DOI: 10.7910/dvn/fdrmu2
title: Alive & Thrive Cote d’Ivoire NetCode Monitoring in Abidjan Health Facilities

description: In 2013, Cote d’Ivoire adopted Decree No. 2013-416 to regulate the marketing of breast milk substitutes (BMS). However, there is limited implementation and enforcement of the decree, and few health workers are familiar with the contents and requirements of the decree. Since the adoption of the decree and in the context of limited knowledge and enforcement, there have been no studies on violations of the decree. Alive & Thrive (A&T) in collaboration with the National Nutrition Program and STP-CNN undertook cross-sectional surveys to document violations of Decree No 2013-416 and The International Code of Marketing of Breast Milk Substitutes. 
The overall objective of the study was to assess violations of the national decree in health facilities in Abidjan, Cote d’Ivoire and to estimate the prevalence of exposure to the marketing of BMS among mothers of children under 24 months of age. 
The study followed the methods developed by the Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breast-milk Substitutes and Subsequent Relevant World Health Assembly Resolutions (NetCode) and published in the NetCode Toolkit: Monitoring the Marketing of Breast-milk Substitutes: Protocol for Periodic Assessments. Quantitative surveys were undertaken in French with (1) mothers of children aged 0-23 months and (2) health providers and utilized the tools provided in the NetCode Toolkit.
description: Sample and sampling procedures: The study sampling procedures followed those outlined in the NetCode periodic assessment which includes two samples of health facilities: health centers providing immunization/child-growth/nutrition services and hospitals providing maternity/delivery services. In total, 43 facilities were selected across the Abidjan area: 33 health centers and 10 hospitals. Health centers were selected using probability proportional to size, with children served per month (2018) as the measure of size. The sampling frame included all public and private facilities in Abidjan’s two health districts providing the relevant services in 2018. Maternity hospitals were selected purposively, choosing the 10 that performed the highest number of deliveries in 2018 across the two health regions of Abidjan. In each of the 43 health facilities, three health workers involved in maternity, immunization, child-growth, and/or nutrition services were purposively identified and surveyed. Providers that were targeted included (1) head of facility, pediatrics, or obstetrics/gynecology; (2) physician assigned to pediatrics or obstetrics/gynecology; and (3) nurse, midwife, or health worker in pediatrics or obstetrics/gynecology. A total of 129 were selected. Mothers attending the 33 selected health centers seeking well-baby/well-child services for their child 0-23 months were identified and approached for survey. Mothers were classified into two categories—with a child under 6 months and with a child 6-23 months—and five mothers were surveyed per category, totaling 10 per facility and 330 for the whole survey. // 
 Weighting: Weighting is not necessary. The design of the electronic data collection form for the providers produced two datasets. The primary dataset is Providers_Dataset, where each row represents one provider, uniquely identified by the variable prov_id. The secondary dataset is Providers_q4-q7_Dataset, where each row represents a company/brand associated with a BMS promotion as reported by the providers. Providers were able to report multiple companies/brands. Each row includes the unique id of the associated provider. The secondary dataset can be merged into primary dataset using the unique identifier prov_id.
description: Surveys with Mothers
description: Surveys with Providers