The document discusses evidence from community health worker programs in multiple countries that care seeking for newborn illness from qualified providers outside the home is higher than originally assumed, as cultural taboos can be overcome through community education. It also examines the roles of community health workers in improving newborn care practices through home visits and facilitating care seeking, finding that while practices and care seeking increased, timely care seeking could still be improved. Overall, the key lessons highlighted are that demand for care can be generated through community programs, but treatment also needs to be accessible, and strengthening monitoring and follow up of referrals is important.
The Philadelphia Department of Public Health's Kathleen Brady presented on Philadelphia's Fetal Infant Mortality Rate (FIMR) process at the January 2015 meeting of the Philadelphia Ryan White Part A Planning Council.
Effect of Peer Counselling by Mother Support Groups on Infant and Young Child...POSHAN
This presentation was made by Arun Gupta (Breastfeeding Promotion Network of India) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016.
For more information about the conference visit our website: www.poshan.ifpri.info
The Philadelphia Department of Public Health's Kathleen Brady presented on Philadelphia's Fetal Infant Mortality Rate (FIMR) process at the January 2015 meeting of the Philadelphia Ryan White Part A Planning Council.
Effect of Peer Counselling by Mother Support Groups on Infant and Young Child...POSHAN
This presentation was made by Arun Gupta (Breastfeeding Promotion Network of India) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016.
For more information about the conference visit our website: www.poshan.ifpri.info
CORE Group Fall Meeting 2010. WHO/UNICEF - Joint Statement Service Delivery & Program Implications, - Winnie Mwebesa & Stella Abwao, Save the Children.
Improving women's diet quality preconceptionally and during gestation: Effect...POSHAN
This presentation was made by Dr. Sirazul Ameen Sahariah (Centre for the Study of Social Change) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016, New Delhi.
For more information about the conference visit our website: www.poshan.ifpri.info
Paul Mosley, MPH, Health Programs Coordinator, Mennonite Central Committee discusses the Care Group approach used by the Mennonite Central Committee to improve maternal and child health through a local Maasai partner in Tanzania at the 2018 CCIH conference.
Providing Health in Difficult Contexts: Pre-Pilot Performance-Based Financing...RBFHealth
A presentation delivered during the RBF Health Seminar,
"Providing Health in Difficult Contexts: Pre-pilot Performance-Based Financing Experiences in Adamawa State in North-East Nigeria" on April 24, 2014. It highlights the experiences from the Adamawa Performance-based financing (PBF) Pilot, the challenges faced, the early results and how the pilot is leading the way for improved coordination and sustainable health system changes.
Mother-to-child transmission of HIV (MTCT) is the main route by which infants acquire HIV infection globally. In 2010, children living with HIV in Nigeria contributed 15.3% to the 370,000 infected children worldwide, thus, the region with the highest number of unprotected childhood infection. This accounts for about 90% of HIV infection in children below 15 years of age.Most children below 15 years living with HIV contract diseases through MTCT (FMoH, 2010)
Overall incidence of MTCT without intervention is 20%-45% distributed over
-Antenatal period
-Labour & Delivery
-Breastfeeding
Without intervention,
About 30% of infants of HIV infected mothers will be infected during pregnancy and delivery
An additional 5-20% will also be infected through breastfeeding practices.
CORE Group Fall Meeting 2010. WHO/UNICEF - Joint Statement Service Delivery & Program Implications, - Winnie Mwebesa & Stella Abwao, Save the Children.
Improving women's diet quality preconceptionally and during gestation: Effect...POSHAN
This presentation was made by Dr. Sirazul Ameen Sahariah (Centre for the Study of Social Change) in the session on 'Implementation research on delivery of interventions during pre-pregnancy through lactation' at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016, New Delhi.
For more information about the conference visit our website: www.poshan.ifpri.info
Paul Mosley, MPH, Health Programs Coordinator, Mennonite Central Committee discusses the Care Group approach used by the Mennonite Central Committee to improve maternal and child health through a local Maasai partner in Tanzania at the 2018 CCIH conference.
