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Wetzel care groups

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CORE Group Fall Meeting 2010. Key Findings from Care Group Operational Research. Sofala, Mozambique Research conducted from April to May 2010 as part of the project: Achieving Equity, Coverage, and …

CORE Group Fall Meeting 2010. Key Findings from Care Group Operational Research. Sofala, Mozambique Research conducted from April to May 2010 as part of the project: Achieving Equity, Coverage, and Impact through a Care Group Network. - Carolyn Wetzel, Food for the Hungry

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  • Promoters in Phase I districts over-estimate the literacy of CG Volunteers . 44% of Phase I Promoters believe that more than 75% of the CG Volunteers can read the messages on the flipchart, whereas only 18% of LMs say that they can read any of the words on the flipchart and 29% of BMs. In Phase II districts, Promoters under estimate the literacy level of Leader and Beneficiary Mothers. 11% of Phase II Promoters believe that more than 75% of CG Volunteers can read the messages on the flipchart, but 25% of LMs abd 21% if BMs say that they can read most or all of the words on the flipchart.
  • The first image LM and BM were shown can be seen above. The message this image is intended to convey is that diarrhea for more than two weeks is an emergency. Only 17% of LM and 33% of BM were able to correctly state the complete message. About a third of LM incorrectly associated this image with “diarrhea with blood” or “dysentery”. The other third stated that diarrhea was an emergency but left out “for ten days”. CG participants did better at identifying the next two images. The key image associated with the image to the left is that “breastfeeding prevents malnutrition and other illnesses”. 66% of LM and both Phase I & II participants could correctly state this key message. The 3rd image was meant to convey that children 12m of age should take de-worming medicine every six months. 65% of LM and 65% of BM were able to correctly state this key message.
  • Ideas for sharing messages with men: radio messaging, husband groups, and community leader led discussion. Consider cost/benefit.
  • Can delete if covered by Henry
  • When Leonora’s two children eliminated many intestinal worms her husband asked her to forgive him because he had been sleeping around and he knew if he continued his promiscuous behavior his children would get so many worms, it would eventually kill them. He promised to be faithful to Leonora from then on. This happened because in the community people believe that if a child is sick it is because his parents have extramarital partners and if the mother cooks for the children or if the father touches the children their unfaithfulness causes illness or in the case of Leonora’s children, round worms. Before this happened, Leonora was a beneficiary mother in the CG Volunteer Joaquina’s care group. She didn’t give much importance to the meetings Joaquina led that taught mothers about health and nutrition behaviors that would supposedly prevent children’s deaths and malnutrition. Leonora only came when she felt like it. So when deworming was scheduled to occur for all the pregnant women and children under five in Joaquina’s group of mothers, Joaquina had to make a special trip to Leonora’s house to invite her to the event. Leonora didn’t come, so the following day the Food for the Hungry promoter, Clara, went to Leonora’s house and gave Leonora, who was pregnant, and her two children the deworming medicine, Albendazole. She also counseled Leonora to go the hospital for a prenatal consult. Within two days Leonora’s children had passed huge amounts of worms, something that had never happened to them before. It was then that Leonora’s husband confessed and repented of the behavior he believed had led to his children’s poor state of health. Leonora went to the Promoter to thank her for helping her children and her marriage. A few months later she gave birth to her third child and began to regularly attend the CG Volunteer meetings, often being the first to arrive. Eventually Leonora learned that worms are prevented by practicing good hygiene and sanitation, she even shared this information with her husband.
  • Transcript

