44 J Health Popul Nutr Mar 2007 Table 7 presents the proportion of the inadequately-per- forming areas using a sample size of 28. Here also, the proportions of the inadequately-performing areas were similar for the LQAS method and HDSS. In all the cas- es, the probability of misclassification was reduced. The consistency between the HDSS and the LQAS results are presented in Table 8. The table shows that all the work-areas were considered adequate by both HDSS and LQAS method for BCG, 55 for DPT, 53 for mea- sles, and 54 for family planning. Feasibility of using LQAS by field-level supervisors It was revealed that, both during training and applica- tion of the LQAS method that most supervisors could understand the procedures to be adopted in making the decision and conducting the survey. Use of the register of clients they maintain for services as a sampling frame was also convenient for them. In the review session after a month, it was revealed that two of the 17 supervisors did not use LQAS due to shortage of time. Those who did use it reported the following problems: (a) lack of accurate information on the number of households in their work-area, (b) selec- Bhuiya A et al. tion of respondents for collecting data on various serv- ice components, and (c) decision about the lower and upper threshold levels of service coverage for identify- ing inadequately-performing areas. DISCUSSION While the proportion of areas in terms of use of health services based on the LQAS method was statisti- cally similar to those obtained using HDSS data, the LQAS method seemed to perform better in our case in identifying the adequately-performing areas than in identifying the inadequately-performing areas. This could be due to the peculiarity of the area with a very high coverage of services, leaving a very small number of the inadequately-performing areas. This observed poor performance of the LQAS method in identifying the in- adequately-performing areas should not be of concern for the magnitude of the probability of misclassifica- tion should remain within the limit set under the LQAS scheme. It should, however, be mentioned that, although the theoretical basis of the LQAS method is sound, its performance in settings with medium and low coverage cannot be concluded based on this study. It is reported, however, that the method is not very useful in areas with less than 20% coverage (11). Table 6. Consistency between HDSS and LQAS method using the scheme in Table 5 to classify 57 work-areas LQAS DPT LQAS (n=19) BCG LQAS (n=19) Measles LQAS (n=19) CPR LQAS (n=19) Method LQAS HDSS Sample size Statistics Z p HDSS Adequate Inadequate Adequate Inadequate Adequate Inadequate Adequate Inadequate No. of areas 57 57 Adequate Inadequate Predictability of LQAS (%) 55 0 57 0 51 5 54 3 2 0 0 0 1 0 0 0 Sensitivity=96.7 Specificity=0.0 Sensitivity=100.0 Specificity=Indeterminate Sensitivity=91.1 Specificity=0.0 Sensitivity=94.5 Specificity=Indeterminate Proportion inadequate (number inadequate) DPT: 65-95% Measles: 60-90% BCG: 65-95% 0.00 (0) 0.05 (3) 0.00 (0) 0.04 (2) 0.02 (1) 0.00 (0) 28 28 28 0.86 0.39 0.36 0.72 Not done - CPR: 50-80% 0.05 (3) 0.00 (0) 28 1.11 0.27 CPR=Contraceptive prevalence rate; HDSS=Health and demographic surveillance system; LQAS=Lot quality assurance sampling Table 7. Proportion of areas classified as inadequate based on 28 samples in LQAS and use of data from HDSS CPR=Contraceptive prevalence rate; HDSS=Health and demographic surveillance system; LQAS=Lot quality assurance sampling