DHS COMPARATIVE

REPORTS 49

FACILITY-BASED NUTRITION 

READINESS AND DELIVERY OF 

MATERNAL AND CHILD NUTRITION 

SERVICES USING SERVICE PROVISION 

ASSESSMENT SURVEYS

September 2018

This publication was produced for review by the United States Agency for International Development (USAID). The report was prepared by

Lindsay Mallick, Gheda Temsah, and Rukundo K. Benedict.

DHS Comparative Reports No. 49 

Facility-based Nutrition Readiness and Delivery of Maternal 

and Child Nutrition Services Using Service Provision 

Assessment Surveys 

Lindsay Mallick1,2

Gheda Temsah3

Rukundo K. Benedict2,3

ICF 

Rockville, Maryland, USA 

September 2018 

1

 Avenir Health 

2

 The DHS Program 

3

 ICF 

Corresponding author: Rukundo Kambarami Benedict, International Health and Development, ICF, 530 

Gaither Road, Suite 500, Rockville, MD 20850, USA; phone: 301-407-0537; fax: 301-407-0211; email: 

Rukundo.benedict@icf.com 
Acknowledgments: We would like to thank Tom Fish for designing maps, Anika Hannan for formatting 

tables and figures, Allison Schmale for data preparation, and Sarah Yang for creating the brief summarizing 

indicators. Special thanks to Sorrel Namaste for her comments and Melinda Munos for her technical review. 

Finally, we would like to thank Erin Milner (USAID) for her conceptual support of this report. 

Editor: Diane Stoy 

Document Production: Joan Wardell 

This study was carried out with support provided by the United States Agency for International 

Development (USAID) through The DHS Program (#AID-OAA-C-13-00095). The views expressed are 

those of the authors and do not necessarily reflect the views of USAID or the United States Government. 

The DHS Program assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. Additional information about The DHS Program can be obtained 

from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; telephone: +1 301-407-6500, fax: 

+1 301-407-6501, email: info@DHSprogram.com, internet: www.DHSprogram.com. 

Recommended citation: 

Mallick, Lindsay, Gheda Temsah, and Rukundo K. Benedict. 2018. Facility-based Nutrition Readiness and 

Delivery of Maternal and Child Nutrition Services Using Service Provision Assessment Surveys. DHS 

Comparative Reports No. 49. Rockville, Maryland, USA: ICF. 
iii 

CONTENTS 

TABLES ........................................................................................................................................................ v

FIGURES ..................................................................................................................................................... ix 

PREFACE .................................................................................................................................................... xi 

ABSTRACT................................................................................................................................................ xiii 

1 INTRODUCTION AND RATIONALE ............................................................................................... 1

2 DATA AND METHODS ................................................................................................................... 3 

2.1 Data ..................................................................................................................................... 3 

2.2 Methods .............................................................................................................................. 6 

3 RESULTS ...................................................................................................................................... 11 

3.1 Antenatal Nutrition ............................................................................................................. 11 

3.1.1 Service readiness ................................................................................................ 11 

3.1.2 Service delivery .................................................................................................... 12

3.1.3 Service readiness and delivery by region and facility background 

characteristics ...................................................................................................... 15 

3.2 Child Nutrition .................................................................................................................... 19 

3.2.1 Service readiness ................................................................................................ 20 

3.2.2 Service delivery .................................................................................................... 20

3.2.3 Service readiness and delivery by region and facility background 

characteristics ...................................................................................................... 23 

4 DISCUSSION ................................................................................................................................. 25 

4.1 Summary of Findings ........................................................................................................ 25 

4.2 Limitations ......................................................................................................................... 26 

4.3 Recommendations for Next Steps .................................................................................... 27 

4.4 Conclusions ....................................................................................................................... 28 

REFERENCES ............................................................................................................................................ 29 

APPENDIX .................................................................................................................................................. 33 

v 

TABLES 

Table 1 Sample design of included surveys .............................................................................. 4 

Table 2a Nutrition indicators in antenatal care services .............................................................. 8 

Table 2b Nutrition indicators in curative child care and growth monitoring services ................... 9 

Table 3 Percent of facilities with capacity to provide nutrition-related care 

among facilities with ANC and percent of providers with training 

on maternal nutrition, by country ................................................................................ 12 

Table 4 Percent of facilities with capacity to provide nutrition interventions 

among facilities with curative child care services and percent of providers 

with training on child nutrition topics, by country ........................................................ 20 

Table 5 Availability of infant and child scales among facilities that provide curative 

child care services, by country and region ................................................................. 24 

Appendix Table 1 Percent of facilities providing antenatal care services, curative child care 

services, and growth monitoring services, by country ................................................ 33 

Appendix Table 2 Percent of facilities with capacity to provide nutrition-related care in ANC, 

percent of clients observed and reporting nutrition-related counseling among 

clients attending ANC, and percent of providers with training on nutritional 

assessment in pregnancy, by country ........................................................................ 34 

Appendix Table 3 Percent of facilities with capacity to provide nutrition-related care in ANC, 

percent of clients observed and reporting nutrition-related counseling among 

clientsattending ANC, and percent of providers with training on nutritional 

assessment in pregnancy, by background characteristics, Bangladesh 

SPA 2014 ................................................................................................................... 36 

Appendix Table 4 Percent of facilities with capacity to provide nutrition-related care in ANC, 

percent of clients observed and reporting nutrition-related counseling among 

clientsattending ANC, and percent of providers with training on nutritional 

assessment in pregnancy, by background characteristics, Haiti SPA 2013 .............. 37 

Appendix Table 5 Percent of facilities with capacity to provide nutrition-related care in ANC, 

percent of clients observed and reporting nutrition-related counseling among 

clientsattending ANC, and percent of providers with training on nutritional 

assessment in pregnancy, by background characteristics, Kenya SPA 2010 ........... 38 

Appendix Table 6 Percent of facilities with capacity to provide nutrition-related care in ANC, 

percent of clients observed and reporting nutrition-related counseling among 

clientsattending ANC, and percent of providers with training on nutritional 

assessment in pregnancy, by background characteristics, Malawi SPA 2013-14 ..... 39 

Appendix Table 7 Percent of facilities with capacity to provide nutrition-related care in ANC, 

percent of clients observed and reporting nutrition-related counseling among 

clientsattending ANC, and percent of providers with training on nutritional 

assessment in pregnancy, by background characteristics, Namibia SPA 2009 ........ 40 
vi 

Appendix Table 8 Percent of facilities with capacity to provide nutrition-related care in ANC, 

percent of clients observed and reporting nutrition-related counseling among 

clientsattending ANC, and percent of providers with training on nutritional 

assessment in pregnancy, by background characteristics, Nepal SPA 2015 ............ 41 

Appendix Table 9 Percent of facilities with capacity to provide nutrition-related care in ANC, 

percent of clients observed and reporting nutrition-related counseling among 

clientsattending ANC, and percent of providers with training on nutritional 

assessment in pregnancy, by background characteristics, Rwanda 

SPA 2007 ................................................................................................................... 42 

Appendix Table 10 Percent of facilities with capacity to provide nutrition-related care in ANC, 

percent of clients observed and reporting nutrition-related counseling among 

clientsattending ANC, and percent of providers with training on nutritional 

assessment in pregnancy, by background characteristics, Senegal SPA 

2016 ....................................................................................................................... 43 

Appendix Table 11 Percent of facilities with capacity to provide nutrition-related care in ANC, 

percent of clients observed and reporting nutrition-related counseling among 

clientsattending ANC, and percent of providers with training on nutritional 

assessment in pregnancy, by background characteristics, Tanzania 

SPA 2014-15 .............................................................................................................. 44 

Appendix Table 12 Percent of facilities with capacity to provide nutrition-related care in ANC, 

percent of clients observed and reporting nutrition-related counseling among 

clientsattending ANC, and percent of providers with training on nutritional 

assessment in pregnancy, by background characteristics, Uganda SPA 

2007 ....................................................................................................................... 45 

Appendix Table 13 Availability of IFA supplements among facilities that provide ANC and 

percent of women provided or prescribed IFA supplements, by country 

and region ................................................................................................................... 46 

Appendix Table 14 Percent of facilities with capacity to provide nutrition-related care in curative 

child care services, percent of clients observed and caretakers reporting nutritionrelated counseling among clients attending sick child care visits, and percent of 

providers with training on child nutrition topics, by country ........................................ 47 

Appendix Table 15 Percent of facilities with capacity to provide nutrition-related care in curative 

child care services, percent of clients observed and caretakers reporting nutritionrelated counseling among clients attending sick child care visits, and percent of 

providers with training on child nutrition topics, by facility background 

characteristics, Bangladesh SPA 2014 ...................................................................... 49 

Appendix Table 16 Percent of facilities with capacity to provide nutrition-related care in curative 

child care services, percent of clients observed and caretakers reporting nutritionrelated counseling among clients attending sick child care visits, and percent of 

providers with training on child nutrition topics, by facility background 

characteristics, Haiti SPA 2013 .................................................................................. 50 
vii 

Appendix Table 17 Percent of facilities with capacity to provide nutrition-related care in curative 

child care services, percent of clients observed and caretakers reporting nutritionrelated counseling among clients attending sick child care visits, and percent of 

providers with training on child nutrition topics, by facility background 

characteristics, Kenya SPA 2010 ............................................................................... 51 

Appendix Table 18 Percent of facilities with capacity to provide nutrition-related care in curative 

child care services, percent of clients observed and caretakers reporting nutritionrelated counseling among clients attending sick child care visits, and percent of 

providers with training on child nutrition topics, by facility background 

characteristics, Malawi SPA 2013-14 ......................................................................... 52 

Appendix Table 19 Percent of facilities with capacity to provide nutrition-related care in curative 

child care services, percent of clients observed and caretakers reporting nutritionrelated counseling among clients attending sick child care visits, and percent of 

providers with training on child nutrition topics, by facility background 

characteristics, Namibia SPA 2009 ............................................................................ 53 

Appendix Table 20 Percent of facilities with capacity to provide nutrition-related care in curative 

child care services, percent of clients observed and caretakers reporting nutritionrelated counseling among clients attending sick child care visits, and percent of 

providers with training on child nutrition topics, by facility background 

characteristics, Nepal SPA 2015 ................................................................................ 54 

Appendix Table 21 Percent of facilities with capacity to provide nutrition-related care in curative 

child care services, percent of clients observed and caretakers reporting nutritionrelated counseling among clients attending sick child care visits, and percent of 

providers with training on child nutrition topics, by facility background 

characteristics, Rwanda SPA 2007 ............................................................................ 55 

Appendix Table 22 Percent of facilities with capacity to provide nutrition-related care in curative 

child care services, percent of clients observed and caretakers reporting nutritionrelated counseling among clients attending sick child care visits, and percent of 

providers with training on child nutrition topics, by facility background 

characteristics, Senegal SPA 2016 ............................................................................ 56 

Appendix Table 23 Percent of facilities with capacity to provide nutrition-related care in curative 

child care services, percent of clients observed and caretakers reporting nutritionrelated counseling among clients attending sick child care visits, and percent of 

providers with training on child nutrition topics, by facility background 

characteristics, Tanzania SPA 2014-15 ..................................................................... 57 

Appendix Table 24 Percent of facilities with capacity to provide nutrition-related care in curative 

child care services, percent of clients observed and caretakers reporting nutritionrelated counseling among clients attending sick child care visits, and percent of 

providers with training on child nutrition topics, by facility background 

characteristics, Uganda SPA 2007 ............................................................................. 58 

ix 

FIGURES 

Figure 1a Percent distribution of facilities according to facility type, by country .......................... 5 

Figure 1b Percent distribution of facilities according to managing authority, by country .............. 5 

Figure 1c Percent distribution of facilities according to locale, by country ................................... 6 

Figure 2 Percent of facilities providing ANC services, by country ............................................ 11 

Figure 3 Percent of women prescribed or provided IFA supplements during an ANC 

visit and percent of women receiving IFA-related counseling among those 

prescribed or provided IFA supplements, by country ................................................. 13 

Figure 4 Percent of women receiving weight assessment and maternal nutrition 

counseling during an ANC visit, by country ................................................................ 14 

Figure 5 Percent of women assessed or tested for anemia during an ANC visit, 

by country ................................................................................................................... 14 

Figure 6 Percent of women receiving breastfeeding counseling during an ANC visit, 

by country ................................................................................................................... 15 

Figure 7 Percent of facilities with IFA supplements available among facilities that provide 

ANC services, by region ............................................................................................. 17 

Figure 8 Percent of women attending ANC who were provided with or prescribed iron or 

folic acid (or both), by region ...................................................................................... 18 

Figure 9 Percent of facilities providing curative care and growth monitoring services for 

children, by country .................................................................................................... 19 

Figure 10 Percent of children whose weight was measured and percent of children whose 

weight was plotted on a growth chart among children weighed during sick child 

consultations, by country ............................................................................................ 21 

Figure 11 Percent of children who received vitamin A during sick child visits, by country ......... 22 

Figure 12 Percent of caretakers who discussed feeding or breastfeeding practices 

during illness or wellness during sick child visits, by country ..................................... 22 

xi 

PREFACE 

The Demographic and Health Surveys (DHS) Program is one of the principal sources of international data 

on fertility, family planning, maternal and child health, nutrition, mortality, environmental health, 

HIV/AIDS, malaria, and provision of health services. 

One of the objectives of The DHS Program is to provide policymakers and program managers in low- and 

middle-income countries with easily accessible data on levels and trends for a wide range of health and 

demographic indicators. DHS Comparative Reports provide such information, usually for a large number 

of countries in each report. These reports are largely descriptive, without multivariate methods, but when 

possible they include confidence intervals and/or statistical tests. 

The topics in this series are selected by The DHS Program in consultation with the U.S. Agency for 

International Development. 

It is hoped that the DHS Comparative Reports will be useful to researchers, policymakers, and survey 

specialists, particularly those engaged in work in low- and middle-income countries. 

Sunita Kishor 

Director, The DHS Program 

xiii 

ABSTRACT 

Persistent malnutrition in low- and middle-income countries requires an exploration of nutrition-related 

services provided by health facilities in order to identify potential areas for future interventions. The 

Demographic and Health Surveys (DHS) Program Service Provision Assessment (SPA) surveys provide 

nationally representative facility data for such exploration. The SPA surveys provide key information about 

service readiness (availability of resources required to perform services) and service delivery (care and 

counseling that clients receive during consultations) within facilities. 

This report identifies 40 indicators of nutrition intervention readiness and delivery as part of antenatal care 

(ANC) and sick child care according to SPA surveys conducted in 10 countries. We first describe the 

availability of ANC and sick child care at the national level. We then describe service readiness in terms of 

availability of commodities and provider training, service delivery, and, more specifically, counseling 

provided during ANC and sick child visits related to nutrition. We describe regional-level estimates for 

selected indicators, including the availability and provision of iron and folic acid (IFA) supplements and 

the availability of infant and child scales. Finally, we provide supplemental information on nutrition-related 

readiness according to facility background characteristics. 

This report demonstrates variation in the availability of medication and equipment for pregnant women and 

children across countries. Supplement availability ranged from 58%-92% for IFA among women and from 

4%-70% for iron among children. Availability of adult weighing scales was over 88% across countries, 

while availability of child and infant scales ranged from 35%-95%. Provider training for nutrition-related 

topics was low, ranging from 11%-25% for nutritional assessment in pregnancy to 14%-43% for training in 

infant and young child feeding practices. Observations of counseling on breastfeeding and maternal 

nutrition during ANC ranged from 1%-13% and 33%-48%, respectively. Overall, regional variation within 

countries was less than variation across countries, and there were no strong trends when comparing 

availability by facility background characteristics. However, a key finding of this study is that across all 

countries, there is considerable room for improvement in provider training and provider counseling on 

nutrition-related topics, particularly breastfeeding practices. This indicates a need for new or strengthened 

strategies to boost training among providers and further investigations into the extent that lack of provider 

training leads to poor nutrition practices. 

KEYWORDS: antenatal care, breastfeeding, complementary feeding, growth monitoring, health facility 

assessment, IFA supplementation, maternal nutrition, service provision assessment 

1 

1 INTRODUCTION AND RATIONALE 

Despite improvements in maternal and child nutrition over the past two decades, malnutrition is still a 

problem in several low- and middle-income countries (Development Initiatives 2017). Essential nutrition 

interventions that target women and children are primarily delivered by the health system through facilityand community-based services and address the immediate causes of malnutrition (Black et al. 2013; World 

Health Organization [WHO] 2013). Essential nutrition interventions for women include iron and folic acid 

(IFA) supplementation and calcium and other micronutrient supplements as part of routine antenatal care 

(ANC) visits, as well as counseling on maternal dietary practices (WHO 2013). Essential nutrition 

interventions for children include counseling on infant and young child feeding (IYCF), micronutrient 

supplementation (iron, vitamin A, zinc), and growth monitoring services (WHO 2013). However, a lack of 

trained health workers, shortages of supplies, and poor-quality services can limit access to nutrition 

interventions (Chopra et al. 2012; Kavle and Landry 2018). As countries work to achieve the Sustainable 

Development Goals on nutrition, it is important to measure the delivery of facility-based nutrition services. 

Global health facility surveys such as The DHS Program’s Service Provision Assessment (SPA) and the 

World Health Organization’s Service Availability and Readiness Assessment (SARA) are relatively new 

and have been underutilized. These surveys characterize service availability and readiness to provide 

services, and SPA surveys also include information on service delivery. Service availability is defined as 

the physical presence of health services at the facility (WHO 2016). Service readiness is the capacity of 

health facilities to provide services, including basic amenities, equipment, trained staff, and essential 

medicines (WHO 2016). Service delivery refers to the delivery process. This includes independent 

observations of service visits and the perceptions of clients and health workers of services and the service 

environment. Facility-based surveys make it possible to describe the availability of nutrition-related 

services and readiness to deliver nutrition interventions within health facilities. 

The SPA surveys are being used to describe health facility readiness and coverage of maternal, newborn, 

and child health services across different contexts. Also, some studies link SPA surveys to DHS surveys. 

Assessments of effective coverage—a measure of coverage of health care services adjusted for service 

quality—of maternal and child health (MCH) services, including family planning, ANC, and care for sick 

children, show that there have been improvements over time, although overall coverage is still low (Nguhiu, 

Barasa, and Chuma 2017). Other studies in different country contexts that have examined service 

availability, readiness, and quality of care report low coverage and quality for antenatal, delivery, infectious 

disease, newborn, and obstetric services but note that there are variations by country and geographic 

inequalities within many countries (Assaf, Wang, and Mallick 2016; Leslie et al. 2017; Mallick et al. 2016; 

Winter et al. 2017; Kanyangarara et al. 2018; Kanyangarara, Munos, and Walker 2017; Wang, Winner, and 

Burgert-Brucker 2017). As assessments and monitoring of service availability, readiness, and delivery 

continue for many health facility services, so will understanding of the nutrition-specific components of 

these services. 

Currently, maternal and child nutrition-related indicators in SPA surveys are included in ANC and child 

care services, although specific reporting on essential nutrition intervention readiness is largely absent. This 

report seeks to address this deficit. More specifically, this report describes and compares nutrition 

intervention indicators (service readiness and delivery) in SPA surveys across 10 countries. The report also 

describes the indicators disaggregated by health facility characteristics including locale (rural and urban), 

managing authority (public and private facilities), and facility type (hospital and other). 

3 

2 DATA AND METHODS 

2.1 Data 

This report uses data collected in the most recent SPA survey conducted by The DHS Program in the 

following 10 countries where SPA surveys have been conducted since 2007: Bangladesh (2014), Haiti 

(2013), Kenya (2010), Malawi (2013-2014), Namibia (2009), Nepal (2015), Rwanda (2007), Senegal 

(2016), Tanzania (2014-2015), and Uganda (2007). Given the wide time frame during which The DHS 

Program conducted these SPA surveys, most of the report focuses on the most recent surveys, which were 

conducted within the previous 5 years (2013 to present)—Bangladesh, Haiti, Malawi, Nepal, Senegal, and 

Tanzania—in order to avoid comparisons with countries that have potentially outdated data. However, the 

appendix tables include results from all 10 surveys. The SPA survey in Senegal is an annual (continuous) 

series of surveys. There were two surveys conducted in Senegal prior to the survey included in this report 

(2012-13 and 2014). This report includes the most recent survey available. 

The data from the SPA surveys are used to assess the extent of nutrition intervention service readiness and 

provision at the facility level, which includes the availability of various nutrition intervention supplies, 

counseling, procedures, or services provided to the client and nutrition-related training for health service 

providers. The readiness results represent formal-sector health facilities and their providers, and the service 

provision data represent patients at those facilities. Formal-sector health facilities include public, private 

(for-profit, not-for-profit, nongovernmental, faith-based), and mixed private-public facilities. Pharmacies, 

mobile clinics, and individual doctors’ offices are usually not included as formal-sector facilities. 

The SPA surveys include several questionnaires that collect data on the service environment of the facility: 

1. An inventory questionnaire that examines the availability of services, infrastructure, 

commodities, procedures, and resources at the facility. 

2. A health worker interview that collects information from providers on routine duties, training, 

and demographic characteristics. 

3. An observation checklist that records the content and quality aspects of the selected health visits. 

The observations are specific to types of health visits and include ANC, child health, family 

planning, and birth and delivery services. 

4. A client exit interview in which clients whose visit was observed provide their perceptions on the 

visit and demographic information. 

In most countries, the SPA survey is based on a sample of randomly selected formal-sector health facilities; 

exceptions are Haiti, Malawi, and Namibia, where information was collected from all formal-sector health 

facilities. The study sample is designed for key indicators to be representative at the national and 

subnational levels and by facility type and managing authority. The sample of facilities in Nepal was further 

stratified by ecological region, by development-ecological region, and for private hospitals according to 

number of beds (less than 100 versus 100 or more). The sample design for the selection of facilities and the 

total number of facilities are summarized in Table 1. 
4 

A sample of 8-15 health providers who were present in the facility on the day of the assessment are 

randomly selected from provider lists at each health facility. Preference is given to providers who provided 

consultation services, counseling, health education, or laboratory services, which were assessed in the SPA 

survey. If fewer than eight providers were present on the day of the assessment, all providers present that 

day were interviewed. 

For ANC and curative care for sick children, clients were systematically selected based on the expected 

number of clients at each service site on the day of the assessment. In other cases, where the number of 

clients could not be determined in advance, clients were selected upon arrival at the facility. If numerous 

clients were available, interviewers selected two new clients for every returning or follow-up client, with a 

preference for ANC clients who were women attending their first ANC visit for that pregnancy. In general, 

a maximum of five clients per provider of the service were interviewed, with a maximum of 15 observations 

per type of service (ANC or curative care for sick children) per facility. To select the interval between 

clients, the total number of expected clients was divided by 5 to obtain the Nth interval for selecting the 

next client for observation. Exit interviews were conducted with every observed client prior to the client 

departing the facility that day. 

Table 1 Sample design of included surveys 

Survey Selection of 

facilities 

Stratification Number of 

facilities 

Bangladesh 2014 Sample Facility type, district 1,548 

Haiti 2013 Census None 905 

Kenya 2010 Sample Facility type, managing authority, region 695 

Malawi 2013-14 Census None 977 

Namibia 2009 Census None 411 

Nepal 2015 Sample Facility type, managing authority, ecological 

region, development-ecological region, 

number of inpatient beds (for hospitals only; 

less than 100 versus 100 or more) 

963 

Rwanda 2007 Sample Facility type, province 538 

Senegal 2016 Sample Facility type, managing authority, region 468 

Tanzania 2014-15 Sample Facility type, managing authority, region 1,188 

Uganda 2007 Sample Facility type, region 491 

Figures 1a though 1c describe the background characteristics of the facilities in each country. We recoded 

the characteristics to facilitate comparisons across countries. For facility type, all lower-level facilities were 

grouped together to compare with hospitals (Figure 1a). Lower-level facilities typically include health 

centers, clinics, dispensaries, maternity units, health posts, or other formal outlets that are unique to each 

country. For the managing authority, private and combined public-private facilities were grouped together 

to compare with public facilities (Figure 1b). Facility locale—urban or rural—is described for surveys that 

included this information (Figure 1c). 

Figure 1a indicates that hospitals represent between 3% and 13 % of all facilities in each country. Figure 

1b shows that in Bangladesh, Nepal, Senegal, and Tanzania, facilities are largely government-managed. 