Providing Health in Difficult Contexts: Pre-Pilot Performance-Based Financing...RBFHealth
A presentation delivered during the RBF Health Seminar,
"Providing Health in Difficult Contexts: Pre-pilot Performance-Based Financing Experiences in Adamawa State in North-East Nigeria" on April 24, 2014. It highlights the experiences from the Adamawa Performance-based financing (PBF) Pilot, the challenges faced, the early results and how the pilot is leading the way for improved coordination and sustainable health system changes.
Mother-to-child transmission of HIV (MTCT) is the main route by which infants acquire HIV infection globally. In 2010, children living with HIV in Nigeria contributed 15.3% to the 370,000 infected children worldwide, thus, the region with the highest number of unprotected childhood infection. This accounts for about 90% of HIV infection in children below 15 years of age.Most children below 15 years living with HIV contract diseases through MTCT (FMoH, 2010)
Overall incidence of MTCT without intervention is 20%-45% distributed over
-Antenatal period
-Labour & Delivery
-Breastfeeding
Without intervention,
About 30% of infants of HIV infected mothers will be infected during pregnancy and delivery
An additional 5-20% will also be infected through breastfeeding practices.
Newborn survival and perinatal health in resource-constrained settings in Asia and the Pacific: Applying Global Evidence to Priorities Beyond 2015
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Study on utilization of antenatal care and outcome of pregnancy in a medical ...Sudipta Naskar
A study on Ante-natal care utilization by the mothers in Calcutta National Medical College & Hospital done by the 3rd Professional (Part I) M.B.B.S. students of Calcutta National Medical College under the guidance of the teachers of Community Medicine.
Study on utilization of antenatal care and outcome of pregnancy in a medical ...Suman Biswas
An Observational, Descriptive, Hospital Based Cross-sectional Study was done in Postnatal Ward of Obstetrics and Gynecology Department of Calcutta National Medical College & Hospital, Kolkata. Mothers admitted in postnatal ward of Calcutta National Medical College & Hospital were asked questions in a structured interview basis and the medical records were collected and reviewed from the department after taking proper informed consent with the guidance of the Department of Community Medicine of Calcutta national Medical College and hospital, Kolkata, India. The field work was done actively by me and my group of fellow medical students in between May and June of 2013.
The results were presented as a PowerPoint slide in the department of Community Medicine and they were submitted in the hospital for further evaluation and implementation. It was a part of MBBS medical graduation program.
This slide contains information regarding Maternal and Child Health Program. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated. Thank you!
As part of the Strong Start for Mothers and Newborns effort, the CMS Innovation Center hosted a webinar to discuss why it is important to reduce early elective deliveries and share best practices on how reducing early elective deliveries improves the health of mothers and newborns across the country. Individuals representing the American College of Obstetricians and Gynecologists, the March of Dimes, providers and payers conveyed examples of successes and how reducing early elective deliveries can be accomplished. All interested parties were invited to attend this event.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
Care Seeking for Newborn Illness a Changing Paradigm_Steve Wall_4.25.13
1. Care seeking for newborn
illness: A changing
paradigm?
Steve Wall
Save the Children
CORE Meeting
Baltimore
April 25, 2013
2. 0
20
40
60
80
1990 1995 2000 2005 2010 2015 2020 2025 2030 2035
Source: UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011;
UNICEF, Required Acceleration for Child Mortality Reduction beyond 2015, 2012; team analysis
SNL/Save the Children team analysis for NMR projection for Call for Action meeting
MortalityRate(deaths/1000births)
20
35
Accelerated U5MR ARR = 5.1%
Current U5MR ARR = 2.2%
* ARR = annual rate of reduction
MDG 4 target =
34 U5MR
Global Progress for child survival
U5MR and NMR decline 1990-2010, projected to 2035
15
Current NMR ARR = 1.8%
If 1-59 month mortality accelerates further but neonatal mortality continues on
same trend then with
2 million child deaths in 2035, 1.5 million may be neonatal.