    • 1. Key Findings from Care Group Operational Research Sofala, Mozambique Research conducted from April to May 2010 As part of the project: Achieving Equity, Coverage, and Impact through a Care Group Network Carolyn Wetzel, RN, MPH&TM
    • 2. Objective of OR
      • Identify the key components to the effective use of the Care Group Methodology.
      • The OR included qualitative and quantitative survey methods to determine if the Care Group methodology was carried out as designed and identified methodological adaptations that occurred based on problems and difficulties that arose.
    • 3. Methodology
      • The research consisted of three components:
      • Focus Group Discussions
        • 5 Promoter FG
        • 15 CG Volunteer FG
        • 25 Beneficiary Mother FG
        • 10 Community Leader FG
      • The development and implementation of a KPC Survey
      • - Stratified Random Sampling was used to identify 100 CGV and 100 CGB in Phase I and Phase II Districts (400)
      • - All CS Promoters (60) were interviewed by non-CS staff.
      • Four day workshop with selected project staff to interpret and draw conclusions from the results of the Focus Group Discussions and KPC Survey results.
    • 4.
      • CG Volunteers were older than expected (average 37 years), especially in Phase I with an average age of 41 years. (Life expectancy in Mozambique is 48 years)
      • Beneficiary Mothers are on average 10 years younger than CG Volunteers.
      • No association was found between the age of the CGV or CGB and key knowledge.
      Age and Key Knowledge Lesson Learned: Select CB Volunteers based on respect, influence, and experience. CB Volunteers do not have to be in the target beneficiary group.   PHASE I PHASE II PHASE I & II Mean age of CG Volunteer 41 34 37 % of CGV who have children < 2 years of age or are pregnant 36% 50% 43% Mean age of CG Beneficiary 29.7 26.2 27.9 % of CGB who have children < 2 years of age or are pregnant 95% 97% 96% Mean age of Promoter 31 29 30 % of Promoter's who are Female 28% 20% 23%
    • 5. Perceived and Actual Literacy of CG Volunteers
    • 6. How well did the visual images convey key messages?
      • Take a minute to create an image to represent the following key message:
      • Breastfeeding prevents malnutrition and other illnesses.
    • 7.
      • 66%
      Breastfeeding prevents malnutrition and other illnesses. Diarrhea for more than ten days is an emergency Children >12m of age should take de-worming medicine every six months 25% 65% Lesson Learned: Plan time and money for image development, testing, and refinement. Improve training on key message image recognition.
    • 8. Attendance, Turnover and Replacement
      • How replacement works: If a woman indicates her child is out of the age range then she is asked to bring another woman in the community who is pregnant or has a child under 2 years of age to the next meeting.
      70-75% of CGV share messages mostly or only through group teaching sessions. 25-30% share mostly or only through home visits. Lesson Learned: CGV’s providing bi-monthly education through home visits or group education is a realistic expectation.
    • 9. Distance Traveled and Length of Meetings
      • On average, CGB spend 13 minutes walking to CGV led meetings
      • On average, CGV spend 16 minutes walking to visit their CGB
      • On average, CGV spend 17 minutes walking to Promoter led meetings
      • 77% of CGB who missed a lesson received the information
      • 99% of CGV who missed a lesson received the information
      70-75% of CGV share messages mostly or only through group teaching sessions. 25-30% share mostly or only through home visits. 82% of CGV report having group meeting that lasted at least one hour. Lesson Learned: It is important to assure that CGVs do not have to travel long distances to beneficiary households.  Beneficiaries can be reached through a combination of group and HH visits and still be effective.
    • 10. Reaching Men and Women
      • Men learn Care Group material when his wife shares with him what she has learned or he asks.
      • Men are reached through bi-annual community leader meetings (normally only men present).
      • Sensitive topics should only be discussed in single sex groups according to the KPC review panel.
      • Care Group material being developed includes pictures of men caring for children and learning from or with their wives .
      • Two or at times three generations of Mothers reached during Care Group Visits
    • 11. Time Contribution (in hours) by Type of Project Staff October 2005 – September 2010
    • 12. Dondo Success Story: How treating Intestinal Worms changed a Family There are changes in relationships as a result of Care Groups. Changes in marital relationships, possibly domestic abuse, changes in how women are viewed, their relationship with community leaders and with their neighbors and extended family that we need to capture and document
    • 13. The preceding slides were presented at the CORE Group 2010 Fall Meeting Washington, DC To see similar presentations, please visit: www.coregroup.org/resources/meetingreports

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