Public and private facilities are more evenly divided in Malawi. In Haiti, 62% of facilities are managed by 

private entities. Figure 1c shows that 8% of facilities in Bangladesh are located in urban areas; by 

contrast, a greater share of facilities in Haiti, Malawi, Senegal, and Tanzania are urban (with a range of 

27% in Tanzania to 39% in Haiti). 
5 

Figure 1a Percent distribution of facilities according to facility type, by country 

Figure 1b Percent distribution of facilities according to managing authority, by country 

Hospital

2.7%

Other 

facilty 

type

97.3%

Bangladesh 2014 (N=1,548)

Hospital

13.3%

Other 

facilty 

type

86.7%

Haiti 2013 (N=905)

Hospital

11.5%

Other 

facilty 

type

88.5%

Malawi 2013-14 (N=977)

Hospital

9.7%

Other 

facilty 

type

90.3%

Nepal 2015 (N=963)

Hospital

4.4%

Other 

facilty 

type

95.6%

Senegal 2016 (N=468)

Hospital

3.9%

Other 

facilty 

type

96.1%

Tanzania 2014-15 (N=1,188)

Public

93.0%

Private, 

other

7.0%

Bangladesh 2014 (N=1,548)

Public

Private, 37.8%

other

62.2%

Haiti 2013 (N=905)

Public

83.5%

Private, 

other

16.5%

Senegal 2016 (N=468)

Public

Private, 48.3%

other

51.7%

Malawi 2013-14 (N=977)

Public

90.4%

Private, 

other

9.6%

Nepal 2015 (N=963)

Public

72.1%

Private, 

other

27.9%

Tanzania 2014-15 (N=1,188)
6 

Figure 1c Percent distribution of facilities according to locale, by country 

2.2 Methods 

This report focuses on maternal and child nutrition and uses nutrition intervention indicators collected in 

SPA surveys, selected according to their applicability to the package of essential nutrition actions (WHO 

2013). We examined the indicators separately by the relevant service. In the first section of the results, we 

examine facility readiness, provider interactions (providing counseling or other care), client reports, and 

health worker training as they pertain to providing ANC. These indicators relate to maternal nutrition as 

well as counseling on future nutrition for the unborn child (breastfeeding). In the second section, we assess 

nutrition readiness, counseling, client reports, and provider training related specifically to child nutrition. 

These services are captured among facilities that provide curative care for children under age 5. 

Observations of child nutrition-related provider interactions and caretakers’ reports on visits are based on 

consultations for sick child care services. Provider training is based on providers who offer any services 

within the facility, with laboratory staff or other non-qualifying providers excluded, based on countryspecific preferences. 

The indicators include six interventions: (1) iron-folic acid (IFA) supplementation, (2) micronutrient 

supplementation for children, (3) anthropometry for women and children, (4) infant and young child feeding 

counseling, (5) maternal nutrition counseling, and (6) anemia assessment or testing. Tables 2a and 2b show 

indicators for each area. 

All indicators are first recoded to binary variables in which a value of 1 indicates that a specific nutritionrelated supply, counseling or advice, procedure, or training indicator was available or was provided and a 

value of 0 indicates that the indicator was not available or provided. We recoded missing responses as 0. 

Rural

91.6%

Urban

8.4%

Bangladesh 2014 (N=1,548)

Rural

60.9%

Urban

39.1%

Haiti 2013 (N=905)

Rural

69.0%

Urban

31.0%

Malawi 2013-14 (N=977)

Rural

67.3%

Urban

32.7%

Senegal 2016 (N=468)

Rural

72.7%

Urban

27.3%

Tanzania 2014-15 (N=1,188)
7 

Prior to 2013, SPA surveys were not standardized. The data recoding process standardized the indicators to 

the extent possible. The description of each indicator and additional notes on the methods used in 

calculating the indicators are summarized in Tables 2a and 2b. Table 2a describes the indicators relevant to 

ANC and Table 2b the indicators for child care services. The availability of each item may differ in this 

report from the SPA final reports because there can be differences in the definitions of the indicators. 

In the main body of the report, we present all indicators related to service readiness and observation of 

service delivery for nutrition-related readiness and care for women’s ANC and sick children’s visits. 

Because observation data are considered the gold standard as compared with exit interview data (Choi 

2018), reports of service delivery according to client exit interviews are included only in the appendix 

tables. Research shows that there are discrepancies between observations and client exit interviews (Assaf, 

Wang, and Mallick 2016). Clients may overestimate the care provided (Choi 2018), and their reports may 

be subject to recall and courtesy bias (Bessinger and Bertrand 2001). The main body of the report also 

includes results from recent surveys to avoid comparison with potentially outdated information. 

All analyses adjusted for health worker and client non-response with provider and client weights. In all 

countries (except Haiti, Malawi, and Namibia) where a census of facilities was conducted, the complex 

multistage stratified sample design is taken into consideration, facility non-response is considered in the 

sampling weights, and confidence intervals are provided in all descriptive analyses. We conducted all 

analyses using Stata 15.0. 

This report presents descriptive statistics of facility characteristics illustrating percentage distributions by 

facility type, managing authority, locale, and region. Data on nutrition intervention service readiness and 

provision across the topics assessed are presented for each country and stratified by health facility 

characteristics (facility type, managing authority, locale, and region). 
8 

Table 2a Nutrition indicators in antenatal care services 

Indicator Description1 Questionnaire 

 IFA supplementation 

Iron tablets for women available Iron, folic acid, and IFA tablets are available and valid (not expired) in any service area 

of the facility such as the general area or ANC service area. Not all country SPAs 

include a filter on whether the tablets are valid. 

Facility inventory2

Folic acid for women available 

IFA for women available 

IFA provided/prescribed to client Observed the provider prescribe or give the client iron tablets or folic acid (IFA) or both 

during the visit. 

ANC observation 

IFA counseling on the purpose of 

the tablets 

Observed the provider explain the purpose of iron or folic acid tablets among women 

who were provided or prescribed iron, folic acid, or IFA.3

IFA counseling on how to take 

the tablets 

Observed the provider explain how to take iron or folic acid tablets among women who 

were provided or prescribed iron, folic acid, or IFA.3 

Counseling provided on iron side 

effects 

Observed the provider explain side effects of iron tablets among women who were 

provided or prescribed iron, folic acid, or IFA.3 

IFA provided/prescribed Client reported that she was provided/prescribed iron tablets, folic acid, or iron with folic 

acid on this visit, past visits, or both visits. 

ANC client exit interview 

Counseling provided on how to 

take iron tablets 

Client reported that provider explained how to take the iron tablets on this visit, previous 

visits, or both.4

Counseling provided on side 

effects of iron 

Client reported that provider explained the side effects of iron tablets during the visit.4

Client’s knowledge of iron side 

effects 

Client identified at least one side effect of iron, folic acid, or IFA: nausea, black stools, 

or constipation.4

Pregnancy growth monitoring 

Adult weighing scale available Adult weighing scale was observed and functioning in any service area among facilities 

that provide ANC. 

Facility inventory4

Physical examination of weight of 

pregnant women 

Observed provider weigh the client. ANC observation 

 Maternal nutrition 

Training on ANC nutritional 

assessment for pregnant 

women 

Provider received training or a training update on ANC nutritional assessment of 

pregnant women within the previous 24 months. 

Health worker interview5

Gave advice on nutrition during 

pregnancy 

Observed provider give advice on nutrition during pregnancy (quality and quantity of 

food to eat). 

ANC observation 

 Anemia assessment or testing 

Physical examination for anemia 

(conjunctiva/palms) 

Observed provider examine client for anemia (conjunctiva/palms).

6 ANC observation 

Anemia test Observed provider ask about, perform, or refer client for an anemia test. 

Breastfeeding counseling 

Counseling on exclusive 

breastfeeding 

Observed provider discuss exclusive breastfeeding during this visit. ANC observation 

Counseling on early and 

prolonged breastfeeding 

Observed provider discuss early and prolonged breastfeeding with the client.7 

Reported counseling on 

importance of exclusive 

breastfeeding 

Client reported that provider gave advice about exclusive breastfeeding. ANC client exit interview 

Reported counseling on duration 

of exclusive breastfeeding 

Client reported that provider recommended that she exclusively breastfeed for 6 

months during this visit, past visits, or both visits (among clients who received 

counseling on exclusive breastfeeding). 

1 Bangladesh SPA does not include observation or exit interviews for ANC visits or child health visits. 2 Among facilities that provide ANC

3

 Newer surveys do not include a filter for IFA counseling; however, we standardized the variable for the purpose of this report. 4 Among clients who reported being prescribed or provided with iron, folic acid, or IFA 5 Provider training in Kenya includes training up to 36 months before the survey. Laboratory technicians and other country-specific non-qualifying 

providers are excluded. 

6

 The observation checklist for Rwanda and Uganda did not include a question on physical examination for anemia. 7 In Namibia, Rwanda, and Uganda, health providers’ observations related to exclusive breastfeeding only. 
9 

Table 2b Nutrition indicators in curative child care and growth monitoring services 

Indicator Description1 Questionnaire

Growth monitoring 

Infant weighing scale 

available 

Infant weighing scale (100-gram gradation) was observed and functioning in any service 

area.2

 

Facility inventory3

Child weighing scale available Child weighing scale (250-gram gradation) was observed and functioning in any service 

area.4 

Stadiometer/height rod 

available 

Stadiometer or height rod was observed and functioning in any service area. 

Tape measure available Measuring tape was observed in any service area. 

Physical examination of child 

weight 

Observed provider weigh the child. Sick child observation 

Plotted child’s weight on 

growth chart 

Observed provider plot the child’s weight on a growth chart. 

Weighed the child Client reported that child was weighted during the visit. Sick child client exit 

interview 

Discussed child’s growth Client reported that child’s growth was discussed during the visit. 

Micronutrient supplementation for children

Iron tablets for children 

available 

Iron tablets are available for child health services in the facility.5 Facility inventory3

Vitamin A for children 

available 

Vitamin A supplementation is available for child health services in the facility.6 

Zinc tablets for children 

available 

Zinc tablets are available for child health services in the facility.7 

Provider asked if child 

received vitamin A 

Observed provider ask if child received vitamin A within past 6 months Sick child observation 

Infant and young child feeding counseling 

Training on breastfeeding Provider received training on breastfeeding in the previous 24 months. Health worker interview8

Training on early and 

exclusive breastfeeding 

Provider received any in-service training or training updates on early and exclusive 

breastfeeding in the previous 24 months.9

Training on complementary 

feeding in infants 

Provider received training on complementary feeding in the previous 24 months. 

Training on infant and young 

child feeding 

Provider received training on infant and young child feeding in the previous 24 months. 

Asked client about feeding or 

breastfeeding when child is 

not ill 

Observed provider ask about normal feeding or breastfeeding habits or practices when the 

child is not ill. 

Sick child observation 

Asked client about feeding or 

breastfeeding during illness 

Observed provider ask about feeding or breastfeeding habits or practices for child during 

this illness. 

Reported provider discussed 

feeding or breastfeeding 

when child is not ill 

Provider asked about of feeding solids or liquids (or breastfeeding) when child is not ill. Sick child client exit 

interview10

Reported counseling on 

feeding or breastfeeding 

during illness 

Client reported counseling on of feeding solids or liquids (or breastfeeding) during illness 

and identified the recommended practices. 

1

 Bangladesh SPA does not include observation or exit interviews for ANC visits or child health visits. 2 Or a digital standing scale with gradations of 100 grams or less on which an adult can hold a child to be weighed 3 All facility-based indicators are calculated among facilities that provide curative child care services. 4 Or a digital standing scale with gradations of 250 grams or less on which an adult can hold a child to be weighed 5 Iron dosage is not specified. 

6 Some country SPAs (Kenya, Rwanda, and Uganda) inquired about the number of days that vitamin A supplementation is available; in those cases, the 

variable is coded yes if vitamin A supplementation is available at least 1 day per month. The threshold of 1 day was selected to facilitate comparison with 

other countries. 

7 Zinc for treatment of diarrhea

8

 Provider training in Kenya includes training up to 36 months prior to the survey. 9

 In Namibia, Rwanda, and Tanzania, health providers were interviewed about receipt of training related to exclusive breastfeeding rather than early and 

exclusive breastfeeding. 

10 Question wording varies in older surveys 

11 

3 RESULTS 

3.1 Antenatal Nutrition 

This section describes service readiness in terms of facility capacity to provide nutrition-related care during 

pregnancy and service delivery for the provision of nutritional care for pregnant women who attend ANC 

visits at facilities assessed by recent SPA surveys in six countries: Bangladesh, Haiti, Malawi, Nepal, 

Senegal, and Tanzania. First, we describe availability of ANC at facilities by country. We then present the 

level of facility readiness to provide nutrition-related ANC and provider training in nutrition for pregnant 

women. Next, we describe provision of nutrition-related care and counseling during ANC visits at the 

national level. Finally, we present maps that represent readiness for and delivery of two nutrition 

interventions by region in each country: (1) availability of IFA at facilities with ANC (service readiness) 

and (2) percentage of clients who received IFA during ANC (service delivery). The information included in 

this chapter focuses on the most recent SPA surveys, although for each figure and table we include a 

corresponding appendix table with country estimates assessed through surveys conducted before 2013. We 

also include appendix tables (3-12) that present the availability of each item by facility type, managing 

authority, and locale (as available). 

Figure 2 Percent of facilities providing ANC services, by country 

Figure 2 shows the percentage of facilities in the six countries with recent SPA surveys that provide ANC 

services. Over 90% of facilities in Bangladesh (97%), Haiti (92%), and Nepal (96%) provide ANC. ANC 

services are least available in facilities in Malawi (65%). Appendix Table 1 includes data on the availability 

of ANC in all 10 countries assessed and the 95% confidence intervals (CIs) for sample-based surveys. 

3.1.1 Service readiness 

Among facilities that offer ANC, Table 3 shows the percentage that have resources available to provide 

nutritional care for pregnant women. Table 3 also includes the percentage of providers who have received 

training related to nutrition counseling for pregnant women. There is a range of availability within and 

across countries, with IFA and an adult weighing scale being the two most commonly available items across 

all countries (except Haiti). Approximately 80% or more of facilities have IFA, except in Haiti (58%), and 

88% of facilities in all countries have an adult scale. 

84.6

76.3

96.2

64.7

91.9

97.4

Antentatal Care

Bangladesh Haiti Malawi Nepal Senegal Tanzania
12 

Iron and folic acid (as separate tablets) are less commonly available, with more variation between countries. 

Availability ranges from 1% of facilities with folic acid and 5% with iron in Senegal to 69% of facilities in 

Tanzania with folic acid and 65% of facilities in Haiti with iron available. Given that iron and folic acid are 

usually provided together in the combined IFA supplement, it is reassuring that the countries with the least 

availability of separate iron and folic acid tablets, such as Malawi, Nepal, and Senegal, are well equipped 

to provide the combined IFA. Across all six countries, only one-fifth or less of providers of all types—

except those in non-qualifying positions (e.g., laboratory technicians or those who do not have direct contact 

with clients)—have received recent training in provision of nutritional care for pregnant women, with a 

range from 11% in Nepal to 22% in Bangladesh. Appendix Table 2 presents data on the availability of these 

items (and 95% CIs) and counseling and care components observed or reported during exit interviews for 

all 10 countries. 

Table 3 Percent of facilities with capacity to provide nutrition-related care among facilities with ANC and 

percent of providers with training on maternal nutrition, by country 

Bangladesh SPA 

2014 

Haiti SPA 

2013 

Malawi SPA 

2013-14 

Nepal SPA 

2015 

Senegal SPA 

2016 

Tanzania SPA 

2014-15 

% 95% CI1

 % 95% CI1 % 95% CI1 % 95% CI1 % 95% CI1 % 95% CI1

Facilities with ANC 

Iron for women 61.8 [57.7,65.8] 64.9 37.3 12.5 [10.2,15.3] 5.2 [3.2,8.1] 41.1 [37.1,45.4] 

Folic acid for women 57.7 [53.6,61.6] 54.9 29.5 10.6 [8.6,13.0] 1.3 [0.5,3.3] 68.5 [64.4,72.4] 

IFA for women 88.4 [85.3,91.0] 58.1 92.0 90.7 [88.0,92.9] 79.2 [74.1,83.5] 92.4 [89.8,94.4] 

Vitamin A for women 64.6 [61.2,67.9] 55.5 51.6 89.4 [86.9,91.4] 60.0 [55.2,64.6] 73.8 [70.0,77.3] 

Adult weighing scale 88.3 [85.2,90.8] 92.9 93.8 94.9 [92.6,96.5] 93.7 [89.0,96.5] 88.0 [84.6,90.7] 

Number of facilities with ANC 1,508 832 632 926 357 1,005 

Provider training2 

Recent training on nutritional 

assessment for pregnant 

women 21.5 [19.1,24.1] 16.0 [14.3,17.8] 16.5 [15.0,18.2] 11.3 [9.7,13.0] 17.3 [15.4,19.4] 13.1 [11.8,14.5] 

Number of providers 4,169 3,967 2,538 3,709 1,623 6,078 

 

1 The 95% CI reflects the upper and lower bounds of the 95% confidence interval. There are no CIs for facility-based indicators for Haiti and Malawi because 

these two countries had census-based surveys. However, CIs are included for provider- and client-based indicators for all countries. 2 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

3.1.2 Service delivery 

Figures 3 through 6 present data on care provision for women attending ANC at facilities in five countries 

with recent SPA surveys in which observation of ANC was available (with supporting information in 

Appendix Table 2). Figure 3 shows counseling and care related to iron, folic acid, or IFA. This figure 

indicates that while IFA is commonly provided or prescribed (with a range of 63% in Nepal to 87% and 

88% in Malawi and Senegal, respectively), counseling on why and how to take IFA, as well as potential 

side effects, is less common and varies substantially across and within countries. Across all five countries, 

counseling related to side effects was least common, offered to only 14% or fewer of women who were 

provided IFA. The percentages of women counseled on why and how to take IFA mirrored each other in 

each country, with percentages slightly lower for why versus how women should take IFA. Counseling on 

these two items was lowest in Nepal (18% counseled on why and 28% counseled on how) and highest in 

Tanzania (73% and 78%). 

Figure 4 shows the percentage of women who were weighed during their ANC visit and the percentage who 

received counseling on nutrition during pregnancy. Three quarters or more of women in all countries had 

their weight assessed; 74% were weighed in Nepal and 93% in Senegal. Only one-third (33% in Tanzania) 

to one-half (48% in Nepal) of women were counseled about nutrition during their visit. There is a wide 
13 

range of anemia assessment and testing across the countries (Figure 5). Except in Haiti, more women in 

each country are physically assessed for anemia than are tested during ANC. Women are nearly universally 

assessed for anemia via physical exams of conjunctiva and palms in Senegal (96%), although only 30% of 

these same women are given a blood test. Similarly in Malawi, 79% of women were assessed with an 

observation, but only 8% were tested. Figure 6 shows that, overall, very few women were counseled on 

exclusive breastfeeding and early initiation of and prolonged breastfeeding during ANC. Tanzanian women 

were counseled more frequently, although only 13% were counseled on exclusive breastfeeding and 9% on 

early and prolonged breastfeeding. Only 1% of women in Nepal were counseled on both aspects of 

breastfeeding. 

Figure 3 Percent of women prescribed or provided IFA supplements during an ANC visit and percent of 

women receiving IFA-related counseling among those prescribed or provided IFA supplements, 

by country 

Note: Shaded portion indicates counseling items that were assessed only among the women who were provided or given a prescription for IFA.

70.9

35.4

43.0

3.5

86.5

65.9

68.6

10.6

62.7

18.0

28.4

4.0

87.5

41.0

48.0

1.8

75.3

72.6

77.6

14.2

IFA provided/prescribed

Counseled on IFA (purpose)

Counseled on IFA (how to take)

Counseled on IFA (side effects)

Haiti Malawi Nepal Senegal Tanzania
14 

Figure 4 Percent of women receiving weight assessment and maternal nutrition counseling during an 

ANC visit, by country 

Figure 5 Percent of women assessed or tested for anemia during an ANC visit, by country 

80.8

43.3

75.1

39.1

74.0

48.1

93.4

38.4

80.2

32.5

Weight assessed

Counseled on maternal nutrition during ANC

Haiti Malawi Nepal Senegal Tanzania

49.4

57.8

78.9

8.4

36.9

32.3

96.3

29.6

58.7

42.3

Physical exam for anemia

Tested for anemia

Haiti Malawi Nepal Senegal Tanzania
15 

Figure 6 Percent of women receiving breastfeeding counseling during an ANC visit, by country 

3.1.3 Service readiness and delivery by region and facility background characteristics 

Appendix Tables 3-12 describe the availability of IFA and the provision of IFA during ANC by facility 

background characteristics, including facility type, managing authority, and either urban or rural locale. 

Although we did not assess the significance of the differences, we found that the availability of resources, 

counseling related to nutritional care, and provider training varied within and across countries by 

background characteristics. No clear trend emerged across countries, within most countries, or by whether 

the indicator reflected measures of availability of resources, provision of care, or provider training. 

Figures 7 and 8 (and Appendix Table 13) show maps of each country with recent SPA surveys that reflect 

the regional availability of IFA among facilities that provide ANC services (Figure 7) and the percentage of 

women who were given IFA or a prescription for IFA during ANC consultations (Figure 8). Because 

availability and provision of IFA are generally high, the scale on the maps is demarcated in ranges of 10%, 

with the lowest range including all regions with IFA readiness or delivery of 60% or less. 

Figure 7 shows that, within each country, there is little variation by region; the range of IFA availability is 

no greater than 20% in any country except for Haiti and Tanzania. In Haiti, Artibonite has the lowest 

availability (43%) and Nord the highest (71%). In Tanzania, over 90% of facilities in most zones have IFA 

available, although facilities in Zanzibar are much less prepared to provide IFA (62%). 

There is a greater amount of variation between and, to some extent, within countries in terms of IFA 

distribution during ANC (Figure 8). Observation of ANC was not a part of the SPA in Bangladesh, as 

represented by the gray map for the country. In Haiti, women were either given or prescribed IFA at 95% 

of ANC visits in Grande-Anse, although as few as 62% of women received IFA in the Ouest department. In 

5.6

1.5

6.7

4.4

0.9

1.4

2.2

1.8

12.5

8.7

Counseled on exclusive breastfeeding

Counseled on early and prolonged breastfeeding

Haiti Malawi Nepal Senegal Tanzania
16 

Malawi and Senegal, IFA was commonly prescribed or given during ANC, at a rate above 80% in all 

regions. Regional provision of IFA in Nepal ranged only from 50% to 72%. 

Comparing regional availability of IFA and regional provision of IFA within each country, we found that 

provision, including prescriptions, outperformed availability in Haiti and Senegal. However, in Malawi, 

Nepal, and Tanzania, provider provision of IFA lagged behind the facility’s capacity to provide the 

supplement on-site. In Nepal and Tanzania, the areas with the lowest availability of IFA (the Far Western 

and Central regions of Nepal and the Western and Zanzibar zones of Tanzania) also had the lowest levels 

of provision. 
17 

Figure 7 Percent of facilities with IFA supplements available among facilities that provide ANC services, 

by region 

Bangladesh Haiti

 

Malawi Nepal 

 

Senegal Tanzania 

 
18 

Figure 8 Percent of women attending ANC who were provided with or prescribed iron or folic acid (or 

both), by region 

Bangladesh Haiti

Malawi Nepal 

Senegal Tanzania 
19 

3.2 Child Nutrition 

This section first presents the availability of services for children including diagnosis and treatment of 

malnutrition, growth monitoring, and curative care services, service readiness to provide nutrition-related 

care for children among facilities with curative care services, and service delivery of nutrition-related care 

provided for children attending sick child consultations. We present the regional availability of a 

functioning infant weighing scale and a functioning child scale at facilities with curative care services 

(readiness). The information presented here focuses on the most recent SPA surveys. For each figure and 

table, we include a corresponding appendix table with the upper and lower bounds of the 95% CI (for 

sample-based surveys), as well as the estimates for countries assessed through surveys conducted before 

2013. Also, Appendix Tables 15-24 show estimates for each item by facility type, managing authority, and 

locale (where available). In addition to indicators of facility readiness, provider training, and care observed 

during sick child visits, the appendix tables include information on reports of care received according to 

the caretaker who participated in client exit interviews. 

Figure 9 (and Appendix Table 1) shows the availability of malnutrition, growth monitoring, and curative 

care services for children according to recent SPA surveys in six countries. While curative care services are 

nearly universal (93% or higher in each country), there is more variation in availability of growth 

monitoring services by country. Growth monitoring is available in as many as 94% of facilities in Nepal 

but as few as 62% of facilities in Bangladesh. Services for diagnosis and treatment for malnutrition are 

common, nearly 80% or higher among all countries. 

