This study compared the efficacy of mothers versus community health workers (CHWs) screening children for severe acute malnutrition (SAM) in Niger. Over 12,000 mothers and 36 CHWs were trained to use mid-upper arm circumference (MUAC) color-coded bracelets. Results showed similar coverage rates, but mothers detected cases earlier with higher MUAC agreement rates and fewer children requiring inpatient care. Training mothers was lower cost but achieved better outcomes than using CHWs. The study demonstrates that empowering mothers to screen for malnutrition can improve programs and relieve pressure on health systems.
This document summarizes a study that assessed the impact of an educational program on female workers' knowledge, attitudes, and practices related to breast cancer and breast self-examination in Sana'a, Yemen. The study involved 103 females in a control group and 103 females who received the educational intervention as the case group. Results showed improvements in the case group's knowledge of breast risk factors and attitudes/practices related to breast self-examination compared to the control group. The educational program was found to be an effective way to improve females' knowledge, attitudes, and behaviors toward breast cancer screening.
CSHGP Operations Research Findings_David Shankin_5.8.14CORE Group
The project aimed to improve maternal and child health in rural Honduras by establishing community-based health units (UCOS) staffed by volunteers. An evaluation found that the UCOS model significantly improved six coverage indicators, such as the proportion of the target population served. It also improved some outcomes, like the number of women receiving prenatal care. Costs to clients were much lower than using existing facilities. The Ministry of Health recognized benefits but recommended further testing the model. ChildFund continues supporting some initial UCOS sites and expanding the approach.
The document summarizes updated systematic reviews of interventions to increase screening for breast, cervical, and colorectal cancers. Nine interventions were reviewed: group education, one-on-one education, client reminders, reducing out-of-pocket costs, reducing structural barriers, and provider assessment and feedback. New recommendations were made for group education to increase mammography screening and one-on-one education to increase colorectal cancer screening with FOBT. Evidence for the effectiveness of client reminders to increase FOBT screening was upgraded. Previous findings on the other interventions were reaffirmed. Research gaps in increasing screening, especially for colorectal cancer, were also identified.
Objective: To evaluate the utility of a targeted lecture in improving FP awareness amongst clinicians.
Design: This is a dual institution, prospective survey-based study assessing if an educational lecture can increase the likelihood of FP consideration, discussion, and referral.
The document discusses effective practices in gastric cancer programs based on a survey conducted by the Association of Community Cancer Centers (ACCC). Key findings from the survey show that strong gastric cancer programs include a multidisciplinary team approach with tumor boards, support staff such as nutritionists and social workers, expert physicians, and access to clinical trials and financial assistance. Four member programs were identified as having experience treating gastric cancer patients and could serve as community resource centers: Curtis & Elizabeth Anderson Cancer Institute, Massachusetts General Hospital Cancer Center, Stanford Cancer Center, and University of Colorado Hospital/Cancer Center.
This document summarizes a study examining non-adherence to contraceptive vaginal ring (CVR) use among women in Kisumu, Kenya from 2014-2015. Non-adherence was assessed through self-report, pharmacy records, and residual hormone levels in returned rings. Non-adherence was 14.0% by self-report and 54.5% by pharmacy records. Women with salary-based income had lower non-adherence. Participants dissatisfied with 4 or more aspects of the ring were more likely to report non-adherence. Over time, residual hormone levels showed increasing non-adherence in 46.5% of participants. Economic empowerment and education on CVR features may help reduce non
This study examined the impact of the 21-gene breast cancer assay (Oncotype DX) on adjuvant therapy decisions in a Mexican public hospital. 98 early-stage breast cancer patients were tested. Following assay results, treatment decisions changed for 32% of patients (27% of node-negative and 41% of node-positive patients). The proportion recommended chemotherapy decreased from 48% to 34% after testing. 92% of physicians reported being more confident in their recommendations after ordering the assay. The results suggest the 21-gene assay can meaningfully impact adjuvant treatment decisions and potentially reduce chemotherapy use in the Mexican public health system.
Effect of a Training Program about Maternal Fetal Attachment Skills on Prenat...iosrjce
to assess effect of a training program about maternal fetal attachment skills on prenatal attachment
among primigravida women.
Subjects and Methods: A quasi experimental research design was utilized. From a specific private Antenatal
Clinic in Mansoura city-Egypt eighty primigravida women aged 20 to 35 years, at 30th week gestation, had
singleton pregnancy and can read and write were selected purposively between of January and August 2011
and was equally divided into two groups; intervention group: received a training program on two MFA skills
and control group: received the routine antenatal care. Using interview sheet and Cranley's Maternal Fetal
Attachment Scale (MFAS) the data were collected at baseline and after two and four weeks of the enrollment.
Results: MFAS score had significantly increased in the intervention group from 61.6±5.9 at the baseline to
68.5±6.8 and 69.6 ±5.9 at 32nd, 34th week gestation respectively. While the changes of the MFAS total score in
the control group were insignificant.
Conclusion: MFAS total scores had significantly increased in the intervention group at 32nd and 34th week
gestation compared to the baseline score. Conversely, the MFAS total score did not differ significantly between
the baseline and two and four weeks after enrollment among the control group.
Recommendations: Enhancing the health care providers' awareness of the MFA skills to utilize in the
promotion of the prenatal MFA and motivate the active role of the nurses in helping the pregnant women to
adhere to the appropriate MFA skills are recommended.
This document summarizes a study that assessed the impact of an educational program on female workers' knowledge, attitudes, and practices related to breast cancer and breast self-examination in Sana'a, Yemen. The study involved 103 females in a control group and 103 females who received the educational intervention as the case group. Results showed improvements in the case group's knowledge of breast risk factors and attitudes/practices related to breast self-examination compared to the control group. The educational program was found to be an effective way to improve females' knowledge, attitudes, and behaviors toward breast cancer screening.
CSHGP Operations Research Findings_David Shankin_5.8.14CORE Group
The project aimed to improve maternal and child health in rural Honduras by establishing community-based health units (UCOS) staffed by volunteers. An evaluation found that the UCOS model significantly improved six coverage indicators, such as the proportion of the target population served. It also improved some outcomes, like the number of women receiving prenatal care. Costs to clients were much lower than using existing facilities. The Ministry of Health recognized benefits but recommended further testing the model. ChildFund continues supporting some initial UCOS sites and expanding the approach.
The document summarizes updated systematic reviews of interventions to increase screening for breast, cervical, and colorectal cancers. Nine interventions were reviewed: group education, one-on-one education, client reminders, reducing out-of-pocket costs, reducing structural barriers, and provider assessment and feedback. New recommendations were made for group education to increase mammography screening and one-on-one education to increase colorectal cancer screening with FOBT. Evidence for the effectiveness of client reminders to increase FOBT screening was upgraded. Previous findings on the other interventions were reaffirmed. Research gaps in increasing screening, especially for colorectal cancer, were also identified.
Objective: To evaluate the utility of a targeted lecture in improving FP awareness amongst clinicians.
Design: This is a dual institution, prospective survey-based study assessing if an educational lecture can increase the likelihood of FP consideration, discussion, and referral.
The document discusses effective practices in gastric cancer programs based on a survey conducted by the Association of Community Cancer Centers (ACCC). Key findings from the survey show that strong gastric cancer programs include a multidisciplinary team approach with tumor boards, support staff such as nutritionists and social workers, expert physicians, and access to clinical trials and financial assistance. Four member programs were identified as having experience treating gastric cancer patients and could serve as community resource centers: Curtis & Elizabeth Anderson Cancer Institute, Massachusetts General Hospital Cancer Center, Stanford Cancer Center, and University of Colorado Hospital/Cancer Center.
This document summarizes a study examining non-adherence to contraceptive vaginal ring (CVR) use among women in Kisumu, Kenya from 2014-2015. Non-adherence was assessed through self-report, pharmacy records, and residual hormone levels in returned rings. Non-adherence was 14.0% by self-report and 54.5% by pharmacy records. Women with salary-based income had lower non-adherence. Participants dissatisfied with 4 or more aspects of the ring were more likely to report non-adherence. Over time, residual hormone levels showed increasing non-adherence in 46.5% of participants. Economic empowerment and education on CVR features may help reduce non
This study examined the impact of the 21-gene breast cancer assay (Oncotype DX) on adjuvant therapy decisions in a Mexican public hospital. 98 early-stage breast cancer patients were tested. Following assay results, treatment decisions changed for 32% of patients (27% of node-negative and 41% of node-positive patients). The proportion recommended chemotherapy decreased from 48% to 34% after testing. 92% of physicians reported being more confident in their recommendations after ordering the assay. The results suggest the 21-gene assay can meaningfully impact adjuvant treatment decisions and potentially reduce chemotherapy use in the Mexican public health system.
Effect of a Training Program about Maternal Fetal Attachment Skills on Prenat...iosrjce
to assess effect of a training program about maternal fetal attachment skills on prenatal attachment
among primigravida women.
Subjects and Methods: A quasi experimental research design was utilized. From a specific private Antenatal
Clinic in Mansoura city-Egypt eighty primigravida women aged 20 to 35 years, at 30th week gestation, had
singleton pregnancy and can read and write were selected purposively between of January and August 2011
and was equally divided into two groups; intervention group: received a training program on two MFA skills
and control group: received the routine antenatal care. Using interview sheet and Cranley's Maternal Fetal
Attachment Scale (MFAS) the data were collected at baseline and after two and four weeks of the enrollment.
Results: MFAS score had significantly increased in the intervention group from 61.6±5.9 at the baseline to
68.5±6.8 and 69.6 ±5.9 at 32nd, 34th week gestation respectively. While the changes of the MFAS total score in
the control group were insignificant.
Conclusion: MFAS total scores had significantly increased in the intervention group at 32nd and 34th week
gestation compared to the baseline score. Conversely, the MFAS total score did not differ significantly between
the baseline and two and four weeks after enrollment among the control group.
Recommendations: Enhancing the health care providers' awareness of the MFA skills to utilize in the
promotion of the prenatal MFA and motivate the active role of the nurses in helping the pregnant women to
adhere to the appropriate MFA skills are recommended.
