Design effects and intraclass correlation coefficients from a health facility cluster survey in Benin

To the Editor: For at least two decades, disease control correlation coefficient and m is the average number of consultations per cluster ([3], p. 162). The intraclass correlation programs in developing countries have used clinical guidelines for health workers to improve the management of ill children coefficient is a measure of the homogeneity of elements within clusters and has a maximum value of +1 when there and prevent childhood deaths. To monitor health worker performance and evaluate the implementation of such guide-is complete homogeneity within clusters, and a minimum value of -1/(m-1) when there is extreme heterogeneity lines, a common method has been to conduct health facility cluster surveys in which health workers are observed during within clusters ([3], p. 171). For survey planners, however, a practical problem with this approach is deciding what number consultations [1,2]; a cluster is usually defined as all, or a sample of, consultations occurring at a given health facility to use for the design effect: firstly, health facility surveys can measure dozens of quality-of-care variables and each variable on a given day. Data from these surveys tend to be correlated because of the similarity in case management quality for may have a different design effect; and secondly, to the best of our knowledge, there are no published design effects, or children seen at the same health facility (often all children are seen by only one or two health workers).