Figure 9 Percent of facilities providing curative care and growth monitoring services for children, by 

country 

97.6

84.8

80.0

95.4

87.6

91.1

97.2

93.6

88.7

93.8

73.8

78.0

93.7

66.8

79.0

92.9

62.2

86.6

Curative child care

Growth monitoring

Malnutrition

Bangladesh Haiti Malawi Nepal Senegal Tanzania
20 

3.2.1 Service readiness 

Table 4 shows the national-level availability of essential items for providing nutrition-related care for 

children among facilities that provide curative child care services. Both child and infant scales range in 

their availability across countries. Facilities in Bangladesh and Nepal appear least equipped to provide 

growth monitoring services. Only one-third (35%) of facilities in Bangladesh have an infant scale, 41% 

have a tape measure, and just over 60% have a child scale or a stadiometer/height rod. In Nepal, less than 

30% of facilities have a stadiometer/height rod (24%) or a tape measure (29%), and less than half (46%) 

have a child weighing scale. Almost all facilities in Senegal have an infant scale (95%) and a tape measure 

(92%). 

Facilities in Nepal that provide curative child care services commonly have vitamin A (90%) and zinc (96%) 

available. Although iron supplementation is not commonly available in Nepal and Senegal (13% and 4%, 

respectively), SPA surveys do not specify the dosage of iron; iron supplementation availability in SPA 

surveys may reflect only the availability of adult doses of iron (e.g., for pregnant women in need who are 

attending ANC). Only around one-third or fewer providers in most countries have received recent training 

in child nutrition-related topics, including breastfeeding, complementary feeding, and infant and young 

child feeding. The exception is Senegal, where nearly half (49%) of all providers were recently trained in 

complementary feeding and 43% were recently trained on breastfeeding. 

Table 4 Percent of facilities with capacity to provide nutrition interventions among facilities with curative 

child care services and percent of providers with training on child nutrition topics, by country 

Bangladesh SPA 

2014 

Haiti SPA 

2013 

Malawi SPA 

2013-14 

Nepal SPA 

2015 

Senegal SPA 

2016 

Tanzania SPA 

2014-15 

% 95% CI1 % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI 

Facilities with curative child care 

Child weighing scale available 61.3 [57.2,65.3] 70.6 73.6 45.5 [41.0,50.0] 65.1 [60.9,69.0] 82.6 [79.4,85.5] 

Infant scale available 34.8 [31.3,38.4] 74.0 71.0 78.4 [74.3,82.0] 95.1 [92.4,96.8] 73.9 [70.2,77.2] 

Stadiometer/height rod available 62.6 [58.4,66.5] 64.2 71.3 24.3 [20.8,28.0] 81.5 [77.7,84.8] 53.9 [49.8,57.9] 

Tape measure available 40.9 [37.0,45.1] 78.2 51.8 29.3 [25.4,33.5] 92.0 [88.5,94.5] 63.1 [59.1,66.9] 

Vitamin A supplementation 

available 64.0 [60.6,67.3] 82.1 42.8 89.6 [87.2,91.6] 49.1 [45.0,53.2] 66.6 [63.0,70.0] 

Iron supplementation available 61.6 [57.4,65.6] 64.9 38.3 12.5 [10.2,15.3] 4.4 [2.8, 6.8] 37.8 [34.1,41.8] 

Zinc supplementation available 63.7 [60.1,67.2] 54.2 76.3 95.5 [94.3,96.5] 53.6 [49.5,57.6] 44.3 [40.3,48.3] 

Number of facilities with curative 

child care 1,437 848 917 936 447 1,160 

Provider training2 

Recent training on breastfeeding 42.7 [39.7,45.8] 26.7 [24.2,29.3] 34.9 [32.3,37.5] 31.5 [29.0,34.1] 42.8 [39.8,45.8] 15.1 [13.9,16.5] 

Recent training on early and 

exclusive breastfeeding 27.6 [24.8,30.5] 17.4 [15.6,19.4] 23.2 [21.3,25.3] 21.5 [19.4,23.8] 31.7 [28.9,34.5] 24.7 [23.2,26.3] 

Recent training on complementary 

feeding 38.9 [36.0,41.8] 22.5 [20.2,24.9] 35.8 [33.2,38.4] 27.9 [25.4,30.5] 48.7 [45.6,51.8] 19.3 [17.8,20.9] 

Recent training on infant and 

young child feeding 20.8 [18.4,23.4] 20.5 [17.8,23.6] 35.0 [32.7,37.4] 6.9 [5.8,8.3] 14.9 [13.4,16.5] 32.1 [30.4,34.0] 

Number of providers 4,169 3,967 2,538 3,709 1,623 6,078 

1 The 95% CI reflects the upper and lower bounds of the 95% confidence interval. There are no CIs for facility-based indicators for Haiti and Malawi because 

these two countries had census-based surveys. However, CIs are included for provider- and client-based indicators for all countries. 2 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions

3.2.2 Service delivery 

Figures 10 and 11 show the percentage of children who were observed receiving nutrition-related care and 

counseling during sick child visits; Figure 12 shows the percentage of caretakers who discussed feeding or 

breastfeeding practices. Appendix Table 14 includes these estimates, along with 95% confidence intervals 

for sample-based surveys, and the corresponding indicators of care received as reported by caretakers via 
21 

exit interviews. Although services for growth monitoring may be assessed during routine visits or prior to 

the start of the sick child visit based on country- or facility-specific procedures or protocols, observed levels 

of counseling and care for growth monitoring vary widely by country (Figure 10). It is important to note 

that assessment of child nutritional status (weight and height plotted on a growth chart or mid-upper arm 

circumference) is a component of Integrated Management of Childhood Illness (IMC). The percentage of 

children who were weighed ranged from 16% in Tanzania to 85% in Senegal. The second set of bars, in the 

shaded portion of the figure, represents the percentage of children whose growth was plotted on a growth 

chart (among children who were weighed during the consultation). Again, service delivery varied by 

country; only 16% of children in Haiti who were weighed had their growth plotted, as compared with 59% 

of children in Senegal. 

Figure 10 Percent of children whose weight was measured and percent of children whose weight was 

plotted on a growth chart among children weighed during sick child consultations, by country 

WHO recommends that in settings where vitamin A deficiency is a public health problem, children age 6-

11 months receive a high dose of vitamin A once, while children age 12-59 months should receive a highdose vitamin A supplement every 4 to 6 months (WHO 2018). Overall, very few children received a dose 

of vitamin A (between 1% and 3% in Haiti, Malawi, Nepal, and Tanzania), although 30% of children in 

Senegal were observed receiving vitamin A (Figure 11). The low provision of vitamin A in health facilities, 

however, may not reflect facility capacity to provide vitamin A, because children could be receiving vitamin 

A from other sources, during either routine visits or mobile campaigns. 

The percentage of children whose caretakers were counseled on feeding practices during sick child visits 

varied across countries (Figure 12). Fourteen percent of caretakers in Malawi and 40% in Haiti discussed 

76.2

15.5

26.5

27.0

49.7

24.4

85.0

59.1

16.1

21.6

Child weight assessed

Child weight plotted on growth chart

Haiti Malawi Nepal Senegal Tanzania
22 

feeding or breastfeeding while a child was well, while 16% in Malawi and Nepal and 25% in Haiti discussed 

feeding or breastfeeding practices while a child was ill. 

Figure 11 Percent of children who received vitamin A during sick child visits, by country 

Figure 12 Percent of caretakers who discussed feeding or breastfeeding practices during illness or 

wellness during sick child visits, by country 

2.7

1.9

1.1

29.6

3.1

Child received vitamin A

Haiti Malawi Nepal Senegal Tanzania

40.1

25.2

14.2

15.5

17.7

16.3

31.1

18.6

27.9

18.8

Counseled on feeding or breastfeeding when child

is well

Counseled on feeding or breastfeeding during

illness

Haiti Malawi Nepal Senegal Tanzania
23 

3.2.3 Service readiness and delivery by region and facility background characteristics 

Appendix Tables 15-24 describe the availability of child nutrition items, provision of child nutrition services 

as observed and reported by the caretaker, and provider training for all 10 countries by facility 

characteristics. Facility capacity to care for the nutritional needs of children, provision of care during sick 

child visits, and provider training on these topics varied by level of readiness and service delivery and by 

facility characteristics, both within and between countries. We were unable to uncover any consistent 

pattern because we did not assess the significance of differences, and in many cases differences by facility 

characteristics were minor. 

Table 5 shows the availability of an infant scale (a scale with a gradation of 100 grams) and the availability 

of a child scale (a scale with a gradation of 250 grams), which are necessary components of growth 

monitoring for children under age 5. Although we have corresponding service delivery data for whether or 

not the child was weighed during the consultation, this intervention may not be accurately captured in all 

countries because children may be weighed prior to the start of the observation of the consultation. Also, 

this information is available for some but not all countries. In fact, as part of the inventory questionnaire, 

facilities are asked if they provide certain routine services before each consultation, including an assessment 

of the child’s weight. This information is included in the SPA data set. We tabulated these data and found 

that, in many countries, it is a common procedure to weigh a child before the consultation (results not 

shown). 

There was a considerable range across countries in the percentage of facilities with infant and child scales. 

Neither type of scale was consistently more available than the other across countries. However, within 

countries, there was some variation for each indicator. Tanzania demonstrated the largest differences by 

zone, with differences as large as 40 and 41 percentage points for the availability of an infant and child 

scale, respectively. In each country except for Bangladesh, two-thirds or more of facilities in most regions 

had an infant scale available. For each country, contrary to expectations, the regions where the capital city 

is located did not have the highest availability of scales. 

 
24 

Table 5 Availability of infant and child scales among facilities that provide curative child care services, 

by country and region 

Percentage of facilities 

that have an infant 

scale1

 available and 

functioning in any 

service area among 

facilities that provide 

curative child care 

services 

Percentage of facilities 

that have a child scale2

available and 

functioning in any 

service area among 

facilities that provide 

curative child care 

services 

Country % 95% CI N % 95% CI N 

Bangladesh Barisal 34.5 [26.9,43.0] 112 62.5 [53.2,71.0] 112 

Chittagong 31.4 [24.8,38.7] 265 59.1 [50.3,67.4] 265 

Dhaka 32.1 [25.1,39.9] 380 50.2 [40.5,59.9] 380 

Khulna 31.6 [22.8,42.0] 195 61.3 [49.8,71.7] 195 

Rajshahi 32.1 [22.5,43.4] 190 57.6 [45.2,69.1] 190 

Rangpur 46.5 [35.5,57.8] 200 84.0 [73.5,90.9] 200 

Sylhet 42.6 [32.3,53.6] 96 70.0 [58.4,79.6] 96 

Haiti 

Ouest 69.6 298 67.6 298 

Sud-Est 69.1 55 69.1 55 

Nord 78.8 85 71.8 85 

Nord-Est 74.3 35 65.7 35 

Artibonite 72.8 114 66.7 114 

Centre 81.8 44 75.0 44 

Sud 88.9 63 84.1 63 

Grand-Anse 78.6 42 83.3 42 

Nord-Ouest 72.7 83 64.0 83 

Nippes 73.3 30 86.7 30 

Malawi 

North 80.1 158 68.2 158 

Central 70.1 340 74.0 340 

South 68.3 418 75.3 418 

Nepal 

Eastern development region 64.1 [54.3,72.9] 208 42.9 [33.7,52.6] 208 

Central development region 78.8 [71.3,84.8] 308 33.2 [26.1,41.1] 308 

Western development region 80.1 [68.9,88.0] 201 53.1 [41.9,64.0] 201 

Mid-western development region 91.3 [83.9,95.5] 130 55.4 [44.5,65.8] 130 

Far-western development region 87.8 [77.2,93.9] 89 62.1 [49.7,73.2] 89 

Senegal 

Ouest 95.1 [88.6,98.0] 115 57.6 [46.5,68.0] 115 

Centre 95.0 [87.3,98.1] 106 65.4 [57.6,72.6] 106 

Nord 97.7 [92.5,99.3] 95 54.7 [46.6,62.6] 95 

Sud 93.2 [86.9,96.5] 130 78.9 [73.2,83.7] 130 

Tanzania 

Western 86.4 [76.6,92.5] 91 88.7 [75.3,95.3] 91 

Northern 68.5 [58.9,76.7] 171 78.0 [67.3,86.0] 171 

Central 72.6 [59.7,82.6] 121 86.4 [75.7,92.8] 121 

Southern Highlands 80.0 [67.6,88.4] 123 83.2 [71.3,90.7] 123 

Southern 84.2 [68.8,92.9] 70 99.3 [97.2,99.8] 70 

South West Highlands 84.8 [71.7,92.4] 117 95.0 [89.0,97.8] 117 

Lake 73.8 [63.9,81.8] 231 83.5 [75.4,89.2] 231 

Eastern 65.5 [55.3,74.5] 193 72.2 [60.7,81.4] 193 

Zanzibar 45.8 [36.2,55.6] 43 57.7 [46.2,68.3] 43 

1 Or a digital standing scale with gradations of 100 grams or less on which an adult can hold 

a child to be weighed 

2 Or a digital standing scale with gradations of 250 grams or less on which an adult can hold 

a child to be weighed 

CI = confidence interval 
25 

4 DISCUSSION 

4.1 Summary of Findings 

This report consolidates information related to service readiness and delivery of nutrition-related care for 

pregnant women and children under age 5. We examined nutrition-related intervention readiness, including 

availability of commodities, provider training related to nutrition topics, and delivery of nutrition-related 

care, at the national level and by region for six countries with SPA surveys conducted since 2013. Among 

women attending ANC, nutrition-related equipment and medications were largely available, although 

counseling on IFA varied across countries and counseling was low for maternal nutrition and breastfeeding. 

In contrast, for children who had curative care visits, nutrition-related equipment, medication, and growth 

monitoring varied across countries, while counseling on child feeding during illness or wellness was low 

across countries. Provider training on nutritional assessment in pregnancy and infant and young child 

feeding counseling was also low across countries. Stratifications by public or private facilities, urban or 

rural facilities, and hospitals or lower-care facilities revealed minor differences that varied by country and 

nutrition intervention. 

Most women (around three quarters of women observed in almost all countries) are being prescribed or 

provided with IFA supplements and are being weighed during ANC visits. Analyses of DHS survey data on 

IFA supplementation in several low- and middle-income countries have identified points of “faltering” for 

women not consuming the recommended dose of IFA supplementation because of multiple health system 

failures and have recommended reporting these “falter” points for tracking country IFA supplementation 

programming (Sununtnasuk, D'Agostino, and Fiedler 2016). The faltering points include ANC attendance, 

receipt or purchase of IFA supplements, consumption of supplements, and adequate dosage (Sununtnasuk, 

D'Agostino, and Fiedler 2016). A key gap in knowledge is the inability to identify the supply and demand 

factors that lead to faltering. An advantage of this analysis is the information on national and subnational 

coverage of IFA and related counseling that can help countries identify where faltering is occurring in their 

health facilities. Such information can be used by policymakers and program managers to improve IFA 

supplementation programs. 

IFA supplement availability, prescription, and provision showed more variation across different countries 

than within countries. In two countries where IFA supplementation was readily available in most regions, 

Nepal and Tanzania, observed prescription and provision of IFA supplements were lagging. Conversely, in 

Haiti and Senegal, prescription and provision of IFA supplements among women exceeded IFA availability 

in facilities with ANC. On the surface, the findings suggest that providers in Nepal or Tanzania may not be 

prescribing and providing IFA supplements despite availability in the facility. However, provision of IFA 

supplements in this report is captured only during the observed visit and not during any of a woman’s 

previous ANC visits (Appendix 2). In Haiti and Senegal, providers may be prescribing IFA supplements 

despite the fact that facilities may not be stocked with supplements (with the expectation that women will 

acquire supplements from outside sources). However, whether or not a woman is provided or prescribed 

IFA supplements could depend on several factors, such as facility rationing of supplements, whether she 

already has a supply of supplements, or whether she has acquired supplements from other non-facility 

sources. 
26 

Counseling on maternal nutrition and breastfeeding during ANC was low across all countries, as seen in an 

earlier study that examined counseling during ANC (Assaf, Wang, and Mallick 2016). Research shows that 

counseling during ANC can influence maternal dietary practices, child birthweight, and childhood feeding 

practices (Ahmad et al. 2012; Nikièma et al. 2017); better counseling can also influence a caretaker’s intent 

to return to the facility for future care (Larson, Leslie, and Kruk 2017). Our report also indicates low levels 

of training. Recent research identified a link between increased provider counseling and increased levels of 

training and education (Larson, Leslie, and Kruk 2017). Thus, strategies to strengthen and improve health 

worker training, including regular refresher training that helps health workers retain knowledge on all 

aspects of nutrition counseling, will be important (Chopra et al. 2012). 

Compared with maternal nutrition resources, our findings show that there was greater variation in readiness 

for growth monitoring and curative care interventions for children across countries. Senegal was among the 

best prepared, with the highest proportion of recently trained providers and the highest coverage of nutrition 

interventions for children. This finding is consistent with other research reporting high levels of multisectoral engagement in nutrition policy and programming in Senegal (Kampman et al. 2017); similar 

investments in other countries would also likely be beneficial for nutrition. 

Our report identifies a number of areas of improvement for child nutrition. We observed that a small 

proportion of children were weighed during sick child visits in some countries. However, as noted in the 

results section, weighing may be part of a routine assessment that is conducted prior to the visit. Thus, the 

findings related to weighing and growth monitoring should be interpreted with caution. Across all countries, 

we also observed that caretakers were counseled infrequently on feeding or breastfeeding practices when 

the child was either ill or well. Recent provider training on feeding or breastfeeding was not routine. Given 

the small amount of facility-level counseling and training in many countries, strengthening health facility 

worker training may improve nutrition counseling (Larson, Leslie, and Kruk 2017). Receipt of vitamin A 

was nearly non-existent during the observed visits (except in Senegal). Children are most likely to receive 

vitamin A outside of these visits, during mobile campaigns, child health days, or routine visits (Horton et 

al. 2018). As countries shift to using routine health services for vitamin A distribution, tracking vitamin A 

supplementation across health system platforms may need to be strengthened to facilitate monitoring of 

intervention coverage (Horton et al. 2018). 

Sick child visits are part of the longstanding integrated management of childhood illness (IMCI) program. 

Children’s nutrition status can change rapidly during illness. Despite recommendations for feeding children 

during and after illness and guidelines for measuring height and weight that assess and manage overweight 

and obesity in children, evidence suggests that IMCI may have little impact on nutrition status (Paintal and 

Aguayo 2016; WHO 2017; Gera et al. 2016). A possible explanation is that readiness and delivery of many 

child nutrition interventions are low in most countries (Assaf, Wang, and Mallick 2016; Leslie et al. 2017). 

Our results demonstrate that, in many countries, more action is needed to ensure that facility capacity and 

training are adequate to address important nutrition interventions in the context of IMCI. 

4.2 Limitations 

There are some limitations of this report. First, many indicators of nutrition-related care for children (e.g., 

growth monitoring, vitamin A) are preventative and part of routine child care and not necessarily curative 

child care services. Thus, it may be important to capture routine well-child visits in SPA surveys. However, 

in areas where routine care for children is hindered by access related to cost of care, distance to a facility, 
27 

or other issues, these visits may be an opportunity for children to receive nutritional supplements and growth 

monitoring services. In addition, some routine elements of care, such as weighing a child, may have 

occurred before the visit. 

Second, although many nutrition interventions are delivered through health facilities, many are also based 

in the community. Common examples in low- and middle-income countries include behavior change 

interventions for infant and young child feeding to improve child health and survival and distribution of 

IFA supplementation and counseling to reduce anemia in pregnant women (Chapman et al. 2010; Kavle and 

Landry 2018). Community health workers deliver many preventative and curative nutrition interventions 

outside of the health facility, which extends the reach and effectiveness of nutrition interventions (Perry and 

Zulliger 2012; Menon et al. 2014). Thus, actual population-level coverage of nutrition interventions may 

differ from estimates in this report. 

For women, counseling on nutrition and breastfeeding may not be standard for every ANC visit throughout 

pregnancy. Maternal nutrition may be discussed only early in pregnancy, while counseling on breastfeeding 

may occur only towards the end of pregnancy, particularly if the provider adheres to scheduled counseling 

as per the WHO “focused” ANC four-visit model (Lincetto et al. 2006). These factors are important to 

consider when reporting service readiness and delivery during ANC. However, in areas where contact with 

health facilities during pregnancy is minimal, counseling during any visit may be conducted. 

Another limitation of this report is that SPA surveys have been collected in a small number of countries in 

the past decade. In four countries (reported in the appendix only), the surveys are 10 or more years old and 

therefore do not reflect recent improvements in health systems and nutrition programming. In the future, 

more countries should conduct regular SPA surveys as global efforts to strengthen health systems continue. 

Finally, although SPA surveys include data on service readiness or delivery for nutrition interventions in 

children under age 5, we have not presented service delivery information stratified by the child’s age. The 

first 1,000 days from conception to a child’s second birthday is a critical window for nutrition intervention. 

Reporting on service delivery by age group would provide more helpful information on targeting of 

nutrition interventions within health facilities. 

4.3 Recommendations for Next Steps 

Nutrition interventions are embedded within different service areas in health facilities, such as ANC, 

curative care for sick children, and growth monitoring. Collecting information on delivery of all nutrition 

interventions, including availability of micronutrient powders for children and pregnant women, ready-touse therapeutic foods, and ready-to-use supplementary foods, would complement service readiness data 

and foster better representation of nutrition interventions in health facilities. It will also be important for 

surveys such as SPAs to consider adding community assessment components for common service areas in 

order to capture community readiness and delivery of many important nutrition interventions. 

As shown in other studies, summary indices can offer important information about the overall capacity of 

facilities to provide services in specific areas and provide a simplified means of benchmarking facilities 

over time and across countries (Bellows et al. 2016; Mallick, Wang, and Temsah, 2017). Future research 

can use the indicators defined in this report and create service readiness and delivery nutrition indices for 

key nutrition interventions. For example, a readiness index for facility implementation of the Baby Friendly 
28 

Hospital Initiative (BFHI) would allow countries to monitor and track BFHI readiness in facilities. The 

WHO landscape analysis on readiness to act in nutrition also uses multiple data sources such as DHS 

surveys and country health management information systems to track country progress on global nutrition 

targets (WHO 2012). The landscape analysis includes data on facility availability and readiness to provide 

nutrition interventions that could leverage SPA data to create a nutrition index and contribute to monitoring 

country action on nutrition. 

Finally, The DHS Program conducts closely timed surveys among households and facilities in a number of 

countries. It is often possible to link SPA and DHS data to assess the association between service provision 

and utilization, behavior, or coverage. Future research can explore the relationship between service 

readiness and the uptake of nutrition behaviors reported by women interviewed in household surveys. 

4.4 Conclusions 

This report describes nutrition intervention readiness and delivery at health facilities in the context of 

antenatal and curative care services. The availability of trained providers, medications, and equipment for 

pregnant women and children varies by country, although some countries appear well-equipped to provide 

nutrition interventions. However, provider counseling on nutrition-related topics lags in all countries, 

particularly with respect to maternal diet, breastfeeding, and complementary feeding practices. In addition, 

the majority of providers have not received recent training on nutrition-related topics for women and 

children. 

Increased use of SPA and community-based surveys by more countries is warranted in order to describe 

nutrition intervention readiness and delivery in health facilities and the community. Given the importance 

of counseling for many nutrition behaviors, future efforts should focus on improving health worker training 

and counseling skills. The findings from this report can be used by governments and program planners as 

they work toward addressing the nutrition-related Sustainable Development Goals. 