Sixty Second Science: Maternal and Child HealthCORE Group
A new cadre of
community health worker
for sanitation and hygiene
promotion in rural
Zimbabwe
Key findings:
- Mothers value CHWs as accessible, affordable source of health information
- CHWs build trust through regular home visits and personalized care
- CHWs help address social determinants through referrals and follow up
- CHWs play a key role in health education and behavior change
Implications:
- Invest in regular supportive supervision and refresher training for CHWs
- Consider incentives to motivate and retain CHWs
- Strengthen CHW linkages to formal health facilities for referrals
- Involve communities in CHW selection to build trust and ownership
Presented by:
The document discusses quality cancer care and outlines several principles and recommendations. It presents 12 principles for quality cancer care established by the National Coalition for Cancer Survivorship, including the rights of cancer patients and survivors to access affordable care, clinical trials, psychosocial services and follow up care. It also summarizes 10 recommendations from the Institute of Medicine to improve cancer care quality, such as ensuring treatment at high-volume facilities, using evidence-based guidelines, measuring quality, coordinating care, investing in research and addressing disparities.
1) Moffitt Cancer Center provides timely access to a multidisciplinary care team for melanoma patients, allowing diagnosis, staging, and treatment planning to occur in one to two visits. The team reviews pathology reports prior to the first visit to ensure consensus on diagnosis and treatment options.
2) Moffitt streamlines care by having oncologists, dermatologists, surgeons, pathologists, and other providers who are teaching faculty all see patients as part of the comprehensive melanoma care team.
3) Moffitt addresses barriers to care like insurance issues, transportation costs, and travel expenses through dedicated social work support staff to help melanoma patients.
Use of complementary and alternative medicine by cancer patients at the Unive...home
CAM use is common among cancer patients in Nigeria. Most users do not obtain the
expected benefits, and adverse events are not uncommon. Every clinician in the field of oncology
should ask his/her patients about the use of CAM; this knowledge will enable them to better
counsel the patients
Application of the Management Process in Thyroid NodulesReynaldo Joson
16th Chancellor Alfredo T. Ramirez Memorial Lecture
Application of the Management Process in Thyroid Nodules: Thirty Years of Experience.
Reynaldo O. Joson
September 7, 2016
Diamond Hotel, Manila
https://rojosonmedicalclinic.wordpress.com/2016/09/07/application-of-the-management-process-in-thyroid-nodules-thirty-years-of-experience/
This document provides information about an oncology social worker and their role. It discusses what an oncology social worker sees, hears, and feels in working with cancer patients. It outlines the types of support oncology social workers provide, including emotional support, practical assistance, information, and advocacy. It also summarizes the standards and scope of practice for oncology social work according to the Association of Oncology Social Work. Finally, it discusses common issues cancer survivors face and encourages patients to take advantage of oncology social work services.
Administration Of The Hpv Vaccine In Womens Health ClinicsJolene Bethune
The document discusses educating mothers and adolescent clients about HPV and promoting HPV vaccination in women's health clinics. HPV is very common among adolescents and can cause genital warts and cervical cancer. The HPV vaccine effectively protects against the types that cause most warts and cancer. The document recommends educating clients about HPV and susceptibility during adolescence, and vaccinating girls ages 11-26 to prevent infection.
This study examined early exclusive breastfeeding rates and maternal attitudes towards infant feeding in new mothers in San Francisco. The researchers found that 79.8% of mothers were exclusively breastfeeding between 1-4 days postpartum, with no significant differences by WIC participation status. Independent risk factors for mixed or formula feeding included Asian/Pacific Islander ethnicity and lower education levels. Thinking that breastfeeding was physically painful or uncomfortable was also associated with not breastfeeding. The study suggests future research should address negative attitudes towards breastfeeding in Asian populations and promote breastfeeding as a comfortable practice.
Ijsrp p8825 Caregiver factors influencing seeking of Early Infant Diagnosis (...Elizabeth kiilu
Caregiver factors influencing seeking of Early Infant Diagnosis (EID) of HIV services in selected hospitals in Nairobi County, Kenya:A qualitative Study
This document discusses various clinical assessment tools used to evaluate nutritional status in hospitals. It describes several common tools: Mini Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST), Subjective Global Assessment (SGA), Nutritional Risk Screening 2002 (NRS-2002), and Malnutrition Screening Tool (MST). For each tool, it provides details on what it measures, how it is administered, and how it is used to identify nutritional problems or risk of malnutrition. It also summarizes two review articles that compared the performance of these tools against established definitions of malnutrition.
Original Article Predicting Late-stage Breast/tutorialoutletdotcomwilliamtrumpz5zc
Over 21% of women diagnosed with breast cancer in Appalachia had late-stage diagnoses, and only 46.9% of eligible women received adjuvant hormonal therapy. Predictors of late-stage diagnosis included age, insurance status, access to primary care physicians. Predictors of receiving adjuvant therapy included comorbidities, economic status, and access to mammography centers. The 2-step floating catchment area method of measuring spatial access to care was found to have the greatest predictive validity compared to traditional methods when examining these clinical outcomes in Appalachia.
HRSA Comprehensive Geriatric Education Grant Posternomadicnurse
This grant funds a Clinical Nurse Specialist position to work with current Gerontological CNS in providing education, mentoring / support, developing / measuring outcomes for knowledge, practice change and patient outcomes by:
Expanding NICHE training at Piedmont Hospital in Atlanta beyond Acute Care nurses to include Emergency Department nurses;
2) Introducing NICHE training at Piedmont Fayette, Piedmont Newnan and Piedmont Mountainside for Acute Care and Emergency Department nurses;
3) Introducing NICHE training for nursing staff at two of our Long-Term Care facility partners; and
4) Disseminating program materials and information to other healthcare entities throughout Georgia and the U.S. through local workshops and presentations at national healthcare conferences.
The document provides an overview of a collaborative project between the Association of Community Cancer Centers (ACCC) and the American Psychosocial Oncology Society (APOS) to study three member programs' psychosocial distress screening processes. Site visits were conducted at three cancer centers - Bennett Cancer Center in Connecticut, Simmons Cancer Center in Texas, and CHI Health Good Samaritan Cancer Center in Nebraska. Key findings from the individual site visits are described, including tools used, staff involved, and process flowcharts. The goal is to identify effective practices that could help other cancer programs implement distress screening.
The survey of over 2,800 undergraduate students at UC Irvine found:
1) 35% had used some form of CAM in the past 12 months, and over 90% believed CAM can be effective. However, only 31% had received prior education on CAM.
2) The most common CAM therapies used were supplements, massage, body movement like yoga, herbal medicine, and traditional Chinese medicine.
3) Factors associated with higher CAM use included being female, Asian ethnicity, and having prior CAM education. Most students said they would be interested in CAM courses if they fulfilled graduation requirements or were in their major.
4) The study supports that education is a key factor in CAM use decisions
The survey of 371 female university students found significant gaps in their knowledge about HPV infection, cervical dysplasia, and prevention methods. While most were aware of the HPV vaccine, only 6% understood how HPV spreads and is prevented. The main barriers to vaccination identified were cost (62%), concerns over adverse effects (43%), and lack of knowledge (36%). Many students wanted more information on HPV infection, vaccine safety, and other questions. Providing free vaccination may increase uptake, but educational programs are still needed to address knowledge deficits.
The document provides a resource guide for materials from the NYS DOH Cancer Services Program to promote cancer screening. It includes public education materials on breast, cervical, colorectal, and prostate cancer. It also lists professional development resources for providers, as well as presentations and technical assistance available from CSP staff on cancer screening best practices.
Lessons in the Integration of CMAM & IMCI Activities_Swedberg_5.12.11CORE Group
This study evaluated the effectiveness of a community-based program for managing severe acute malnutrition (SAM) in Bangladesh. 261 community health workers were trained to screen, assess, and treat children aged 6-36 months with SAM. Preliminary results found high recovery rates and low mortality. Early identification and treatment of SAM and illness likely contributed to the positive outcomes. Coverage was also high due to the decentralized network of health workers and community mobilization around SAM. While facility-based care had low uptake and high default rates, community-based management integrating outpatient and inpatient care was an effective strategy for ensuring treatment of SAM cases.
1) The document presents guidelines from the Indian Academy of Pediatrics (IAP) on the integrated management of severe acute malnutrition (SAM) in children under five years of age in India.
2) It defines SAM based on weight-for-height Z-scores and mid-upper arm circumference (MUAC) cut-offs using WHO growth charts.
3) The guidelines recommend an integrated approach, treating SAM as part of broader nutrition and child health programs. They provide guidance on outpatient and inpatient treatment, including the use of therapeutic foods.
1) The document presents guidelines from the Indian Academy of Pediatrics (IAP) on the integrated management of severe acute malnutrition (SAM) in children under five years of age in India.
2) It defines SAM based on weight-for-height Z-scores and mid-upper arm circumference (MUAC) cut-offs using WHO growth charts.
3) The guidelines recommend an integrated approach, treating SAM as part of broader nutrition and child health programs. They provide guidance on outpatient and inpatient treatment, including use of therapeutic foods.
RESEARCH ARTICLE Open AccessQuality of antenatal care pred.docxrgladys1
RESEARCH ARTICLE Open Access
Quality of antenatal care predicts retention
in skilled birth attendance: a multilevel
analysis of 28 African countries
Adanna Chukwuma1,2* , Adaeze C. Wosu3, Chinyere Mbachu4 and Kelechi Weze1
Abstract
Background: An effective continuum of maternal care ensures that mothers receive essential health packages from
pre-pregnancy to delivery, and postnatally, reducing the risk of maternal death. However, across Africa, coverage of
skilled birth attendance is lower than coverage for antenatal care, indicating mothers are not retained in the
continuum between antenatal care and delivery. This paper explores predictors of retention of antenatal care
clients in skilled birth attendance across Africa, including sociodemographic factors and quality of antenatal care
received.
Methods: We pooled nationally representative data from Demographic and Health Surveys conducted in 28 African
countries between 2006 and 2015. For the 115,374 births in our sample, we estimated logistic multilevel models of
retention in skilled birth attendance (SBA) among clients that received skilled antenatal care (ANC).
Results: Among ANC clients in the study sample, 66% received SBA. Adjusting for all demographic covariates and
country indicators, the odds of retention in SBA were higher among ANC clients that had their blood pressure
checked, received information about pregnancy complications, had blood tests conducted, received at least one
tetanus injection, and had urine tests conducted.
Conclusions: Higher quality of ANC predicts retention in SBA in Africa. Improving quality of skilled care received
prenatally may increase client retention during delivery, reducing maternal mortality.
