Kathleen Hill & Evelyn Kamgang                                                     CORE Spring Meeting May 2012           ...
Kathleen Hill & Evelyn Kamgang                                              CORE Spring Meeting May 2012                  ...
Kathleen Hill & Evelyn Kamgang                                                           CORE Spring Meeting May 2012     ...
Kathleen Hill & Evelyn Kamgang                                                          CORE Spring Meeting May 2012      ...
Kathleen Hill & Evelyn Kamgang                                                                             CORE Spring Mee...
Kathleen Hill & Evelyn Kamgang                                             CORE Spring Meeting May 2012                   ...
Kathleen Hill & Evelyn Kamgang                                                 CORE Spring Meeting May 2012               ...
Kathleen Hill & Evelyn Kamgang                                                CORE Spring Meeting May 2012                ...
Kathleen Hill & Evelyn Kamgang                                                 CORE Spring Meeting May 2012               ...
Kathleen Hill & Evelyn Kamgang                                           CORE Spring Meeting May 2012                     ...
Kathleen Hill & Evelyn Kamgang                                                CORE Spring Meeting May 2012                ...
Kathleen Hill & Evelyn Kamgang                                              CORE Spring Meeting May 2012                  ...
Kathleen Hill & Evelyn Kamgang                                             CORE Spring Meeting May 2012                   ...
Kathleen Hill & Evelyn Kamgang                                          CORE Spring Meeting May 2012                     A...
Kathleen Hill & Evelyn Kamgang                                           CORE Spring Meeting May 2012                     ...
Kathleen Hill & Evelyn Kamgang                                            CORE Spring Meeting May 2012                    ...
Kathleen Hill & Evelyn Kamgang                                              CORE Spring Meeting May 2012                  ...
Kathleen Hill & Evelyn Kamgang                                               CORE Spring Meeting May 2012                 ...
Kathleen Hill & Evelyn Kamgang                                             CORE Spring Meeting May 2012                   ...
Kathleen Hill & Evelyn Kamgang                                                    CORE Spring Meeting May 2012            ...
Kathleen Hill & Evelyn Kamgang                                                      CORE Spring Meeting May 2012          ...
Kathleen Hill & Evelyn Kamgang                                                        CORE Spring Meeting May 2012        ...
Kathleen Hill & Evelyn Kamgang                                                       CORE Spring Meeting May 2012         ...
Kathleen Hill & Evelyn Kamgang                                                            CORE Spring Meeting May 2012    ...
Kathleen Hill & Evelyn Kamgang                                                  CORE Spring Meeting May 2012              ...
Kathleen Hill & Evelyn Kamgang                                                            CORE Spring Meeting May 2012    ...
Kathleen Hill & Evelyn Kamgang                                               CORE Spring Meeting May 2012                 ...
Kathleen Hill & Evelyn Kamgang                                        CORE Spring Meeting May 2012                        ...
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Many Actors Tackling Anemia_Hill & Kamgang_5.1.12

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Many Actors Tackling Anemia_Hill & Kamgang_5.1.12

  1. 1. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Many Actors One Goal: Actors, Tackling Anemia in Mothers & Children A Country Case Study: Mali Kathleen Hill & Evelyn Kamgang USAID Health Care Improvement Project University Research Co., LLC CORE Spring Meeting May 1st, 2012 1 Session Outline I. Presentation: Mali Case Study • HCI Mali anemia project objectives • Anemia prevalence & causes in Mali (women & children) • Anemia control best practices: what, when & where? • Findings from a baseline assessment in Mali’s Sikasso region 2. Group work: Moving to Implementation • Many actors, One goal: achieving inter-sectorial implementation in a complex environment • Models to support implementation planning: CFIR; Program Assessment Guide (PAG); Breakthrough Series Improvement Collaborative 3. Plenary Discussion: Putting it all together 2 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 1