 
29 

REFERENCES 

Ahmad, M. O., U. Sughra, U. Kalsoom, M. Imran, and U. Hadi. 2012. “Effect of Antenatal Counselling 

on Exclusive Breastfeeding.” J Ayub Med Coll Abbottabad 24 (2): 116-9. 

http://www.ncbi.nlm.nih.gov/pubmed/24397070 

Assaf, S., W. Wang, and L. Mallick. 2016. Provider Counseling and Knowledge Transfer in Health 

Facilities of Haiti, Malawi, and Senegal. DHS Analytical Studies No. 60. Rockville, Maryland, USA: ICF 

International. https://dhsprogram.com/pubs/pdf/AS60/AS60.pdf 

Black, R. E., C. G. Victora, S. P. Walker, et al. 2013. “Maternal and Child Undernutrition and 

Overweight in Low-Income and Middle-Income Countries.” Lancet 382 (9890): 427-51. 

http://www.ncbi.nlm.nih.gov/pubmed/23746772 

Bellows, B., R. Behl, T. Abuya, A. Muriuki, A. Bajracharya, and Y. Choi. 2016. “Benchmarking to 

Assess Quality of Family Planning Services: Construction and Use of Indices for Family Planning 

Readiness in Kenya with Data from 2010 and 2014.” In Quality Measurement in Family Planning: Past, 

Present, Future: Papers from the Bellagio Meeting on Family Planning Quality, edited by A. Sprockett, 

S. H. Leisher, K. Longfield, and D. Montagu. Oakland, California, USA: Metrics for Measurement. 

http://m4mgmt.org/wp-content/uploads/2017/07/Bellagio-book-web.pdf 

Bessinger, R. E., and J. T. Bertrand. 2001. “Monitoring Quality of Care in Family Planning Programs: A 

Comparison of Observations and Client Exit Interviews.” Int Fam Plann Perspect 27 (2): 63-70. 

https://pdfs.semanticscholar.org/fb43/221351e1ec1812dfce046048a9f54d0f5d91.pdf 

Chapman, D. J., K. Morel, A. K. Anderson, G. Damio, and R. Perez-Escamilla. 2010. “Breastfeeding Peer 

Counseling: From Efficacy through Scale-Up.” J Hum Lact 26 (3): 314-26. 

http://www.ncbi.nlm.nih.gov/pubmed/20715336 

Choi, Y. 2018. “Estimates of Side Effects Counseling in Family Planning Using Three Data Sources: 

Implications for Monitoring and Survey Design.” Stud Fam Plann 49 (1): 23-39.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/sifp.12044

Chopra, M., A. Sharkey, N. Dalmiya, D. Anthony, N. Binkin, and UNICEF Equity in Child Survival, 

Health and Nutrition Analysis Team. 2012. “Strategies to Improve Health Coverage and Narrow the 

Equity Gap in Child Survival, Health, and Nutrition.” Lancet 380 (9850): 1331-40. 

http://www.ncbi.nlm.nih.gov/pubmed/22999430 

Development Initiatives. 2017. Global Nutrition Report 2017: Nourishing the SDGs. Bristol, UK: 

Development Initiatives. http://globalnutritionreport.org/the-report/ 

Gera, T., D. Shah, P. Garner, M. Richardson, and H. S. Sachdev. 2016. “Integrated Management of 

Childhood Illness (IMCI) Strategy for Children under Five.” Cochrane Database Syst Rev 6: CD010123. 

http://www.ncbi.nlm.nih.gov/pubmed/27378094 
30 

Horton, S., L. S. Blum, M. Diouf, et al. 2018. “Delivering Vitamin A Supplements to Children Aged 6-59 

Months: Comparing Delivery through Campaigns and through Routine Health Services in Senegal.” Curr 

Dev Nutr 2 (4): nzy006. http://www.ncbi.nlm.nih.gov/pubmed/30019030 

Kampman, H., A. Zongrone, R. Rawat, and E. Becquey. 2017. “How Senegal Created an Enabling 

Environment for Nutrition: A Story of Change.” Glob Food Security 13: 57-65. 

http://www.sciencedirect.com/science/article/pii/S2211912416301109 

Kanyangarara, M., V. B. Chou, A. A. Creanga, and N. Walker. 2018. “Linking Household and Health 

Facility Surveys to Assess Obstetric Service Availability, Readiness and Coverage: Evidence from 17 

Low- and Middle-Income Countries.” J Glob Health 8 (1): 010603. 

http://www.ncbi.nlm.nih.gov/pubmed/29862026 

Kanyangarara, M., M. K. Munos, and N. Walker. 2017. “Quality of Antenatal Care Service Provision in 

Health Facilities across Sub-Saharan Africa: Evidence from Nationally Representative Health Facility 

Assessments.” J Glob Health 7 (2): 021101. http://www.ncbi.nlm.nih.gov/pubmed/29163936 

Kavle, J. A., and M. Landry. 2018. “Community-Based Distribution of Iron-Folic Acid Supplementation 

in Low- and Middle-Income Countries: A Review of Evidence and Programme Implications.” Public 

Health Nutr 21 (2): 346-54. http://www.ncbi.nlm.nih.gov/pubmed/29061205 

Larson, E., H. H. Leslie, and M. E. Kruk. 2017. “The Determinants and Outcomes of Good Provider 

Communication: A Cross-Sectional Study in Seven African Countries.” BMJ Open 7 (6): e014888. 

http://www.ncbi.nlm.nih.gov/pubmed/28674138 

Leslie, H. H., A. Malata, Y. Ndiaye, and M. E. Kruk. 2017. “Effective Coverage of Primary Care Services 

in Eight High-Mortality Countries.” BMJ Glob Health 2: e000424. 

http://gh.bmj.com/content/bmjgh/2/3/e000424.full.pdf 

Lincetto, O., S. Mothebesoane-Anoh, P. Gomez, and S. Munjanja. 2006. “Antenatal Care.” In 

Opportunities for Africa’s Newborns: Practical Data, Policy and Programmatic Support for Newborn 

Care in Africa. Geneva, Switzerland: World Health Organization.

Mallick, L., R. Winter, W. Wang, and J. Yourkavitch. 2016. Integration of Infectious Disease Services 

with Antenatal Care Services at Health Facilities in Kenya, Malawi, and Tanzania. DHS Analytical 

Studies No. 62. Rockville, Maryland, USA: ICF International. 

Mallick, L., W. Wang, and G. Temsah. 2017. A Comparison of Summary Measures of Quality of Service 

and Quality of Care for Family Planning in Haiti, Malawi, and Tanzania. DHS Methodological Report 

No. 20. Rockville, Maryland, USA: ICF. 

Menon, P., N. M. Covic, P. B. Harrigan, et al. 2014. “Strengthening Implementation and Utilization of 

Nutrition Interventions through Research: A Framework and Research Agenda.” Ann N Y Acad Sci 1332: 

39-59. http://www.ncbi.nlm.nih.gov/pubmed/24934307 

Nikièma, L., L. Huybregts, Y. Martin-Prevel, et al. 2017. “Effectiveness of Facility-Based Personalized 

Maternal Nutrition Counseling in Improving Child Growth and Morbidity up to 18 Months: A Cluster-
31 

Randomized Controlled Trial in Rural Burkina Faso.” PLoS One 12 (5): e0177839. 

http://www.ncbi.nlm.nih.gov/pubmed/28542391 

Nguhiu, P. K., E. W. Barasa, and J. Chuma. 2017. “Determining the Effective Coverage of Maternal and 

Child Health Services in Kenya, Using Demographic and Health Survey Data Sets: Tracking Progress 

Towards Universal Health Coverage.” Trop Med Int Health 22 (4): 442-53. 

http://www.ncbi.nlm.nih.gov/pubmed/28094465 

Paintal, K., and V. M. Aguayo. 2016. “Feeding Practices for Infants and Young Children During and 

After Common Illness. Evidence from South Asia.” Matern Child Nutr 12 (Suppl 1): 39-71. 

http://www.ncbi.nlm.nih.gov/pubmed/26840205 

Perry, H., and R. Zulliger. 2012. How Effective Are Community Health Workers? An Overview of Current 

Evidence with Recommendations for Strengthening Community Health Worker Programs to Accelerate 

Progress in Achieving the Health-Related Millennium Development Goals. Baltimore, Maryland, USA: 

Johns Hopkins Bloomberg School of Public Health. https://ccmcentral.com/wpcontent/uploads/2013/12/How-Effective-are-CHWs-Evidence-Summary-Condensed_JHSPH_2012.pdf 

Sununtnasuk, C., A. D’Agostino, and J. L. Fiedler. 2016. “Iron+Folic Acid Distribution and Consumption 

through Antenatal Care: Identifying Barriers across Countries.” Public Health Nutr 19 (4): 732-42. 

http://www.ncbi.nlm.nih.gov/pubmed/26022914 

Wang, W., M. Winner, and C. R. Burgert-Brucker. 2017. “Limited Service Availability, Readiness, and 

Use of Facility-Based Delivery Care in Haiti: A Study Linking Health Facility Data and Population 

Data.” Glob Health Sci Pract 5 (2): 244-60. http://www.ncbi.nlm.nih.gov/pubmed/28539502 

WHO. 2012. Landscape Analysis on Countries’ Readiness to Accelerate Action in Nutrition: Country 

Assessment Tools. http://www.who.int/nutrition/landscape_analysis/publications_and_information/en/ 

WHO. 2013. Essential Nutrition Actions: Improving Maternal, Newborn, Infant and Young Child Health 

and Nutrition. http://www.who.int/nutrition/publications/infantfeeding/essential_nutrition_actions/en/ 

WHO. 2016. Service Availability and Readiness Assessment (SARA): Indicators and Questionnaire. 

http://www.who.int/healthinfo/systems/sara_indicators_questionnaire/en/ 

WHO. 2017. Guideline: Assessing and Managing Children at Primary Health-Care Facilities to Prevent 

Overweight and Obesity in the Context of the Double Burden of Malnutrition: Updates for the Integrated 

Management of Childhood Illness (IMCI). http://www.who.int/nutrition/publications/guidelines/childrenprimaryhealthcare-obesity-dbm/en/ 

WHO. 2018. E-Library of Evidence for Nutrition Actions (eLENA).

http://www.who.int/elena/titles/en/#I. 

Winter, R., J. Yourkavitch, W. Wang, and L. Mallick. 2017. “Assessment of Health Facility Capacity to 

Provide Newborn Care in Bangladesh, Haiti, Malawi, Senegal, and Tanzania.” J Glob Health 7 (2): 

020509. http://www.ncbi.nlm.nih.gov/pubmed/29423186 

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APPENDIX 

Appendix Table 1 Percent of facilities providing antenatal care services, curative child care services, and 

growth monitoring services, by country 

Antenatal 

care 

Curative 

child care 

Growth 

monitoring 

Country % 95% CI1 % 95% CI1 % 95% CI1

Bangladesh 97.4 [96.2,98.2] 92.9 [90.3,94.8] 62.2 [58.1,66.0] 

Haiti 91.9 93.7 66.8 

Kenya 73.4 [68.0,78.2] 96.1 [92.8,97.9] Malawi 64.7 93.8 73.8 

Namibia 73.7 86.1 Nepal 96.2 [94.7,97.3] 97.2 [96.7,97.7] 93.6 [92.4,94.7] 

Rwanda 80.7 [78.4,82.7] 96.5 [94.9,97.6] Senegal 76.3 [72.3,80.0] 95.4 [92.7,97.2] 87.6 [84.3,90.3] 

Tanzania 84.6 [81.6,87.2] 97.6 [96.1,98.6] 84.8 [81.8,87.4] 

Uganda 70.5 [66.0,74.7] 98.3 [96.4,99.2] 1 The 95% CI reflects the upper and lower bounds of the 95% confidence interval. There 

are no CIs for facility-based indicators for Haiti, Malawi, and Namibia as these countries 

had census-based surveys. However, CIs are included for provider- and client-based 

indicators for all countries. 
34 

Appendix Table 2 Percent of facilities with capacity to provide nutrition-related care in ANC, percent of clients observed and reporting nutritionrelated counseling among clients attending ANC, and percent of providers with training on nutritional assessment in pregnancy,

by country 

Bangladesh 

SPA 2014 

Haiti SPA 

2013 

Kenya SPA 

2010 

Malawi SPA 

2013-14 

Namibia SPA 

2009 

Nepal SPA 

2015 

Rwanda SPA 

2007 

Senegal SPA 

2016 

Tanzania SPA 

2014-15 

Uganda SPA 

2007 

% 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI 

Facilities with ANC 

Iron for women 61.8 [57.7,65.8] 64.9 58.8 [52.4,64.8] 37.3 14.9 12.5 [10.2,15.3] 75.3 [71.3,79.0] 5.2 [3.2,8.1] 41.1 [37.1,45.4] 42.0 [36.2,48.1] 

Folic acid for women 57.7 [53.6,61.6] 54.9 72.1 [65.9,77.6] 29.5 40.9 10.6 [8.6,13.0] 1.3 [0.5,3.3] 68.5 [64.4,72.4] 

IFA for women 88.4 [85.3,91.0] 58.1 18.1 [13.8,23.4] 92.0 88.8 90.7 [88.0,92.9] 75.3 [71.3,79.0] 79.2 [74.1,83.5] 92.4 [89.8,94.4] 40.0 [34.0,46.3] Vitamin A for women 64.6 [61.2,67.9] 55.5 93.4 [89.6,95.9] 51.6 97.4 89.4 [86.9,91.4] 60.0 [55.2,64.6] 73.8 [70.0,77.3] 77.3 [71.8,82.0] 

Adult weighing scale 88.3 [85.2,90.8] 92.9 89.8 [83.4,93.8] 93.8 92.4 94.9 [92.6,96.5] 84.8 [81.2,87.8] 93.7 [89.0,96.5] 88.0 [84.6,90.7] 69.8 [63.8,75.3] 

Number of ANC facilities 1,508 832 510 632 303 926 434 357 1,005 347 

Observation of ANC1

IFA provided/prescribed 70.9 [67.2,74.3] 49.9 [44.4,55.4] 86.5 [83.1,89.3] 74.8 [66.7,81.4] 62.7 [57.5,67.6] 41.8 [35.3,48.6] 87.5 [84.4,90.1] 75.3 [71.8,78.5] 73.9 [67.9,79.1] 

Counseling on IFA 

(purpose)2 35.4 [30.7,40.4] 77.3 [71.3,82.4] 65.9 [60.9,70.6] 69.9 [62.5,76.3] 18.0 [13.5,23.6] 80.1 [71.6,86.6] 41.0 [34.9,47.4] 72.6 [68.6,76.2] 45.5 [37.0,54.3] 

Counseling on IFA (how to 

take)2 43.0 [38.2,47.9] 78.8 [72.4,84.1] 68.6 [63.9,72.9] 86.1 [81.0,90.0] 28.4 [23.3,34.1] 90.1 [84.4,93.8] 48.0 [41.8,54.3] 77.6 [74.2,80.7] 68.3 [60.0,75.6] 

Counseling on IFA (side 

effects)2 3.5 [2.2,5.6] 19.0 [14.4,24.7] 10.6 [8.1,13.9] 20.5 [13.8,29.4] 4.0 [2.5,6.4] 36.4 [27.1,46.9] 1.8 [1.0,3.3] 14.2 [11.7,17.3] 9.1 [5.9,13.7] 

Counseled on breastfeeding 5.6 [4.1,7.7] 23.4 [19.3,28.0] 6.7 [4.3,10.3] 39.0 [30.3,48.5] 0.9 [0.4,2.2] 20.5 [15.3,27.0] 2.2 [1.0,4.6] 12.5 [10.4,14.8] 17.6 [12.8,23.7] 

Counseled on early and 

prolonged breastfeeding 1.5 [0.8,2.9] 19.5 [15.7,24.1] 4.4 [2.5,7.7] n/a 1.4 [0.7,2.9] n/a 1.8 [0.8,4.3] 8.7 [6.9,10.9] n/a 

Weight assessed 80.8 [76.4,84.5] 96.2 [92.9,97.9] 75.1 [69.9,79.6] 94.9 [90.6,97.3] 74.0 [67.3,79.6] 98.5 [95.3,99.5] 93.4 [89.6,95.9] 80.2 [76.0,83.8] 76.6 [68.3,83.3] Counseled on nutrition 43.3 [39.3,47.4] 47.1 [41.7,52.6] 39.1 [34.3,44.2] 48.9 [40.0,57.9] 48.1 [43.3,53.0] 39.6 [33.3,46.3] 38.4 [32.7,44.4] 32.5 [29.2,36.0] 29.5 [23.7,36.0] 

Physical exam for anemia 49.4 [45.2,53.6] 82.5 [78.0,86.2] 78.9 [75.1,82.2] 62.0 [52.6,70.6] 36.9 [32.0,42.1] 96.3 [94.6,97.5] 58.7 [55.0,62.3] 

Tested for anemia 57.8 [54.1,61.3] 42.8 [38.7,47.1] 8.4 [5.7,12.3] 84.0 [77.0,89.1] 32.3 [27.4,37.7] 35.0 [28.3,42.5] 29.6 [25.2,34.4] 42.3 [38.7,46.1] 20.0 [14.5,26.8] 

Number of clients 1,620 1,409 2,068 859 1,509 722 849 4,007 373 

Women’s report of ANC3

IFA provided/prescribed 82.4 [79.7,84.8] 67.4 [62.5,71.9] 93.3 [90.8,95.2] 94.8 [90.6,97.2] 77.3 [71.7,82.1] 47.2 [41.1,53.5] 97.6 [96.0,98.6] 85.6 [82.6,88.2] 81.9 [77.3,85.7] 

Counseling on IFA (how to 

take)4 84.6 [81.1,87.6] 93.3 [90.1,95.5] 96.7 [95.6,97.5] 95.3 [93.1,96.7] 91.0 [87.8,93.3] 89.7 [85.0,93.1] 83.6 [79.8,86.8] 97.2 [95.9,98.1] 88.6 [81.6,93.1] 

Counseling on IFA (side 

effects)4 19.9 [16.9,23.2] 20.8 [16.8,25.4] 16.8 [14.2,19.7] 30.6 [24.9,36.8] 20.7 [17.1,24.8] 11.1 [7.6,16.1] 5.1 [3.4,7.5] 26.7 [24.0,29.6] 20.0 [14.6,26.8] 

Client can identify at least 

one side effect4 22.0 [18.8,25.7] 31.9 [26.8,37.6] 10.3 [8.4,12.5] 22.5 [18.3,27.4] 16.1 [12.7,20.2] 7.3 [4.7,11.2] 35.8 [31.6,40.2] 15.2 [13.4,17.2] 23.6 [17.8,30.7] 

Counseled on importance of 

exclusive breastfeeding 31.4 [28.2,34.8] 38.0 [34.3,42.0] 52.6 [49.2,55.9] 71.1 [65.9,75.7] 15.9 [12.8,19.6] 32.4 [27.1,38.3] 4.6 [3.0,7.1] 34.6 [31.7,37.7] 31.9 [25.6,39.0] 

Counseled on duration of 

exclusive breastfeeding5 67.7 [61.7,73.1] 81.7 [75.8,86.5] 67.6 [63.1,71.8] 15.6 [10.5,22.5] 58.9 [47.2,69.7] 84.6 [77.1,90.0] 53.9 [28.3,77.6] 76.3 [72.5,79.7] 63.7 [52.2,73.8] 

Counseled on nutrition 41.0 [37.7,44.4] 51.0 [46.7,55.3] 65.1 [61.3,68.8] 66.4 [61.0,71.4] 73.1 [68.2,77.4] 37.7 [32.4,43.2] 47.3 [41.6,53.2] 44.0 [40.9,47.2] 50.6 [44.4,56.7] 

Number of clients 1,620 1,409 2,068 859 1,509 722 849 4,007 373 

Provider training6

Recent training on nutritional 

assessment for pregnancy 21.5 [19.1,24.1] 16.0 [14.3,17.8] 16.9 [14.6,19.4] 16.5 [15.0,18.2] 10.4 [8.3,13.0] 11.3 [9.7,13.0] n/a 17.3 [15.4,19.4] 13.1 [11.8,14.5] n/a 

Number of providers 4,169 3,967 2,518 2,538 1,283 3,709 1,719 1,623 6,078 1,590 
35 

1 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 2 In older surveys (Kenya, Namibia, Rwanda, and Uganda), observations of these items were recorded only if the provider gave or prescribed IFA; filter was applied to current surveys for the purposes of comparability in this 

report. 

3 Exit interview counseling items based on current or past visits4 IFA-related counseling assessed only among women who reported that their provider prescribed or provided them with IFA 5 Asked only among women who reported that the provider counseled on exclusive breastfeeding 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

CI = confidence interval; n/a = not available 
36 

Appendix Table 3 Percent of facilities with capacity to provide nutrition-related care in ANC, percent of 

clients observed and reporting nutrition-related counseling among clients attending 

ANC, and percent of providers with training on nutritional assessment in pregnancy, by 

background characteristics, Bangladesh SPA 2014 

Facility type Managing authority Locale 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with ANC 

Iron for women 73.9 [64.0,81.8] 61.6 [57.4,65.6] 60.9 [56.5,65.1] 75.8 [68.4,81.9] 60.8 [56.3,65.0] 74.2 [68.2,79.3] 

Folic acid for women 72.6 [62.4,80.9] 57.3 [53.1,61.4] 56.5 [52.1,60.7] 74.7 [67.2,81.0] 56.4 [51.9,60.7] 72.6 [66.6,77.9] 

IFA for women 81.3 [71.4,88.3] 88.6 [85.3,91.2] 88.5 [85.2,91.2] 86.8 [80.7,91.2] 88.4 [85.0,91.1] 88.5 [83.5,92.2] 

Vitamin A for women 56.8 [45.7,67.3] 64.8 [61.3,68.1] 64.7 [61.1,68.2] 63.2 [55.1,70.6] 64.6 [60.9,68.1] 65.0 [58.6,70.9] 

Adult weighing scale 88.1 [77.4,94.1] 88.3 [85.2,90.9] 87.9 [84.6,90.6] 93.6 [88.8,96.5] 87.8 [84.4,90.5] 94.3 [90.6,96.6] 

Observation of women’s ANC (n/a) 

IFA provided/prescribed Counseling on IFA (purpose) Counseling on IFA (how to take) 

Counseling on IFA (side effects) Counseled on breastfeeding Counseled on early and prolonged 

breastfeeding 

Weight assessed 

Counseled on nutrition during ANC 

Physical exam for anemia 

Tested for anemia 

Women's report of ANC (n/a) 

IFA provided/prescribed Counseling on IFA (how to take) Counseling on IFA (side effects) Client can identify at least one side 

effect 

Counseled on importance of exclusive 

breastfeeding Counseled on duration of exclusive 

breastfeeding Counseled on nutrition during ANC 

Provider training1 

Recent training on nutritional 

assessment for pregnant women 14.8 [10.5,20.3] 22.2 [19.6,25.1] 21.8 [19.1,24.7] 19.8 [15.4,25.2] 22.4 [19.4,25.7] 18.7 [15.8,21.9] 

1 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

CI = confidence interval; n/a = not available 

 

 
37 

Appendix Table 4 Percent of facilities with capacity to provide nutrition-related care in ANC, percent of 

clients observed and reporting nutrition-related counseling among clients attending 

ANC, and percent of providers with training on nutritional assessment in pregnancy, by 

background characteristics, Haiti SPA 2013

Facility type Managing authority Locale 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with ANC 

Iron for women 72.5 63.8 62.4 66.5 61.7 70.3 

Folic acid for women 71.6 52.6 49.1 58.8 50.2 62.9 

IFA for women 71.6 56.2 57.3 58.6 56.1 61.3 

Vitamin A for women 46.1 56.8 64.3 49.7 59.3 49.1 

Adult weighing scale 99.0 92.0 90.0 94.8 91.4 95.5 

Observation of women’s ANC1 

IFA provided/prescribed 67.7 [60.8,73.9] 72.9 [68.8,76.8] 73.6 [68.3,78.3] 68.7 [63.5,73.4] 74.9 [69.8,79.4] 68.0 [62.9,72.7] 

Counseling on IFA (purpose)2 34.2 [25.8,43.6] 36.1 [30.7,42.0] 29.0 [22.9,35.8] 41.0 [34.3,48.1] 34.7 [28.7,41.1] 36.0 [29.1,43.4] 

Counseling on IFA (how to take)2 41.3 [32.4,50.9] 44.0 [38.5,49.5] 43.5 [36.1,51.3] 42.5 [36.3,48.9] 45.3 [38.9,51.9] 41.1 [34.2,48.4] 

Counseling on IFA (side effects)2 2.9 [1.3,6.5] 3.9 [2.3,6.8] 3.0 [1.4,6.4] 4.0 [2.3,7.0] 3.0 [1.7,5.5] 3.9 [2.1,7.4] 

Counseled on breastfeeding 5.8 [3.4,9.9] 5.5 [3.7,8.0] 5.5 [3.4,8.8] 5.7 [3.7,8.6] 5.6 [3.5,8.8] 5.6 [3.7,8.6] 

Counseled on early and prolonged 

breastfeeding 2.0 [0.6,6.3] 1.2 [0.7,2.1] 1.0 [0.5,2.3] 1.9 [0.8,4.6] 0.9 [0.4,1.9] 2.0 [0.9,4.5] 

Weight assessed 77.7 [68.4,84.9] 82.7 [78.3,86.4] 79.8 [72.3,85.7] 81.6 [76.1,86.0] 78.8 [72.4,84.1] 82.1 [76.0,87.0] 

Counseled on nutrition during ANC 38.6 [31.3,46.5] 46.3 [41.9,50.8] 41.1 [34.9,47.6] 45.1 [40.0,50.3] 46.0 [40.2,51.8] 41.4 [36.1,47.0] 

Physical exam for anemia 49.8 [42.0,57.7] 49.1 [44.4,53.8] 49.2 [42.3,56.1] 49.6 [44.4,54.7] 45.2 [39.1,51.3] 52.4 [46.7,58.1]