3. Why are we focused on newborn survival?
Three killers –
prematurity, asphy
xia, and infections
- account for 81%
of all neonatal
deaths3.1 million
Sources: CHERG/WHO 2010. Estimates for 193 countries for 2008. Black R et al Lancet 2010. UNICEF, State of the World's Children, 2011.
Causes of death in children under-five in developing countries –
Newborn deaths are almost half of all deaths of children under
five
4. REGION Neonatal mortality rate
Average annual change
1990-2010
Africa 1.3%
East Med 1.6%
Southeast Asia 2.2%
Western Pacific 4.2%
Americas 3.6%
Europe 3.6%
Maternal mortality ratio = 4.2%
1- 59 month mortality rate = 3%
Neonatal mortality rate = 1.8%
All 3 measures show increased progress since 2000
Source: Lawn J,E. et al. 2012. Newborn survival: a multi-country analysis of a decade of change. Health Policy and Planning.
27(Suppl. 3): iii6-ii28. Data sources: Oestergaard et al 2011 PLoS, UNICEF 2012 www.childinfo.org
2165
2085
Mortality average annual rate of reduction
WHEN WILL REGIONS REDUCE NMR TO
CURRENT RATE OF HIGH INCOME
COUNTRIES
(3 per 1000)?
5. Care seeking for NBs: Our Original Assumptions
• Home-based management of sick
newborns is effective and saves lives
• Care seeking from qualified providers
outside the home is low, influenced by
entrenched cultural beliefs and practices.
– Seclusion, contamination
– Evil eye
– Traditional beliefs about illness and remedies
– Lack of trust in “western” medicine
6. • Case identification in Projahnmo (Bangladesh)
coincided with the days of scheduled post-natal
home visits “active” case detection
seemed needed
Baqui et al. BMJ, 2009.
Family acceptance of referral to facilities:
Bangladesh – ~ 1/3
Pakistan – 20%
Baqui et al. Lancet. 2008; Zaidi et al. XXX.
Evidence “confirming” these assumptions
7. More recent evidence and program experience
• Nepal:
• MINI – FCHVs counseled family, who notified
FCHVs of suspected newborn illness
• FCHVs identified signs of PSBI, treated with
cotrimoxazole and referred to gov‟t CHW for
injectable gentamicin
• CHW provided 7 days of gentamicin
• Initially at home; but families became willing to go to
health posts/centers for gentamicin
MINI model incorporated into 10-district pilot of
Community-Base Newborn Care Program (CB
NCP)
Recent CB NCP data show families infrequently
contact FCHVs, but tend to directly seek care at
health posts/centers
8. More recent evidence and program experience - 2
• Ethiopia
• COMBINE (cRCT) introduced NBS management
(amoxicillin + gentamicin x 7 days) by Health
Extension Workers (HEW) at Health Posts
• Expectation of “active case detection” by
volunteers and HEWs
• Initially, very low case identification in intervention
areas.
• Qualitative research identified barriers –
cultural/religious taboos against taking newborns
outside the home; lack of knowledge of newborn
illness, treatment, and availability of such
treatment at HPs.
• Project worked with community/religious
leaders, volunteers to provide information.
• Increased care seeking for sick newborns was
largely „self-referral‟
9. COMBINE care seeking for NB illness
Table 1: Expected births & care-seeking
For newborn illness
2011 2012
Q3 Q4 Q1 Q2 July
Intervention Expected No. of births 2711 2395 2123 2468 880
No. (%) seen at HP 8 (0.3) 28 (1) 131 (6.2) 170 (7.0) 54 (6.1)
No. (%) seen at HC 0 (0) 8 (0.33) 102 (4.8) 38 (1.5) 12 (1.6)
Control Expected No. of births 2731 2394 2068 2419 894
No. (%) seen at HP
5 (0.18) 6 (0.25) 16 (0.75) 7 (0.28) 8 (0.91)
No. (%) seen at HC
3 (0.1) 5 (0.2) 42 (2) 31 (1.3) 13 (1.5)
10. Implications
• Families ARE willing to seek care for NB
illness (from qualified providers) outside
the home.