  2. 2. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Acknowledgements • USAID Mali Mission (funding & technical support) • USAID Washington Staff (Nutrition, Malaria, MNCH) • Consultant: Dr. Halimatou Alaofe • HCI Project staff in Mali & Niger: Dr. Maina Boucar, Dr. Karim Sangare, M S b Djib i K i S Mr. Sabou Djibrina, D Z k i S l Dr. Zakari Saley 3 USAID HEALTH CARE IMPROVEMENT PROJECT HCI Mali Anemia Project Goal and Objectives Program Goal: To reduce anemia prevalence in pregnant women, mothers and young children in Mali’s Sikasso region (one district) Program Objectives: 1. To improve household and community uptake of anemia prevention/control best practices for pregnant women, mothers and young children 2. 2 To achieve broad coverage and quality of high impact MOH anemia prevention/control interventions for mothers and children within essential lifecycle windows of opportunity (pregnancyearly post-partuminfancyearly childhood) 4 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 2
  3. 3. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Mali Context  Total population: 14.2 million (Feed the Future)  73% of population rural; 64% li on < 1 f l ti l live USD per day  ANC rate: 72% (one visit); 63% (2 or more visits)  Skilled birth attendance rate: 49% (UNICEF 2010)  Infant mortality rate: 131 per 1000 (UNICEF 2010) Sikasso region: 2nd most  Under 5 mortality rate: 178 per 1000 live populous & poorest region; births (WHO/UNICEF 2010) most agriculturally productive; highest stunting rate; Feed the  Moderate-severe underweight < 5 years: Future priority region About 27% (UNICEF)  Moderate to severe stunting < 5 years: about 38% (UNICEF) USAID HEALTH CARE IMPROVEMENT PROJECT 6 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 3
  4. 4. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Main Direct & Indirect Causes of Anemia for Women & Children in Mali Direct Causes:  Micronutrient Deficiency: primarily iron deficiency; also vitamin A & zinc (decreased production red blood cells)  Malaria: hemolytic anemia (destruction red blood cells)  Other parasitic infections: mainly schistosomiasis & hookworm (excessive loss red blood cells) Indirect Causes:  Lack of childbirth spacing  Food insecurity, malnutrition, poverty  Poor sanitation & access to potable water  Weak access to health services  Early childhood feeding practices (e.g., delayed breastfeeding) 7 USAID HEALTH CARE IMPROVEMENT PROJECT How Big is the Problem? Anemia & Related Prevalence Rates in Mali Other Anemia Iron- Malaria parasite Prevalence deficiency prevalence prevalence (Any & severe) anemia (Schisto.) (S hi t ) 76% 73% 23% Schisto. Pregnant (FAO 2010) (Aguayo, 48% 8% Hookworm women 2005) (Ayoya 2006) 85% (Mali) Children 91% (Sikasso) ?? 38% Mali 51% Schisto. 6-59 mos 26% severe (Mali) mos. (Dabo 2011) 35% severe 59% Sikasso (Sikasso) 39% 12-17 months (EA&P 2010) (EA&P2010) USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 4
  5. 5. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Critical Lifecycle Windows for Uptake and Delivery of Anemia Best Practices for Mothers & Young Children Early Post- Infancy Early partum Childhood Pregnancy (0-6 (Mother & (6 mos-5 Newborn) months) years) Focused ANC Early & exclusive EEBF Complementary feeding breastfeeding from 6 months Iron/folate (EEBF) suppl. Diversified feeding Micronutrient Vit A suppl. Deficiency Nutrition best Active feeding sick practices Iron suppl. mother child Nutrition best Vit A suppl (2x/year); practices (mother) Zinc for diarrhea IPTp x 2 (SP) LLITN use (mother LLITN use (mother LLITN use (mother & Malaria & newborn) & infant) newborn) Long-lasting insecticide-trtd Prompt care Prompt care seeking bednet (LLITN) seeking fever fever use Accessible/quality Accessible/quality care care febrile illness febrile illness Hygiene Food & personal