Knowledge, Practices, and Coverage Survey 2000+ (KPC2000+)

Name: Knowledge, Practices, and Coverage Survey 2000+ (KPC2000+)

Purpose: The Knowledge, Practices, and Coverage Survey (KPC) assists Private Voluntary Organizations to monitor and estimate results of their child survival (CS) activities. The tool was originally developed by the Child Survival Support Program of Johns Hopkins University but has been revised substantially by the Child Survival Technical Support Project (CSTS) and the Child Survival Collaborations and Resources (CORE) Group. The new tool is called the KPC2000+ and consists of the Rapid CATCH (Core Assessment Tool on Child Health) and 15 modules related to key CS technical interventions. There are several modules related to maternal and neonatal health such as breastfeeding, maternal anthropometry, antenatal care, delivery and immediate newborn care, postpartum care, and child spacing. All KPC2000+ tools and documents can be downloaded from the CSTS website at http://www.childsurvival.com/kpc2000/kpc2000.cfm.

Type of Design: Descriptive, cross-sectional

Sample Size: 300 mothers/caregivers of children less than two years of age

Where Used: Used in countries throughout Africa, Asia, NIS, and Latin America and the Caribbean

Survey Tool: http://www.childsurvival.com/kpc2000/kpc2000.cfm

BASIC INFORMATION

Name: Knowledge, Practices, and Coverage Survey 2000+ (KPC2000+>)

Origin / Source: Originally developed by the Child Survival Support Program of Johns Hopkins University; revised substantially by the Child Survival Technical Support Project (CSTS) and the Child Survival Collaborations and Resources (CORE) Group

Technical Area: Maternal and Newborn Health

Basic Description: The KPC is a management tool used to collect beneficiary-level information related to maternal and child health and survival. In addition, the survey fosters local participation in identifying health priorities and monitoring community health status.

Country Applications: Used in countries throughout Africa, Asia, NIS, and Latin America and the Caribbean

Language(s) Available: The KPC2000+ is available in its entirety in English. In addition, several Private Voluntary Organizations have translated portions of the survey into Spanish, French, and other languages.

Technical Scope/Purpose: The KPC2000+ covers a broad spectrum of issues related to maternal health and child health/survival. Organizations use relevant sections of the KPC2000+ as part of baseline assessments to plan child survival (CS) activities, as well as to monitor/estimate beneficiary-level results during and at the end of their projects. The survey process is also a mechanism to build consensus among project stakeholders.

Design: Descriptive, cross-sectional survey that yields information on individuals, households, and communities

Method: Quantitative

Frequency of Administration: It is usually administered at the beginning and end of a project; however, some projects have used a small subset of questions from the survey for the purposes of project monitoring.

Key Users of the Information: CS project staff, individuals from local governmental and non-governmental agencies/institutions, donor agencies, communities

Objectives and Scope of the Tool:

  • The KPC is designed to do the following:
  • Assess critical knowledge and practices that affect child health and survival
  • Estimate CS intervention coverage
  • Build local capacity to gather and use information for health decisionmaking

The current version, the KPC2000+, consists of the Rapid CATCH (Core Assessment Tool on Child Health) and 15 modules corresponding to key CS technical interventions. The Rapid CATCH is linked to a concise set of indicators that reflect current international standards in child health and survival. It contains 26 questions from the KPC2000+ modules and provides a snapshot of the target population in terms of child health. The Rapid CATCH represents the bare minimum in terms of issues that CS projects should consider in their assessments. In order to create a tool that reflects their program activities, objectives, and the contexts in which they are working, PVOs should refer to the modules for additional questions. When adapting the tool, it is important to strive for a questionnaire that a) only includes items that are programmatically useful and b) can be administered within 30-45 minutes.

Below are the modules that constitute the KPC2000+.

Module 1A: Water and Sanitation
Module 1B: Respondent Background Information
Module 2: Breastfeeding and Infant/Child Nutrition
Module 3: Growth Monitoring and Maternal/Child Anthropometry
Module 4A: Childhood Immunization
Module 4B: Sick Child
Module 4C: Diarrhea
Module 4D: Acute Respiratory Infections (ARI)
Module 4E: Malaria
Module 5A: Prenatal Care
Module 5B: Delivery and Immediate Newborn Care
Module 5C: Postpartum Care
Module 6: Child Spacing
Module 7: HIV/AIDS
Module 8: Health Contacts and Sources of Information

Each module contains the following:

  • interviewer instructions
  • examples of questions/themes that can be explored using qualitative research
  • suggested quantitative research questions
  • basic tabulation plan with key indicators

The KPC was designed to be participatory. It can be used to develop local capacity to gather, analyze, and use information for decisionmaking. PVOs should view the KPC as an opportunity to strengthen capacity both within and outside of the project.

Key Indicators: The KPC yields numerous indicators. When adapting the tool, projects should identify a concise and manageable set of indicators. Below are the key indicators related to maternal and newborn health.

  1. Percentage of mothers with children age 0-23 months who received at least two tetanus toxoid injections before the birth of the youngest child.
  2. Percentage of mothers who had at least one prenatal visit prior to the birth of her youngest child less than 24 months of age.
  3. Percentage of mothers who received / bought iron supplements while pregnant with the youngest child less than 24 months of age.
  4. Percentage of mothers with children age 0-23 months who received malaria prophylaxis during pregnancy (in endemic areas only).
  5. Percentage of children age 0-23 who were born at least 24 months after the previous surviving child.
  6. Percentage of children age 0-23 whose births were attended by skilled health personnel.
  7. Percentage of children age 0-23 whose delivery involved use of a clean birth kit or whose cord was cut with a new razor.
  8. Percentage of children age 0-23 who were breastfed within one hour after delivery.
  9. Percentage of children age 0-23 who were placed with their mother immediately after birth.
  10. Percentage of mothers who had at least one postpartum check-up
  11. Percentage of mothers able to report at least two known maternal danger signs during the postpartum period.
  12. Percentage of mothers able to report at least two known neonatal danger signs.
  13. Percentage of mothers who received a Vitamin A dose during the first two months after delivery.

