Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
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                        ...
Upcoming SlideShare
Loading in …5
×

Many Actors Tackling Anemia_Hill & Kamgang_5.1.12

1,443 views

Published on

Published in: Health & Medicine, Travel
  • Be the first to comment

  • Be the first to like this

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

×