Food & personal Food & personal Parasitic 9 hygiene USAID HEALTH CARE IMPROVEMENT PROJECT hygiene hygiene Infections Systematic de- Main Delivery Venues for MOH Anemia Control Best Practices • Community- and home-based: antenatal, early post- partum & early childhood services via community health workers (“Agents de Sante Communautaire” ASC) and ( Agents Communautaire”, community-based health volunteers (“Relais Communautaire” , RC) • Facility-based antenatal & early post-partum consultations: community health centers (CSCOM) & district referral health centers (CSRef) • Facility-based well-child and sick-child consultations (CSCOM & CSRef) • Quarterly regional MOH-sponsored “Week of Intensive Nutrition Actions” (SIAN) 10 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 5
  6. 6. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Current Status of Selected Anemia Control Best Practices in Mali • Breastfeeding within 1st hour of birth: 46% (DHS) • Exclusive BF until 6 months: 38% (DHS) ( ) • Complementary feeding from 6 to 11 months (fruits, vegetables, meat): 11-12% (DHS) • Bednet use previous night: 75-80% (children 0-4 yrs; however < 10% used pre-treated net) • Intermittent Preventive Therapy for Malaria in Pregnancy (IPTp): 2 SP doses in pregnancy: 4% (DHS 2006) • Care-seeking w/in 24hr onset of fever in children: 23% • Treatment of febrile illness with ACT: 7.8% Sources: EA&P Survey, 2010; DHS 2006 11 USAID HEALTH CARE IMPROVEMENT PROJECT Preparing for Implementation : Baseline Evaluation in Mali’s Sikasso Region Baseline Assessment Objectives: 1. Assess anemia-related knowledge, attitudes & practices among beneficiaries & providers 2. Assess implementation of community- and home-based anemia control interventions 3. Assess implementation of high-impact MOH Health Center-based Center based anemia control interventions including interventions, cross cutting health system service delivery supports 12 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 6
  7. 7. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 13 USAID HEALTH CARE IMPROVEMENT PROJECT Data Collection Sites: 12 Communes (household/ community) & 15 Health Centers in Kadialo & Bougouni Districts (Sikasso Region) District 15 Health Centers 12 Communes (CSCOM & CSRef) 1 CSCOM Urban Kadiolo Kadiolo K di l 1 CSR f CSRef Missenu 3 CSCOM Rural Nimbougou Dyou 3 CSCOM Urban Bougouni 1 CSRef Bougouni Koumantou Bladié 6 CSCOM Rural Banimonotié Bladiè Tièmala Koumantou Koumantou Défina 14 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 7
  8. 8. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Data Sources & Sample Sizes Community Interviews (12 communes) : • Community leaders (n=42) • C CHW ( C/ SC) ( (RC/ASC) (n=30; 75% RC) % C) • Household (pregnant women & mothers) (n=480) • Observation of 1 SIAN Health Center (15 centers) • Interviews managers (n=12) & providers (n=30) • Client exit interviews: antenatal, sick & well child consultations (total n=459 ) • Chart audit (n=550) • Inventory of inputs & service organization (n=12) 15 USAID HEALTH CARE IMPROVEMENT PROJECT Selected Results • Household • Community • SIAN (Week of Intensive Nutritional Activities) • Facility 16 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 8
  9. 9. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 17 USAID HEALTH CARE IMPROVEMENT PROJECT Household & Client Exit Interviews: % Pregnant Women Who Correctly Identified 3 Main Causes of Anemia (n=688; n=359 household interviews; n=329 client exit interviews) 18 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 9
  10. 10. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Household & Client Exit Interviews: % Pregnant Women Who Correctly Identified Anemia Prevention Measures (n=688) 19 USAID HEALTH CARE IMPROVEMENT PROJECT 20 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 10
  11. 11. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Household & Client Exit Interview Results: % Pregnant Women Who Reported Selected Anemia Control Best Practices (n=688) 21 USAID HEALTH CARE IMPROVEMENT PROJECT Household Interviews: % Mothers of Young Children by District Who Correctly Identified Pregnancy & Childhood Anemia Control Best Practices (n=251; n=121 household; n=130 client exit interviews) 22 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 11