– Taboos can be overcome (rapidly ?) if
families/communities have knowledge about
preventable newborn deaths, need for early
care seeking, and availability of services
– Services must be reliable (set times for health
worker at HP, medicines in stock)
11. Issues/Questions
• Is care seeking timely enough for effective
treatment? Any prior care seeking from
unqualified providers?
• Can community participation and CHW
role(s) help “facilitate” care seeking?
• How different might this care seeking
pattern be in different regions or different
country contexts (eg, need for formative
research and pilots)?
• How rapidly can community norms be
changed and will these changes be
sustained?
12. Additional questions for discussion?
• In some countries
(eg, India, Pakistan), care seeking for
newborn illness may be mostly from
private providers (many unqualified). How
to address this challenge?
• What is care seeking pattern for sick
newborns in the first week of life, and how
can this be increased?
– First week NBS is more lethal
condition, requires early identification and
treatment, and is more prevalent than later
neonatal NBS.
13. Further considerations
• Roles of CHWs (SNL 2 experiences) in
changing household practices and care
seeking
• Role of community mobilization in
changing expectations &
norms, household practices and care
seeking, and care quality
15. SNL2 Vision
To have reduced global
neonatal mortality by
providing catalytic
assistance to develop, and
implement, effective
evidence-based newborn
care interventions at scale.
17. Description of programs
Program elements:
• Home visits by Community Health Workers during pregnancy & after birth to:
Encourage ANC and facility delivery
Promote optimal care practices for newborn and mother
Counsel families to identify danger signs and seek care
Identify sick newborns and refer to facilities (+ pre-referral oral antibiotic in
Nepal only)
• Facility strengthening (varied)
• Community engagement (varied)
Data from pilot districts in 4 countries:
• Malawi
• Uganda
• Nepal
• Bangladesh
18. Community workers conducting home visits
Differences across programs:
• Population catchment size
• Gender
• Education level
• Salaried government
employee vs. volunteer
• Incentives
• How workers are recruited
• Residency
• Time in community
• Length of pre-service training
Similarities across programs:
• Length of training in
maternal newborn health
package
• Content of counseling on
newborn care practices
• Made home visits during
pregnancy and soon after
birth
LESSON: Delivery platforms vary substantially and delivery
systems can change.
19. Implementation Questions
1. How many women and newborns received home visits?
2. What did CHWs do for newborns during visits?
3. How many families sought timely and appropriate care
when their newborns had danger signs?
4. What was the role of CHWs in identifying and referring
newborns with danger signs?
5. What have we learned about increasing uptake of
healthy newborn care practices?
20. Percent of mothers/babies receiving home visits
FINDINGS:
• Low in Malawi, higher in
Bangladesh and Nepal
• More received pregnancy
visits than postnatal visits
• If a postnatal visit was
received, it was usually within
3 days after birth
LESSON: Percent receiving home visits varied substantially
and we need to consider what each community platform
can handle.
0
20
40
60
80
100
Nepal
(N=615)
Bangladesh
(N=398)
Malawi
(N=900)
1 or more home visits during pregnancy
1st postnatal home visit 0-3 days after birth
1st postnatal home visit 4-7 days after birth
Percentage of mothers/newborns that
received home visits
Data from interviews with mothers with a live birth in previous 12 months
21. What was done for newborns during postnatal home
visits within 3 days after birth
FINDINGS:
• Nearly all newborns that received an early postnatal home visit had
at least one key function done
• Weighing baby low in Nepal, but FCHVs only instructed to weigh
babies not previously weighed at facility
0
20
40
60
80
100
Checked cord Breastfeeding supportChecked temperature Weighed baby All 4 functions
Nepal
(N=307)
Malawi
(N=95)
Percentage of newborns that received a postnatal home visit ≤3 days after birth and signal functions were
performed by CHW
LESSON: When postnatal visits are done, CHWs performed
key tasks. BUT need to monitor quality.
