CORE Group Global Health Practitioner Conference Fall 2017

1. 90-SECOND SCIENCE
Fernando Chang-Muy, Moderator

2. IMPACT OF WOMEN’S
EMPOWERMENT
Building Community Capacity And Increasing Social Capital
Through A Women’s Empowerment Initiative In The Oromia
Region Of Ethiopia
Will Story, University of Iowa
Impact of Empowerment of Most Marginalized Women in
Bihar, India on Reproductive, Maternal, Neonatal and Child
Health: The Role of Efficacy, Cohesion and Collectivization
Janine Schooley, PCI

3. Building Community Capacity and Increasing Social Capital through
a Women’s Empowerment Initiative in the Oromia Region of
Ethiopia
William T. Story1, Jason Rubin2, Teweldebrhan Hailu Abrha3, Belaynesh Engidawork3, Anwar Sadik3, Feysel Mohammed3, and
Teshale Abdisa3
1University of Iowa College of Public Health, 2PCI-US, 3PCI-Ethiopia

4. Impact of empowerment of most marginalized women in Bihar, India on reproductive,
maternal, neonatal and child health: The role of efficacy, cohesion and collectivization
Presented by Janine Schooley, MPH – CORE Fall Meeting 2017
Research Team: PCI India and Population Council India staff - Funded by the BMGF
Bihar, India – 545 self help groups (SHGs/VSLs) comprised of most marginalized women
participating in PCI’s Parivartan Program (SHG plus health SBC), followed over a period of
12 months (data gathered at 2 time periods) and compared with 545 control SHGs (no health SBC)
Key findings:
Women in intervention SHGs more likely to use modern methods of contraception (p<0.001), go for institutional delivery (p<0.05), initiate
timely (p<0.001) and exclusive (p<0.001) breastfeeding, and provide age-appropriate immunization (p<0.001)
Women in intervention SHGs more likely to report: collective efficacy (p<0.001), accompaniment by SHG member for antenatal care
(p<0.05), having a visit by SHG member within 2 days of birth (p<0.001), and receipt of RMNCH information from SHG member (p<0.001)
Although significant impact on newborn care practices, selected indicators of maternal health did not demonstrate effects (number of
antenatal care visits, consumption of IFA tablets and postpartum visit by health worker).
Implications for programmers: Integrating RMNCH SBC with SHGs is a high impact approach with great potential for scale and
sustainability. The lack of impact on maternal health indicators highlights need for improved agency and action. Linking government to
SHG platform can add additional value with women as agents of social accountability and change.
Implications for further research: Future longer term research is needed to study progression from individual and collective efficacy to
collective agency/action and influence on health system accountability. Also, further study would help better understand role of social
cohesion and the interplay between social and economic empowerment of women on sustainable RMNCH impact.

5. IMPROVING MNH SERVICE
PROVISION
Male Involvement and Accommodation During Obstetric Emergencies In
Rural Ghana: A Qualitative Analysis
Will Story, University of Iowa
Expanding Maternal And Newborn Health Coverage Through Existing Local
Structures In Pastoralist Ethiopia
David Shanklin, USAID’s Maternal & Child Survival Program, CORE Group
Citizen Voice And Action - World Vision's Social Accountability Approach
Increases Access To Health Services In India And Kenya
Susan Otchere, World Vision US

6. Male Involvement and Accommodation During Obstetric Emergencies In Rural
Ghana: A Qualitative Analysis
• What are the consequences of male involvement from home to hospital?
• In-depth interviews with 39 mothers and fathers in two districts in Northern and Central Ghana
• Male involvement and accommodation operated along a spectrum
• Interpersonal level
• Not involved during the emergency
• Supportive by providing social support
• Gatekeepers who control resources and decisions
• Facility level
• Not accommodating by ignoring or disrespecting men
• Accommodating men by providing appropriate spaces for them
• Improperly expecting men to be present
• Policies and programs should promote supportive behavior by men during obstetric emergencies
while empowering women
William T. Story1, Clare Barrington2, Corinne Fordham3, Sodzi Sodzi-Tettey4, Pierre M. Barker4, and Kavita Singh2
1University of Iowa College of Public Health, 2 University of North Carolina Gillings School of Global Public Health, 3Johns Hopkins Center for
Communication Programs, 4Institute for Health Care Improvement