  12. 12. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Household & Client Exit Interviews: % Mothers and Pregnant Women Who Report Specific Health Information Sources (n=688 pregnant women; n=251 mothers) 23 USAID HEALTH CARE IMPROVEMENT PROJECT Community Results • Community Leader Interviews • Community Health Worker Interviews CHW Cadres in Mali: • Agent de Sante Communautaire (ASC): Trained paid CHW; provides health promotion, prevention & treatment services; covers 1-3 villages (1,500 persons); helps supervise RCs • Relais Communautaire (RC): voluntary CHW recruited by community; health promotion and prevention; 1 RC per village (approx. 50 households; 300 persons) • Traditional Birth Attendent (TBA) 24 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 12
  13. 13. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Community Leader Interviews: % Community Leaders Who Correctly Identified Anemia Causes by District (n=42) 25 USAID HEALTH CARE IMPROVEMENT PROJECT Community Leader Interviews: % Community Leaders Report Recruiting ASC/RCs and Their Perceptions of Key Services Provided by ASC/RCs (n=42 community leaders) Leaders who report participating in ASC/RC recruitment: 67% Community Leader reported Perception of Main Activities for Leader-reported ASC/RC: – General health education: 60% – Participation in SIAN: 62% – Mosquito-net distribution: 52% – Home or community-based ANC: 26% y – Home or Community-based PNC (post-natal Care): 21% 26 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 13
  14. 14. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 ASC/RC Interviews: % ASC/RC Who Correctly Identify Anemia Causes (n=30) 27 USAID HEALTH CARE IMPROVEMENT PROJECT % ASC/RCs in Urban vs. Rural Communes Who Correctly Identify High-impact Anemia Control Interventions in Pregnancy (n=20 rural; n=10 urban) 28 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 14
  15. 15. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 % ASC/RCs Who Correctly Identify Anemia Control Interventions for Infants & Young Children (n=30) 29 USAID HEALTH CARE IMPROVEMENT PROJECT ASC/RC Interviews: % ASC/RCs Who Report Prior Training in Specific Technical Areas (n=30) 30 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 15
  16. 16. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 ASC/RC Interviews: % ASC/RCs Who Report to Routinely Provide Specific Services as Part of Their Regular Work (n=30) 31 USAID HEALTH CARE IMPROVEMENT PROJECT % ASC/RCs Who Report Specific Timing of Home- based Post-natal Care Visits (# days after birth) (n=30) 32 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 16
  17. 17. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Week of Intensive Nutritional Activities (SIAN): Key Findings by Direct Observation & Interviews Data Collector Observation: • Vitamin A & Albendazole (antiparasite) distribution occurs via 3 primary avenues: Health Center (CSCOM), Village Chief, mobile team (e.g., mosque or marketplace) • Vitamin A distribution is much stronger than nutritional education or anti-parasite treatment • Nutritional Counseling activities were rarely observed as p part of SIAN activities CSCOM Manager Self-reported Participation: • 67% Kadiolo • 29% Bougouni 33 USAID HEALTH CARE IMPROVEMENT PROJECT % ASC/RC Who Report Participation in Specific SIAN Activities (n=30) 34 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 17
  18. 18. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Selected Health Center Results • Manager & Provider Interviews • Chart Reviews • Client-reported high-impact interventions received during antenatal, well-child, and sick-child consultations (client exit and household interviews) 35 USAID HEALTH CARE IMPROVEMENT PROJECT 36 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 18