Data from interviews with mothers with a live birth in previous 12 months
22. Care-seeking for newborns with danger signs
Malawi Uganda Nepal Bangladesh
Endline Endline Baseline Endline Baseline Endline
NB with danger sign 23.4% 50.0% 21.4% 28.8% 52.3% 40.7%
Care-seeking for those with a danger sign:
Sought care (any source) 82.9% 94.2% 85.8% 98.9% 82.0% 88.3%
Sought care <=24 hours at
a facility (public or private)
41.2% 48.3% 36.6% 67.8% NC 20.4%
FINDINGS:
High levels of care-seeking
• High in all countries (baseline & endline, intervention & comparison areas)
Yet fewer newborns taken to a facility within 24 hours after onset of
danger signs
• % newborns with danger signs taken to a facility within 24 hours increased in
Nepal, was moderate in Malawi and Uganda, low in Bangladesh
Data from interviews with mothers with a live birth in the previous 12 months
23. Care-seeking for newborns with danger signs
LESSONS:
Families will leave the home and seek care.
Need to address delays in seeking care from a facility within 24
hours after onset of illness. Noting we found high levels of
newborns with danger signs. Difficulty in relying on survey data –
mothers may not accurately recall or report illnesses.
Need to ensure families are accessing appropriate care. Use of
private facilities and pharmacies/drug shops high in Nepal,
Bangladesh, and Uganda. We saw decreases in Nepal but no change
in Bangladesh (no baseline information from Uganda or Malawi).
24. Access to full course of treatment for newborn sepsis
MALAWI
NEPAL
1 facility per
300,000 people
1 facility per
7,000 people
LESSON: Community-based
programs may create
demand, but treatment needs
to be available closer to home
25. Role of CHWs in referring sick newborns
FINDINGS:
CHWs have good understanding
of newborn danger signs and
appropriate care
• >95% of CHWs in Malawi and Nepal
could name 3+ newborn danger signs
BUT low volumes of CHW
referrals of newborns with danger
signs
• Many newborn not visited by CHWs
within the first week after birth
• Families going straight to facilities
when newborn has danger sign
• Issues with CHWs not getting
required supplies/equipment
Data from interviews with mothers with a live birth in
previous 12 months
0
20
40
60
80
100
Nepal
(N=615)
Bangladesh
(N=398)
Malawi
(N=900)
1 or more home visits during pregnancy
1st postnatal home visit 0-3 days after birth
1st postnatal home visit 4-7 days after birth
Percentage of mothers/newborns that
received home visits
26. Role of CHWs in referring sick newborns
LESSONS:
Need appropriate expectations for the role of CHWs in identification
and referral: Focusing on increasing family-initiated care-seeking may
be more important and more feasible than detection by CHWs.
Examine role of CHW in follow-up and treatment completion: May be
feasible and effective to involve CHWs in follow-up of sick newborns.
Counter-referral systems are needed to implement follow-up.
Strengthen monitoring of referrals and outcomes: Weak systems to
track referrals and referral outcomes.
27. Uptake of 4 key newborn care practices
0
20
40
60
80
100
Malawi* Nepal* Bangladesh Uganda*
Baseline Endline
Immediate breastfeeding
0
20
40
60
80
100
Malawi* Nepal* Bangladesh* Uganda*
Baseline Endline
Bathing delayed ≥6 hours
0
20
40
60
80
100
Malawi Nepal Bangladesh Uganda
Baseline Endline
Skin-to-skin contact
0
20
40
60
80
100
Malawi Nepal* Bangladesh* Uganda*
Baseline Endline
Nothing applied to cord after cutting
*Statistically significant at p<0.05
Data from interviews with mothers with a live birth in previous 12 months
28. Newborn care practices
FINDINGS:
• Practices improved over time with a few exceptions (immediate breastfeeding in
Bangladesh, applying nothing to cord in Malawi and Uganda)
• Practices increased in both intervention and comparison areas, though endline
rates often higher in interventions areas. (Note: comparison area data only
available in Bangladesh and Uganda.)