Tested for anemia 61.9 [55.5,68.0] 55.1 [50.8,59.3] 59.2 [53.7,64.5] 56.6 [51.8,61.3] 52.1 [46.2,57.8] 61.8 [57.2,66.3] 

Women’s report of ANC3 

IFA provided/prescribed 80.9 [75.8,85.2] 83.4 [80.2,86.2] 82.3 [78.1,85.8] 82.6 [78.8,85.7] 86.2 [82.3,89.4] 79.7 [75.9,83.0] 

Counseling on IFA (how to take)4 81.4 [73.6,87.4] 86.6 [83.4,89.3] 84.1 [78.7,88.4] 85.0 [80.1,88.9] 83.9 [78.1,88.5] 85.2 [80.6,88.8] 

Counseling on IFA (side effects)4 22.7 [17.5,29.0] 18.1 [14.7,22.0] 19.3 [14.7,24.7] 20.4 [16.6,24.7] 18.8 [15.2,23.0] 20.7 [16.4,25.8] 

Client can identify at least one side effect4

 22.3 [16.2,29.9] 21.9 [18.4,25.8] 21.0 [16.4,26.5] 22.9 [18.4,28.0] 18.3 [15.0,22.2] 24.9 [19.9,30.6] 

Counseled on importance of exclusive 

breastfeeding 32.9 [27.1,39.3] 30.4 [26.8,34.3] 29.9 [25.0,35.2] 32.6 [28.6,36.9] 30.7 [25.8,36.0] 31.9 [27.7,36.3] 

Counseled on duration of exclusive 

breastfeeding5 71.2 [60.0,80.3] 65.2 [58.3,71.5] 65.0 [55.1,73.8] 69.6 [62.1,76.3] 68.4 [60.2,75.6] 67.2 [58.6,74.7] 

Counseled on nutrition during ANC 35.5 [30.2,41.2] 44.5 [40.5,48.5] 36.8 [31.8,42.0] 44.4 [40.3,48.6] 41.8 [37.1,46.5] 40.4 [35.9,45.2] 

Provider training6 

Recent training on nutritional assessment for 

pregnant women 14.5 [11.8,17.8] 16.8 [14.8,18.9] 13.4 [11.4,15.7] 17.9 [15.6,20.4] 16.6 [14.5,19.0] 15.5 [13.2,18.1] 

 

1 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 2 In older surveys (Kenya, Namibia, Rwanda, and Uganda), observations of these items were recorded only if the provider gave or prescribed IFA; filter was applied 

to current surveys for the purposes of comparability in this report. 3 Exit interview counseling items based on current or past visits 4 IFA-related counseling assessed only among women who reported that their provider prescribed or provided them with IFA 5 Asked only among women who reported that the provider counseled on exclusive breastfeeding 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

CI = confidence interval 

 

 
38 

Appendix Table 5 Percent of facilities with capacity to provide nutrition-related care in ANC, percent of 

clients observed and reporting nutrition-related counseling among clients attending 

ANC, and percent of providers with training on nutritional assessment in pregnancy, by 

background characteristics, Kenya SPA 2010

Facility type Managing authority Locale (n/a) 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with ANC 

Iron for women 62.7 [56.9,68.1] 58.3 [51.3,65.0] 42.7 [34.3,51.7] 82.7 [73.1,89.3] Folic acid for women 69.0 [62.6,74.7] 72.4 [65.6,78.4] 64.2 [55.2,72.3] 84.0 [76.2,89.6] IFA for women 27.0 [22.0,32.6] 17.1 [12.5,23.1] 13.6 [8.6,20.8] 24.9 [17.8,33.6] Vitamin A for women 95.9 [91.9,97.9] 93.1 [88.9,95.8] 98.8 [96.8,99.6] 85.3 [76.1,91.3] Adult weighing scale 96.6 [92.9,98.4] 89.0 [82.0,93.5] 89.9 [81.8,94.7] 89.5 [77.2,95.5] 

Observation of women’s ANC1 

IFA provided/prescribed 49.6 [44.1,55.1] 50.0 [41.9,58.1] 48.4 [41.4,55.3] 54.4 [47.3,61.4] Counseling on IFA (purpose)2 77.1 [69.9,83.0] 77.4 [68.6,84.3] 76.8 [69.4,82.9] 78.6 [67.5,86.7] Counseling on IFA (how to take)2 84.6 [77.9,89.6] 75.6 [66.1,83.1] 75.6 [67.2,82.4] 87.6 [79.8,92.7] Counseling on IFA (side effects)2 16.2 [11.7,22.0] 20.6 [14.0,29.2] 16.2 [11.0,23.1] 26.7 [17.3,38.6] Counseled on breastfeeding 22.6 [17.9,28.1] 23.8 [18.1,30.5] 23.2 [18.4,28.8] 23.9 [16.8,32.7] Counseled on early and prolonged 

breastfeeding 20.4 [15.9,25.8] 19.1 [13.8,25.8] 19.0 [14.5,24.6] 21.1 [14.6,29.6] Weight assessed 97.2 [93.8,98.8] 95.6 [90.3,98.0] 96.2 [92.0,98.3] 96.0 [89.6,98.5] Counseled on nutrition during ANC 48.7 [43.2,54.3] 46.2 [38.3,54.3] 46.7 [40.0,53.5] 48.5 [40.2,57.0] Physical exam for anemia 81.9 [76.9,86.0] 82.8 [76.1,87.9] 80.6 [75.0,85.2] 88.0 [81.0,92.7] 

Tested for anemia 45.2 [41.1,49.3] 41.5 [35.5,47.8] 45.5 [40.5,50.6] 34.7 [28.2,41.7] 

Women’s report of ANC3 

IFA provided/prescribed 66.2 [60.9,71.1] 68.1 [60.9,74.5] 64.5 [58.5,70.0] 76.4 [68.5,82.8] Counseling on IFA (how to take)4 90.6 [86.6,93.5] 94.8 [89.7,97.4] 92.1 [87.8,95.0] 96.3 [92.1,98.3] Counseling on IFA (side effects)4 20.7 [16.5,25.6] 20.8 [15.3,27.7] 18.4 [13.7,24.4] 26.7 [20.0,34.7] Client can identify at least one side effect4

 27.6 [23.0,32.6] 34.4 [26.9,42.7] 29.5 [23.5,36.3] 38.3 [28.6,49.0] Counseled on importance of exclusive 

breastfeeding 43.9 [39.2,48.7] 34.7 [29.4,40.4] 36.2 [31.8,40.9] 43.5 [36.4,50.8] Counseled on duration of exclusive 

breastfeeding5 77.3 [68.8,84.0] 85.0 [76.2,90.9] 79.9 [72.4,85.8] 86.3 [76.4,92.5] Counseled on nutrition during ANC 52.3 [48.3,56.3] 50.3 [44.0,56.7] 45.9 [40.7,51.2] 66.7 [59.8,72.9] 

Provider training6 

Recent training on nutritional assessment for 

pregnant women 16.9 [15.0,19.0] 17.0 [13.8,20.8] 15.0 [12.5,17.9] 19.2 [15.3,23.8] 

1 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 2 In older surveys (Kenya, Namibia, Rwanda, and Uganda), observations of these items were recorded only if the provider gave or prescribed IFA; filter was applied 

to current surveys for the purposes of comparability in this report. 3 Exit interview counseling items based on current or past visits 4 IFA-related counseling assessed only among women who reported that their provider prescribed or provided them with IFA 5 Asked only among women who reported that the provider counseled on exclusive breastfeeding 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

n/a = not available; CI = confidence interval 

 

 
39 

Appendix Table 6 Percent of facilities with capacity to provide nutrition-related care in ANC, percent of 

clients observed and reporting nutrition-related counseling among clients attending 

ANC, and percent of providers with training on nutritional assessment in pregnancy, by 

background characteristics, Malawi SPA 2013-14

Facility type Managing authority Locale 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with ANC 

Iron for women 47.1 35.4 29.5 50.5 33.3 54.8 

Folic acid for women 65.1 22.6 21.3 43.6 23.8 54.7 

IFA for women 96.2 91.2 92.9 90.6 92.2 91.2 

Vitamin A for women 54.7 51.0 46.4 60.5 52.0 49.9 

Adult weighing scale 94.4 93.7 92.1 96.7 93.2 96.7 

Observation of women’s ANC1 

IFA provided/prescribed 87.4 [80.9,91.9] 85.9 [81.8,89.2] 87.6 [83.6,90.7] 83.4 [76.1,88.8] 85.9 [82.0,89.0] 88.1 [80.0,93.2]

Counseling on IFA (purpose)2

 64.0 [53.6,73.3] 67.2 [62.4,71.7] 66.4 [60.2,72.1] 64.6 [56.5,71.9] 66.9 [62.1,71.5] 63.4 [50.5,74.7] 

Counseling on IFA (how to take)2

 68.5 [58.9,76.8] 68.6 [63.8,73.1] 69.2 [63.7,74.3] 66.6 [57.2,74.9] 68.8 [64.0,73.3] 67.9 [56.2,77.7] 

Counseling on IFA (side effects)2

 12.7 [7.9,19.8] 9.2 [6.7,12.5] 10.3 [7.5,14.0] 11.6 [6.6,19.4] 9.8 [7.1,13.3] 12.7 [7.4,20.9] 

Counseled on breastfeeding 9.3 [4.5,18.2] 5.0 [3.3,7.6] 7.1 [4.2,11.9] 5.6 [2.8,10.8] 5.1 [3.4,7.5] 10.9 [4.7,22.9] 

Counseled on early and prolonged 

breastfeeding 6.8 [2.9,15.3] 2.8 [1.7,4.8] 4.3 [2.1,8.9] 4.7 [2.2,9.7] 3.1 [1.9,5.2] 7.7 [2.8,19.6] 

Weight assessed 77.1 [66.2,85.3] 73.7 [68.4,78.3] 71.8 [65.3,77.5] 84.1 [76.3,89.7] 76.6 [71.6,80.9] 71.2 [57.4,81.9] 

Counseled on nutrition during ANC 43.6 [34.1,53.5] 36.2 [31.4,41.2] 39.9 [34.0,46.2] 37.0 [29.4,45.2] 36.4 [31.6,41.4] 46.2 [34.8,57.9] 

Physical exam for anemia 80.5 [73.0,86.3] 77.8 [73.6,81.5] 79.7 [75.1,83.6] 76.6 [69.6,82.4] 77.8 [73.8,81.3] 81.6 [72.0,88.5]

Tested for anemia 18.0 [11.5,27.0] 2.0 [1.3,3.0] 5.5 [3.0,10.0] 16.3 [9.9,25.9] 5.6 [3.2,9.7] 15.4 [8.9,25.4] 

Women’s report of ANC3 

IFA provided/prescribed 93.9 [89.3,96.6] 92.9 [89.5,95.2] 93.4 [90.4,95.6] 92.9 [87.3,96.1] 92.4 [89.3,94.7] 95.4 [90.6,97.8]

Counseling on IFA (how to take)4

 97.1 [94.7,98.4] 96.4 [95.2,97.4] 97.0 [95.7,97.8] 95.9 [93.2,97.6] 96.4 [95.1,97.3] 97.4 [94.6,98.8] 

Counseling on IFA (side effects)4

 18.6 [13.7,24.8] 15.5 [13.2,18.3] 17.4 [14.3,20.9] 15.1 [11.1,20.2] 14.8 [12.4,17.6] 21.7 [15.9,28.9] 

Client can identify at least one side 

effect4 11.2 [7.7,16.0] 9.6 [7.8,11.8] 10.4 [8.3,13.0] 9.9 [6.5,14.9] 9.7 [7.7,12.1] 11.7 [7.8,17.1] 

Counseled on importance of exclusive 

breastfeeding 50.7 [43.9,57.5] 53.8 [50.3,57.2] 51.7 [47.5,55.8] 55.0 [49.5,60.4] 53.4 [50.2,56.5] 50.5 [41.5,59.4] 

Counseled on duration of exclusive 

breastfeeding5 74.4 [65.7,81.5] 63.3 [58.8,67.6] 71.2 [66.0,75.9] 58.1 [50.4,65.4] 65.8 [61.6,69.7] 72.5 [60.5,81.9] 

Counseled on nutrition during ANC 67.3 [59.4,74.3] 63.7 [59.9,67.4] 63.2 [58.5,67.7] 70.5 [64.5,75.9] 65.4 [61.7,68.9] 64.6 [54.4,73.6] 

Provider training6 

Recent training on nutritional 

assessment for pregnant women 18.2 [15.1,21.8] 15.9 [14.2,17.9] 17.9 [15.7,20.2] 14.7 [12.6,17.2] 17.1 [15.2,19.3] 15.2 [12.7,18.2] 

 

1 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 2 In older surveys (Kenya, Namibia, Rwanda, and Uganda), observations of these items were recorded only if the provider gave or prescribed IFA; filter was 

applied to current surveys for the purposes of comparability in this report. 3 Exit interview counseling items based on current or past visits 4 IFA-related counseling assessed only among women who reported that their provider prescribed or provided them with IFA 5 Asked only among women who reported that the provider counseled on exclusive breastfeeding 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

CI = confidence interval 

 

 
40 

Appendix Table 7 Percent of facilities with capacity to provide nutrition-related care in ANC, percent of 

clients observed and reporting nutrition-related counseling among clients attending 

ANC, and percent of providers with training on nutritional assessment in pregnancy, by 

background characteristics, Namibia SPA 2009

Facility type Managing authority Locale (n/a) 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with ANC 

Iron for women 12.5 14.9 13.4 42.9 Folic acid for women 100.0 39.3 37.4 71.4 IFA for women 100.0 88.5 90.8 71.4 Vitamin A for women 100.0 97.3 99.2 57.1 Adult weighing scale 100.0 92.2 91.6 92.9 

Observation of women’s ANC1 

IFA provided/prescribed 86.5 [43.3,98.2] 73.7 [65.3,80.7] 75.5 [66.3,82.8] 25.5 [0.5,96.1] Counseling on IFA (purpose)2

 57.4 [9.6,94.5] 71.2 [63.7,77.6] 70.8 [63.3,77.3] Counseling on IFA (how to take)2

 90.4 [15.7,99.8] 85.7 [80.6,89.6] 85.9 [80.4,90.0] Counseling on IFA (side effects)2

 19.3 [4.8,53.2] 20.7 [13.4,30.4] 20.8 [14.1,29.6] Counseled on breastfeeding 69.5 [10.7,97.7] 36.3 [28.3,45.2] 39.2 [30.1,49.1] Counseled on early and prolonged 

breastfeeding (n/a) Weight assessed 100.0 94.5 [89.8,97.1] 94.4 [89.4,97.2] 29.0 [0.1,99.7] Counseled on nutrition during ANC 63.9 [8.7,97.0] 47.5 [38.9,56.3] 49.8 [40.5,59.2] 0.0 Physical exam for anemia 72.8 [8.9,98.7] 61.1 [51.7,69.7] 63.8 [54.0,72.6] 85.5 [2.3,99.9] Tested for anemia 76.2 [6.7,99.3] 84.7 [78.6,89.2] 84.6 [78.1,89.5] 0.0 

Women’s report of ANC3 

IFA provided/prescribed 91.0 [78.5,96.6] 95.1 [90.4,97.6] 96.5 [93.4,98.2] 65.6 [1.0,99.7] Counseling on IFA (how to take)4

 90.9 [74.7,97.1] 95.6 [93.5,97.1] 95.1 [92.7,96.7] Counseling on IFA (side effects)4

 1.4 [0.1,18.2] 33.0 [27.7,38.9] 29.5 [23.8,35.9] 61.0 [0.0,100.0] Client can identify at least one side 

effect4 11.8 [0.8,70.1] 23.4 [19.3,28.1] 22.5 [17.9,27.8] 22.1 [0.0,100.0] Counseled on importance of 

exclusive breastfeeding 84.3 [62.1,94.6] 69.9 [64.5,74.8] 70.0 [64.6,74.9] 54.5 [3.0,97.9] Counseled on duration of exclusive 

breastfeeding5 23.8 [6.3,59.1] 14.7 [9.5,22.1] 18.2 [12.5,25.8] 26.6 [00.0,100.0] 

Counseled on nutrition during ANC 65.7 [41.7,83.7] 66.4 [60.7,71.7] 66.4 [60.8,71.6] 54.5 [3.0,97.9] 

Provider training6 

Recent training on nutritional 

assessment for pregnant women 10.8 [6.7,16.9] 10.7 [8.6,13.1] 11.5 [9.4,14.1] 3.9 [1.3,10.8] 

1 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 2 In older surveys (Kenya, Namibia, Rwanda, and Uganda), observations of these items were recorded only if the provider gave or prescribed IFA; filter 

was applied to current surveys for the purposes of comparability in this report. 3 Exit interview counseling items based on current or past visits 4 IFA-related counseling assessed only among women who reported that their provider prescribed or provided them with IFA 5 Asked only among women who reported that the provider counseled on exclusive breastfeeding 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

n/a = not available; CI = confidence interval 

 
41 

Appendix Table 8 Percent of facilities with capacity to provide nutrition-related care in ANC, percent of 

clients observed and reporting nutrition-related counseling among clients attending 

ANC, and percent of providers with training on nutritional assessment in pregnancy, by 

background characteristics, Nepal SPA 2015

Facility type Managing authority Locale (n/a) 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with ANC 

Iron for women 47.6 [38.9,56.4] 9.0 [6.7,12.0] 9.5 [7.2,12.4] 51.8 [41.2,62.3] Folic acid for women 57.2 [48.5,65.5] 5.8 [4.0,8.3] 6.5 [4.7,8.9] 63.6 [52.9,73.0] 

IFA for women 74.5 [65.9,81.5] 92.4 [89.4,94.6] 92.3 [89.4,94.5] 70.2 [59.6,79.0] Vitamin A for women 52.6 [44.0,61.1] 93.5 [90.7,95.4] 93.1 [90.5,95.1] 41.1 [30.8,52.2] Adult weighing scale 96.9 [90.4,99.1] 94.6 [92.1,96.4] 94.7 [92.3,96.5] 96.6 [88.2,99.1] 

Observation of women’s ANC1 

IFA provided/prescribed 56.1 [48.5,63.5] 68.8 [62.3,74.6] 66.6 [61.5,71.4] 46.4 [33.5,59.7] Counseling on IFA (purpose)2

 11.5 [7.7,16.9] 22.9 [16.0,31.6] 19.3 [14.2,25.5] 10.6 [4.1,24.9] Counseling on IFA (how to take)2

 19.3 [13.8,26.3] 35.2 [27.7,43.5] 31.5 [25.8,37.8] 9.6 [3.9,21.7] Counseling on IFA (side effects)2

 3.3 [1.5,7.5] 4.6 [2.6,8.0] 4.7 [2.9,7.5] 0.2 [0.0,1.5] Counseled on breastfeeding 0.7 [0.3,1.8] 1.1 [0.3,4.0] 1.0 [0.4,2.6] 0.5 [0.1,4.3] Counseled on early and prolonged 

breastfeeding 1.0 [0.3,2.9] 1.8 [0.7,4.7] 1.4 [0.6,3.1] 1.6 [0.3,7.6] Weight assessed 68.8 [58.0,77.9] 78.7 [70.5,85.0] 75.8 [69.2,81.4] 66.3 [45.9,82.0] Counseled on nutrition during ANC 36.4 [30.2,43.2] 58.8 [52.7,64.7] 53.2 [47.9,58.4] 26.9 [19.4,36.0] Physical exam for anemia 37.0 [30.4,44.2] 36.8 [29.8,44.5] 34.8 [29.5,40.5] 45.8 [33.2,59.0] Tested for anemia 35.1 [28.2,42.6] 29.8 [22.8,37.9] 33.7 [28.2,39.7] 26.5 [17.2,38.5] 

Women’s report of ANC3 

IFA provided/prescribed 66.9 [58.3,74.5] 86.8 [78.8,92.1] 82.7 [76.5,87.5] 54.8 [40.0,68.7] Counseling on IFA (how to take)4

 86.2 [79.6,90.9] 94.3 [91.4,96.3] 91.9 [88.6,94.2] 85.3 [72.4,92.8] Counseling on IFA (side effects)4

 20.9 [16.4,26.1] 20.5 [15.5,26.7] 19.3 [15.5,23.7] 29.5 [20.2,40.9] Client can identify at least one side 

effect4 16.8 [12.5,22.2] 15.6 [11.0,21.8] 16.0 [12.3,20.5] 16.9 [9.0,29.6] Counseled on importance of exclusive 

breastfeeding 13.1 [9.3,18.2] 18.5 [13.9,24.1] 16.8 [13.4,21.0] 12.0 [6.0,22.5] Counseled on duration of exclusive 

breastfeeding5 56.3 [31.2,78.5] 60.7 [51.1,69.4] 61.6 [53.5,69.1] 43.4 [1.8,96.9] 

Counseled on nutrition during ANC 69.5 [64.0,74.5] 76.3 [68.2,82.9] 73.8 [68.2,78.8] 69.8 [61.0,77.4] 

Provider training6 

Recent training on nutritional 

assessment for pregnant women 6.9 [5.5,8.7] 12.7 [10.7,15.0] 12.4 [10.6,14.5] 5.8 [4.1,8.2] 

1 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 2 In older surveys (Kenya, Namibia, Rwanda, and Uganda), observations of these items were recorded only if the provider gave or prescribed IFA; filter was 

applied to current surveys for the purposes of comparability in this report. 3 Exit interview counseling items based on current or past visits 4 IFA-related counseling assessed only among women who reported that their provider prescribed or provided them with IFA 5 Asked only among women who reported that the provider counseled on exclusive breastfeeding 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

n/a = not available; CI = confidence interval 

 
42 

Appendix Table 9 Percent of facilities with capacity to provide nutrition-related care in ANC, percent of 

clients observed and reporting nutrition-related counseling among clients attending 

ANC, and percent of providers with training on nutritional assessment in pregnancy, by 

background characteristics, Rwanda SPA 2007

Facility type Managing authority Locale (n/a) 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with ANC 

Iron for women 86.7 [51.9,97.5] 74.9 [70.8,78.6] 77.1 [71.7,81.7] 72.3 [66.3,77.7] Folic acid for women IFA for women 86.7 [51.9,97.5] 74.9 [70.8,78.6] 77.1 [71.7,81.7] 72.3 [66.3,77.7] Vitamin A for women Adult weighing scale 66.7 [35.4,87.9] 85.4 [81.8,88.4] 84.4 [79.5,88.2] 85.5 [79.4,90.1] 

Observation of women’s ANC1 

IFA provided/prescribed 40.0 [1.1,97.6] 41.9 [35.3,48.7] 42.7 [34.4,51.4] 39.8 [29.9,50.7] Counseling on IFA (purpose)2

 16.7 [1.9,67.0] 81.4 [72.8,87.8] 79.4 [68.2,87.3] 82.1 [67.8,91.0] Counseling on IFA (how to take)2

 33.3 [0.1,99.7] 91.2 [85.4,94.8] 89.4 [81.9,94.1] 91.7 [80.8,96.6] Counseling on IFA (side effects)2 37.2 [27.7,47.7] 39.4 [28.2,52.0] 28.6 [15.5,46.7] Counseled on breastfeeding 20.9 [15.6,27.5] 20.0 [13.8,28.0] 21.8 [12.9,34.5] Counseled on early and prolonged 

breastfeeding Weight assessed 100.0 98.4 [95.2,99.5] 99.6 [98.4,99.9] 95.7 [84.4,98.9] Counseled on nutrition during ANC 33.3 [0.4,98.3] 39.7 [33.4,46.5] 38.2 [30.8,46.1] 43.1 [31.4,55.6] Physical exam for anemia Tested for anemia 66.7 [1.9,99.5] 34.4 [27.6,41.9] 35.2 [27.3,44.1] 34.6 [22.0,49.8] 

Women’s report of ANC3 

IFA provided/prescribed 40.0 [1.1,97.6] 47.4 [41.2,53.7] 46.0 [38.0,54.2] 50.2 [41.0,59.4] Counseling on IFA (how to take)4

 83.3 [0.2,100.0] 89.9 [85.0,93.3] 91.1 [85.8,94.5] 86.8 [74.1,93.8] Counseling on IFA (side effects)4

 16.7 [00.0,99.8] 11.0 [7.4,16.1] 12.3 [7.9,18.8] 8.5 [3.7,18.3] Client can identify at least one side 

effect4 7.5 [4.8,11.4] 7.7 [4.5,12.7] 6.6 [2.9,14.2] Counseled on importance of exclusive 

breastfeeding 20.0 [0.2,97.6] 32.7 [27.3,38.6] 28.6 [22.5,35.5] 41.7 [31.4,52.8] Counseled on duration of exclusive 

breastfeeding5 84.4 [76.8,89.9] 81.5 [70.6,89.0] 89.8 [78.9,95.4] 

