42 J Health Popul Nutr Mar 2007 and 28, were used with the above threshold levels of coverage to examine the level of misclassification error. Based on these two strategies, inadequately-performing CHW’s work-areas were identified. At the third step, use rates of the HDSS were used for identifying inad- equately-performing CHW’s work-areas. CHW’s work- areas with use rates lower than the lower thresholds of coverage were considered inadequately-performing areas. At the final stage, the proportion of CHW’s work- areas obtained using the LQAS method and HDSS were compared for statistical significance with the and alternative hypotheses mentioned earlier. Subsequently, classification of the work-areas by the LQAS method and HDSS was cross-tabulated to examine consistency between the two. Field application by supervisors To test the feasibility of using the method by the field supervisors, the members of the project staff carried out a two-day (3-4 November 2002) training programme in Matlab. The training was attended by 19 participants, 17 of whom were from the government health and fam- ily-planning programme working in the Matlab area (not served by ICDDR,B), and the remaining participants were from Matlab health and family-planning services of ICDDR,B. Of the government programme supervi- sors, five were Health Inspectors, six were Assistant Health Inspectors, five Family Planning Inspectors, one EPI Technician, and two ICDDR,B Field Research As- sistants. The training comprised lectures in the office and practical application in the field. A simple instruction sheet in Bangla, prepared by the project team, was given to the participants at the time of training. The training avoided technical details of the method and explained the procedures of applying the method with only sample size of 19 with varied level of thresholds. The possibi- lity of using other sample sizes was only mentioned with an emphasis that, for most of our purposes, a sample size of 19 would be sufficient. A lot of time was spent on the method of selection of samples, replacement of absen- Bhuiya A et al. tee respondents, compilation of data, and application of the decision rule to consider an area as inadequate. The training concluded with a call to apply the method in the field as a part of their regular activities. The participants also met again after a month of applying it in the field to review and share their experiences and the problems faced in applying the method in the field. RESULTS LQAS method compared to HDSS Table 3 presents the proportion of the inadequately-per- forming CHW’s work-areas identified using the LQAS technique and HDSS data. For DPT, only one CHW- work area was found to be inadequate by the LQAS method compared to two when HDSS data were used. The difference in the proportions of inadequately-per- forming areas as identified by the two methods was not statistically significant. For measles, the LQAS method identified five inad- equately-performing areas; while comparing with HDSS data, only one could be identified as inadequate. How- ever, the difference in proportions was not statistically significant. Using the LQAS technique and HDSS data, a simi- lar consistency of identifying inadequately-performing areas was observed for contraceptive prevalence rate (CPR) and BCG. For CPR, the LQAS method identified two inadequately-performing areas compared to none by the HDSS. For BCG, only one area was identified to be inadequate by the LQAS method and none by the HDSS. The above implied that the inadequately-performing CHW’s work-areas for DPT and BCG could be identified with a sample size of 15 with less than 10% probability of misclassification. For measles and contraceptive use, a sample size of 20 and 26 respectively was enough to Table 3. Proportion of health areas classified as inadequate based on LQAS (classification error less than 10%) and HDSS Method LQAS HDSS Sample size Statistics Z p No. of areas 57 57 Proportion inadequate (number inadequate) DPT: 65-95% Measles: 60-90% BCG: 65-95% CPR: 50-80% 0.02 (1) 0.04 (2) 15 0.08 0.47 0.09 (5) 0.02 (1) 20 1.23 0.22 0.02 (1) 0.00 (0) 15 0.13 0.90 0.05 (2) 0.00 (0) 26 0.86 0.90 CPR=Contracptive prevalence rate; HDSS=Health and demographic surveillance system; LQAS=Lot quality as- surance sampling