Keywords: Antenatal, Continuum, Delivery, Birth, Quality, Determinants, Maternal health
Background
Sub-Saharan Africa has the highest regional maternal
mortality ratio in the world with 546 maternal deaths
per 10,000 live births [1]. The risk of maternal death
peaks around the time of birth, when coverage of care is
at its lowest [2]. An effective continuum of skilled ma-
ternal care ensures that mothers receive essential health
packages from pre-pregnancy to delivery, and postna-
tally, reducing the risk of maternal death [2]. However,
across Africa, the proportion of mothers that receive
skilled birth attendance (51%) is lower than the propor-
tion that receives any skilled antenatal care (78%) [3].
Where this difference is due to dropouts from skilled
delivery care represents missed opportunities to reduce
maternal mortality in Africa.
Understanding predictors of retention in the con-
tinuum of care can inform policy and programs to re-
duce maternal mortality. To date, few studies have
characterized the determinants of retention along the
continuum of care in Africa. These include a recent
study of 6 countries (Ethiopia, Malawi, Rwanda, Senegal,
Tanzania, and Uganda) [4] and another study that fo-
cused on Nigeria [5]. These studies focused exclus.
Innovations in Community-based Diagnosis and Treatment of Acute Malnutrition ...CORE Group
ALIMA began researching training mothers to screen for malnutrition using mid-upper arm circumference (MUAC) in 2011 in response to late treatment presentation and low program coverage. Pilot studies showed mothers could reliably measure MUAC comparable to community health workers. A large-scale 2013-2014 trial in Niger found family MUAC screening by mothers was non-inferior to community health workers, with lower hospitalization rates and costs. Since 2015, over 500,000 caretakers have been trained in family MUAC screening by ALIMA and its partners across multiple countries. Scale-up efforts in Niger have increased coverage to over 60% and reduced median MUAC and hospitalizations.
Sixty Second Science: Maternal and Child HealthCORE Group
A new cadre of
community health worker
for sanitation and hygiene
promotion in rural
Zimbabwe
Key findings:
- Mothers value CHWs as accessible, affordable source of health information
- CHWs build trust through regular home visits and personalized care
- CHWs help address social determinants through referrals and follow up
- CHWs play a key role in health education and behavior change
Implications:
- Invest in regular supportive supervision and refresher training for CHWs
- Consider incentives to motivate and retain CHWs
- Strengthen CHW linkages to formal health facilities for referrals
- Involve communities in CHW selection to build trust and ownership
Presented by:
The document discusses quality cancer care and outlines several principles and recommendations. It presents 12 principles for quality cancer care established by the National Coalition for Cancer Survivorship, including the rights of cancer patients and survivors to access affordable care, clinical trials, psychosocial services and follow up care. It also summarizes 10 recommendations from the Institute of Medicine to improve cancer care quality, such as ensuring treatment at high-volume facilities, using evidence-based guidelines, measuring quality, coordinating care, investing in research and addressing disparities.
1) Moffitt Cancer Center provides timely access to a multidisciplinary care team for melanoma patients, allowing diagnosis, staging, and treatment planning to occur in one to two visits. The team reviews pathology reports prior to the first visit to ensure consensus on diagnosis and treatment options.
2) Moffitt streamlines care by having oncologists, dermatologists, surgeons, pathologists, and other providers who are teaching faculty all see patients as part of the comprehensive melanoma care team.
3) Moffitt addresses barriers to care like insurance issues, transportation costs, and travel expenses through dedicated social work support staff to help melanoma patients.
Use of complementary and alternative medicine by cancer patients at the Unive...home
CAM use is common among cancer patients in Nigeria. Most users do not obtain the
expected benefits, and adverse events are not uncommon. Every clinician in the field of oncology
should ask his/her patients about the use of CAM; this knowledge will enable them to better
counsel the patients
Application of the Management Process in Thyroid NodulesReynaldo Joson
16th Chancellor Alfredo T. Ramirez Memorial Lecture
Application of the Management Process in Thyroid Nodules: Thirty Years of Experience.
Reynaldo O. Joson
September 7, 2016
Diamond Hotel, Manila
https://rojosonmedicalclinic.wordpress.com/2016/09/07/application-of-the-management-process-in-thyroid-nodules-thirty-years-of-experience/
This document provides information about an oncology social worker and their role. It discusses what an oncology social worker sees, hears, and feels in working with cancer patients. It outlines the types of support oncology social workers provide, including emotional support, practical assistance, information, and advocacy. It also summarizes the standards and scope of practice for oncology social work according to the Association of Oncology Social Work. Finally, it discusses common issues cancer survivors face and encourages patients to take advantage of oncology social work services.
Administration Of The Hpv Vaccine In Womens Health ClinicsJolene Bethune
The document discusses educating mothers and adolescent clients about HPV and promoting HPV vaccination in women's health clinics. HPV is very common among adolescents and can cause genital warts and cervical cancer. The HPV vaccine effectively protects against the types that cause most warts and cancer. The document recommends educating clients about HPV and susceptibility during adolescence, and vaccinating girls ages 11-26 to prevent infection.
This study examined early exclusive breastfeeding rates and maternal attitudes towards infant feeding in new mothers in San Francisco. The researchers found that 79.8% of mothers were exclusively breastfeeding between 1-4 days postpartum, with no significant differences by WIC participation status. Independent risk factors for mixed or formula feeding included Asian/Pacific Islander ethnicity and lower education levels. Thinking that breastfeeding was physically painful or uncomfortable was also associated with not breastfeeding. The study suggests future research should address negative attitudes towards breastfeeding in Asian populations and promote breastfeeding as a comfortable practice.
Ijsrp p8825 Caregiver factors influencing seeking of Early Infant Diagnosis (...Elizabeth kiilu
Caregiver factors influencing seeking of Early Infant Diagnosis (EID) of HIV services in selected hospitals in Nairobi County, Kenya:A qualitative Study
This document discusses various clinical assessment tools used to evaluate nutritional status in hospitals. It describes several common tools: Mini Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST), Subjective Global Assessment (SGA), Nutritional Risk Screening 2002 (NRS-2002), and Malnutrition Screening Tool (MST). For each tool, it provides details on what it measures, how it is administered, and how it is used to identify nutritional problems or risk of malnutrition. It also summarizes two review articles that compared the performance of these tools against established definitions of malnutrition.
Original Article Predicting Late-stage Breast/tutorialoutletdotcomwilliamtrumpz5zc
Over 21% of women diagnosed with breast cancer in Appalachia had late-stage diagnoses, and only 46.9% of eligible women received adjuvant hormonal therapy. Predictors of late-stage diagnosis included age, insurance status, access to primary care physicians. Predictors of receiving adjuvant therapy included comorbidities, economic status, and access to mammography centers. The 2-step floating catchment area method of measuring spatial access to care was found to have the greatest predictive validity compared to traditional methods when examining these clinical outcomes in Appalachia.
HRSA Comprehensive Geriatric Education Grant Posternomadicnurse
This grant funds a Clinical Nurse Specialist position to work with current Gerontological CNS in providing education, mentoring / support, developing / measuring outcomes for knowledge, practice change and patient outcomes by:
Expanding NICHE training at Piedmont Hospital in Atlanta beyond Acute Care nurses to include Emergency Department nurses;
2) Introducing NICHE training at Piedmont Fayette, Piedmont Newnan and Piedmont Mountainside for Acute Care and Emergency Department nurses;
3) Introducing NICHE training for nursing staff at two of our Long-Term Care facility partners; and
4) Disseminating program materials and information to other healthcare entities throughout Georgia and the U.S. through local workshops and presentations at national healthcare conferences.
The document provides an overview of a collaborative project between the Association of Community Cancer Centers (ACCC) and the American Psychosocial Oncology Society (APOS) to study three member programs' psychosocial distress screening processes. Site visits were conducted at three cancer centers - Bennett Cancer Center in Connecticut, Simmons Cancer Center in Texas, and CHI Health Good Samaritan Cancer Center in Nebraska. Key findings from the individual site visits are described, including tools used, staff involved, and process flowcharts. The goal is to identify effective practices that could help other cancer programs implement distress screening.
The survey of over 2,800 undergraduate students at UC Irvine found:
1) 35% had used some form of CAM in the past 12 months, and over 90% believed CAM can be effective. However, only 31% had received prior education on CAM.
2) The most common CAM therapies used were supplements, massage, body movement like yoga, herbal medicine, and traditional Chinese medicine.
3) Factors associated with higher CAM use included being female, Asian ethnicity, and having prior CAM education. Most students said they would be interested in CAM courses if they fulfilled graduation requirements or were in their major.
4) The study supports that education is a key factor in CAM use decisions
The survey of 371 female university students found significant gaps in their knowledge about HPV infection, cervical dysplasia, and prevention methods. While most were aware of the HPV vaccine, only 6% understood how HPV spreads and is prevented. The main barriers to vaccination identified were cost (62%), concerns over adverse effects (43%), and lack of knowledge (36%). Many students wanted more information on HPV infection, vaccine safety, and other questions. Providing free vaccination may increase uptake, but educational programs are still needed to address knowledge deficits.
The document provides a resource guide for materials from the NYS DOH Cancer Services Program to promote cancer screening. It includes public education materials on breast, cervical, colorectal, and prostate cancer. It also lists professional development resources for providers, as well as presentations and technical assistance available from CSP staff on cancer screening best practices.
Lessons in the Integration of CMAM & IMCI Activities_Swedberg_5.12.11CORE Group
This study evaluated the effectiveness of a community-based program for managing severe acute malnutrition (SAM) in Bangladesh. 261 community health workers were trained to screen, assess, and treat children aged 6-36 months with SAM. Preliminary results found high recovery rates and low mortality. Early identification and treatment of SAM and illness likely contributed to the positive outcomes. Coverage was also high due to the decentralized network of health workers and community mobilization around SAM. While facility-based care had low uptake and high default rates, community-based management integrating outpatient and inpatient care was an effective strategy for ensuring treatment of SAM cases.
1) The document presents guidelines from the Indian Academy of Pediatrics (IAP) on the integrated management of severe acute malnutrition (SAM) in children under five years of age in India.
2) It defines SAM based on weight-for-height Z-scores and mid-upper arm circumference (MUAC) cut-offs using WHO growth charts.
3) The guidelines recommend an integrated approach, treating SAM as part of broader nutrition and child health programs. They provide guidance on outpatient and inpatient treatment, including the use of therapeutic foods.