Counseled on nutrition during ANC 66.7 [18.2,94.7] 37.1 [31.7,42.7] 34.4 [28.3,41.1] 45.5 [36.2,55.1] 

Provider training6 

Recent training on nutritional 

assessment for pregnant women (n/a) 

1 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 2 In older surveys (Kenya, Namibia, Rwanda, and Uganda), observations of these items were recorded only if the provider gave or prescribed IFA; filter was 

applied to current surveys for the purposes of comparability in this report. 3 Exit interview counseling items based on current or past visits 4 IFA-related counseling assessed only among women who reported that their provider prescribed or provided them with IFA 5 Asked only among women who reported that the provider counseled on exclusive breastfeeding 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

n/a = not available; CI = confidence interval 

 
43 

Appendix Table 10 Percent of facilities with capacity to provide nutrition-related care in ANC, percent of 

clients observed and reporting nutrition-related counseling among clients attending 

ANC, and percent of providers with training on nutritional assessment in pregnancy, by 

background characteristics, Senegal SPA 2016

Facility type Managing authority Locale 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with ANC 

Iron for women 7.3 [1.5,28.3] 5.6 [3.5,9.0] 4.8 [2.8,7.9] 8.1 [2.6,22.5] 5.8 [3.4,9.9] 3.7 [1.5,8.9] 

Folic acid for women 7.3 [1.5,28.3] 1.1 [0.3,3.7] 1.3 [0.4,3.7] 1.2 [0.1,8.7] 1.5 [0.4,4.7] 0.9 [0.2,3.4] 

IFA for women 62.9 [41.2,80.4] 82.1 [77.1,86.2] 81.6 [76.1,86.1] 61.0 [46.1,74.1] 82.4 [76.0,87.4] 72.1 [63.2,79.6] 

Vitamin A for women 16.3 [5.5,39.2] 68.1 [62.9,72.8] 62.0 [56.7,67.0] 44.9 [32.1,58.3] 62.3 [56.2,68.0] 55.0 [46.8,63.0] 

Adult weighing scale 98.5 [95.9,99.4] 92.9 [87.6,96.0] 90.8 [84.1,94.9] Observation of women’s ANC1 

IFA provided/prescribed 79.4 [61.1,90.5] 87.7 [84.6,90.4] 87.7 [84.4,90.4] 84.9 [71.9,92.5] 89.2 [85.6,92.0] 85.6 [80.0,89.9] 

Counseling on IFA (purpose)2

 38.6 [17.5,65.0] 41.1 [34.8,47.6] 41.2 [34.7,48.1] 38.2 [24.4,54.2] 36.3 [30.3,42.7] 46.4 [35.4,57.7] 

Counseling on IFA (how to take)2

 30.2 [14.5,52.4] 48.5 [42.2,55.0] 47.2 [40.7,53.7] 59.6 [43.9,73.5] 45.9 [38.1,53.9] 50.4 [40.2,60.6] 

Counseling on IFA (side effects)2

 0.0 1.8 [1.0,3.4] 1.6 [0.8,3.1] 3.8 [0.4,26.4] 2.9 [1.4,5.5] 0.6 [0.1,4.2] 

Counseled on breastfeeding 0.0 2.2 [1.0,4.7] 2.3 [1.1,4.9] 0.0 2.0 [0.8,4.8] 2.3 [0.7,7.7] 

Counseled on early and prolonged 

breastfeeding 0.0 1.9 [0.8,4.4] 2.0 [0.8,4.6] 0.0 1.4 [0.5,4.1] 2.3 [0.7,7.8] 

Weight assessed 94.4 [82.1,98.4] 93.4 [89.5,95.9] 93.1 [89.0,95.8] 96.9 [93.3,98.6] 92.5 [87.8,95.5] 94.3 [86.9,97.7] 

Counseled on nutrition during ANC 35.6 [21.0,53.4] 38.5 [32.6,44.7] 38.4 [32.4,44.8] 37.9 [22.5,56.2] 32.9 [27.4,39.0] 44.3 [34.1,55.1] 

Physical exam for anemia 95.5 [81.2,99.0] 96.4 [94.5,97.6] 96.2 [94.3,97.5] 97.5 [91.4,99.3] 95.4 [92.8,97.1] 97.3 [94.3,98.7]

Tested for anemia 35.6 [25.3,47.5] 29.4 [24.9,34.4] 30.2 [25.5,35.3] 21.8 [11.8,36.8] 26.6 [21.5,32.4] 32.9 [25.7,41.1] 

Women’s report of ANC3 

IFA provided/prescribed 91.7 [61.4,98.7] 97.8 [96.2,98.8] 97.6 [95.8,98.6] 98.4 [88.1,99.8] 98.6 [96.9,99.3] 96.6 [93.3,98.3] 

Counseling on IFA (how to take)4

 65.4 [44.6,81.7] 84.1 [80.3,87.3] 83.1 [79.0,86.4] 90.2 [77.4,96.1] 83.9 [78.9,87.9] 83.2 [77.0,88.0] 

Counseling on IFA (side effects)4

 6.3 [1.7,20.9] 5.1 [3.4,7.5] 5.1 [3.4,7.6] 5.0 [1.1,19.8] 5.5 [3.3,9.1] 4.6 [2.5,8.4] 

Client can identify at least one side 

effect4 51.6 [30.6,72.1] 35.3 [31.1,39.9] 35.8 [31.3,40.5] 36.5 [25.8,48.8] 31.9 [27.7,36.3] 40.2 [32.5,48.4] 

Counseled on importance of exclusive 

breastfeeding 1.7 [0.2,13.3] 4.7 [3.0,7.2] 4.9 [3.1,7.5] 1.6 [0.2,11.9] 4.3 [2.6,7.1] 4.9 [2.4,9.8] 

Counseled on duration of exclusive 

breastfeeding5 100.0 53.4 [27.6,77.4] 55.3 [28.9,79.0] 0.0 51.7 [26.9,75.7] 56.0 [9.2,94.1] 

Counseled on nutrition during ANC 37.3 [21.2,56.9] 47.7 [41.7,53.7] 47.4 [41.2,53.6] 47.2 [33.2,61.8] 41.4 [35.3,47.7] 53.9 [43.5,64.0] 

Provider training6 

Recent training on nutritional 

assessment for pregnant women 18.6 [11.3,29.1] 18.7 [16.5,21.0] 17.5 [15.5,19.7] 16.2 [10.9,23.2] 16.4 [14.3,18.7] 18.4 [15.1,22.2] 

 

1 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 2 In older surveys (Kenya, Namibia, Rwanda, and Uganda), observations of these items were recorded only if the provider gave or prescribed IFA; filter was 

applied to current surveys for the purposes of comparability in this report. 3 Exit interview counseling items based on current or past visits 4 IFA-related counseling assessed only among women who reported that their provider prescribed or provided them with IFA 5 Asked only among women who reported that the provider counseled on exclusive breastfeeding 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

CI = confidence interval 

 
44 

Appendix Table 11 Percent of facilities with capacity to provide nutrition-related care in ANC, percent of 

clients observed and reporting nutrition-related counseling among clients attending 

ANC, and percent of providers with training on nutritional assessment in pregnancy, by 

background characteristics, Tanzania SPA 2014-15

Facility type Managing authority Locale 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with ANC 

Iron for women 48.5 [39.9,57.1] 40.8 [36.6,45.2] 40.4 [36.0,45.0] 44.5 [34.4,55.1] 40.0 [35.6,44.6] 45.9 [37.1,55.0] 

Folic acid for women 81.5 [75.2,86.5] 68.0 [63.7,71.9] 70.3 [65.9,74.3] 60.5 [49.4,70.6] 69.0 [64.5,73.2] 66.4 [56.0,75.4] 

IFA for women 95.9 [92.9,97.7] 92.3 [89.6,94.4] 93.7 [91.1,95.5] 86.8 [77.2,92.8] 92.4 [89.5,94.6] 92.4 [86.2,96.0] 

Vitamin A for women 52.7 [43.8,61.5] 74.8 [70.7,78.4] 77.0 [73.0,80.6] 59.5 [48.5,69.7] 75.7 [71.5,79.5] 65.7 [56.0,74.2] 

Adult weighing scale 100.0 87.4 [84.0,90.3] 85.8 [81.8,89.0] 97.9 [90.5,99.6] 86.8 [82.9,90.0] 92.9 [85.0,96.8] 

Observation of women’s ANC1 

IFA provided/prescribed 79.5 [75.5,83.0] 74.5 [70.4,78.2] 77.7 [73.7,81.3] 65.0 [58.0,71.3] 76.5 [72.0,80.5] 72.2 [66.9,76.8]

Counseling on IFA (purpose)2

 79.4 [73.0,84.6] 71.2 [66.5,75.4] 71.7 [67.2,75.8] 76.8 [67.8,84.0] 72.9 [68.1,77.3] 71.6 [64.6,77.7] 

Counseling on IFA (how to take)2

 79.8 [73.6,84.8] 77.2 [73.2,80.7] 78.8 [74.9,82.2] 71.7 [64.5,77.9] 80.7 [76.7,84.2] 69.2 [62.0,75.5] 

Counseling on IFA (side effects)2

 18.8 [14.9,23.4] 13.3 [10.4,16.9] 14.6 [11.7,18.0] 12.5 [7.6,19.9] 12.9 [9.9,16.8] 17.8 [13.4,23.2] 

Counseled on breastfeeding 20.6 [16.5,25.3] 10.9 [8.7,13.6] 12.0 [9.7,14.7] 14.6 [10.7,19.5] 11.1 [8.9,13.6] 16.1 [11.8,21.5] 

Counseled on early and prolonged 

breastfeeding 15.5 [12.3,19.3] 7.4 [5.5,10.0] 8.3 [6.2,10.9] 10.6 [7.7,14.6] 7.2 [5.4,9.4] 12.6 [8.5,18.2] 

Weight assessed 88.2 [83.8,91.6] 78.7 [73.8,82.9] 77.4 [72.4,81.7] 92.3 [87.8,95.2] 78.9 [73.4,83.5] 83.6 [77.7,88.3] 

Counseled on nutrition during ANC 40.2 [34.6,46.1] 31.1 [27.3,35.1] 31.9 [28.1,36.0] 34.9 [28.7,41.8] 30.0 [25.9,34.4] 39.0 [33.9,44.3] 

Physical exam for anemia 63.6 [58.2,68.6] 57.8 [53.4,62.0] 59.4 [55.2,63.4] 55.7 [47.7,63.5] 58.6 [54.2,62.9] 58.8 [51.8,65.6]

Tested for anemia 61.0 [55.9,65.8] 38.8 [34.7,43.1] 39.2 [35.2,43.3] 56.0 [47.1,64.4] 33.5 [29.4,37.9] 64.9 [59.9,69.7] 

Women’s report of ANC3 

IFA provided/prescribed 90.1 [87.2,92.4] 84.7 [81.2,87.7] 87.4 [84.1,90.2] 77.6 [70.2,83.7] 86.5 [82.4,89.7] 83.3 [79.5,86.5]

Counseling on IFA (how to take)4

 98.0 [95.9,99.0] 97.0 [95.4,98.0] 97.4 [96.0,98.3] 96.2 [91.3,98.4] 97.7 [96.2,98.6] 95.8 [92.1,97.8] 

Counseling on IFA (side effects)4

 33.9 [30.4,37.5] 25.3 [22.1,28.7] 26.1 [23.1,29.4] 29.4 [24.1,35.3] 24.7 [21.3,28.4] 32.0 [28.0,36.3] 

Client can identify at least one side 

effect4 22.8 [19.8,26.0] 13.7 [11.7,16.0] 14.6 [12.6,16.7] 18.5 [14.2,23.8] 13.2 [11.1,15.7] 20.6 [17.2,24.4] 

Counseled on importance of exclusive 

breastfeeding 51.2 [46.3,56.0] 31.5 [28.2,35.0] 32.3 [29.0,35.7] 44.6 [38.1,51.3] 30.1 [26.8,33.5] 46.2 [40.7,51.9] 

Counseled on duration of exclusive 

breastfeeding5 76.5 [71.1,81.2] 76.2 [71.5,80.3] 74.6 [70.0,78.7] 81.4 [74.8,86.6] 75.6 [71.0,79.7] 77.4 [70.7,82.9] 

Counseled on nutrition during ANC 55.8 [51.8,59.8] 41.8 [38.2,45.5] 42.7 [39.1,46.3] 49.7 [43.3,56.1] 40.4 [36.5,44.5] 53.2 [48.7,57.6] 

Provider training6 

Recent training on nutritional 

assessment for pregnant women 13.0 [11.5,14.7] 13.1 [11.6,14.8] 15.3 [13.6,17.2] 9.0 [7.5,10.9] 15.7 [13.9,17.7] 9.2 [7.8,10.9] 

 

1 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 2 In older surveys (Kenya, Namibia, Rwanda, and Uganda), observations of these items were recorded only if the provider gave or prescribed IFA; filter was 

applied to current surveys for the purposes of comparability in this report. 3 Exit interview counseling items based on current or past visits 4 IFA-related counseling assessed only among women who reported that their provider prescribed or provided them with IFA 5 Asked only among women who reported that the provider counseled on exclusive breastfeeding 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

CI = confidence interval 

 
45 

Appendix Table 12 Percent of facilities with capacity to provide nutrition-related care in ANC, percent of 

clients observed and reporting nutrition-related counseling among clients attending 

ANC, and percent of providers with training on nutritional assessment in pregnancy, by 

background characteristics, Uganda SPA 2007

Facility type Managing authority Locale (n/a) 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with ANC 

Iron for women 70.8 [61.9,78.3] 40.4 [34.3,46.9] 35.1 [28.6,42.2] 62.7 [49.7,74.0] Folic acid for women IFA for women 64.6 [55.4,72.9] 38.6 [32.3,45.3] 29.1 [23.0,36.0] 72.3 [59.4,82.2] Vitamin A for women 72.6 [64.0,79.8] 77.6 [71.7,82.5] 77.7 [71.4,82.9] 76.3 [62.3,86.2] 

Adult weighing scale 85.0 [76.8,90.6] 69.0 [62.6,74.7] 64.0 [57.2,70.4] 87.0 [75.2,93.7] 

Observation of women’s ANC1 

IFA provided/prescribed 81.2 [74.4,86.5] 72.4 [65.3,78.6] 72.8 [65.9,78.8] 80.6 [68.1,89.0] Counseling on IFA (purpose)2

 54.7 [44.9,64.1] 43.4 [33.3,54.1] 41.6 [33.0,50.7] 67.2 [43.3,84.5] Counseling on IFA (how to take)2

 70.1 [61.7,77.3] 67.9 [57.7,76.6] 70.0 [60.6,78.0] 58.6 [40.3,74.7] Counseling on IFA (side effects)2

 17.7 [10.8,27.6] 7.2 [3.9,12.8] 8.8 [5.3,14.2] 10.9 [5.3,21.1] Counseled on breastfeeding 23.8 [17.2,31.8] 16.3 [10.9,23.7] 16.2 [11.9,21.7] 26.2 [10.7,51.4] 

Counseled on early and prolonged 

breastfeeding (n/a) Weight assessed 85.6 [76.9,91.5] 74.8 [64.9,82.7] 73.7 [64.6,81.2] 94.6 [87.6,97.8] Counseled on nutrition during ANC 29.5 [23.0,37.0] 29.5 [22.7,37.3] 28.1 [22.2,35.0] 37.7 [21.7,56.8] Physical exam for anemia (n/a) Tested for anemia 30.3 [23.5,38.1] 17.9 [11.7,26.3] 17.1 [11.8,24.2] 37.6 [20.5,58.5] 

Women’s report of ANC3 

IFA provided/prescribed 84.1 [77.1,89.2] 81.5 [76.0,85.9] 81.2 [75.9,85.5] 86.4 [78.7,91.5] Counseling on IFA (how to take)4

 92.5 [87.8,95.5] 87.7 [79.2,93.1] 89.1 [81.9,93.7] 85.3 [59.3,95.8] Counseling on IFA (side effects)4

 21.7 [15.6,29.4] 19.7 [13.4,27.9] 19.2 [13.4,26.8] 24.5 [12.1,43.3] Client can identify at least one side 

effect4 31.1 [24.4,38.5] 22.1 [15.3,30.8] 23.2 [16.9,30.9] 26.4 [13.4,45.4] Counseled on importance of exclusive 

breastfeeding 39.9 [32.3,48.1] 30.3 [22.9,38.8] 30.3 [23.6,37.9] 42.1 [25.3,61.0] Counseled on duration of exclusive 

breastfeeding5 73.2 [64.1,80.7] 61.1 [46.9,73.7] 65.2 [51.8,76.5] 57.1 [31.0,79.8] 

Counseled on nutrition during ANC 51.2 [43.2,59.1] 50.4 [43.2,57.7] 49.9 [43.0,56.8] 54.6 [40.5,68.0] 

Provider training6 (n/a) 

Recent training on nutritional 

assessment for pregnant women 

1 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 2 In older surveys (Kenya, Namibia, Rwanda, and Uganda), observations of these items were recorded only if the provider gave or prescribed IFA; filter was 

applied to current surveys for the purposes of comparability in this report. 3 Exit interview counseling items based on current or past visits 4 IFA-related counseling assessed only among women who reported that their provider prescribed or provided them with IFA 5 Asked only among women who reported that the provider counseled on exclusive breastfeeding 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

n/a = not available; CI = confidence interval 

 
46 

Appendix Table 13 Availability of IFA supplements among facilities that provide ANC and percent of 

women provided or prescribed IFA supplements, by country and region

Percentage of 

facilities that have 

IFA available and 

valid in any service 

area among facilities 

that provide ANC 

services 

Percentage of ANC 

clients who were 

prescribed or 

provided iron, folic 

acid, or IFA 

Country % 95% CI N % 95% CI N 

Bangladesh Barisal 97.0 [93.2,98.7] 115 n/a Chittagong 84.9 [77.1,90.3] 280 n/a Dhaka 84.3 [75.6,90.3] 412 n/a Khulna 87.7 [77.7,93.6] 191 n/a Rajshahi 92.8 [83.5,97.1] 212 n/a Rangpur 93.6 [84.1,97.6] 203 n/a Sylhet 86.8 [76.3,93.1] 96 n/a Haiti Ouest 59.6 296 61.8 [56.1,67.2] 609 

Sud-Est 57.1 63 76.2 [61.9,86.3] 74 

Nord 70.7 75 72.2 [57.7,83.2] 137 

Nord-Est 64.7 34 83.6 [63.6,93.7] 61 

Artibonite 42.6 108 74.0 [60.4,84.2] 181 

Centre 47.7 44 82.2 [68.0,91.0] 164 

Sud 69.4 62 63.5 [50.4,75.0] 105 

Grand-Anse 57.5 40 94.8 [85.3,98.3] 98 

Nord-Ouest 52.6 82 70.7 [61.6,78.4] 154 

Nippes 69.0 29 76.4 [52.3,90.5] 37 

Malawi 

 

North 96.6 118 84.2 [70.1,92.4] 232 

Central 92.5 235 91.9 [87.7,94.7] 884 

South 89.8 280 82.1 [76.5,86.6] 952 

Nepal 

 

Eastern development region 95.2 [90.5,97.7] 206 64.7 [51.4,76.1] 385 

Central development region 81.1 [74.1,86.5] 301 60.9 [53.0,68.2] 661 

Western development region 97.9 [94.9,99.1] 202 72.4 [60.9,81.6] 232 

Mid-western development region 95.8 [88.7,98.5] 129 58.6 [45.3,70.8] 135 

Far-western development region 89.3 [78.9,94.9] 89 49.7 [38.9,60.4] 96 

Senegal 

 

Ouest 70.6 [59.0,80.1] 98 85.3 [78.4,90.3] 334 

Centre 84.2 [74.2,90.8] 93 89.5 [84.6,93.0] 220 

Nord 73.4 [59.9,83.6] 76 84.9 [77.7,90.0] 162 

Sud 88.1 [79.0,93.5] 90 92.7 [87.7,95.7] 133 

Tanzania 

 

Western 80.3 [66.4,89.4] 89 67.0 [54.4,77.6] 705 

Northern 90.2 [77.5,96.1] 139 74.5 [68.3,79.9] 316 

Central 94.7 [84.9,98.3] 108 83.6 [75.1,89.6] 340 

Southern Highlands 94.0 [83.9,97.9] 118 77.5 [66.1,85.9] 341 

Southern 92.5 [77.8,97.7] 70 78.3 [67.5,86.2] 189 

South West Highlands 96.2 [80.7,99.4] 110 72.0 [56.7,83.5] 290

Lake 97.0 [89.7,99.2] 200 85.4 [80.5,89.3] 1086 

Eastern 96.6 [88.2,99.1] 141 76.2 [67.9,82.8] 359 

Zanzibar 62.0 [49.9,72.8] 31 53.4 [36.4,69.6] 383 

CI = confidence interval; n/a = not available 
47 

Appendix Table 14 Percent of facilities with capacity to provide nutrition-related care in curative child care services, percent of clients observed and caretakers 

reporting nutrition-related counseling among clients attending sick child care visits, and percent of providers with training on child nutrition 

topics, by country 

Bangladesh SPA 

2014 

Haiti SPA 

2013 

Kenya SPA 

2010 

Malawi SPA 

2013-14 

Namibia SPA 

2009 

Nepal SPA 

2015 

Rwanda SPA 

2007 

Senegal SPA 

2016 

Tanzania SPA 

2014-15 

Uganda SPA 

2007 

% 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI % 95% CI 

Facilities with curative child care

Child weighing scale 

available1 61.3 [57.2,65.3] 70.6 69.2 [63.5,74.4] 73.6 77.4 45.5 [41.0,50.0] 70.1 [66.2,73.8] 65.1 [60.9,69.0] 82.6 [79.4,85.5] 73.3 [68.0,77.9] 

Infant scale available2 34.8 [31.3,38.4] 74.0 75.9 [71.1,80.2] 71.0 87.9 78.4 [74.3,82.0] 84.4 [81.5,86.9] 95.1 [92.4,96.8] 73.9 [70.2,77.2] 64.2 [59.3,68.9] Stadiometer/height rod 

available 62.6 [58.4,66.5] 64.2 24.9 [20.4,29.9] 71.3 24.3 [20.8,28.0] 81.5 [77.7,84.8] 53.9 [49.8,57.9] 

Tape measure available 40.9 [37.0,45.1] 78.2 51.8 29.3 [25.4,33.5] 92.0 [88.5,94.5] 63.1 [59.1,66.9] 

Vitamin A supplementation 

available 64.0 [60.6,67.3] 82.1 79.2 [74.8,83.0] 42.8 94.4 [91.4,96.3] 89.6 [87.2,91.6] 49.1 [45.0,53.2] 66.6 [63.0,70.0] 74.7 [69.7,79.1] 

Iron supplementation 

available 61.6 [57.4,65.6] 64.9 50.6 [44.5,56.6] 38.3 15.8 [12.4,20.0] 12.5 [10.2,15.3] 68.4 [64.8,71.8] 4.4 [2.8,6.8] 37.8 [34.1,41.8] 40.5 [35.4,45.8] 

Zinc supplementation 

available 63.7 [60.1,67.2] 54.2 76.3 95.5 [94.3,96.5] 53.6 [49.5,57.6] 44.3 [40.3,48.3] 

Number of facilities 1,437 848 668 917 354 936 519 447 1,160 483 Observation of sick child visits 

Child weight assessed 76.2 [72.6,79.5] 49.8 [44.8,54.8] 26.5 [21.8,31.7] 88.7 [84.8,91.7] 49.7 [44.9,54.6] 64.2 [59.9,68.2] 85.0 [80.2,88.8] 16.1 [13.8,18.7] 45.5 [39.1,52.1] 

Child weight plotted on 

growth chart3 15.5 [12.3,19.3] 36.9 [30.7,43.5] 27.0 [19.7,35.9] 46.3 [40.6,52.0] 24.4 [19.7,29.9] 8.3 [5.9,11.5] 59.1 [52.5,65.4] 21.6 [15.8,28.8] 24.1 [16.7,33.4] 

Provider asked if child 

received vitamin A4 2.7 [2.0,3.6] 23.1 [19.4,27.3] 1.9 [1.3,2.6] 29.7 [25.9,34.0] 1.1 [0.6,1.9] 17.6 [14.6,21.1] 29.6 [25.0,34.7] 3.1 [2.2,4.4] 11.7 [8.7,15.5] 

Asked client about feeding 

or breastfeeding when child is well4 40.1 [37.3,43.0] 44.3 [40.1,48.4] 14.2 [11.9,16.9] 44.1 [40.2,48.1] 17.7 [15.1,20.6] 29.4 [26.3,32.8] 31.1 [27.1,35.4] 27.9 [25.5,30.4] 48.9 [43.6,54.1] 