  19. 19. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Provider Knowledge: % Skilled Maternal & Pediatric Providers Who Correctly Identify Anemia Symptoms & Causes (multiple choice question) Pediatric Providers Maternal Providers (n=5) (n=8) Nurses, doctors Midwives, nurses, doctors d t Anemia Symptoms: Fatigue 20% (1) 50% (4) Pale conjunctivae/skin 100 % (5) 100% (8) (e.g., palms) Shortness of Breath 60 % (3) 63% (5) Anemia Causes: Iron deficiency 20% (1) 63% (8) Malaria 100% (5) 75% (6) Parasite Infections 0% 25% (2) (diarrhea/intestinal) 37 USAID HEALTH CARE IMPROVEMENT PROJECT Maternal Provider Knowledge of Anemia Best Practices in Pregnancy: % Providers Who Correctly Identify High- impact Anemia Control Practices in Pregnancy (n=8 providers) 38 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 19
  20. 20. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Pediatric Provider Knowledge of Anemia Best Practices for Infants/Children: % Providers Who Correctly Identify High- impact Anemia Control Practices for Children (n=8 providers) 39 USAID HEALTH CARE IMPROVEMENT PROJECT Availability Essential Anemia Control Inputs: Laboratory, Micro-nutrient Supplements, Anti-malarial & Anti-parasite Medications: % Facilities with Input (n=12) % Facilities with Essential Anemia Control Input Input Hematocrit Laboratory Testing 13% Vitamine A 80% Iron/Folic Acid (IFA) 100 % Zinc 80% Albendazole (de-worming medication) 87% Sulphadoxine/Pyrimethamine (SP) for IPTp 80 % Malaria Diagnosis & Medication Quinine 400mg & 200 mg (Injectible) 100% Quinine 300mg (oral) 73 % ACT 100 % Rapid Diagnostic Test (RDT) 100 % 40 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 20
  21. 21. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 ANC Chart Review Findings: % Antenatal Charts with Anemia Control Best Practices Recorded (n=300 Charts) Anemia Best Practice Total (n=300 dossiers) Clinical Evaluation Pregnant client questioned regarding +/- bleeding 2% (7) Anemia symptom investigated (any) 32 % (95) Laboratory Examination Hemoglobin or Hematocrit recorded in chart (ever) 3% (8) Malaria test noted ever (thick smear, RDT or other) 3% (8) Anemia Prevention Interventions in Pregnancy (per MOH policy ) SP prescription noted ever (IPTp) 83% (250) Iron/Folic Acid prescription noted (ever) 87 %(261) Deworming with Albendazole 7 %(20) Distribution of insecticide-treated mosquito net 25% (75) 41 USAID HEALTH CARE IMPROVEMENT PROJECT 42 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 21
  22. 22. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Clients Reporting Clinic ANC Anemia Control Best Practices (n=329 ANC client exit interviews) ANC Practice Reported by Client % Clients Who Report Activity Laboratory Testing Hemoglobin level 12% HIV test 3% No laboratory Testing 84% Nutritional Counseling 10% Iron/Folic Acid Prescription/Distribution 98% Malaria & Hookworm Best Practices Deworming ((Albendazole) ) 8% Bednet Counseling 30% SP for Malaria prevention 54% Follow-up Visit (when) 71% 43 USAID HEALTH CARE IMPROVEMENT PROJECT ANC Chart Review Findings: % Antenatal Care Charts/Patient Cards with Counseling Best Practices Recorded (n=300) 44 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 22
  23. 23. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Health Center Manager Interviews: % Managers Who Report Regular Counseling/Education Activities (n=12 managers) Education Session Type Total Kadiolo Bougouni (n=14) (n=4) (n=10) Antenatal Care Consultations (ANC) 14% (2) 0% 20% (2) Individual Counseling only 50% (7) 25 %(1) 60 %(6) Group Counseling only 36% (5) 75 %(3) 20% (2) Individual & Group Counseling Well-child Consultations (SPE) Individual Counseling alone 7 %(1) 25 %(1) 0 Group Counseling alone 29% (4) 0 40% (4) Individual & Group Counseling 50% (7) 75% (3) 40% (4) No education/counseling g 14% (2) ( ) 0 20% (2) ( ) Sick-child Consultations Individual Counseling 50% (7) 50 %(2) 50% (5) Group Counseling 0 0 0 Individual & Group Counseling 29 %(4) 25% (1) 30% (3) No education/counseling 21% (3) 25% (1) 20% (2) 45 USAID HEALTH CARE IMPROVEMENT PROJECT 46 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 23