1) The document presents guidelines from the Indian Academy of Pediatrics (IAP) on the integrated management of severe acute malnutrition (SAM) in children under five years of age in India.
2) It defines SAM based on weight-for-height Z-scores and mid-upper arm circumference (MUAC) cut-offs using WHO growth charts.
3) The guidelines recommend an integrated approach, treating SAM as part of broader nutrition and child health programs. They provide guidance on outpatient and inpatient treatment, including use of therapeutic foods.
RESEARCH ARTICLE Open AccessQuality of antenatal care pred.docxrgladys1
RESEARCH ARTICLE Open Access
Quality of antenatal care predicts retention
in skilled birth attendance: a multilevel
analysis of 28 African countries
Adanna Chukwuma1,2* , Adaeze C. Wosu3, Chinyere Mbachu4 and Kelechi Weze1
Abstract
Background: An effective continuum of maternal care ensures that mothers receive essential health packages from
pre-pregnancy to delivery, and postnatally, reducing the risk of maternal death. However, across Africa, coverage of
skilled birth attendance is lower than coverage for antenatal care, indicating mothers are not retained in the
continuum between antenatal care and delivery. This paper explores predictors of retention of antenatal care
clients in skilled birth attendance across Africa, including sociodemographic factors and quality of antenatal care
received.
Methods: We pooled nationally representative data from Demographic and Health Surveys conducted in 28 African
countries between 2006 and 2015. For the 115,374 births in our sample, we estimated logistic multilevel models of
retention in skilled birth attendance (SBA) among clients that received skilled antenatal care (ANC).
Results: Among ANC clients in the study sample, 66% received SBA. Adjusting for all demographic covariates and
country indicators, the odds of retention in SBA were higher among ANC clients that had their blood pressure
checked, received information about pregnancy complications, had blood tests conducted, received at least one
tetanus injection, and had urine tests conducted.
Conclusions: Higher quality of ANC predicts retention in SBA in Africa. Improving quality of skilled care received
prenatally may increase client retention during delivery, reducing maternal mortality.
Keywords: Antenatal, Continuum, Delivery, Birth, Quality, Determinants, Maternal health
Background
Sub-Saharan Africa has the highest regional maternal
mortality ratio in the world with 546 maternal deaths
per 10,000 live births [1]. The risk of maternal death
peaks around the time of birth, when coverage of care is
at its lowest [2]. An effective continuum of skilled ma-
ternal care ensures that mothers receive essential health
packages from pre-pregnancy to delivery, and postna-
tally, reducing the risk of maternal death [2]. However,
across Africa, the proportion of mothers that receive
skilled birth attendance (51%) is lower than the propor-
tion that receives any skilled antenatal care (78%) [3].
Where this difference is due to dropouts from skilled
delivery care represents missed opportunities to reduce
maternal mortality in Africa.
Understanding predictors of retention in the con-
tinuum of care can inform policy and programs to re-
duce maternal mortality. To date, few studies have
characterized the determinants of retention along the
continuum of care in Africa. These include a recent
study of 6 countries (Ethiopia, Malawi, Rwanda, Senegal,
Tanzania, and Uganda) [4] and another study that fo-
cused on Nigeria [5]. These studies focused exclus.
Innovations in Community-based Diagnosis and Treatment of Acute Malnutrition ...CORE Group
ALIMA began researching training mothers to screen for malnutrition using mid-upper arm circumference (MUAC) in 2011 in response to late treatment presentation and low program coverage. Pilot studies showed mothers could reliably measure MUAC comparable to community health workers. A large-scale 2013-2014 trial in Niger found family MUAC screening by mothers was non-inferior to community health workers, with lower hospitalization rates and costs. Since 2015, over 500,000 caretakers have been trained in family MUAC screening by ALIMA and its partners across multiple countries. Scale-up efforts in Niger have increased coverage to over 60% and reduced median MUAC and hospitalizations.
This document discusses a study on supporting children's adherence to anti-retroviral (ART) therapy in Malawi. The study followed 47 HIV-positive children on ART over 6 months to a year. 72% of children never missed a dose according to caregiver reports. Clinic attendance was also good, with over 80% of visits either on time or within a week of the scheduled date. Focus groups and interviews with caregivers provided insights into challenges of supporting children's adherence, such as costs of medication and transport as well as caregiver responsibilities, but also motivations like seeing children's health improve. The findings highlight the need for more affordable and less complex ART regimes as well as tools to help caregivers support children's adherence
This research article examines factors influencing uptake of cervical cancer screening services among women aged 18-49 seeking care at Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu, Kenya. The researchers conducted a cross-sectional study using questionnaires with 424 women. Their results found that self-reported screening uptake was only 17.5%. Screening uptake was higher among older, more educated, and higher income women. Knowledge of cervical cancer signs and symptoms and perception of higher susceptibility to the disease were also associated with increased screening uptake. Additionally, attending the child welfare clinic increased likelihood of screening. The researchers concluded that increasing knowledge, enhancing health education, providing free services, and targeting child welfare clinics may help increase
1Global Vaccination (attach this please with the previou.docxfelicidaddinwoodie
The document discusses vaccination programs and policies in Malaysia and Saudi Arabia. The Malaysian National Immunization Program provides vaccines for major childhood diseases free of charge at government clinics. Vaccine safety is monitored by the National Centre of Adverse Drug Reactions. Saudi Arabia's Ministry of Health operates vaccination programs through over 2,000 primary health centers, achieving over 90% childhood immunization coverage. Vaccination requirements include proof of meningitis vaccination for Hajj pilgrims. Both countries' programs aim to expand access and monitor vaccine safety.
KNOWLEDGE GAPS IN MALARIA MANAGMENT IN CAMEROON.pptxFidelityP
Malaria is a vector borne infectious disease caused by protozoan parasites of the genus Plasmodium and is transmitted by an infected female Anopheles mosquito. Until the late 19th Century, the contributory agent for malaria was largely unknown.
Malaria is one of the commonest infections, disproportionately affecting children and pregnant women
In 2019, an estimated 409,000 people died of malaria. Most (274,000) were young children, and 94% of the infections and deaths occurred in Africa. (WHO, 2019)
Children under five years are one of the most vulnerable groups affected by malaria. Severe anaemia, hypoglycaemia and cerebral malaria are features of severe malaria more commonly seen in children than in adults.
According to the WHO 2016 report, the global prevalence of malaria among under-five children was 16%. In the same year, the prevalence in Ethiopia was 0.6%.
Malaria is the most widespread endemic disease in Cameroon, responsible for 2.7 million reported cases, and absenteeism from school and work annually. It continues to be a major public health problem and is the first cause of infant-child morbidity and mortality with a mortality rate in children under five, estimated at 40%.
Much is being done to curb and eradicate malaria infection by the government, USAID and more.
Cancer Screening in a Middle Income Country: Malaysia's experienceArunah Chandran
This document summarizes Malaysia's experience with cancer screening and control efforts. It notes that non-communicable diseases like cancer account for over 70% of deaths in Malaysia. The National Strategic Plan for Non-Communicable Diseases aims to reduce cancer morbidity, mortality, and improve quality of life through various prevention, screening, treatment, and palliative care initiatives. Specific programs are in place for cervical cancer screening via Pap smears and HPV vaccination, as well as other cancers. Challenges remain in increasing screening and treatment coverage, addressing barriers, and ensuring access. Continued efforts are needed to work towards cervical cancer elimination targets in Malaysia.
This document discusses processes that have been implemented at a rural hospital with 1200 births per year to improve obstetric patient safety and outcomes. Some of the key processes discussed include establishing a team approach involving all hospital personnel, conducting regular simulations to improve communication and adherence to protocols, implementing mentorship programs for nurses and managers, standardizing communication using SBAR, leveraging electronic medical records and data to monitor quality and outcomes, and promoting a culture of accountability and professionalism. The goal of these initiatives is to reduce errors, minimize harm, and improve outcomes through multidisciplinary collaboration and a systems-based approach. While changing healthcare culture and achieving measurable outcomes can be challenging, continuous monitoring and refinement of processes may help advance safety and quality of
This research article examines strategies to improve uptake of preventive treatment for schistosomiasis among school-age children in Uganda. Serial cross-sectional surveys were conducted before and after a mass drug administration (MDA) program in 2012 that aimed to increase teacher motivation and supervision. The surveys found that self-reported uptake of preventive treatment increased from 28.2% at baseline to 48.9% after the MDA program implemented strategies like retraining teachers, providing incentives and strengthening supervision. However, prevalence and intensity of Schistosoma mansoni infection, children's knowledge of the disease, and reported side effects did not change. The increased treatment uptake was still lower than WHO recommendations and not enough to impact disease prevalence
This study compared non-operative management (antibiotics only) to surgical management (appendectomy) for uncomplicated acute appendicitis in children. 102 children were enrolled and allowed to choose their treatment. At 1 year, the success rate of avoiding appendectomy with non-operative management was 75.7%, and children who received non-operative management had fewer disability days and lower healthcare costs compared to those who received surgery. Non-operative management is an effective treatment option for children with uncomplicated appendicitis that results in less morbidity and costs than surgery.
This study compared the cost-effectiveness of Giemsa and Field's staining techniques for malaria diagnosis among 243 children in Uganda. The study found that Field's staining technique was more cost-effective, correctly diagnosing 93.4% of cases at a cost of $0.030 per test, while Giemsa correctly diagnosed 94.7% of cases but at a higher cost of $0.769 per test. The incremental cost-effectiveness ratio of using Giemsa over Field's was $0.35 per additional correctly diagnosed case. Based on these findings, the study recommends continued use of the more cost-effective Field's staining technique for malaria diagnosis in resource-limited settings with high malaria burdens like Uganda
This study examined risk factors for breast cancer in Senegalese women through a case-control study of 212 breast cancer patients and 424 controls. The results found that a family history of breast cancer, illiteracy, premenopausal status, and unemployment were associated with increased breast cancer risk. Reproductive factors like age of menarche, parity, and breastfeeding history were not associated with risk. The early average age of diagnosis and association with family history suggests a genetic component to breast cancer risk in Senegalese women. However, further genetic investigation was not possible due to financial limitations.
MATERNAL AND FETAL OUTCOME AMONG OBSTETRIC REFERRALS: A CASE STUDY OF THE BA...GABRIEL JEREMIAH ORUIKOR
Abstract: Background: maternal/foetal mortality and morbidity could be reduced by making use of timely
consultations, an efficient referral system, basic and comprehensive emergency obstetric care to pregnant women
and their new-borns. This study was carried out in other to compare maternofoetal outcome and to evaluate the
types of delays experienced by women.