Asked client about feeding 

or breastfeeding during illness4 25.2 [22.8,27.8] 46.9 [43.1,50.8] 15.5 [13.5,17.7] 43.9 [39.7,48.3] 16.3 [13.9,19.1] 42.4 [38.7,46.1] 18.6 [15.3,22.5] 18.8 [16.9,20.9] 43.9 [38.9,49.0] 

Number of clients5 2,442 1,946 3,329 1,544 2,186 1,709 1,027 4,961 769 Caretakers’ report of sick child visit

Child weight assessed 83.8 [80.7,86.5] 50.6 [45.7,55.5] 45.3 [40.0,50.8] 87.6 [83.9,90.6] 59.1 [54.5,63.5] 70.6 [67.0,73.9] 90.4 [86.3,93.3] 30.5 [28.0,33.1] 46.7 [40.5,53.0] 

Discussed child’s growth 39.4 [36.3,42.6] 23.6 [20.3,27.2] 23.4 [20.0,27.2] 30.7 [27.2,34.4] 14.7 [11.9,18.0] 42.1 [38.3,45.9] 27.6 [23.8,31.9] 37.9 [35.4,40.5] 18.8 [14.8,23.4] 

Reported provider discussed feeding or breastfeeding when child is not ill 27.7 [25.2,30.3] 21.6 [18.4,25.1] 11.5 [9.8,13.5] 28.3 [25.3,31.6] 12.7 [10.6,15.0] 9.1 [7.6,11.0] 39.7 [35.3,44.3] 19.9 [18.2,21.7] 25.1 [20.7,30.0] 

Reported counseling on 

feeding or breastfeeding during illness 24.6 [22.4,27.0] 15.4 [12.7,18.5] 11.5 [9.8,13.4] 22.0 [19.3,24.9] 21.8 [19.1,24.7] 9.6 [7.9,11.6] 26.1 [22.4,30.2] 12.8 [11.3,14.5] 37.5 [32.6,42.6] 

Number of caretakers5 2,442 1,946 3,329 1,544 2,186 1,709 1,027 4,961 769 Provider training6

Recent training on 

breastfeeding 42.7 [39.7,45.8] 27.0 [24.2,29.3] 30.0 [26.9,33.1] 35.0 [32.3,37.5] 21.0 [18.4,24.5] 32.0 [29.0,34.1] 9.0 [7.4,10.1] 43.0 [39.8,45.8] 15.0 [13.9,16.5] 25.0 [21.5,29.7] 

Recent training on early 

and exclusive breastfeeding 27.6 [24.8,30.5] 17.4 [15.6,19.4] 22.5 [19.7,25.6] 23.2 [21.3,25.3] 21.6 [18.5,25.1] 21.5 [19.4,23.8] 6.4 [5.3,7.7] 31.7 [28.9,34.5] 24.7 [23.2,26.3] 16.1 [12.8,20.1] 

Recent training on 

complementary feeding 38.9 [36.0,41.8] 22.5 [20.2,24.9] 27.3 [24.6,30.2] 35.8 [33.2,38.4] 20.6 [17.6,24.0] 27.9 [25.4,30.5] 7.3 [6.2,8.6] 48.7 [45.6,51.8] 19.3 [17.8,20.9] 21.6 [17.8,25.9] 

Recent training on infant 

and young child feeding 20.8 [18.4,23.4] 20.5 [17.8,23.6] n/a 35.0 [32.7,37.4] n/a 6.9 [5.8,8.3] n/a 14.9 [13.4,16.5] 32.1 [30.4,34.0] n/a 

Number of providers 4,169 3,967 2,518 2,538 1,283 3,709 1,719 1,623 6,078 1,590 1 Or a digital standing scale with gradations of 250 grams or less on which an adult can hold a child to be weighed 2 Or a digital standing scale with gradations of 100 grams or less on which an adult can hold a child to be weighed 
48 

3 Filter for older surveys (Kenya, Namibia, Rwanda, and Uganda), question asked only if the above item was asked or performed; filter was applied to current surveys for the purposes of comparability in this report. 4 Breastfeeding and vitamin A items had n/a response options in older surveys; however, newer surveys do not have the n/a or skip option for these particular indicators. For comparability, n/a responses were coded as no for older 

surveys. 

5 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

CI = confidence interval; n/a = not available 
49 

Appendix Table 15 Percent of facilities with capacity to provide nutrition-related care in curative child care 

services, percent of clients observed and caretakers reporting nutrition-related 

counseling among clients attending sick child care visits, and percent of providers with 

training on child nutrition topics, by facility background characteristics, Bangladesh 

SPA 2014 

Facility type Managing authority Locale 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with curative child care 

Child weighing scale available1 91.3 [80.2,96.4] 60.7 [56.5,64.7] 59.9 [55.5,64.1] 84.9 [77.0,90.4] 59.3 [54.9,63.6] 86.3 [80.6,90.6] 

Infant scale available2 91.4 [82.0,96.1] 33.5 [30.0,37.2] 32.1 [28.5,35.9] 78.4 [70.5,84.6] 31.0 [27.4,34.9] 81.6 [76.0,86.1] 

Stadiometer/height rod available 54.6 [43.4,65.3] 62.7 [58.5,66.8] 62.3 [58.0,66.5] 66.3 [58.0,73.7] 62.1 [57.6,66.3] 68.8 [62.4,74.5] 

Tape measure available 51.8 [40.4,63.0] 40.7 [36.7,44.9] 39.6 [35.4,44.0] 62.5 [54.0,70.3] 39.4 [35.2,43.8] 60.1 [53.7,66.2] 

Vitamin A supplementation available 50.8 [39.5,62.1] 64.3 [60.8,67.6] 64.2 [60.6,67.6] 60.4 [51.9,68.3] 64.1 [60.4,67.5] 63.3 [56.8,69.4] 

Iron supplementation available 66.2 [55.2,75.6] 61.5 [57.2,65.6] 60.8 [56.4,65.0] 75.2 [67.6,81.4] 60.7 [56.3,65.0] 72.2 [65.9,77.6] 

Zinc supplementation available 60.3 [48.9,70.7] 63.8 [60.1,67.4] 63.9 [60.1,67.6] 61.3 [52.5,69.3] 64.0 [60.1,67.7] 61.0 [54.4,67.3] 

Observation of sick child visits (n/a) 

Child weight assessed 

Child weight plotted on growth chart Provider asked if child received vitamin A 

Asked client about feeding or 

breastfeeding when child is well 

Asked client about feeding or 

breastfeeding during illness 

 

Caretakers’ report of sick child visit (n/a) 

Child weight assessed Discussed child’s growth 

Reported provider discussed feeding or 

breastfeeding when child is not ill 

Reported counseling on feeding or 

breastfeeding during illness 

 

Provider training3 

Recent training on breastfeeding 18.4 [14.6,22.9] 45.3 [42.0,48.7] 45.1 [41.7,48.6] 27.1 [21.8,33.2] 48.2 [44.4,52.1] 24.9 [22.0,27.9] 

Recent training on early and exclusive 

breastfeeding 16.3 [12.0,21.8] 28.8 [25.8,32.0] 29.0 [25.9,32.3] 18.2 [14.2,23.1] 29.6 [26.1,33.3] 21.1 [18.3,24.1] 

Recent training on complementary 

feeding 15.7 [12.2,20.0] 41.4 [38.2,44.6] 41.3 [38.1,44.6] 23.3 [18.0,29.6] 44.3 [40.7,48.0] 21.3 [18.5,24.3] 

Recent training on infant and young child 

feeding 15.6 [11.3,21.3] 21.3 [18.8,24.1] 20.9 [18.3,23.8] 20.1 [15.5,25.5] 21.0 [18.1,24.2] 20.1 [17.2,23.3] 

1 Or a digital standing scale with gradations of 250 grams or less on which an adult can hold a child to be weighed 2 Or a digital standing scale with gradations of 100 grams or less on which an adult can hold a child to be weighed 3 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

CI = confidence interval; n/a = not available 

 

 
50 

Appendix Table 16 Percent of facilities with capacity to provide nutrition-related care in curative child care 

services, percent of clients observed and caretakers reporting nutrition-related 

counseling among clients attending sick child care visits, and percent of providers with 

training on child nutrition topics, by facility background characteristics, Haiti SPA 2013 

Facility type Managing authority Locale 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with curative child care 

Child weighing scale available1 68.6 70.9 70.2 70.8 69.7 72.0 

Infant scale available2 92.4 71.5 79.2 70.7 70.7 79.7 

Stadiometer/height rod available 78.1 62.3 71.7 59.4 64.5 63.8 

Tape measure available 78.1 78.2 82.0 75.7 79.9 75.3 

Vitamin A supplementation available 68.6 84.2 84 80.9 87.6 73.4 

Iron supplementation available 71.4 63.9 61.9 66.8 61.7 70.2 

Zinc supplementation available 28.9 55.8 63.6 48.4 58.7 47.1 

Observation of sick child visits 

Child weight assessed 72.3 [64.1,79.3] 78.1 [74.4,81.5] 75.7 [69.8,80.8] 76.6 [71.9,80.7] 75.9 [70.7,80.5] 76.5 [71.3,80.9] 

Child weight plotted on growth chart3

 15.2 [8.3,26.2] 15.6 [12.6,19.1] 15.9 [10.3,23.8] 15.2 [11.8,19.3] 14.4 [10.1,20.0] 16.5 [12.0,22.1] 

Provider asked if child received vitamin A4

 1.5 [0.7,2.9] 3.3 [2.4,4.6] 2.1 [1.4,3.3] 3.1 [2.1,4.5] 2.6 [1.8,3.8] 2.8 [1.8,4.3] 

Asked client about feeding or 

breastfeeding when child is well4 40.7 [34.8,46.9] 39.8 [36.8,43.0] 39.9 [35.8,44.2] 40.3 [36.5,44.2] 38.9 [34.9,43.0] 41.2 [37.2,45.4] 

Asked client about feeding or 

breastfeeding during illness4 22.1 [17.5,27.7] 26.8 [24.1,29.6] 22.8 [19.6,26.4] 26.9 [23.5,30.5] 25.3 [22.0,28.8] 25.2 [21.7,29.0] 

Caretakers’ report of sick child visit5 

Child weight assessed 81.7 [74.3,87.3] 84.9 [81.7,87.5] 80.7 [75.5,85.0] 85.9 [82.0,89.1] 81.5 [76.5,85.6] 85.9 [81.8,89.2] 

Discussed child’s growth 37.8 [31.3,44.8] 40.2 [36.9,43.6] 38.1 [33.8,42.5] 40.3 [36.0,44.7] 37.9 [33.8,42.2] 40.7 [36.2,45.5] 

Reported provider discussed feeding or 

breastfeeding when child is not ill 28.0 [22.5,34.2] 27.5 [25.1,30.1] 28.0 [24.3,31.9] 27.5 [24.2,31.0] 25.0 [22.0,28.2] 30.1 [26.3,34.1] 

Reported counseling on feeding or 

breastfeeding during illness 25.2 [20.4,30.7] 24.3 [22.0,26.8] 26.1 [22.4,30.3] 23.6 [20.9,26.5] 21.7 [18.8,24.8] 27.3 [24.0,30.8] 

Provider training6 

Recent training on breastfeeding 21.3 [17.0,26.3] 29.6 [26.8,32.5] 25.2 [21.2,29.7] 27.7 [24.8,30.9] 31.3 [27.8,35.1] 23.3 [20.1,26.8] 

Recent training on early and exclusive 

breastfeeding 19.2 [15.3,23.7] 16.5 [14.6,18.5] 15.4 [13.0,18.2] 18.9 [16.3,21.7] 18.7 [15.8,21.9] 16.5 [14.2,19.1] 

Recent training on complementary feeding 18.3 [14.3,23.2] 24.7 [22.1,27.5] 21.2 [17.5,25.3] 23.4 [20.6,26.5] 25.6 [22.4,29.1] 20.2 [17.2,23.6] 

Recent training on infant and young child 

feeding 26.4 [20.3,33.6] 17.3 [15.1,19.8] 21.2 [16.2,27.2] 20.0 [17.2,23.2] 17.3 [14.2,20.8] 22.8 [18.8,27.4] 

 1 Or a digital standing scale with gradations of 250 grams or less on which an adult can hold a child to be weighed 2 Or a digital standing scale with gradations of 100 grams or less on which an adult can hold a child to be weighed 3 Filter for older surveys (Kenya, Namibia, Rwanda, and Uganda), question asked only if the above item was asked or performed; filter was applied to current 

surveys for the purposes of comparability in this report. 

4 Breastfeeding and vitamin A items had n/a response options in older surveys; however, newer surveys do not have the n/a or skip option for these particular 

indicators. For comparability, n/a responses were coded as no for older surveys. 5 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

CI = confidence interval 

 

 
51 

Appendix Table 17 Percent of facilities with capacity to provide nutrition-related care in curative child care 

services, percent of clients observed and caretakers reporting nutrition-related 

counseling among clients attending sick child care visits, and percent of providers with 

training on child nutrition topics, by facility background characteristics, Kenya SPA 

2010

Facility type Managing authority Locale (n/a) 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with curative child care 

Child weighing scale available1 83.8 [78.4,88.1] 68.0 [61.8,73.6] 82.8 [75.0,88.5] 55.4 [46.5,63.9] Infant scale available2 98.7 [95.9,99.6] 74.1 [68.8,78.7] 91.4 [86.4,94.7] 60.1 [51.5,68.1] Stadiometer/height rod available 50.1 [43.8,56.4] 22.8 [18.1,28.3] 31.2 [24.4,39.0] 18.4 [13.1,25.1] Tape measure available (n/a) Vitamin A supplementation available 94.2 [90.0,96.7] 77.9 [73.2,82.1] 96.1 [92.7,97.9] 61.9 [53.6,69.6] Iron supplementation available 62.0 [56.3,67.4] 49.7 [43.1,56.2] 40.5 [32.6,49.0] 60.8 [51.6,69.3] Zinc supplementation available (n/a) 

Observation of sick child visits 

Child weight assessed 50.9 [44.8,56.9] 49.4 [43.2,55.7] 48.7 [42.9,54.6] 52.7 [43.0,62.1] Child weight plotted on growth chart3

 33.4 [26.8,40.7] 38.0 [30.2,46.4] 38.4 [31.1,46.2] 33.1 [21.8,46.7] Provider asked if child received vitamin A4

 15.7 [12.3,19.7] 25.4 [20.7,30.8] 24.9 [20.3,30.2] 18.1 [12.8,25.1] Asked client about feeding or breastfeeding 

when child is well4 44.1 [39.2,49.2] 44.3 [39.2,49.5] 41.9 [37.3,46.7] 50.6 [42.1,59.1] Asked client about feeding or breastfeeding 

during illness4 49.4 [44.2,54.5] 46.2 [41.4,51.0] 44.4 [39.7,49.1] 53.9 [47.4,60.2] 

Caretakers’ report of sick child visit5 

Child weight assessed 53.5 [47.7,59.1] 49.8 [43.6,55.9] 49.5 [43.9,55.2] 53.7 [43.8,63.3] Discussed child’s growth 22.9 [19.3,27.0] 23.8 [19.7,28.4] 23.9 [19.9,28.4] 22.8 [17.7,28.7] Reported provider discussed feeding or 

breastfeeding when child is not ill 19.3 [15.9,23.3] 22.3 [18.3,26.8] 21.7 [17.9,26.0] 21.3 [15.9,27.9] 

Reported counseling on feeding or 

breastfeeding during illness 13.4 [10.4,17.1] 16.0 [12.6,20.0] 15.4 [12.1,19.3] 15.3 [11.2,20.7] 

 

Provider training6 

Recent training on breastfeeding 27.1 [24.5,29.9] 31.5 [27.3,36.1] 29.9 [26.0,34.1] 29.9 [25.4,34.8] 

Recent training on early and exclusive 

breastfeeding 25.1 [22.3,28.1] 21.5 [17.7,25.9] 21.0 [17.7,24.7] 24.4 [19.9,29.5] Recent training on complementary feeding 26.0 [23.4,28.7] 28.2 [24.3,32.4] 26.5 [23.2,30.0] 28.3 [23.9,33.2] Recent training on infant and young child 

feeding (n/a) 

1

 Or a digital standing scale with gradations of 250 grams or less on which an adult can hold a child to be weighed 2 Or a digital standing scale with gradations of 100 grams or less on which an adult can hold a child to be weighed 3 Filter for older surveys (Kenya, Namibia, Rwanda, and Uganda), question asked only if the above item was asked or performed; filter was applied to current 

surveys for the purposes of comparability in this report. 

4 Breastfeeding and vitamin A items had n/a response options in older surveys; however, newer surveys do not have the n/a or skip option for these particular 

indicators. For comparability, n/a responses were coded as no for older surveys. 5 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

n/a = not available; CI = confidence interval 

 

 
52 

Appendix Table 18 Percent of facilities with capacity to provide nutrition-related care in curative child care 

services, percent of clients observed and caretakers reporting nutrition-related 

counseling among clients attending sick child care visits, and percent of providers with 

training on child nutrition topics, by facility background characteristics, Malawi SPA 

2013-14

Facility type Managing authority Locale 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with curative child care 

Child weighing scale available1 88.2 71.7 82.9 64.6 79.2 59.8 

Infant scale available2 96.2 67.6 87.4 55.2 79.5 50.3 

Stadiometer/height rod available 83.5 69.7 89.6 53.7 80.1 49.9 

Tape measure available 64.5 50.2 59.8 44.2 57.0 39.3 

Vitamin A supplementation available 55.5 41.1 45.8 40.0 46.0 35.1 

Iron supplementation available 48.1 37.0 27.8 48.4 31.8 54.1 

Zinc supplementation available 91.7 74.3 86.3 66.7 79.9 67.6 

Observation of sick child visits 

Child weight assessed 45.8 [35.1,57.0] 15.7 [13.3,18.5] 25.0 [19.1,31.9] 31.2 [25.9,37.0] 20.3 [16.1,25.3] 40.0 [29.5,51.5] 

Child weight plotted on growth chart3

 28.2 [17.4,42.3] 25.0 [18.2,33.3] 30.4 [20.4,42.7] 18.5 [11.8,27.8] 24.0 [16.5,33.5] 30.4 [18.1,46.2] 

Provider asked if child received vitamin A4

 1.5 [0.7,3.6] 2.0 [1.4,2.8] 1.5 [0.9,2.4] 3.0 [1.8,4.8] 2.0 [1.4,3.0] 1.4 [0.7,3.1] 

Asked client about feeding or 

breastfeeding when child is well4

 12.3 [7.7,19.1] 15.2 [13.1,17.7] 12.8 [10.1,16.1] 18.6 [15.0,22.8] 15.1 [12.9,17.6] 12.2 [7.4,19.6] 

Asked client about feeding or 

breastfeeding during illness4 13.8 [10.1,18.6] 16.5 [14.3,18.8] 13.2 [11.0,15.8] 22.6 [19.0,26.8] 17.7 [15.4,20.3] 10.7 [7.5,15.0] 

Caretakers’ report of sick child visit5 

Child weight assessed 76.5 [68.2,83.1] 28.0 [25.0,31.3] 45.6 [38.9,52.5] 44.5 [38.6,50.5] 32.5 [28.4,37.0] 73.5 [64.7,80.8] 

Discussed child’s growth 35.5 [27.6,44.2] 16.7 [14.6,19.1] 23.6 [19.3,28.5] 22.7 [19.2,26.6] 18.6 [16.0,21.6] 33.9 [26.1,42.7] 

Reported provider discussed feeding or 

breastfeeding when child is not ill 11.1 [7.2,16.5] 11.8 [10.4,13.3] 11.0 [8.9,13.6] 13.1 [10.7,15.8] 12.1 [10.5,13.8] 10.3 [6.4,16.0] 

Reported counseling on feeding or 

breastfeeding during illness 10.4 [7.0,15.3] 12.1 [10.6,13.7] 10.2 [8.3,12.5] 15.4 [12.7,18.6] 12.6 [11.1,14.3] 9.1 [5.5,14.5] 

Provider training6 

Recent training on breastfeeding 32.5 [28.2,37.2] 35.7 [32.7,38.8] 35.6 [32.0,39.3] 33.9 [30.5,37.5] 35.8 [32.6,39.1] 32.8 [29.0,36.9] 

Recent training on early and exclusive 

breastfeeding 27.9 [24.1,32.1] 21.5 [19.3,24.0] 25.6 [22.8,28.6] 19.9 [17.4,22.8] 24.3 [21.7,27.0] 21.0 [18.1,24.2] 

Recent training on complementary feeding 31.6 [27.4,36.1] 37.3 [34.2,40.4] 38.4 [34.8,42.1] 32.1 [28.6,35.7] 38.3 [35.1,41.6] 30.3 [26.4,34.4] 

Recent training on infant and young child 

feeding 39.6 [35.0,44.3] 33.4 [30.7,36.1] 37.2 [34.0,40.5] 32.0 [28.7,35.5] 35.1 [32.2,38.1] 34.8 [30.9,38.9] 

1

 Or a digital standing scale with gradations of 250 grams or less on which an adult can hold a child to be weighed 2 Or a digital standing scale with gradations of 100 grams or less on which an adult can hold a child to be weighed 3 Filter for older surveys (Kenya, Namibia, Rwanda, and Uganda), question asked only if the above item was asked or performed; filter was applied to current 

surveys for the purposes of comparability in this report. 

4 Breastfeeding and vitamin A items had n/a response options in older surveys; however, newer surveys do not have the n/a or skip option for these particular 

indicators. For comparability, n/a responses were coded as no for older surveys. 5 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

CI = confidence interval 

 

 
53 

Appendix Table 19 Percent of facilities with capacity to provide nutrition-related care in curative child care 

services, percent of clients observed and caretakers reporting nutrition-related 

counseling among clients attending sick child care visits, and percent of providers with 

training on child nutrition topics, by facility background characteristics, Namibia SPA 

2009 

Facility type Managing authority Locale (n/a) 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with curative child care 

Child weighing scale available1 60.6 79.1 80.0 42.3 Infant scale available2 100.0 86.6 89.3 80.8 Stadiometer/height rod available (n/a) Tape measure available (n/a) Vitamin A supplementation available 90.9 94.7 98.7 38.5 Iron supplementation available 27.3 14.6 13.7 42.3 Zinc supplementation available (n/a) 

Observation of sick child visits 

Child weight assessed 91.1 [75.3,97.2] 88.5 [84.4,91.6] 89.9 [85.9,92.8] 48.2 [23.9,73.4] Child weight plotted on growth chart3

 47.3 [21.5,74.7] 46.2 [40.5,52.0] 47.3 [41.3,53.4] 40.1 [12.9,75.2] Provider asked if child received vitamin A4

 29.7 [15.1,50.2] 29.7 [25.7,34.1] 30.9 [26.7,35.4] 17.2 [2.8,59.8] Asked client about feeding or 

breastfeeding when child is well4 56.1 [40.6,70.6] 43.2 [39.2,47.3] 43.6 [39.4,47.8] 56.5 [33.7,76.8] Asked client about feeding or 

breastfeeding during illness4 43.1 [26.3,61.6] 44.0 [39.6,48.5] 43.2 [38.7,47.9] 48.0 [25.4,71.4] 

Caretakers’ report of sick child visit5 

Child weight assessed 83.6 [73.3,90.5] 87.9 [83.9,91.0] 89.5 [85.6,92.4] 44.2 [21.7,69.4] Discussed child’s growth 24.5 [15.8,35.9] 31.2 [27.5,35.1] 31.1 [27.2,35.2] 22.7 [9.9,43.7] Reported provider discussed feeding or 

breastfeeding when child is not ill 32.2 [19.6,48.1] 28.1 [24.9,31.4] 27.3 [24.0,30.8] 27 [15.6,42.6] 

Reported counseling on feeding or 

breastfeeding during illness 18.4 [10.3,30.6] 22.2 [19.4,25.3] 22.6 [19.7,25.8] 12.8 [6.0,25.1] 

Provider training6 

Recent training on breastfeeding 21.1 [15.7,27.7] 22.4 [19.3,25.9] 21.8 [18.8,25.1] 19.2 [11.3,30.8] Recent training on early and exclusive 

breastfeeding 25.3 [18.9,33.0] 20.1 [17.2,23.2] 23.9 [20.2,28.2] 11.9 [6.7,20.2] 

Recent training on complementary feeding 21.9 [15.9,29.4] 20.7 [17.8,24.0] 21.3 [18.1,24.8] 15.7 [9.4,25.1] Recent training on infant and young child 

feeding (n/a) 

1 Or a digital standing scale with gradations of 250 grams or less on which an adult can hold a child to be weighed 2 Or a digital standing scale with gradations of 100 grams or less on which an adult can hold a child to be weighed 3 Filter for older surveys (Kenya, Namibia, Rwanda, and Uganda), question asked only if the above item was asked or performed; filter was applied to current 

surveys for the purposes of comparability in this report. 