• Newborn care practices associated with receipt of home visits from CHW during
pregnancy (except in Uganda)
– Only statistically significant if mother received 3+ home visits during pregnancy
LESSON: Home visits during pregnancy are an opportunity to improve
newborn care practices and programs able to reach large numbers of
women during pregnancy. BUT may be difficult to achieve 3+ visits.
29. Mobilizing communities for sustainable change in newborn
health expectations, care giving practices, and care seeking
Angie Brasington, Save the
Children
CORE Group SPRING MEETING
April 25, 2013
Mobilizing communities for improved maternal & newborn
health:
lessons and questions
Angie Brasington,
Save the Children
CORE Group
SPRING MEETING
April 25, 2013
30. Outline:
CORE Group Newborn Health Survey
CM for Newborn Health – what are we learning?
Questions that need exploration
31. Carolyn Kruger, Ph.D.
Sr. Advisor MNCH
PCI
CORE Group co-chair: Safe motherhood &
reproductive Health Working Group
CORE Group
Newborn Health Survey Results
32. USAID Priority Countries:
Supporting Newborn Care
Belize
Dominican Republic
Guatemala
Mexico
Nicaragua
Colombia
Ecuador
Peru
Ethiopia
Kenya
Senegal
South Sudan
Mali
India
33. Newborn Health Areas Supported
(18 Organizations)
Number of organizations
16
16
15
15
12
12
12
11
10
10
9
9
8
7
6
5
3
2
2
1
34. Cross-Cutting Approaches
• CHW capacity building - 100%
• Behavior change/communication - 78%
• Community mobilization - 70%
• Community health system strengthening - 70%
• Care groups - 50%
• mHealth approaches - 48%
• Mass communication - 42%
• C-IMCI/CCM - 38%
35. Innovative Strategies
• mHealth reminders on assessment of mothers and newborns
• Mobile job aids - counseling messages
• Newborn screening on birth defects
• Preconception care
• Casa Materna birthing home model
• Community Kangaroo Mother Care
• CHW capacity to recognize danger signs
• Involving fathers during pregnancy, delivery and PP care
• EBF among adolescent mothers using text messaging and support groups
37. Community-based Activities
=
Community Mobilization
• Day celebrations, competitions, use of action cards to stimulate
group dialogue are all examples of behavior change strategies.
• The process of stimulating a community to identify, plan and
implement strategies and activities to achieve an agreed upon
goal is community mobilization.
• CM often incorporates participatory behavior change
strategies, however
• BC strategies can be effective without CM, so why…..
Mobilizing Communities…..
38. 1. We have evidence it works:
WEWE problems
So, why mobilize communities?
Costello et al, Effect of a participatory intervention with women’s groups on birth outcomes
in Nepal: cluster-randomized controlled trial. Lancet 2004; 364: 970 – 979.
Baqui et al, Effect of community-based newborn-care intervention package implemented
through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-
randomized controlled trial. Lancet 2008; 371: 1936–44.
Kumar et al, Effect of community-based behaviour change management on neonatal
mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomized controlled trial. Lancet
2008; 372: 1151–62.
Costello et al, Effect of a participatory intervention with women's groups on birth outcomes
and maternal depression in Jharkhand and Orissa, India: a cluster-randomized controlled
trial. Lancet 2010; 375: 1182-1192
39. 2. The principles behind CM fit with our mission and context:
• Decentralization and democratization require increased
community level decision-making --- CM is an entry point for civil
society strengthening and democracy building.
• CM builds mechanisms and systems to sustain improvements in
individuals’, families’ and communities’ well-being.
• Communities can apply political pressure to improve services.
• CM can strengthen community members’ capacity to address the
underlying causes of poor health.f problems
So, why mobilize communities?