  24. 24. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Anemia Best Practices Received during Post-partum & Early Infancy Clinic Visits As Reported by Mothers of Infants < 7 months (Recent or Current) (n=66; 34 client exit & 32 household interviews) Anemia Best Practice Reported by Mothers As % Mothers Recieved During Post-partum & Routine Infancy Clinic Visits Reporting Best Practice FAF prescription (for lactating mother) 39% Vit. A for mother post-partum 42% Nutrition Counseling Reported by Client Exclusive breastfeeding 39% Nutritional best practices lactating mother 27% Nutritional best practices infant (0-6 mos) 33% Iron-rich foods 3% Vitamin A –rich foods 3% Vitamin A supplementation needs for infant 17% Malaria & Hookworm Prevention Counseling Reported by Clients 21% Regular de-worming Infancy 3% Use of insectide-treated nets Danger Signs & Follow-up Counseling Reported by Clients 2% Follow-up for infant (when & where) 17% Newborn/infant danger signs 47 USAID HEALTH CARE IMPROVEMENT PROJECT Well-child Visit Chart Review Findings: % SPE Charts (or Patient Carnets) with Recorded Anemia or Anemia-related Best Practice (n=100 charts; children 0-2 years) Anemia Control Best Practice Average 2 Bougouni Kadiolo Recorded During Routine Care Districts n=60 charts n=40 charts n=100 charts Growth Monitoring & Acute Malnutrition Weight recorded 40 % 50 % 25 % Height recorded 40 % 50 % 25 % Weight/height % recorded 23 % 22% 25% Mid upper arm circumference 20 % 17 % 25 % Clinical examination for 0% 0% 0% anemia Vit. A Supplementation 17% 0% 43% Child feeding status assessed 30% 17 % 43 % (e.g., BF/not BF) Any feeding problems noted 0% 0% 0% Bednet counseling noted 20 % 0% 50 % Deworming recorded 10 % 0% 25 % 48 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 24
  25. 25. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Well-child Chart Review Counseling Results: % Well-child Chart Visits (or Patient Cards) with Counseling Best Practices Recorded (n=100 charts; children 0-2 years) 49 USAID HEALTH CARE IMPROVEMENT PROJECT Sick-child Chart Review Findings: % Sick-child Chart (or Patient Carnet) Visits with Recorded Anemia or Anemia- related Best Practice (n=100 charts; children 0-2 years) Anemia Best Practices % Charts Best Practice General Evaluation Weight recorded 9% (13) Fever/temperature recorded 23% (34) Anemia Evaluation & Diagnosis/Iron Suppl. Anemia symptoms recorded (+ or -) 3 % (4) Hemoglobin or hematocrit recorded (laboratory) 1% (2) Anemia diagnosis recorded 4% (6) Iron supplement prescribed 3% (5) Vitamin A supplement last 12 months 16% (24) De-worming last 12 months 18% (27) Malaria Evaluation & Diagnosis Thick smear or RDT recorded 59% (88) Malaria treatment 49% (73) Zinc if diarrhea 5% (7) 50 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 25
  26. 26. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Anemia Counseling Best Practices during Well-child Visits (7 mos-2 years): % Mothers Who Report Best Practice (n=33 Client Exit Interviews Mothers) 51 USAID HEALTH CARE IMPROVEMENT PROJECT Conclusions Selected Challenges: • Many anemia knowledge & practice gaps (beneficiaries; skilled and unskilled providers) • Many coverage gaps i d li M in delivery of hi h i f high-impact anemia control i t t i t l interventions ti during critical lifecycle windows at community, household & health center levels • Many missed opportunities to deliver best practices (e.g., weak counseling/BCC in established services; poor timing of post-partum visits) • Differences between Kadiolo & Bougouni Districts (may be an opportunity if positive deviance factors can be identified) • Political context Selected Opportunities: • Defined MOH policy for anemia control & best practices • Country initiatives: PMI, Feed the Future, etc. • Many strong partners on the ground for many years (HKI, others) • Many engaged community leaders & RC/ASC 52 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 26
  27. 27. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 THANK YOU Expert Commentary Questions Q ti Instructions for Small Group Work 53 53 Moving From Assessment to Implementation: Group Work • Applying Consolidated Framework for Implementation Research (CFIR) • Applying Breakthrough Series Collaborative Improvement Methods (Systems-focused QI methodology) 54 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 27
  28. 28. Kathleen Hill & Evelyn Kamgang CORE Spring Meeting May 2012 Breakthrough Series Collaborative Improvement Methodology 55 USAID HEALTH CARE IMPROVEMENT PROJECTUSAID Health Care Improvement Project./URC 28

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