7. Community-Based Newborn Health
Promotion in Pastoralist Ethiopia
• Problem: Ethiopia has greatly lowered child mortality rates (a drop of 67% by
2012 from a rate of 204 deaths per 1,000 live births in 2002). Neonatal death
rates remain stubbornly high, especially among marginalized populations in some
regions of the country with limited health service access.
• Hypothesis: Using community-based (CB) resources and delivery platforms, we
aimed to increase demand for perinatal health care, and improve maternal and
neonatal practices in the home.
• Intervention: A local NGO member of the Ethiopia CORE Group Polio Project
conducted a pilot study to extend their vaccination work to include training of 23
HEWs and 64 community health volunteers (HVs) to register pregnant women
and provide support and messages in communities/homes. Community support
by sensitized local stakeholders was also promoted.
• Results: Within a 4-month period, 60% of pregnant women who were registered
had received ANC and newborn health messages, more than twice as many
women sought facility-based delivery services (7.1% to 14.2%), 53. 9% who
delivered in a health facility had previously been registered by HVs, and
registration of pregnant women quadrupled (7.4% to 30.0%).

8. Title: CitizenVoice and Action (CVA) - WorldVision's social accountability approach increases access to health services
in India and Kenya.
Project team: WorldVision Kenya and India.
Results:
Location: Kenya: Alego-Usonga sub-county (200,000 population), Siaya County.
• Between January 2014 and June 2016, CVA teams participated in the 2015, 2016 and 2017 County budget process.
• In June 2014, CVA teams in Nyamila township mobilized funds through their Member of County Assembly to increase
security of their health facility resulting in a 30% increase in health facility deliveries.
Location: India: Hardoi district (390,000 population), Uttar Pradesh.
• Nine of 17 village heads requested and received 35,000 Rupees (US$562, 2016) in government funds that was used to
refurbish 17 Auxiliary Nurse-Midwife (ANM) sub-centers between February 2015-September 2016.
• ANM sub-center records showed 29,316 condoms distributed, 1,121 and 3,156 women voluntarily choosing and
accepting to use intra-uterine devices and oral pills respectively.
Future programmatic considerations: Social accountability should be viewed as an integrated strategy in community
health programming. It serves as a platform for education and can be successfully used to mobilize communities to
identify, discuss, solve problems and contribute to improving services that affect them.
Presented by: Asha Plattner Belsan, Intern, WVUS on behalf of Susan Otchere, MOMENT Project Director, World Vision US.

9. NUTRITION SCIENCE
African Indigenous Foods (AIFs) And Their Role In Household
Resiliency And Food Security
Everlyn Matiri, Catholic Relief Services
Effectiveness of Micronutrient Interventions During the
1,000 Days in Bangladesh on Children's Growth
Zeina Maalouf-Manasseh, FANTA Project, FHI 360

10. African indigenous foods (AIFs) and theirrole in household resiliencyand food security
Everlyn Matiri – CRS
Location and population
Northern Uganda (Karamoja and West Nile Regions)
• Utilizing FGDs, KIIs, household dietary recalls, market surveys, and botanical collections
Key findings
• Over 50 AIF species identified; appreciated for taste, health benefits, medicinal effects, accessibility, income, drought
resistance and food sources during lean periods.
• Concerns related to nutrition retention and availability during food preparation and preservation
• Barriers to access: loss of wild habitat, low yield, availability restricted to rainy season, and change in texture of dried
vegetables.
Suggestion for how implementers can incorporate key findings in future programmatic work.
• Promotion of AIFs to address malnutrition challenges and micronutrient deficiencies; bridge income gaps.
• Coming up with seed varieties that can be home grown for adoption.