40. LESSONS:
Men want to be involved
Communities are able and
willing to contribute
resources
Communities are changing
rapidly
Communities take action:
emergency transport
systems and funds, advocacy
for satellite clinics and
staff, pregnancy surveillance.
What have we learned from communities lately?
41. Challenges and lessons
LESSONS:
Need appropriate expectations
for the role of CHWs: MOH
staff who are closest to the
community are already thinly
stretched.
• Should CHWs lead or only
support CM efforts?
• Can existing community
leaders, volunteers or members
of civil society organizations
feed input from communities to
the health system?
• ‘Sharing the burden lightens the
load’
42. Challenges and lessons
LESSONS:
Community mobilization competes with many other priorities
(clinical training, infrastructure development) within a resource
limited environment.
• Make every effort to integrate CM into broader national health
strategies, especially when existing MOH policy calls for strong community
engagement.
• When communities, CHWs and program managers experience results, the
relative value of CM is compelling and support is more likely.
43. Challenges and lessons
LESSONS:
Community mobilization takes time.
• Simplify the process as much as possible before you start and refine
further as you roll out.
• As staff becomes more confident and skilled , CM processes speed up.
Good training is essential.
• CM successes build momentum and can lead to organic expansion.
• Communities and groups with prior experience organizing to solve
problems can move more quickly.
44. Challenges and lessons
LESSONS:
Community mobilization at scale takes thoughtful planning.
It can be done when:
• Designed with scale in mind
• Effective training materials and guides are produced to support the
process
• Financial and political support is available
• Partners are interested in adopting the approach
• Systems are in place to support capacity-building of program teams
(including monitoring and evaluation, training and ongoing technical
assistance)
45. So how can we ensure communities are
engaged?
Questions:
Why are communities consistently left out of the Household to
Hospital Continuum of Care (HHCC)?
What do we as PVOs/INGOs require to inspire and equip more
partners to engage communities for improved MNH?
• More evidence on ‘how’ CM works?
• More advocacy?
Editor's Notes
* The data for this study comes from all sick neonates (n=687 cases) tracked at the HP or HC. * Key messages to convey areThe total number of cases seen increases over time. At the beginning very little cases were seen. Percentages are computed against expected number of births estimated for control and intervention separately. More number of cases are recorded across the intervention clusters.
Further confirms what we saw in MINI and Ethiopia.
Note: In Malawi, there may be some health centers that
Further confirms what we saw in MINI and Ethiopia.
CORE Group fosters collaborative action and learning to improve and expand community-focused public health practices for underserved populations around the work. Established in 1997 in Washington D.C., CORE Group is an independent 501(c)3 organization, and home of the Community Health Network, which brings together CORE Group their member and associate organizations with scholars, advocates and donors to foster collaboration, strengthen technical capacity, develop state-of-the-art tools and resources, and advocate for effective community-focused health approaches. Through their Community Health Network, CORE Group reaches more that 720 million people a year in over 180 countries.
To make map: http://www.29travels.com/travelmap/
CORE Group recently conducted an online survey, using Survey Monkey, of its 59 Member and 16 Associate Organizations on their newborn health activities and needs. An invitation to participate was shared via CORE Group’s Member and Associate Organizations’ listservs. The survey was open for input between March 13th and 24th, 2013. The survey team did a preliminary analysis of the results using Survey Monkey tools based on responses from 18 different international NGOs. The objectives of the survey were to: 1) Obtain updated information on CORE Group member newborn health activities, assets, and needs. 2) Assess where and how CORE Group might facilitate newborn health collaboration and scale-up.3) Determine member participation in newborn-related Global Development Alliances (GDAs): Helping Babies Breathe® (HBB) and Handwashing with Soap for Newborn Survival. Shannon, Karen asked how many and via which listservs. Also 2 reports were received yesterday from one NGO, so we have to verify results with them.
Further confirms what we saw in MINI and Ethiopia.