The main objective was to evaluate maternal and foetal outcome of obstetric referrals.
Method: A case control study was carried out. All pregnant women that were referred, consented and met with the
inclusion criteria were recruited as cases, while those who came to deliver on their own were recruited as the controls.
Data were collected on pretested questionnaires. The chi square test was used as nonparametric test.
Result: Most of the participants 75.4% (n=49) were found between 15-30 years. The majority (n=35, 53.8%) of
pregnant women were referred from health centres. Cases with at least one delay was twice that of the controls (cases
42, 64.6% controls 22, 33.8% p value =0.00). 6.2 %and 9.8 %babies delivered from cases and control group
respectively were born dead. Admission in the Neonatal intensive care unit was in greater proportion for the babies
delivered from cases than the controls (cases 15, 23.1% controls 9, 13.8% p value=0.175). Most of the women
delivered through ceserian section (cases 27, 41.5% controls 32, 49.2% p value =0.378). No maternal mortality was
recorded. 60% of the women spent 7-14days in the hospital.
Conclusion: for non-referred pregnant women, maternal outcome is poor but foetal outcome is better.
MATERNAL AND FETAL OUTCOME AMONG OBSTETRIC REFERRALS: A CASE STUDY OF THE BA...GABRIEL JEREMIAH ORUIKOR
Background: maternal/foetal mortality and morbidity could be reduced by making use of timely
consultations, an efficient referral system, basic and comprehensive emergency obstetric care to pregnant women
and their new-borns. This study was carried out in other to compare maternofoetal outcome and to evaluate the
types of delays experienced by women.
The main objective was to evaluate maternal and foetal outcome of obstetric referrals.
Method: A case control study was carried out. All pregnant women that were referred, consented and met with the
inclusion criteria were recruited as cases, while those who came to deliver on their own were recruited as the controls.
Data were collected on pretested questionnaires. The chi square test was used as nonparametric test.
Result: Most of the participants 75.4% (n=49) were found between 15-30 years. The majority (n=35, 53.8%) of
pregnant women were referred from health centres. Cases with at least one delay was twice that of the controls (cases
42, 64.6% controls 22, 33.8% p value =0.00). 6.2 %and 9.8 %babies delivered from cases and control group
respectively were born dead. Admission in the Neonatal intensive care unit was in greater proportion for the babies
delivered from cases than the controls (cases 15, 23.1% controls 9, 13.8% p value=0.175). Most of the women
delivered through ceserian section (cases 27, 41.5% controls 32, 49.2% p value =0.378). No maternal mortality was
recorded. 60% of the women spent 7-14days in the hospital.
Conclusion: for non-referred pregnant women, maternal outcome is poor but foetal outcome is better.
Keywords: Obstetrics, Referrals, Haemorrhage, Infection, Outcome.
This document discusses gender mainstreaming in India's national health programs from a historical perspective. It outlines how early women's health programs from the 1950s focused narrowly on women's reproductive roles and population control rather than women's overall health and rights. While the National Rural Health Mission and other current programs now acknowledge gender, implementation has been lacking. The document calls for strengthened implementation of gender-sensitive approaches across health programs to address issues like maternal health, malaria in pregnancy, and tuberculosis from a gender perspective. It emphasizes the important role that district collectors can play in convergence between departments, ensuring reporting and reviews of maternal deaths, community monitoring, and functioning of district health structures.
This document proposes solutions to reduce malnutrition globally. It states that malnutrition affects billions and contributes to millions of child deaths daily from lack of essential nutrients. It recommends providing affordable vitamin/mineral supplements to vulnerable people and encouraging communities to improve food production/consumption. The proposed solutions aim to integrate health services, ensure quality care, alleviate cost barriers, and receive funding from eliminating user fees and establishing cash transfer systems. However, challenges include lack of political will due to funding issues, lack of awareness, and orthodox societies.
This document summarizes a presentation on improving maternal mortality through policy perspectives. It discusses the high maternal mortality ratio in countries like Sierra Leone compared to low ratios in countries like Grenada. The root causes of maternal mortality are identified as inequality, low socioeconomic status, lack of healthcare access, and cultural practices. Effective policies to reduce mortality ratios include increasing access to skilled healthcare workers, emergency services, transportation, and community health programs.
Similar to Innovations in Community-based Diagnosis and Treatment of Acute Malnutrition Handout (20)
Presentation_Behar - Private Public Partnerships and CKDuCORE Group
The document summarizes statistics and information about the sugarcane agribusiness in Mexico, including:
- It produced over 6 million tons of sugar in 2017/2018 and generated nearly 500,000 direct jobs.
- It has a complex supply chain involving sugarcane suppliers, mills, transportation, and the food industry.
- It has a legal framework including laws governing sustainable development of sugarcane and labor relations in mills.
- The government has a National Sugarcane Agribusiness Program to increase productivity and competitiveness.
Presentation_World Vision - Private Public Partnerships and CKDuCORE Group
The Fields of Hope project by World Vision Mexico seeks to prevent and reduce child labor in the sugarcane and coffee sectors in the states of Veracruz and Oaxaca. It aims to benefit 1,520 children at risk of or engaged in child labor across 24 communities and 4 municipalities. The project takes an integral approach through advocacy, collaboration with the private sector, and sensitizing communities and workers, while also promoting access to education.
Presentation_Wesseling - Private Public Partnerships and CKDuCORE Group
This document discusses the epidemic of chronic kidney disease of unknown etiology (CKDu) affecting agricultural workers along the Pacific coast of Central America. It provides evidence that the disease has an occupational etiology related to heat stress and dehydration experienced by sugarcane and other field workers. Studies show physiological changes in workers consistent with heat stress and dehydration across work shifts. Longitudinal studies find declines in kidney function over harvest seasons among heat-exposed occupations. Intervention studies reducing heat stress through water, rest, and shade have shown reduced declines in kidney function. While some non-occupational factors may also contribute, the evidence strongly suggests that prolonged occupational heat stress is a primary driver of the CKDu epidemic.
Presentation_NCDs - Private Public Partnerships and CKDuCORE Group
Non-communicable diseases like cardiovascular disease, cancer, chronic respiratory disease, and diabetes are leading causes of death and disability globally but receive little focus from global health initiatives. While communicable diseases have declined in recent decades, deaths from non-communicable diseases have increased and pose growing health and economic challenges as treatments remain limited. Experts call for greater prioritization and resources for non-communicable diseases on the global health agenda.
Presentation_HRH2030 - Opportunities to optimize and integrate CHWCORE Group
This document summarizes a conference session on integrating and optimizing community health workers (CHWs) in health systems from global and local perspectives. The session included a fishbowl-style debate where attendees were invited to discuss questions about implementing the WHO CHW Guideline recommendations, important partnerships for training CHWs, priorities for managing and supporting newly recognized CHWs, considerations for optimizing the role of CHWs, and innovations needed to shape and sustain CHWs' roles by 2030.
Presentation_Save the Children - Building Partnerships to Provide Nurturing CareCORE Group
This document discusses the experiences of a mother giving birth to a preemie baby named Becky at 30 weeks gestation. Some key points include:
- Becky spent time in the NICU and the mother felt her discharge was rushed, leaving her unprepared to deal with feeding and breathing issues at home.
- Becky faced various developmental issues over time, including low muscle tone, sensory processing disorder, autism, ADHD, and scoliosis.
- The mother advocates for increased support for preemie babies and their families, including more parent education, counseling, early intervention services, and IEP supports over time.
Presentation_Video - Building Partnerships to provide nurturing careCORE Group
This 4 minute video provides an overview of the key events in the history of the United States from 1492 to the early 2000s. It touches on major milestones like the founding of colonies, the American Revolution, westward expansion, the Civil War, industrialization, both World Wars, the Cold War, and events of the early 21st century. The video presents a high-level chronological summary of major political, economic and social developments that shaped America over the past 500+ years.
Presentation_Perez - Building Partnerships to provide nurturing careCORE Group
This document provides information on empowering health workers and caregivers to deliver therapeutic early childhood development care at home. It discusses how 90% of brain development occurs before age 5 and the importance of nurturing care for young children. The document outlines capacity development for parents and caregivers, including guidance on conducting activities that integrate motor, social-emotional, and therapeutic skills into daily routines. It also stresses the importance of addressing caregiver stress and depression through psychosocial support groups to promote child development.
Presentation_Robb-McCord - Building Partnerships to provide nurturing careCORE Group
The document summarizes key points from a CORE Group meeting on nurturing care for preterm newborns. It discusses how nurturing care involves providing a stable, sensitive environment that meets children's health needs from birth to 3 years. The evidence review examines interventions like skin-to-skin contact, breastfeeding, managing pain and stress, sleep protection and stimulation. Country case studies from both high and low income nations are also being conducted to understand policies and guidelines supporting nurturing care concepts.
Presentation_Discussion - Norms Shifting InterventionsCORE Group
Participants in a small group discussed how to integrate norms-shifting interventions into current projects and programs. They considered what new partnerships would be needed when working to shift social norms and what evidence of the effectiveness of norms-shifting interventions should be collected, for whom, and how.
Presentation_Krieger - Norms Shifting InterventionsCORE Group
The document discusses the origins and theories of social norms. It notes that early theorists like Durkheim, Weber, and Ogburn contributed to understanding where norms come from and how they guide behavior. Parsons further explored how members of society are socialized to norms. Later, feminist anthropologists studied norms and social control, especially regarding gender. The document contrasts philosophical, psychological, and anthropological approaches to studying norms and culture. It argues that knowledge of cultural norms can help reduce unexpected outcomes in social science and shift narratives to achieve behavior change. The example of the Albania Family Planning Project shows how understanding local norms was key to successfully promoting contraceptive use.
Presentation_NSI - Norms Shifting InterventionsCORE Group
This document discusses the key attributes of norms-shifting interventions. It identifies several attributes that make an intervention effective at shifting social norms, including seeking community-level change, engaging people at multiple levels, correcting misperceptions around harmful behaviors, confronting power imbalances related to gender, creating safe spaces for critical reflection, rooting the issue within community values, accurately assessing norms, using organized diffusion, and creating positive new norms. The document provides examples and explanations for each of these attributes.
