhoea in Nigeria
Nigeria has high incidence of diarrhoea cases in children across the geo-political zones, especially in children 0-5years, resulting in percentage increase in children being affected by diarrhoea. Repeated episodes of diarrhoea exacerbate children’s poor health status and accelerate malnutrition, creating a deadly cycle of infection and malnutrition.
The recent 2013 NHDS shows that 10% of children under age 5 were reported to have had diarrhoea in the last two weeks and 2% had diarrhoea with blood with an average 7.5% of children with diarrhoea cases reported in Lagos State. Diarrhoea was most common among children aged between 12–23 months (17%) and least common among those aged between 48-59 months (5%). Diarrhoea with blood was also most common in children age 12-23 months.
Dehydration caused by diarrhoea is a major cause of illness and death among young children, even though the condition can be easily treated with oral rehydration therapy (ORT). Exposure to diarrhoea-causing pathogens is frequently related to the consumption of contaminated water and to unhygienic practices in food preparation and disposal of excreta. The combination of high cause-specific mortality and the existence of an effective remedy make diarrhoea and its treatment a priority concern for the health sector. Diarrhoea leads to stunting due to its association with poor nutrient absorption and appetite loss. Thirty-seven percent of children under age 5 are stunted, eighteen per cent are underweight.
Children of mothers with no education were twice as likely as children of mothers with more than a secondary education to have had diarrhoea. There was also a direct relationship between family wealth and diarrhoea prevalence, with children from wealthier households being less likely to have diarrhoea. Overall, 29 percent of children under age 5 with diarrhoea were taken for advice or treatment at a health facility or provider across the LGAs in Lagos.
Some of the key measures to prevent childhood diarrheal episodes include promoting exclusive breastfeeding, hand washing with soap, improving hygiene and quality of drinking water, vitamin A supplementation and promoting rehydration and zinc intake as prescribed in the WHO/UNICEF 7-point plan for diarrhoea prevention and control. ORS and Zinc remains the cornerstone of appropriate case management of diarrheal dehydration and is considered the single most effective strategy to prevent diarrheal deaths in children under 5.
The Stop Diarrhoea Initiative (SDI)
Through the Stop Diarrhoea Initiative (SDI), Save the Children in partnership with the Lagos State Government and Reckitt Benckiser (RB), aim to fully implement the WHO/UNICEF 7 point plan as a Signature Programme in Shomolu Local Government Area (LGA). This four year programme will contribute to Save the Children and RB’s global ambition of removing diarrhoea as a top five leading cause of death amongst children by 2020. In line with Save the Children’s theory of change, the programme will: test the effectiveness and efficacy of the WHO/UNICEF 7 point plan; collate evidence to demonstrate proof of concept and value for money and advocate the Lagos State and Federal Government of Nigeria, and its partners, to replicate and scale up the approach nationally.
The Stop Diarrhoea Initiative (SDI) focuses on the treatment and prevention of diarrhea in the targeted communities. The aim is to contribute to at least 50% reduction in the prevalence of diarrhea. The core programme elements include child health, Water, Sanitation and Hygiene (WASH), advocacy, community capacity building/participation, service delivery and partnership.
Purpose of the Household Survey
The purpose of the research is to measure progress achieved against the SDI objectives in Shomolu LGA after first Year of implementation through a household survey focused on a pre-agreed set of Key Performance Indicators (KPIs). The survey will provide a breakdown of results between intervention areas supported in Year one and intervention areas not yet supported by SDI.
Findings from this research will support the project’s accountability requirements to its many stakeholders, and will provide invaluable information to the project’s implementing partners prior to the commencement of the Year two activities.
This process is a key component of the stepped wedge design upon which the SDI project is been implemented.
Target audience: Primary caregivers of children less than five years in Shomolu.
Key Indicators of interest
This list is not exhaustive and may include additional indicators.
% households reporting access to improved sanitation facility
% households in target areas with access to safe drinking water / improved sources of drinking water
% households practicing safe water treatment and storage
% of households practicing hand washing with soap and water at three critical times
% of households / carers in the target communities identify diarrhoea and its associated risk factors
% of children under five with diarrhoea treated with ORS and Zinc according to National guidelines
% of caregivers/ mothers with knowledge on home management of diarrhoea and treatment with ORS and Zinc
% of caregivers practicing continued breastfeeding during diarrhoeal illness
% women practicing exclusive breastfeeding
% of households in the target communities identifying diarrhoea and its associated risk factors
Research Methodology
The research methodology will consist of a statistically robust household survey in the Shomolu LGA using a structured questionnaire developed in collaboration with Save the Children and focused on a set of pre-agreed indicators.
The proposal should provide details on the sampling framework, the sample size and corresponding power calculations, and the proposed surveying techniques and protocols.
The design will be expected to allow for disaggregation of findings between intervention areas supported in Year 1 and intervention areas not yet supported by SDI.
Educational background, skills and competencies required
At least MSc degree in statistics, sociology, demography, psychology or any other related social sciences. A Ph.D. holder in any of the above subject will be an added advantage and preferred
At least 5 to 10 field experience in previous work related to survey or operation research.
Demonstrable and practice ability indicating good experience in household survey through previous work in rural communities.
Experience in quantitative and contemporary statistical packages.
Experience in conducting high quality quantitative research in communities in Nigeria;
Experience of conducting research in the area of public health and / or water and sanitation;
Child safeguarding and Ethical considerations regarding data collection, including confidentiality must be clearly highlighted in the methodology. Planning should take into consideration Ethical Checking Requirements in country.
Key deliverables and outputs of this research
A detailed Technical and financial proposal
An inception report, including a final methodology and data collection tools for the household survey; to be reviewed and approved by Save the Children before start of field work
A feasible and realistic work plan for the research
A short pilot report summarising the findings of the pilot and the recommended adjustments, if any, to the data collection tools or surveying techniques;
A draft report presenting the research findings, compliant with the TOR requirements and with the report template to be developed during the inception phase; to be reviewed by Save the Children;
A final report addressing the comments and suggestions made by Save the Children and partners on the first draft; to be reviewed and approved by Save the Children
Reference materials to be reviewed by the consultant to be reviewed during inception phase
Stop Diarrhoea Initiative project proposal
Stop Diarrhoea Initiative baseline report and KAP survey
The consultants should also be able to carry out their own individual on-line research and browsing on the topics under research.
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