Tool Design: The KPC is a rapid assessment. Data collection usually lasts between three and four days. In general, the survey targets 300 mothers of children age 0-23 months. However, projects are beginning to experiment with different methodologies, survey targets, and sample sizes to best assess the needs of each context. Traditionally, KPC samples have been selected using the 30-cluster sampling methodology associated with Expanded Programme on Immunization (EPI) coverage surveys. Today, projects are beginning to experiment with methodologies and sampling strategies such as Lot Quality Assurance Sampling (LQAS) or parallel sampling.

In light of the fact that the KPC is a small-sample survey, it is very important to pay attention to the way in which sample areas, households, and respondents are selected. The KPC2000+ Field Guide (Draft) provides a detailed discussion of methodological issues and sampling options for KPC surveys.

In terms of technical assistance required for the survey, projects will need to identify a person (preferably someone local) who can serve as the Survey Coordinator. Some projects hire consultants when they cannot identify local persons with KPC training or experience. Even when a consultant is hired, a project should identify staff members who can work closely with the consultant to develop the necessary skills to plan, carry out, and analyze similar surveys in the future.

Implementation and Training:

Ideally, interviewer training should take place over a three-day period, allowing for sufficient time to review all aspects of field implementation and provide interviewers with hands-on experience conducting interviews. It is helpful to hold a special one-day overview training with field supervisors before conducting the interviewer training. In addition to the one-day overview, supervisors should attend the interviewer training session in its entirety.

The nature and format of the training is left to the discretion of each project; however, a KPC training workshop should at minimum cover the following:

  1. Survey purpose
  2. Content and format of the adapted questionnaire
  3. Proper interviewing techniques
  4. Field procedures, including protocols for household and respondent selection
  5. Quality-control procedures

There may be other topics that need to be discussed, given the local context. Regardless of the training's content, interviewers should have sufficient time to cultivate interviewing skills through role playing and field practice. In addition, training facilitators should strive to create a trusting atmosphere that is conducive to team building and supportive supervision.

The KPC2000+ Field Guide discusses specifics regarding training and quality control procedures during field implementation.

Manuals and Guidelines (if applicable): CSTS is in the process of developing a self-instructional field guide to assist projects in planning, conducting, and analyzing KPC surveys. The field guide is intended for individuals with past KPC experience, as well as for persons who will be conducting KPC surveys but do not have prior KPC training or experience.

The field guide orients the reader on the following:

  • Purpose of a KPC survey and its role in project monitoring and evaluation
  • KPC2000+ tools
  • Phases of the KPC process
  • Useful research materials produced by other agencies and organizations

The field guide contains an expanded section on sampling options for KPC surveys and stresses the importance of incorporating qualitative research, partnership-building, and capacity development into the KPC process.

Data Processing and Analysis: KPC data can either be hand tabulated or analyzed with the aid of statistical software such as Epi Info. Even though many projects conduct computer-based analyses, people at the local level often have difficulties understanding how information collected from individual respondents translates into numbers and percentages generated by a computer. For that reason, it is recommended that projects hold a Hand Tabulation Workshop with local partners and stakeholders (in addition to or in lieu of computer analysis) to tabulate key indicators, prioritize problems, and begin to develop action plans.

In the past, projects have limited their analyses to simple frequencies. They are now encouraged to conduct extended analyses, within the scope of the survey. Although KPC sample sizes are typically small, cross tabulations of the data by key variables (e.g., sex of child, maternal age) might suggest important differences between subgroups of mothers/children that warrant further investigation. Identification of differentials will assist a project in providing a more targeted response to the problems faced by the target population.

The KPC2000+ Field Guide provides explicit details in terms of the tabulation and analysis of KPC data.

Reporting and Dissemination of Results (if applicable): The KPC survey report is an important outcome of the KPC process. It should provide a detailed description of the study, present survey findings, and discuss the program implications of those findings. Individuals who were not involved in the study should be able to read the report and get a good sense of the process and methods, not just the major findings. KPC report-writing guidelines are available on the CSTS website (http://www.childsurvival.com/kpc2000/kpc2000.cfm).

In addition to providing guidance on how data can be present, the guidelines stress the importance of discussing partnership and capacity-building activities as they relate to KPC surveys. Projects are encouraged to share the report with partner organizations, donor agencies, and other agencies/institutions working in the same geographic area. If the KPC is implemented as part of a project's baseline assessment, the survey report can serve as background material when writing Detailed Implementation Plans. Project staff can also work with local partners and stakeholders to share and display KPC findings and track result-level information during the life of the project.

Cost: Costs associated with KPC surveys vary according to a myriad of factors. Nevertheless, the survey is designed to be a rapid assessment for use at the local level. Because the KPC is a small sample survey, the implementation costs are minimal relative to other types of assessments.

Contact:
Donna Espeut, email: despeut@macroint.com
Macro International Inc.
11785, Beltsville Drive, Calverton, MD 20705
Phone: 301-572-0200