4 Breastfeeding and vitamin A items had n/a response options in older surveys; however, newer surveys do not have the n/a or skip option for these particular 

indicators. For comparability, n/a responses were coded as no for older surveys. 5 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

n/a = not available; CI = confidence interval 

 

 
54 

Appendix Table 20 Percent of facilities with capacity to provide nutrition-related care in curative child care 

services, percent of clients observed and caretakers reporting nutrition-related 

counseling among clients attending sick child care visits, and percent of providers with 

training on child nutrition topics, by facility background characteristics, Nepal SPA 2015

Facility type Managing authority Locale (n/a) 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with curative child care 

Child weighing scale available1 36.5 [28.7,44.9] 46.4 [41.6,51.3] 46.5 [41.8,51.3] 31.3 [22.1,42.3] Infant scale available2 82.8 [74.7,88.8] 77.9 [73.5,81.8] 78.3 [74.0,82.1] 79.3 [68.9,86.9] 

Stadiometer/height rod available 49.8 [41.8,57.8] 21.6 [18.0,25.8] 22.6 [19.1,26.6] 45.8 [35.9,56.0] Tape measure available 50.6 [42.2,58.9] 27.1 [23.0,31.8] 27.8 [23.7,32.3] 49.3 [38.9,59.7] 

Vitamin A supplementation available 50.3 [42.2,58.4] 93.6 [90.9,95.6] 93.2 [90.6,95.2] 41.8 [31.5,52.8] 

Iron supplementation available 48.2 [39.8,56.8] 8.9 [6.6,11.9] 9.3 [7.1,12.2] 54.2 [43.5,64.4] 

Zinc supplementation available 67.3 [58.9,74.8] 98.5 [97.2,99.2] 98.2 [97.0,98.9] 60.5 [49.8,70.2] 

Observation of sick child visits 

Child weight assessed 59.2 [50.0,67.8] 45.2 [39.7,50.8] 45.9 [41.0,51.0] 72.8 [59.3,83.1] Child weight plotted on growth chart3

 16.8 [9.9,27.0] 29.2 [23.4,35.8] 28.4 [22.9,34.6] 9.2 [3.2,23.5] Provider asked if child received vitamin A4

 0.8 [0.3,2.3] 1.2 [0.6,2.3] 1.2 [0.7,2.1] 0.6 [0.2,2.2] Asked client about feeding or breastfeeding 

when child is well4 23.4 [18.2,29.4] 15.0 [12.2,18.3] 16.5 [13.8,19.6] 25.0 [17.7,34.0] Asked client about feeding or breastfeeding 

during illness4 20.3 [15.5,26.0] 14.5 [11.8,17.6] 14.8 [12.4,17.5] 25.6 [16.9,36.8] 

Caretakers’ report of sick child visit5 

Child weight assessed 74.7 [68.1,80.4] 51.6 [45.8,57.3] 54.3 [49.3,59.3] 87.9 [79.2,93.2] Discussed child’s growth 14.5 [10.4,19.8] 14.8 [11.3,19.1] 14.8 [11.9,18.4] 14.0 [7.5,24.5] 

Reported provider discussed feeding or 

breastfeeding when child is not ill 14.0 [10.8,18.1] 12.0 [9.5,15.0] 12.4 [10.2,15.0] 14.3 [9.6,20.7] 

Reported counseling on feeding or 

breastfeeding during illness 19.4 [15.5,23.9] 22.9 [19.5,26.7] 21.6 [18.8,24.8] 22.4 [15.6,31.2] 

Provider training6 

Recent training on breastfeeding 12.0 [10.0,14.5] 38.4 [35.2,41.8] 36.7 [33.8,39.8] 7.4 [5.2,10.4] Recent training on early and exclusive 

breastfeeding 10.4 [8.3,12.9] 25.6 [22.9,28.5] 24.7 [22.3,27.4] 6.8 [4.5,10.0] 

Recent training on complementary feeding 10.3 [8.4,12.5] 34.2 [31.0,37.6] 32.7 [29.8,35.8] 5.6 [3.8,8.2] 

Recent training on infant and young child 

feeding 6.9 [5.4,8.8] 6.8 [5.4,8.6] 7.6 [6.2,9.2] 3.7 [2.5,5.4] 

1

 Or a digital standing scale with gradations of 250 grams or less on which an adult can hold a child to be weighed 2 Or a digital standing scale with gradations of 100 grams or less on which an adult can hold a child to be weighed 3 Filter for older surveys (Kenya, Namibia, Rwanda, and Uganda), question asked only if the above item was asked or performed; filter was applied to current 

surveys for the purposes of comparability in this report. 

4 Breastfeeding and vitamin A items had n/a response options in older surveys; however, newer surveys do not have the n/a or skip option for these particular 

indicators. For comparability, n/a responses were coded as no for older surveys. 5 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

n/a = not available; CI = confidence interval 

 

 
55 

Appendix Table 21 Percent of facilities with capacity to provide nutrition-related care in curative child care 

services, percent of clients observed and caretakers reporting nutrition-related 

counseling among clients attending sick child care visits, and percent of providers with 

training on child nutrition topics, by facility background characteristics, Rwanda SPA 

2007 

Facility type Managing authority Locale (n/a) 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with curative child care 

Child weighing scale available1 87.5 [73.3,94.7] 68.7 [64.5,72.6] 69.5 [64.3,74.2] 87.5 [64.8,76.5] Infant scale available2 97.5 [82.9,99.7] 83.3 [80.2,86.0] 90.5 [86.9,93.2] 97.5 [70.3,80.4] 

Stadiometer/height rod available Tape measure available 

Vitamin A supplementation available (n/a) Iron supplementation available 77.5 [61.0,88.4] 67.6 [63.9,71.1] 74.8 [69.6,79.3] 59.3 [54.6,63.9] Zinc supplementation available (n/a) 

Observation of sick child visits 

Child weight assessed 59.6 [45.0,72.7] 64.5 [60.0,68.7] 64.2 [59.0,69.2] 59.6 [56.7,70.8] Child weight plotted on growth chart3

 11.9 [3.1,36.2] 8.1 [5.7,11.4] 8.2 [5.2,12.6] 11.9 [5.0,14.0] Provider asked if child received vitamin A4

 12.1 [4.1,30.7] 18.0 [14.8,21.6] 17.0 [13.3,21.4] 12.1 [13.8,25.0] Asked client about feeding or 

breastfeeding when child is well4 39.4 [26.0,54.6] 28.8 [25.6,32.2] 27.9 [24.0,32.1] 39.4 [27.1,37.9] Asked client about feeding or 

breastfeeding during illness4 50.5 [36.2,64.8] 41.9 [38.1,45.7] 38.2 [33.9,42.7] 50.5 [43.5,56.3] 

Caretakers’ report of sick child visit5 

Child weight assessed 67.7 [52.5,79.8] 70.7 [67.0,74.2] 70.1 [65.4,74.3] 67.7 [65.8,76.6] Discussed child’s growth 51.5 [36.3,66.4] 41.5 [37.6,45.5] 40.6 [35.9,45.4] 51.5 [38.4,51.4] Reported provider discussed feeding or 

breastfeeding when child is not ill 10.1 [5.5,17.7] 9.1 [7.5,11.0] 8.8 [6.9,11.2] 9.7 [7.2,12.9] 

Reported counseling on feeding or 

breastfeeding during illness 13.1 [5.8,27.1] 9.4 [7.7,11.4] 7.7 [5.8,10.2] 13.0 [9.9,16.9] 

Provider training6 

Recent training on breastfeeding 6.9 [4.3,10.8] 8.9 [7.6,10.5] 8.4 [6.9,10.2] 6.9 [7.1,11.6] Recent training on early and exclusive 

breastfeeding 5.9 [3.5,9.9] 6.5 [5.3,7.9] 6.4 [5.0,8.1] 5.9 [4.6,8.7] 

Recent training on complementary feeding 5.9 [3.6,9.6] 7.5 [6.3,9.0] 7.4 [6.0,9.1] 5.9 [5.4,9.5] Recent training on infant and young child 

feeding (n/a) 

1 Or a digital standing scale with gradations of 250 grams or less on which an adult can hold a child to be weighed 2 Or a digital standing scale with gradations of 100 grams or less on which an adult can hold a child to be weighed 3 Filter for older surveys (Kenya, Namibia, Rwanda, and Uganda), question asked only if the above item was asked or performed; filter was applied to current 

surveys for the purposes of comparability in this report. 

4 Breastfeeding and vitamin A items had NA response options in older surveys; however, newer surveys do not have the NA or skip option for these particular 

indicators. For comparability, NA responses were coded as no for older surveys. 5 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

n/a = not available; CI = confidence interval 

 

 
56 

Appendix Table 22 Percent of facilities with capacity to provide nutrition-related care in curative child care 

services, percent of clients observed and caretakers reporting nutrition-related 

counseling among clients attending sick child care visits, and percent of providers with 

training on child nutrition topics, by facility background characteristics, Senegal SPA 

2016 

Facility type Managing authority Locale 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with curative child care 

Child weighing scale available1 53.0 [33.7,71.4] 67.1 [62.8,71.1] 67.5 [63.1,71.6] 50.1 [38.3,62.0] 66.8 [61.9,71.3] 61.2 [53.3,68.6] 

Infant scale available2 87.1 [70.0,95.1] 95.3 [92.2,97.2] 97.3 [94.7,98.6] 81.6 [68.6,90.0] 98.2 [95.6,99.3] 88.0 [80.8,92.8] 

Stadiometer/height rod available 62.3 [40.9,79.8] 94.4 [91.4,96.4] 82.7 [78.6,86.2] 73.9 [62.7,82.7] 80.8 [76.1,84.7] 83.1 [76.1,88.4] 

Tape measure available 85.5 [67.6,94.3] 95.6 [92.8,97.4] 93.9 [90.0,96.3] 80.6 [68.9,88.6] 93.6 [88.9,96.4] 88.6 [82.1,92.9] 

Vitamin A supplementation available 14.4 [5.1,34.8] 63.8 [58.7,68.7] 51.3 [46.8,55.7] 36.0 [26.0,47.2] 50.5 [45.8,55.2] 46.0 [38.5,53.6] 

Iron supplementation available 6.5 [1.4,24.9] 5.5 [3.4,8.7] 3.9 [2.3,6.5] 7.3 [2.8,18.1] 4.6 [2.7,7.9] 3.9 [1.7,8.8] 

Zinc supplementation available 23.1 [12.1,39.5] 69.3 [64.3,73.9] 56.1 [51.7,60.4] 38.0 [27.4,49.9] 58.4 [53.8,62.7] 42.8 [34.5,51.5] 

Observation of sick child visits 

Child weight assessed 67.8 [44.4,84.8] 86.0 [81.0,89.8] 87.3 [82.8,90.8] 69.6 [48.4,84.8] 84.6 [77.2,89.9] 85.4 [78.6,90.3] 

Child weight plotted on growth chart3

 32.5 [15.3,56.3] 60.3 [53.4,66.8] 60.6 [53.8,67.0] 46.8 [20.2,75.4] 58.9 [50.6,66.8] 59.3 [48.1,69.6] 

Provider asked if child received vitamin A4

 1.2 [0.2,6.7] 31.2 [26.4,36.6] 32.4 [27.5,37.6] 11.5 [5.0,24.6] 28.7 [23.4,34.6] 30.7 [23.2,39.3] 

Asked client about feeding or 

breastfeeding when child is well4 36.1 [23.6,50.7] 30.8 [26.6,35.3] 31.5 [27.0,36.3] 28.5 [19.5,39.5] 31.4 [26.4,36.9] 30.7 [24.2,38.1] 

Asked client about feeding or 

breastfeeding during illness4 13.3 [6.5,25.4] 18.9 [15.5,23.0] 18.4 [14.9,22.6] 20.0 [12.3,31.0] 20.0 [16.0,24.8] 17.0 [12.0,23.6] 

Caretakers’ report of sick child visit5 

Child weight assessed 91.3 [78.7,96.8] 90.3 [86.0,93.4] 92.3 [88.8,94.8] 77.7 [55.3,90.8] 87.6 [80.5,92.4] 93.5 [89.2,96.2] 

Discussed child’s growth 31.0 [13.9,55.7] 27.4 [23.5,31.8] 28.2 [24.0,32.8] 24.1 [15.0,36.3] 28.7 [24.1,33.8] 26.4 [20.3,33.6]

Reported provider discussed feeding or 

breastfeeding when child is not ill 41.0 [25.2,58.9] 39.6 [35.1,44.4] 40.9 [36.1,45.8] 32.1 [21.8,44.4] 43.8 [37.9,50.0] 35.1 [28.4,42.3] 

Reported counseling on feeding or 

breastfeeding during illness 31.2 [15.4,52.9] 25.8 [22.0,30.1] 26.7 [22.6,31.2] 22.2 [14.3,32.8] 27.9 [22.5,34.0] 24.1 [18.8,30.3] 

Provider training6 

Recent training on breastfeeding 30.3 [22.7,39.0] 41.7 [38.4,45.0] 45.4 [42.1,48.8] 26.1 [20.0,33.3] 49.8 [45.7,53.9] 34.8 [31.0,38.8] 

Recent training on early and exclusive 

breastfeeding 36.2 [25.7,48.2] 32.6 [29.7,35.8] 32.7 [29.7,35.8] 25.4 [18.7,33.4] 35.1 [31.6,38.7] 27.9 [23.6,32.6] 

Recent training on complementary feeding 32.0 [23.1,42.4] 48.1 [44.7,51.5] 51.5 [48.1,54.8] 31.5 [23.5,40.7] 56.6 [52.7,60.5] 39.8 [35.3,44.4] 

Recent training on infant and young child 

feeding 22.4 [16.8,29.3] 15.4 [13.7,17.2] 15.2 [13.6,17.0] 13.1 [9.2,18.3] 14.3 [12.2,16.6] 15.7 [13.5,18.1] 

1 Or a digital standing scale with gradations of 250 grams or less on which an adult can hold a child to be weighed 2 Or a digital standing scale with gradations of 100 grams or less on which an adult can hold a child to be weighed 3 Filter for older surveys (Kenya, Namibia, Rwanda, and Uganda), question asked only if the above item was asked or performed; filter was applied to current 

surveys for the purposes of comparability in this report. 

4 Breastfeeding and vitamin A items had n/a response options in older surveys; however, newer surveys do not have the n/a or skip option for these particular 

indicators. For comparability, n/a responses were coded as no for older surveys. 5 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

CI = confidence interval

 

 
57 

Appendix Table 23 Percent of facilities with capacity to provide nutrition-related care in curative child care 

services, percent of clients observed and caretakers reporting nutrition-related 

counseling among clients attending sick child care visits, and percent of providers with 

training on child nutrition topics, by facility background characteristics, Tanzania SPA 

2014-15

Facility type Managing authority Locale 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with curative child care 

Child weighing scale available1 90.5 [86.0,93.7] 82.3 [78.9,85.3] 89.4 [86.0,92.0] 63.9 [55.7,71.4] 89.1 [85.7,91.7] 64.6 [56.4,72.1] 

Infant scale available2 90.9 [72.3,97.4] 73.2 [69.4,76.6] 81.6 [77.5,85.1] 52.4 [44.6,60.0] 82.2 [78.2,85.7] 50.4 [42.4,58.3] 

Stadiometer/height rod available 81.2 [75.5,85.8] 52.8 [48.6,56.9] 57.4 [52.7,61.9] 44.1 [36.0,52.5] 53.9 [49.2,58.5] 53.8 [45.9,61.5] 

Tape measure available 68.4 [58.0,77.2] 62.9 [58.7,66.8] 67.7 [63.2,71.8] 50.3 [41.6,59.0] 67.0 [62.5,71.3] 52.1 [44.3,59.7] 

Vitamin A supplementation available 50.8 [42.6,58.9] 67.3 [63.5,70.8] 75.5 [71.4,79.1] 41.9 [34.4,49.8] 73.0 [68.8,76.9] 48.7 [41.5,55.9] 

Iron supplementation available 48.4 [40.2,56.6] 37.4 [33.5,41.5] 39.5 [35.1,44.0] 33.3 [26.1,41.4] 38.5 [34.2,42.9] 36.1 [29.3,43.6] 

Zinc supplementation available 72.3 [65.8,77.9] 43.1 [39.0,47.3] 41.5 [37.0,46.2] 51.9 [43.6,60.1] 43.1 [38.6,47.7] 47.5 [39.8,55.4] 

Observation of sick child visits 

Child weight assessed 19.6 [15.4,24.5] 15.5 [13.0,18.5] 14.8 [12.3,17.7] 21.6 [16.2,28.1] 16.5 [14.0,19.5] 15.0 [10.5,20.9] 

Child weight plotted on growth chart3

 14.8 [9.1,23.4] 22.9 [16.1,31.5] 24.8 [17.4,34.0] 12.4 [7.4,20.0] 24.9 [17.3,34.5] 12.6 [7.9,19.3] 

Provider asked if child received vitamin A4

 3.6 [2.6,4.9] 3.1 [2.1,4.5] 3.3 [2.2,4.8] 2.5 [1.7,3.8] 3.4 [2.3,5.2] 2.4 [1.6,3.6] 

Asked client about feeding or 

breastfeeding when child is well4 34.4 [30.5,38.4] 26.9 [24.2,29.7] 26.4 [23.7,29.3] 34.2 [29.8,38.9] 26.9 [24.0,30.0] 30.3 [26.6,34.4] 

Asked client about feeding or 

breastfeeding during illness4 22.5 [19.4,25.9] 18.2 [16.1,20.6] 18.6 [16.5,21.0] 19.6 [15.6,24.2] 18.9 [16.5,21.6] 18.5 [15.3,22.2] 

Caretakers’ report of sick child visit5 

Child weight assessed 36.8 [32.3,41.6] 29.5 [26.7,32.4] 28.3 [25.5,31.2] 39.8 [33.9,46.0] 30.3 [27.2,33.5] 31.1 [26.5,36.0] 

Discussed child’s growth 38.8 [35.4,42.2] 37.7 [34.9,40.7] 37.3 [34.4,40.4] 40.2 [35.5,45.1] 38.0 [34.8,41.4] 37.5 [33.8,41.3]

Reported provider discussed feeding or 

breastfeeding when child is not ill 20.6 [17.8,23.8] 19.8 [17.8,21.8] 19.5 [17.6,21.6] 21.4 [18.0,25.3] 20.0 [18.0,22.2] 19.6 [16.4,23.2] 

Reported counseling on feeding or 

breastfeeding during illness 12.2 [9.9,14.9] 12.9 [11.2,14.8] 12.9 [11.2,14.8] 12.3 [9.3,16.2] 12.2 [10.5,14.2] 14.2 [11.2,17.9] 

Provider training6 

Recent training on breastfeeding 12.9 [11.4,14.5] 15.7 [14.2,17.3] 17.9 [16.3,19.6] 10.2 [8.3,12.4] 17.4 [15.6,19.4] 11.8 [10.1,13.8] 

Recent training on early and exclusive 

breastfeeding 21.4 [19.4,23.6] 25.5 [23.7,27.5] 29.7 [27.6,31.8] 15.7 [13.6,18.0] 30.5 [28.2,32.8] 16.3 [14.3,18.5] 

Recent training on complementary feeding 16.5 [14.7,18.6] 20.0 [18.2,21.9] 22.7 [20.7,24.7] 13.1 [11.1,15.5] 22.1 [19.9,24.4] 15.2 [13.2,17.4] 

Recent training on infant and young child 

feeding 31.0 [28.6,33.4] 32.4 [30.3,34.6] 37.1 [34.8,39.4] 23.1 [20.4,26.0] 37.1 [34.7,39.5] 24.8 [22.3,27.6] 

 

1 Or a digital standing scale with gradations of 250 grams or less on which an adult can hold a child to be weighed 2 Or a digital standing scale with gradations of 100 grams or less on which an adult can hold a child to be weighed 3 Filter for older surveys (Kenya, Namibia, Rwanda, and Uganda), question asked only if the above item was asked or performed; filter was applied to current 

surveys for the purposes of comparability in this report. 

4 Breastfeeding and vitamin A items had n/a response options in older surveys; however, newer surveys do not have the n/a or skip option for these particular 

indicators. For comparability, n/a responses were coded as no for older surveys. 5 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

CI = confidence interval 

 

 
58 

Appendix Table 24 Percent of facilities with capacity to provide nutrition-related care in curative child care 

services, percent of clients observed and caretakers reporting nutrition-related 

counseling among clients attending sick child care visits, and percent of providers with 

training on child nutrition topics, by facility background characteristics, Uganda SPA 

2007

Facility type Managing authority Locale (n/a) 

Hospital Other Public Private, other Rural Urban 

% CI % CI % CI % CI % CI % CI 

Facilities with curative child care 

Child weighing scale available1 86.3 [78.6,91.6] 72.7 [67.3,77.6] 71.8 [65.6,77.2] 78.0 [66.8,86.2] Infant scale available2 98.3 [93.3,99.6] 62.8 [57.7,67.7] 64.3 [58.6,69.6] 64.0 [53.6,73.3] 

Stadiometer/height rod available (n/a) Tape measure available (n/a) 

Vitamin A supplementation available 71.8 [63.3,79.0] 74.8 [69.6,79.4] 75.6 [69.8,80.6] 71.6 [60.4,80.6] Iron supplementation available 70.1 [61.4,77.5] 39.3 [34.0,44.8] 34.2 [28.6,40.3] 60.6 [49.8,70.4] Zinc supplementation available (n/a) 

Observation of sick child visits 

Child weight assessed 59.6 [49.9,68.5] 44.3 [37.4,51.5] 44.3 [37.3,51.5] 53.2 [37.0,68.8] Child weight plotted on growth chart3

 22.0 [14.3,32.3] 24.3 [16.3,34.7] 25.3 [16.8,36.2] 17.4 [8.1,33.5] Provider asked if child received vitamin A4

 16.9 [12.4,22.7] 11.2 [8.1,15.4] 11.8 [8.6,16.0] 11.2 [5.2,22.4] Asked client about feeding or breastfeeding 

when child is well4 59.0 [51.3,66.3] 48.0 [42.4,53.7] 48.6 [42.8,54.4] 50.9 [36.5,65.1] Asked client about feeding or breastfeeding 

during illness4 50.3 [42.4,58.1] 43.4 [38.0,48.9] 44.5 [39.1,50.1] 39.8 [27.7,53.3] 

Caretakers’ report of sick child visit5 

Child weight assessed 68.6 [59.1,76.7] 44.8 [38.2,51.6] 44.9 [38.1,51.9] 58.2 [42.4,72.5] Discussed child’s growth 23.8 [17.1,32.0] 18.3 [14.2,23.4] 17.8 [13.5,23.0] 25.0 [15.3,38.1] Reported provider discussed feeding or 

breastfeeding when child is not ill 24.0 [17.8,31.7] 25.1 [20.4,30.5] 24.1 [19.4,29.6] 31.1 [20.1,44.8] 

Reported counseling on feeding or 

breastfeeding during illness 34.7 [27.2,43.1] 37.7 [32.5,43.2] 38.3 [33.0,43.9] 32.3 [20.8,46.5] 

 

Provider training6 

Recent training on breastfeeding 32.4 [28.1,37.0] 23.7 [19.0,29.0] 24.7 [20.2,29.9] 26.8 [19.7,35.3] 

Recent training on early and exclusive 

breastfeeding 23.0 [19.6,26.8] 14.5 [10.6,19.5] 14.4 [10.4,19.8] 20.0 [14.6,26.7] Recent training on complementary feeding 27.6 [23.7,31.9] 20.2 [15.7,25.5] 21.4 [17.0,26.6] 22.1 [15.6,30.4] Recent training on infant and young child 

feeding (n/a) 

1

 Or a digital standing scale with gradations of 250 grams or less on which an adult can hold a child to be weighed 2 Or a digital standing scale with gradations of 100 grams or less on which an adult can hold a child to be weighed 3 Filter for older surveys (Kenya, Namibia, Rwanda, and Uganda), question asked only if the above item was asked or performed; filter was applied to current 

surveys for the purposes of comparability in this report. 

4 Breastfeeding and vitamin A items had n/a response options in older surveys; however, newer surveys do not have the n/a or skip option for these particular 

indicators. For comparability, n/a responses were coded as no for older surveys. 5 Only clients who agreed to be observed and interviewed and only at facilities where there were observations 6 Excludes providers who exclusively worked in the laboratory of the facility or in other non-qualifying positions 

n/a = not available; CI = confidence interval