11. Effectiveness of lipid-based nutrient supplements in Bangladesh
Pregnant and lactating
women up to 6 mo
postpartum, children
6–24 mo
https://www.fantaproject.org/research/lipid-based-nutrient-supplements-bangladesh
Kathryn G. Dewey, Malay K. Mridha , Susana L. Matias, Charles D. Arnold, Joseph R. Cummins, Md Showkat Ali Khan,
Zeina Maalouf-Manasseh, Zakia Siddiqui, Md Barkat Ullah, and Stephen A. Vosti
0
5
10
15
20
25
30
35
40
45
50
0 6 12 18 24
LowLAZ(%)
Month
Stunting by Child Age
Control
Child-only MNP
Child-only LNS
Comprehensive
LNS
a
ab
ab
b
Northwest Bangladesh,
community health and
development program
Tested messaging
Consider adding
LNS to community
programs
Adequate support to
CHWs

12. EVIDENCE-BASED ON IMPROVED
MEASUREMENT INSTRUMENTS
A Novel Tool For Community-Based Surveillance Of Maternal
Mortality
Frank Anderson, University of Michigan
Engaging Urban Communities in Sierra Leone with Data for
Decision Making: Preliminary Findings from a Participatory
Community-Based Health Information System
Megan Christensen, Concern Worldwide

13. Community Based Surveillance for Maternal Deaths
in Rural Areas• Most Maternal Mortality Data is from Hospitals or National surveys/ other sources
• Absence of death and birth certificates means data is general/outdated
• Local/community issues are not identified
• Varying definitions of what exactly is a “maternal death”
• Maternal Deaths are found only among deaths to women of reproductive age (WRA)
• Can be identified through the RAMOS 4+2 method asked by local or community health workers to families where
a death to WRA has occurred
• Was she pregnant when she died?
• Did she have a child younger than one when she died?
• Was she pregnant within the year before she died?
• Did she die from a miscarriage or abortion?
• Did she die at home or at a health facility?
• What do you think was the cause of her death.
• Follow up with Verbal Autopsy methods by nurse, midwife or doctor at home and hospitals to create the full story
• Create/Utilize a forum for discussion (Maternal Mortality Review Committee meetings) with Administrators,
Physicians, Midwives and Health workers, Community members to identify areas of intervention/policy
development
• Experience in Ghana suggests a doubling or more of the number of maternal deaths in the districts studied
• Opportunities for ongoing surveillance at district, regional or national levels
Geynisman J, Latimer A, Ofosu A, Anderson FW: Improving maternal mortality reporting at the community level with a 4-question modified reproductive age mortality survey (RAMOS).
Int J Gynaecol Obstet 114(1): 29-32, 2011. PM21501839
Adomako J, et al Community-based surveillance of maternal deaths in rural Ghana Bulletin of the World Health Organization 94(2): 86-91, 2016. PM26908958

14. Intervention
• RCT in 10 urban slums of Freetown, Sierra
Leone implemented from May 2015 to Mar
2017
• Trained 1,300+ Community Health Volunteers
(CHVs) and Peer Supervisors; collected
morbidity and mortality data; conducted 222
verbal autopsies
• Shared findings with ward-level stakeholders,
bimonthly basis
Key Findings
• Communities can use data to make decisions
and take localized, targeted actions
• Performance of CHVs and Peer Supervisor was
significantly better in the intervention area
• Verbal autopsy cause of death 1m-59m:
malaria and pneumonia; deaths in first 27 days
of life: neonatal pneumonia
• Social autopsy: traditional care & traditional
beliefs were common; 25% of cases had no
engagement with formal health system; 50%
sought care from traditional providers after
obtaining facility-based care; for 85% of deaths
that occurred in facilities no cause of death
given to caretakers
Implementation considerations
• Data collected from communities should be a
two-way street
• Communities are empowered by data; data
foster ownership and build critical
relationships
• Social autopsy data were of high interest to
community stakeholders
Can communities use a participatory, community-
based health information system to improve their
health?