Presentation_Igras - Norms Shifting InterventionsCORE Group
This document discusses using theory to inform the work of a learning collaborative (LC) on norms-shifting interventions for adolescent reproductive health. It outlines several relevant theories, including social norm and behavior change theory and communication and behavior change theories. It also discusses the value of "bottom-up" program change theory developed from implementation experience. The LC aims to facilitate collaboration between organizations, build knowledge, and develop shared tools to guide effective social norm measurement and practice at scale. By working collaboratively, the LC can take a more experimental approach in this nascent field while still being informed by relevant theories.
Presentation_Petraglia - Norms Shifting InterventionsCORE Group
This document discusses a constructivist perspective on norms and normative change. Some key points of constructivism are that knowledge is constructed through social interaction and prior experiences, and meaning is negotiated through language. Constructivism acknowledges that individuals belong to multiple reference groups and can choose which norms to follow in a given situation. Normative change interventions cannot directly manage or control norms, but may be able to influence them by facilitating dialogue, clarifying language, and encouraging ethical persuasion rather than direct attribution. Norms and beliefs are also difficult to accurately measure.
Presentation_Sprinkel - Norms Shifting InterventionsCORE Group
This presentation provides an overview of CARE's Tipping Point initiative which aims to address child, early and forced marriage in Nepal and Bangladesh through community programming and evidence generation. In Phase 1 from 2013-2017, the project worked with adolescents, parents and leaders in 16 districts across the two countries. Norms influencing child marriage include excluding girls' voices, controlling girls' sexuality, and perceptions of risks/benefits of marriage timing. Phase 2 implements a randomized control trial to generate evidence on effective gender transformative programming and the value of social norms approaches. Challenges included discussing sexuality while successes included girls gaining greater freedom and mobility.
Presentation_Tura - Norms Shifting InterventionsCORE Group
This document discusses the Care Group approach used in an intervention in Nepal from 2005-2010. It aimed to shift social norms around maternal and child health issues through community groups. Formative research identified key norms and barriers. Community groups engaged women to reflect critically and root issues in community values. Evaluations found sustained impact on behaviors like breastfeeding years later. Challenges included focusing directly on norm drivers and unrealistic community health worker workloads. Further research on accurate norm assessment and evidence-based norm-shifting is still needed.
Presentation_Sacher - Norms Shifting InterventionsCORE Group
This document summarizes Cristina Bicchieri's theory of social norms, which is grounded in philosophy, game theory, and psychology. The key aspects of the theory include conditional preferences that depend on social expectations, personal normative beliefs about what should be done, and expectations about what others in one's reference network do and think should be done. The implications for practice highlighted in the document include providing a theory of change, identifying the nature of norms to design appropriate interventions, and using data and illustrative vignettes to measure norms and guide social change programs.
Innovative Financing Mechanisms and Effective Management of Risk for Partners...CORE Group
The document summarizes the Utkrisht Development Impact Bond in India, which aims to improve quality of care in private maternity facilities. It discusses how impact bonds can mobilize private capital for development by lowering investment risk. The Utkrisht bond provides funds for accrediting 360-440 private facilities over 3 years. Facilities receive quality improvement support and investors are repaid based on the number of facilities accredited. Early lessons show facilities are motivated to improve if it grows their business and they receive support meeting standards. The bond also provides a framework for continuously improving the project and managing risks between partners.
Presentation_Multisectoral Partnerships and Innovations for Early Childhood D...CORE Group
This document summarizes a discussion on multi-sectoral partnerships and innovation for early childhood development. It was presented by several experts, including Dr. Maureen Black from RTI International, Dr. Joy Noel Baumgartner from Duke University, Mohammed Ali from Catholic Relief Services, Dr. Chessa Lutter from RTI International, and Dr. Erin Milner from USAID. The discussion covered topics like the importance of early childhood development, the Nurturing Care Framework, metrics and measures for childhood development, partnerships for early childhood programs, and challenges and next steps.
Presentation_Jurczynska - Catalyzing Investments in RMNCAH at the Community L...CORE Group
The document describes an evidence-based advocacy model called the Family Planning – Sustainable Development Goals (FP-SDGs) model. The model allows users to quantify the impacts of different family planning scenarios on 13 Sustainable Development Goal indicators out to 2030 or 2050. Users input baseline data and create three future scenarios capturing various levels of ambition for family planning and other socioeconomic factors. The model then projects population figures and calculates outcomes for the SDG indicators. Results can support advocacy efforts to increase funding and prioritization of family planning programs and policies. Examples of the model's use in Malawi, Tanzania, and West Africa demonstrate its ability to quantify potential development impacts of expanding access to voluntary family planning.
CHAPTER 1 SEMESTER V COMMUNICATION TECHNIQUES FOR CHILDREN.pdfSachin Sharma
Here are some key objectives of communication with children:
Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
Strengthen the bond between children and caregivers, peers, and other adults.
Support Learning and Development:
Aid cognitive and language development through engaging and meaningful conversations.
Teach Social Skills:
Encourage polite, respectful, and empathetic interactions with others.
Resolve Conflicts:
Provide tools and guidance for children to handle disagreements constructively.
Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
Offer comfort and understanding during times of distress or uncertainty.
Reinforce Positive Behavior:
Acknowledge and encourage positive actions and behaviors.
Guide and Educate:
Offer clear instructions and explanations to help children understand expectations and learn new concepts.
By focusing on these objectives, communication with children can be both effective and nurturing, supporting their overall growth and well-being.
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VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
More@: https://tinyurl.com/2shrryhx
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At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
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At Malayali Kerala Spa Ajman, we firmly believe that everyone should have the option to experience top-quality massage services regularly. To achieve that goal we offer cheap massage services in Ajman.
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R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
English Drug and Alcohol Commissioners June 2024.pptxMatSouthwell1
Presentation made by Mat Southwell to the Harm Reduction Working Group of the English Drug and Alcohol Commissioners. Discuss stimulants, OAMT, NSP coverage and community-led approach to DCRs. Focussing on active drug user perspectives and interests
Exploring the Benefits of Binaural Hearing: Why Two Hearing Aids Are Better T...Ear Solutions (ESPL)
Binaural hearing using two hearing aids instead of one offers numerous advantages, including improved sound localization, enhanced sound quality, better speech understanding in noise, reduced listening effort, and greater overall satisfaction. By leveraging the brain’s natural ability to process sound from both ears, binaural hearing aids provide a more balanced, clear, and comfortable hearing experience. If you or a loved one is considering hearing aids, consult with a hearing care professional at Ear Solutions hearing aid clinic in Mumbai to explore the benefits of binaural hearing and determine the best solution for your hearing needs. Embracing binaural hearing can lead to a richer, more engaging auditory experience and significantly improve your quality of life.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
2. (Continued from previous page)
Conclusions: Mothers were not inferior to CHWs in screening for malnutrition at a substantially lower cost.
Children in the Mothers Zone were admitted at an earlier stage of SAM and required fewer hospitalizations.
Making mothers the focal point of screening strategies should be included in malnutrition treatment programs.
Trial registration: The trial is registered with clinicaltrials.gov (Trial number NCT01863394).
Keywords: Severe acute malnutrition, Mid-upper arm circumference, Community management of acute malnutrition,
Screening by mothers
Background
For the past 20 years, the diagnosis and treatment of severe
acute malnutrition (SAM) has become increasingly decen-
tralized, from a strictly hospital-based approach for all
cases to the current model of outpatient care for children
with uncomplicated SAM and inpatient care for children
presenting with complications or failing to respond to
treatment. [1] Even though this decentralization has led to
a scaled-up response, only 10–15 % of the nearly 20 million
children suffering from SAM have access to treatment [2].
Since the 1980s, it has been shown that mid-upper arm
circumference (MUAC) can be performed by minimally
trained personnel [3] leading to current recommendations
for community health workers (CHWs) to screen by
MUAC [4]. MUAC holds many advantages: It is a better
predictor of mortality, especially when repeated frequently
over time [5], compared to other practicable anthropo-
metric measures such as the weight-for-height z-score
(WHZ) [6–8]. MUAC is simple to use; and regular screen-
ings in the community increases early diagnosis and re-
duces the risk of mortality and morbidity requiring costly
and specialized hospital care [9, 10].
Mothers are in the best position to detect signs of
nutritional deterioration in their own children, and
training mothers to regularly screen by MUAC and check
for edema is a logical next step in this process of
decentralization. This could lead to improved coverage, as
well as earlier detection and treatment seeking that im-
proves program outcomes and reduces cost per case
treated. A recent study comparing CHWs and mothers
performing MUAC by color-coded class rather than meas-
urement showed the promise of such an approach [11].
Mothers had a high sensitivity and specificity for SAM
and moderate acute malnutrition (MAM, 115 mm < =
MUAC < 125 mm), there were high levels of agreement
between the mothers and CHWs and a similar number of
classification errors which occurred only at the boundaries
between normal/MAM and MAM/SAM. Accuracy was
not influenced by which arm (right or left) was measured
nor by how the mid-point of the upper arm was deter-
mined (by-eye or by measurement), providing evidence
that could simplify training while maintaining accuracy
and precision.
Food insecurity and infections leading to childhood
malnutrition is a seasonal and recurrent crisis for
families in Niger, particularly in the rural areas around
Maradi and Zinder where rates of global acute malnu-
trition (GAM, defined as the total of MAM and SAM),
and stunting are consistently near or above emergency
thresholds [12]. In 2014, 364,837 children were admit-
ted for SAM treatment by all actors in the country,
and even with the investments Niger has made in nu-
trition over the past decade, 47,225 of these children
(12.9 %) still required hospitalization. [13] Such a high
need for inpatient services is problematic in a country
like Niger which faces a chronic shortage of qualified
health personnel [14].
The objective of this study was to evaluate the efficacy
(in terms of point coverage, MUAC at admission, and the
need for inpatient care) and costs of two community-
based strategies to screen children aged between 6 and
59 months for SAM by MUAC class. Mothers and care-
takers (henceforth referred to as mothers) were compared
to CHWs in separate health zones in Niger’s Mirriah
District. It was hypothesized that training mothers to per-
form MUAC would lead to earlier SAM detection and
attendance and lower rates of hospitalization, thus reliev-
ing pressure on a resource-poor health system by reducing
the need for inpatient care.
Methods
This pragmatic interventional, non-randomized efficacy
study was conducted according to the guidelines laid
down in the Declaration of Helsinki. The study protocol
was given ethical approval by the National Consultative
Ethics Committee of Niger’s Ministry of Public Health on
April 10, 2013 (Deliberation Number 006/2013/CCNE.)
