COMMUNITY DIRECTED INTERVENTIONS TO IMPROVE MALARIA IN PREGNANCY CONTROL SERVICES IN NIGERIA William R Brieger, Bright Orj...
Background <ul><li>Akwa Ibom State, Nigeria has high malaria transmission but is late in receiving malaria interventions <...
Key MIP Interventions <ul><li>Intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine </li><...
Akwa Ibom State, Nigeria: Year Round Malaria Risk CDI MP PILOT
Baseline in 2007 - MIP Indicators during Last Pregnancy 60% was RBM Target for 2005
Nigeria MIP Partnership Concept and Project Design CLINIC MIP performance standards developed and implemented COMMUNITY MI...
Basic CDI Processes - Onchocerciasis <ul><li>Community entry by Clinic Staff and meeting chiefs </li></ul><ul><li>Communit...
Community Organization for CDI in MIP <ul><li>Front line staff  conducted community outreach, meetings </li></ul><ul><li>K...
CDDs equipped <ul><li>Counseling Card </li></ul><ul><li>Medicines (SP) </li></ul><ul><li>Village Register </li></ul><ul><l...
Capacity Building at State, District & Facility Levels <ul><li>Trained 18 State and 25 LGA core trainers on FANC, MIP, PMT...
Quality Improvement Processes: Standards Based Management and Recognition <ul><li>SBM-R is a collaborative process </li></...
IPTp and ITN Delivery
Service Statistics: IPTp2 Distribution LLINs Q1 '09 Q2 '09 Q3 '09 Q4 '09 Total Coverage Control Clinic 251 360 292 187 109...
Exit Interviews at Intervention Clinics
CDDs trained for ITN Distribution
Service Statistics: LLIN Distribution LLINs Q1 '09 Q2 '09 Q3 '09 Q4 '09 Total Coverage Control Clinic 40 25 8 0 73 3.8% In...
Service Statistics: ANC Attendance 2009
Service Statistics: ANC Attendees Receiving Tetanus Toxoid in 2009
Improving Performance Quality
SBM-R Scores (%) for ANC Services
Follow-up Results
Malaria Transmission Knowledge: Mosquitoes
IPTp – Took SP Twice Last Pregnancy IPTp with SP was provided in the intervention arm at both ANC Clinics and  through vol...
At Ikot Ebok TBA/CDD Brought Her Clients to Receive ANC Services TBA/CDD
Attended ANC at Local Government Clinic Community Directed Distributors were trained to refer pregnant women to the ANC cl...
Used ITN During Last Pregnancy ITN supplies were difficult to obtain. The World Bank Booster support for Akwa Ibom State w...
Achievements and Challenges <ul><li>All pregnant women in intervention area received at least I dose of IPTp and two-third...
Advocacy: State Commissioner, LGA Chairs and Legislators
Success stories <ul><li>ANC attendance improves at all facilities </li></ul><ul><li>CDDs remember to track net use </li></...
Key Lessons for CDI <ul><li>CDI is a practical way to reach women who would not normally have attended ANC and be protecte...
Next Steps <ul><li>Refresher training of current CDDs </li></ul><ul><li>Continued advocacy for free services and commodity...
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Community Directed Interventions to Improve Malaria in Pregnancy Control Services in Nigeria

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Community Directed Interventions to Improve Malaria in Pregnancy Control Services in Nigeria

William R Brieger, Bright Orji, Joseph Okeibunor, Emmanuel Otolorin, Gbenga Ishola, Barbara Rawlins

JHPIEGO

Safe Motherhood and Reproductive Health Working Group Showcase

CORE Group Spring Meeting, April 29, 2010

Published in: Health & Medicine
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Community Directed Interventions to Improve Malaria in Pregnancy Control Services in Nigeria

