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PD/Hearth and Nutrition Weeks in RwandaExperiences from Kabeho Mwana EIP and Tangiraneza I-CSPMelanie Morrow & Melene KabadegeCORE Group Spring MeetingApril 24, 2013
Kabeho Mwana Expanded Impact ProjectLocation: 6 of 30 Districts in RwandaTotal Population: 1.8 Million people~18% of national pop.Interventions: iCCM for Malaria, Pneumonia and Diarrhea& BCC for C-IMCI, using government CHWsAdded PD/Hearth in two districts with Scottish Govt. sub-grant thanksto Concern Worldwide, the lead agency for Kabeho MwanaPD/Hearth in Kabeho MwanaExpanded Impact Project 2006-2011
Pd/H Training & Expansion Oct 2009-Feb 2011PD/Hearth in Kabeho MwanaExpanded Impact Project 2006-2011Workshops in 2 sep. districts with HC staff, sector head of Social Affairs, and EIPstaff. PDIs conducted in conjunction with workshops, not every village.Menus developed during PD/H workshop with HC staff, Social Affairs In-Charge andEIP staff. Finalized after technical review and follow-up meetings.Nyamagabe District; 3 HC Catchment Areas (73 Hearth sites)• 1 Nutrition Officer, and 1 Promoter per Health Center worked with the HCNutritionist trained local leaders and government CHWs in PD/Hearth.Added Nyamasheke District in final year; 7 HC Catchment Areas (70 Hearth sites)• 1 Nutrition Officer worked with HC nutritionists to train local leaders andgovernment CHWs in PD/Hearth. Promoters from Nyamagabe helped with initialtraining but not ongoing supervision. Support from Hospital Director.286 CHWs (2 per site) received 4 days of training as Light Mothers in Total
ImplementationPD/Hearth in Kabeho MwanaExpanded Impact Project 2006-2011ScreeningMonthly Growth Monitoring (both Wt for Age & MUAC per MOH)• Anthropometry done by trained CHWs• SAM Refer to Health Center• MAM (MUAC 115-125 mm) and/or moderate malnutrition based onWt. for Age Hearth143 PD/H sites in the community (73 in Nyamagabe, 70 in Nyamasheke)
Screening and MeasurementPD/Hearth in Kabeho MwanaExpanded Impact Project 2006-2011Screening: Monthly Growth Monitoring (both Wt for Age & MUAC per MOH)• Anthropometry done by trained CHWs• SAM Refer to Health Center• MAM (MUAC 115-125 mm) and/or moderate malnutrition based onWt. for Age Z Scores HearthIntervention: Two weeks of daily participation (6 days per week, 12 days total)2.5 months of follow-up at home.Weights and MUAC measured 4 times after preliminary screening:Day 1Day 12 (End of two-week intensive phase, technically Day 13)Day 45 +/- (One month after intensive phase)Day 90 (2.5 months after intensive phase, three months since Day 1)Graduation Criteria: MUAC > 125 mm and Wt gain of 600 g over 3 months
ImplementationPD/Hearth in Kabeho MwanaExpanded Impact Project 2006-2011143 PD/H sites in the community (73 in Nyamagabe, 70 in Nyamasheke)Total of 2,884 Children admitted to Hearth:• 2,204 in Nyamagabe, 91% rehabilitated• 680 in Nyamasheke, 83% rehabilitated
Results using MUAC and Weight GainPD/Hearth in Kabeho MwanaExpanded Impact Project 2006-2011Data from first 3 (of four) rounds of implementation in Nyamagabe DistrictCured Not-curedChildrenAdmittedLost MUAC Wt gainof 600gMUAC& WtMUAC Wt gainof 600gMUAC& Wt1) 728 0 656(90.1%)673(92.4%)641(88.0%)72(9.8%)55(7.6%)87(12%)2) 583 0 481(82.5%)497(85.2%)432(74.1%)102(17.5%)86(14.8%)151(25.9%)3) 482 2 445(92.3%)456(94.6%)435(90.2%)35(7.2%)24(4.9%)45(9.3%)Total 1793 2 1,582(88.2%)1,626(90.7%)1,508(84.1%)209(11.6%)165(9.2%)283(15.8%)
Results using MUAC onlyPD/Hearth in Kabeho MwanaExpanded Impact Project 2006-2011Data from first 3 (of four) rounds of implementation in Nyamagabe DistrictCured Not-CuredChildrenAdmittedLost MUAC> 125MUAC< 1251) 725 0 653(90.1%)72(9.8%)2) 582 0 480(82.5%)102(17.5%)3) 480 2 443(92.3%)35(7.2%)Total:17872 1,576(88.2%)209(11.6%)
PD/Hearth in Kabeho MwanaExpanded Impact Project 2006-2011
Nutrition Weeks InnovationTangiraneza SP (2012-2016)World Relief Rwanda Tangiraneza Innovation CSPProject Catchment Area:Nyamagabe District in Southern Rwanda,Total population 337,116 people in 536 Villages.Target Beneficiaries:79,559 Women 15-49 years of age54,949 Children 0-59 monthsProject Goal: To reduce morbidity, mortality and underlying malnutrition of children underfive and pregnant women in Nyamagabe District of Rwanda.Intermediate Results:IR 1. Improved geographic access to and demand for high quality MNCH servicesIR 2. Improved coordination of and impact of community health activitiesIR 3. Innovation tested to improve the effectiveness of the Community Based
Nutrition Weeks InnovationTangiraneza SP (2012-2016)World Relief Rwanda Tangiraneza Innovation CSPGeneral problem to be addressed by OR: Malnutrition in children <2.Strategic relevance within the country:Rwanda has 5th highest stunting rate in the world;MOH wants treatment of malnutrition to be addressed by health facilities.Research location: Selected villages in Nyamagabe DistrictInnovation based on PD/Hearth: Nutrition WeeksExpected outcomes: Improved feeding practices, reduced malnutrition and assessment offeasibility for MOH implementation and scale up.