Written informed consent was obtained from all mothers
or heads of households. The trial is registered with clini-
caltrials.gov (Trial number NCT01863394).
The trial was performed from May 2013 to April
2014 in Mirriah, a rural district in Niger’s southeast
Zinder region bordering Nigeria. Dogo (Mothers Zone)
served as the intervention zone and Takieta (CHWs
Zone) served as the comparison zone where screening
Alé et al. Archives of Public Health (2016) 74:38 Page 2 of 12
3. by color-coded MUAC class (Fig. 1) was performed by
mothers and CHWs, respectively.
Health zone selection
In 2013, the characteristics of 12 health zones in
Mirriah District where the Alliance for International
Medical Action (ALIMA) and Bien Etre de la Femme et
de l’Enfant au Niger (BEFEN) ran health and malnutrition
treatment programs were examined in order to identify
two areas with similar demographics, geography, SAM
burden, health care provision, access barriers, and pro-
gram performance. Takieta and Dogo showed the most
similarities, especially for SAM prevalence at the begin-
ning of the study and the percentage of children under
5 years of age treated for SAM over a period of 9 months
prior to the study. (Table 1) Takieta was chosen as the
comparison zone (CHWs Zone) because, according to the
management team, it had the most functional CHW net-
work, and Dogo was chosen as the intervention zone
(Mothers Zone). Each health zone has one health center
overseen by a medical doctor or nurse and where most
primary health services, including outpatient SAM treat-
ment, are delivered. Takieta has six health posts and Dogo
has four, where limited services are provided by a CHW.
All complicated cases were referred and transported to
the ALIMA/BEFEN hospital in Mirriah for further clinical
evaluation and, if indicated, inpatient care. In both zones,
SAM treatment, moderate acute malnutrition (MAM)
treatment, and general pediatric health care outside of the
nutrition programs is available free of charge. The avail-
ability and quality of MAM treatment, however, differed
in each zone. In the CHWs Zone, a national NGO ran the
supplementary nutrition program (SNP) program decen-
tralized to the health post level that had no reported stock
ruptures of the lipid-based ready-to-use supplementary
food provided. In the Mothers Zone, the SNP was central-
ized at the health center, had no implementing partner,
and reported frequent stock outs of the fortified blended
flour it provided (Corn Soy Blend with milk, or CSB++.)
Trainings and evaluation
Trainings were conducted in both zones in May 2013
and a post-training evaluation was conducted in the
Mothers Zone whereas CHWs received supervision
during the study. Additional one-on-one trainings were
provided in the Mothers Zone during quarterly surveys
and at the health center throughout the study. Content
of the trainings can be seen in Table 2.
In the Mothers Zone, eight 2-person teams consisting
of former CHWs and qualified nutrition assistants from
the area covered 75 villages (the largest with a popula-
tion of 2,208 and the smallest with a population of 42)
over the course of ten days, with the final days reserved
for return visits to train mothers who were not covered
during the initial pass. In order to generate awareness
and mobilize communities, teams visited each village the
week before trainings to explain the study to village
leaders. Villages received a reminder the day before to
maximize chances that mothers would be available.
Women with children aged between 3 and 59 months as
well as caretakers (defined as a person who currently
supports a child aged between 3 and 59 months, often a
grandmother or sister of a deceased or traveling mother)
were eligible, and on average, there were 120 mothers/
caretakers per village. Training consisted of group ses-
sions (up to 30 mothers/caretakers per session) followed
by short home-based individual trainings that included
obtaining written consent and distribution of MUAC
tapes. An evaluation grid was used, and mothers were
retrained if necessary.
In the CHWs Zone, a one-day training session was
conducted at the health center in Takieta. Thirty six
CHWs were recruited or retained to cover 82 villages
(the largest with a population of 3,367 and the smallest
with a population of 16), making sure there was a proper
geographic distribution of approximately one CHW per
250 children aged under five years. CHWs raised aware-
ness about the signs of malnutrition during screenings,
and gave referral slips to the mothers of children indicat-
ing why the child was referred (including for having a
MUAC <115 mm). Mothers did not need a CHW refer-
ral but could go directly to the health center if they
detected signs of malnutrition or were worried about
their child’s health. A monthly incentive of $44 USD was
provided to each CHW.
Figure 2 shows the flow of beneficiaries from the
village through the health center in both zones. At the
health center, a health agent first asked why mothers
came, then measured the child’s MUAC and checked for
edema. The readings by the health agent were compared
to the MUAC color or edema stated by the referral in
order to assess agreement and evaluate the efficiency of
mothers and CHWs in performing MUAC and checking
Fig. 1 Example of color-coded mid-upper arm circumference tapes
Alé et al. Archives of Public Health (2016) 74:38 Page 3 of 12
4. Table 1 Pre-study comparison of demographics and severe acute malnutrition prevalence and treatment program data in two health
zones of Mirriah District, Niger in June 2013
Health Zone Dogo (Mothers Zone) Takieta (Community Health
Workers Zone)
p-value
Population <5 years (Total Population) 9 908 (37 389) 8 867 (33 449) —
Percentage of population >15 km from health center 39 42 —
Prevalence of severe acute malnutritiona
June 2013 4.4 4.7 0.43
Point coverage June 2013, n (%) 76/258 (29.5) 54/190 (28.4) 0.81
Top 3 barriers to coverage ranked by frequency cited June 2013 Previous rejection of a child Previous rejection of a child —
Poor reception at health
center
Child not perceived as sick
Child not perceived as sick Poor reception at health center
Admissions for severe acute malnutrition April to December 2012
(Percentage of population <5 years)
1 047 (10.6) 902 (10.2) —
Percentage of severe acute malnutrition admissions receiving in-patient
care, April to December 2012
21.6 27.8 0.001
a
Severe acute malnutrition defined as mid-upper arm circumference <115 or presence of bilateral pitting edema
Table 2 Content and instructions for training mothers or community health workers to screen children for malnutrition in separate
health zones of Mirriah District, Niger between May 2013 and April 2014
Mothers Zone Community Health Workers Zone
Training received - 30 min group (20–30 participants) session with
practical demonstration;
- 2–3 min individual home-based session
- Further individual training if needed following
evaluation
- Check for MUAC and edema whenever you feel
necessary or at least once a month on market day.
- Individual trainings at the health center waiting area
- 6 h group theoretical training and 2 h practical training (per current
CHW training modules recommended by the WHO and UNICEF.)a
- Check MUAC and edema monthly or as needed
- Each CHW records in notebook the children he or she has recorded
with a red MUAC/edema.
- One supervisor for the 36 CHWs throughout the study.
Total number trained 12,893 36
Instructions for using
MUAC bracelets
- Perform the MUAC on children who are at least 6 months of age OR 67 cmb
or taller in height (For mothers: measure a
mark at 67 cm on the wall in your home, or cut a piece of cloth/wood to 67 cm)
- Slide the MUAC bracelet on the left arm to what you estimate is the mid-point.
- Make sure the arm is hanging down straight, and is not bent
- Make sure the tape is snug – not too tight or too loose on the arm
Instructions for reading
the MUAC color-codes
Look at the color in the window. If it is:
RED – Your child may be sick and have severe acute malnutrition. You should go to the health center/health post
within 48 h.
YELLOW – Your child needs to eat nutritious food like beans, carrots, meat, and eggs. You should go to the MAM
treatment center at the earliest opportunity but we cannot guarantee that food will be available every day
there. (For mothers only: You should take regular MUAC readings to make sure your child does not become
more malnourished.)
GREEN – Your child is properly nourished. Continue to feed him or her well. (For mothers only: take a MUAC regularly and
watch for signs discussed during group sessions.)
Mothers could always visit the health center/health post if they thought their child was sick, regardless of MUAC status
(and without a referral slip in the CHWs’ Zone.)
Instructions for
checking for edema
- Press your thumbs down on top of your child’s feet for three seconds
- If there is still an imprint a few seconds after you have removed your thumbs, your child may have edematous
malnutrition, or kwashiorkor, so you should go to the health center as soon as possible.
MUAC mid-upper arm circumference, CHW Community Health Worker
a
United Nations Department of Technical Co-operation for Development and Statistical Office. Annex 1: “Summary Procedures” in How to weigh and measure
children: assessing the nutritional status of young children in household surveys. New York: United Nations; 1986
b
At the beginning of the study in May 2013, the national protocols called for a 65 cm height cut-off for MUAC use. The protocols were revised to 67 cm during
the course of the study
Alé et al. Archives of Public Health (2016) 74:38 Page 4 of 12
5. for edema. Mothers with discordant readings or previously
untrained mothers in the Mothers Zone received a MUAC
demonstration. All children were then seen by a Nutrition
Assistant who measured MUAC, assessed WHZ, and
checked for edema. Any child meeting program inclusion
criteria was admitted, and those with complications were
transferred to hospital. Health sensitization was given to
all mothers on health and nutrition topics including mal-
nutrition, malaria, diarrhea, general hygiene, breastfeeding,
and the importance of compliance with prescribed med-
ical care, including the use of RUTF. Vaccinations were
updated as needed.
Fig. 2 Flow of referrals from village to health center in health zones where malnutrition screening was performed by mothers or community
health workers, Mirriah District, Niger between June 2013 and May 2014
Alé et al. Archives of Public Health (2016) 74:38 Page 5 of 12
6. Mass screenings, coverage surveys, and data collection
and analysis
Exhaustive, door-to-door MUAC screenings were orga-
nized at baseline (May 2013) and three times thereafter
(August 2013, December 2013, April 2014) in all villages
of both zones. This was used to determine program
coverage and as a safeguard in the event that screening
by mothers was not effective. Twelve teams of two
investigators each were managed by four supervisors
(i.e. 3 teams per supervisor) and performed MUAC
screenings on all children identified as being between 6
and 59 months of age and ≥ 67 cm in length. Like many
countries in West and Central Africa, Niger’s protocol
includes this length restriction for MUAC eligibility.
Children not already receiving treatment but identified
as severely malnourished (MUAC <115 mm and/or
edema) or moderately malnourished (115 mm ≤
MUAC <125 mm) were referred for SAM or moderate
acute malnutrition (MAM) treatment, respectively.
Mothers of children with MUAC < 115 mm and not in
treatment were interviewed to identify their reasons
for non-attendance.