  1. 1. COMMUNITY DIRECTED INTERVENTIONS TO IMPROVE MALARIA IN PREGNANCY CONTROL SERVICES IN NIGERIA William R Brieger, Bright Orji, Joseph Okeibunor, Emmanuel Otolorin, Gbenga Ishola, Barbara Rawlins
  2. 2. Background <ul><li>Akwa Ibom State, Nigeria has high malaria transmission but is late in receiving malaria interventions </li></ul><ul><li>Jhpiego with support from ExxonMobil Foundation and the Akwa Ibom State Ministry of Health is working to reduce burden of malaria in pregnancy (MIP) using a two-ponged approach to reach pregnant women </li></ul><ul><ul><li>improving antenatal care (ANC) service quality and </li></ul></ul><ul><ul><li>community involvement through community-directed intervention (CDI) </li></ul></ul>
  3. 3. Key MIP Interventions <ul><li>Intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine </li></ul><ul><li>Insecticide treated bednets (ITNs) </li></ul><ul><li>Prompt and Appropriate malaria case management </li></ul><ul><li>Delivered on the platform of Antenatal Care </li></ul>
  4. 4. Akwa Ibom State, Nigeria: Year Round Malaria Risk CDI MP PILOT
  5. 5. Baseline in 2007 - MIP Indicators during Last Pregnancy 60% was RBM Target for 2005
  6. 6. Nigeria MIP Partnership Concept and Project Design CLINIC MIP performance standards developed and implemented COMMUNITY MIP skills and responsibilities implemented through community directed intervention Training, Supervision Mobilization, Commodities Referrals, Records, Feedback
  7. 7. Basic CDI Processes - Onchocerciasis <ul><li>Community entry by Clinic Staff and meeting chiefs </li></ul><ul><li>Community orientation by Clinic Staff </li></ul><ul><li>Community selects community directed distributors (CDDs) </li></ul><ul><li>CDDs trained by Clinic Staff </li></ul><ul><li>Community conducts census </li></ul><ul><li>Community plans dates, approach </li></ul><ul><li>Community collects ivermectin from Clinic </li></ul><ul><li>Community distributes ivermectin </li></ul><ul><li>Monitor, treat and/or refer reactions </li></ul><ul><li>Clinic Supervises </li></ul><ul><li>Community submits treatment records to Clinic </li></ul><ul><li>Community evaluates its efforts and improves </li></ul>
  8. 8. Community Organization for CDI in MIP <ul><li>Front line staff conducted community outreach, meetings </li></ul><ul><li>Kin groups formed basis of CDD selection </li></ul><ul><li>Community members in 489 kin groups (clans) chose 734 trained CDDs who were trained by front line staff </li></ul><ul><li>CDD kits provided – medicine, counseling cards, registers </li></ul><ul><li>Communities conducted mapping to identify socio-economic structures that will support MIP programming </li></ul><ul><li>Communities conducted census to estimate quantities of commodities required by each kindred </li></ul>
  9. 9. CDDs equipped <ul><li>Counseling Card </li></ul><ul><li>Medicines (SP) </li></ul><ul><li>Village Register </li></ul><ul><li>Monthly Tally Sheet </li></ul><ul><li>Referral Form </li></ul>
  10. 10. Capacity Building at State, District & Facility Levels <ul><li>Trained 18 State and 25 LGA core trainers on FANC, MIP, PMTCT, M&E, and CDI </li></ul><ul><li>Stepped down the training to 311 frontline health workers in 27 health facilities – intervention and control for basic MIP, intervention only for CDI and Performance Standards Improvement </li></ul>
  11. 11. Quality Improvement Processes: Standards Based Management and Recognition <ul><li>SBM-R is a collaborative process </li></ul><ul><li>Assessments are both external and self-assessments </li></ul><ul><li>Assessments lead to action plans </li></ul><ul><li>Plan implementation leads to measurable progress </li></ul>
  12. 12. IPTp and ITN Delivery
  13. 13. Service Statistics: IPTp2 Distribution LLINs Q1 '09 Q2 '09 Q3 '09 Q4 '09 Total Coverage Control Clinic 251 360 292 187 1090 18.7% Intervention Clinic 395 384 409 385 1573 21.4% Community Distributors 2092 1246 1617 1823 6778 92.2%
  14. 14. Exit Interviews at Intervention Clinics
  15. 15. CDDs trained for ITN Distribution
  16. 16. Service Statistics: LLIN Distribution LLINs Q1 '09 Q2 '09 Q3 '09 Q4 '09 Total Coverage Control Clinic 40 25 8 0 73 3.8% Intervention Clinic 20 0 2 8 30 0.4% Community Distributors 1683 37 225 3699 5644 76.8%
  17. 17. Service Statistics: ANC Attendance 2009
  18. 18. Service Statistics: ANC Attendees Receiving Tetanus Toxoid in 2009
  19. 19. Improving Performance Quality
  20. 20. SBM-R Scores (%) for ANC Services
  21. 21. Follow-up Results
  22. 22. Malaria Transmission Knowledge: Mosquitoes
  23. 23. IPTp – Took SP Twice Last Pregnancy IPTp with SP was provided in the intervention arm at both ANC Clinics and through volunteer Community Directed Distributors. In the control area SP was made available at the clinics.
  24. 24. At Ikot Ebok TBA/CDD Brought Her Clients to Receive ANC Services TBA/CDD
  25. 25. Attended ANC at Local Government Clinic Community Directed Distributors were trained to refer pregnant women to the ANC clinic. One challenge was ANC card fee charges of N200-300.
  26. 26. Used ITN During Last Pregnancy ITN supplies were difficult to obtain. The World Bank Booster support for Akwa Ibom State was delayed and not available throughout the intervention period.
  27. 27. Achievements and Challenges <ul><li>All pregnant women in intervention area received at least I dose of IPTp and two-thirds received two doses </li></ul><ul><li>Quality improved but transfer of health staff trained by project slowed quality gains </li></ul><ul><li>Irregular stocks of commodities made ITN distribution difficult </li></ul><ul><li>Continued charging of user fees by local governments discourage ANC attendance </li></ul><ul><li>Continued motivation of health staff and CDDs was required </li></ul>
  28. 28. Advocacy: State Commissioner, LGA Chairs and Legislators
  29. 29. Success stories <ul><li>ANC attendance improves at all facilities </li></ul><ul><li>CDDs remember to track net use </li></ul><ul><li>Improvement on community linkages with facilities (CDDs obtain MIP commodities and information and share with community members) </li></ul><ul><li>Community and opinion leaders happy with project, demand for inclusion of other members of the community. </li></ul>
  30. 30. Key Lessons for CDI <ul><li>CDI is a practical way to reach women who would not normally have attended ANC and be protected from malaria </li></ul><ul><li>Even if health services charge fees and discourage ANC attendance, health staff play a crucial role in community mobilization to guarantee malaria control services </li></ul><ul><li>Constant advocacy and encouragement are needed </li></ul>
  31. 31. Next Steps <ul><li>Refresher training of current CDDs </li></ul><ul><li>Continued advocacy for free services and commodity stocks </li></ul><ul><li>Training of health staff in additional facilities in both intervention and control local governments </li></ul><ul><li>Training of CDDs in Control Communities </li></ul>
  32. 32. Thank you

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