Coverage was assessed using the Semi-Quantitative
Evaluation of Access and Coverage (SQUEAC) method
[15, 16]. Only point coverage was estimated because this
study was most interested in the ability of programs to
find and recruit cases. Point coverage is defined as the
proportion of children aged between 6 and 59 months
with MUAC < 115 mm or bilateral edema at the time of
the survey who were effectively supported in the appro-
priate nutrition program (determined by presence of a
program bracelet on the child’s foot, ration card with the
ALIMA logo, or a stock of therapeutic food in the
house). The point coverage estimator does not account
for recovering cases and so does not reflect the pro-
gram's ability to retain cases from admission to cure.
Point coverage tends, therefore, to underestimate overall
program performance.
Data from the nutrition rehabilitation program were
collected weekly from sites in both health zones. MUAC
in mm at admission was collected and used to determine
the distribution of MUAC at admission for children ad-
mitted by MUAC < 115 mm. Hospital referrals for med-
ical complications at admissions and during the
treatment episode were used to determine the propor-
tion of admissions requiring hospitalization. Common
descriptive statistics techniques were used for data ana-
lysis (including graphic analysis). Proportions, as well as
risk ratios (RR) and/or risk difference (RD) with their as-
sociated 95 % confidence intervals (CI), were presented
for each group. To measure the association between
each strategy and the variable of interest, two-tailed p-
value for Yates corrected chi-square test or two-tailed p-
value for Fisher exact test (when indicated) were used.
Differences were considered statistically significant at a
p < 0.05. Cost data was entered in the accounting soft-
ware SAGE between June 1 and December 31, 2013 and
used retrospectively in order to estimate the cost of
implementing and monitoring each screening strategy.
Supervision fees and premiums were projected for 5
additional months (i.e. until May 30, 2014) in order to
cover the period of the study.
Results
A total of 12,893 mothers and caretakers were trained to
screen children by MUAC color-coded class and check
for edema in the Mothers Zone during the initial train-
ing sessions and subsequent coverage surveys. (Table 3)
A further 329 previously untrained mothers were trained
at the health center in the Mothers Zone during the
study. In the CHWs Zone, 36 CHWs were trained and
given appropriate supervision.
Referrals by MUAC <115 mm in the Mothers Zone
were more likely to be in agreement with the health
center agents compared to the CHWs Zone (risk ra-
tio = 1.88 [1.69; 2.10], risk difference = 35.31 [30.39;
40.23], p < 0.0001). (Table 4) The small number of re-
ferrals for edema in either zone (42 in the Mothers
Zone and 1 in the CHWs Zone) means that this ana-
lysis lacks statistical power (p = 0.4471). Table 5 shows
the percentage of children admitted by each of the in-
clusion criteria. Table 6 shows the source of referral for
those children admitted by MUAC < 115 mm, with a lar-
ger percentage in the Mothers Zone reporting that they
came to the health center spontaneously suggesting that
training mothers led to increased awareness of malnutri-
tion and available treatment. The distribution of MUAC at
admission for children admitted to SAM treatment by
MUAC <115 mm in the two zones is shown in Fig. 3. The
difference between the medians was estimated to be
1.6 mm higher in the Mothers Zone (95 % CI = 0.65; 1.87)
Table 3 Number of mothers and caretakers trained to screen
for malnutrition in Dogo health zone, Mirriah District, Niger
between May 2013 and April 2014
May
2013
Aug
2013
Dec
2013
Apr
2014
Estimated number of mothers with
children, 3–59 months
7,727 7,727 7,727 7,916a
Mothers trained and given a mid-upper
arm circumference tape during training
sessions
6,799 534 377 737
Caretakers trained and given a mid-
upper arm circumference tape during
training sessions
2,703 0 0 1,743
Cumulative number mothers and
caretakers trained and given a mid-
upper arm circumference tape
9,502 10,036 10,413 12,893
a
Estimated natural growth of the population since the beginning of 2014
Alé et al. Archives of Public Health (2016) 74:38 Page 6 of 12
7. using a smoothed bootstrap procedure; the null hypothesis
of no difference between the means was rejected (p =
0.007). Consistent with earlier detection and treatment
seeking, children admitted in the Mothers Zone were less
likely to require inpatient care than children in the CHWs
Zone, both at admission and at any point in their treatment
episode, with the most pronounced difference at admis-
sion for those enrolled by MUAC < 115 mm (risk ratio =
0.09 [95 % CI 0.03; 0.25], risk difference = −7.05 % [95 %
CI −9.71 %; −4.38 %], p < 0.0001). (Tables 7, 8) Point
coverage was similar in both zones at the end of the study
(35.14 % Mothers Zone vs 32.35 % CHWs Zone, differ-
ence 2.78 %, [95 % CI −16.34 %; 21.90 %], p = 0.9484, Yates
corrected chi-square test.) (Table 9) Coverage improved in
both health zones, especially after the second survey likely
because the seasonal spike in malaria prompted
mothers to go to health centers at the first sign of a
child’s fever. During the fourth coverage survey,
6,678 of the 7,421 mothers (90.0 %) surveyed in the
Mothers Zone had been trained in the use of
MUAC. Of these, 6,529 (97.8 %) still possessed the
MUAC tape in good condition. Lost or damaged
MUAC tapes were replaced.
Even though the Mothers Zone required a higher ini-
tial investment, overall costs for the year were less than
half those in the CHWs Zone ($8,600 vs $21,980.)
(Table 10) While initial costs for the CHWs Zone were
low, the modest monthly incentives for CHWs repre-
sented the largest part (85 %) of the higher costs.
Discussion
Late presentation of SAM (e.g. children well below the ad-
mission threshold) carries a greater risk of death, and is
commonly associated with medical complications that re-
quire more costly hospital-based care. [17] This study
demonstrates that earlier detection of SAM can be
achieved by training mothers to classify the nutritional
status of their children by regular MUAC screenings.
Mothers were not inferior to CHWs in terms of cover-
age at a substantially lower cost, and regular MUAC
screening by mothers, in addition to the mass sensitization
from training sessions and quarterly surveys, contributed
to a higher median MUAC at admission and lower
hospitalization rates at admission and during the course
of treatment.
There is growing understanding that MUAC can be
used safely and effectively as the sole anthropometric
criterion for admission, management, and discharge
from malnutrition treatment [18–21]. A recent study
also showed promising results from integrating SAM
and MAM programs under one MUAC-only protocol
[22]. Such an integrated approach could be important
moving forward because having separate SAM and MAM
programs often poses problems, leading to convoluted
Table 4 Comparison of health center agreement for referrals in health zones where mothers or community health workers
performed malnutrition screening, Mirriah District, Niger between June 2013 and April 2014
Type of Referral Mothers Zone Community Health
Workers Zone
Risk Ratioa
Risk Difference p-value
[95 % CI] [95 % CI]
MUAC <115 mm 721/956 (75.42 %) 221/551 (40.11 %) 1.88 [1.69; 2.10] 35.31 % [30.39; 40.23] <0.0001b
Edema 42/89 (47.19 %) 1/5 (20.00 %) 2.36 [0.40; 13.81] 27.19 % [−9.37; 63.75] 0.4771c
MUAC mid-upper arm circumference, CHW Community Health Worker
a
Risk Ratio: The ratio of the proportion in agreement in the Mothers Zone to the proportion in agreement in the CHWs Zone
Risk Difference: The difference between the proportion in agreement in the Mothers Zone and the proportion in agreement in the CHWs Zone
b
Two-tailed p-value for Yates corrected chi-square test. (In Mothers Zone: red MUAC found by mother versus red MUAC found by health center agent; in CHWs
Zone: red MUAC found by CHW versus red MUAC found by health center agent.)
c
Two-tailed p-value for Fisher exact test (In Mothers Zone: edema found by mother versus edema found by health center agent; in CHWs Zone: edema found by
CHW versus edema found by health center agent.)
Table 5 Children admitted for treatment of severe acute malnutrition by admissions criteria in health zones where mothers or
community health workers performed malnutrition screening, Mirriah District, Niger between June 2013 and May 2014
Admission Criteria Mothers Zone Community Health Workers Zone Risk Differencea
[95 % CI]
p-value
(n = 1,371) (n = 988)
Edema 9 (0.66 %) 4 (0.40 %) 0.25 % [−0.33; 0.83] 0.4154a
Edema, MUAC <115 mm, height ≥ 65/67 cm 5 (0.36 %) 6 (0.61 %) −0.24 % [−0.82; 0.34] 0.3935c
MUAC <115 mm, height ≥ 65/67 cm 564 (41.14 %) 407 (41.19 %) −0.06 % [−4.08; 3.97] 0.9781a
WHZ < −3, MUAC ≥115 mm, height ≥ 65/67 cm 572 (41.72 %) 410 (41.50 %) 0.22 % [−3.81;4,26] 0.9135a
WHZ < −3, height <65/67 cm (no MUAC taken) 221 (16.12 %) 161 (16.30 %) −0.18 % [−3.29; 3.84] 0.9089a
MUAC mid-upper arm circumference, CHW Community Health Worker, MAM Moderate acute malnutrition, WHZ weight for height Z-score
a
Risk Difference: The difference between the proportion admitted in the Mothers Zone and the proportion admitted in the CHWs Zone
b
Two-tailed p-value for Yates corrected chi-square test (admission criteria in Mothers Zone and admissions criteria in CHWs Zone.)
c
Two-tailed p-value for Fisher exact test (admission criteria in Mothers Zone and admissions criteria in CHWs Zone.)
Alé et al. Archives of Public Health (2016) 74:38 Page 7 of 12
8. messaging and uneven health care delivery. It was likely
confusing for mothers in both zones, for example, to be
told to go to different programs based on MUAC color
at screening (i.e. red for SAM and yellow for MAM).
Thus a mother-centered screening strategy will be most
successful in programming that integrates SAM and
MAM treatment and relies on MUAC from the home
to the health center, helping to facilitate a scale-up that
meets current global needs.
Coverage surveys in multiple contexts have identified
major reasons why mothers do not utilize available SAM
treatment, including a lack of awareness about malnutri-
tion (signs, etiology, and treatment) and existing CMAM
programs, as well as previous rejection [23, 24]. Barriers
to coverage were noted at baseline and not analyzed
further here, but mothers welcomed an approach that
allowed and expected them to be more engaged in deci-
sions related to their children’s health. Several reported
understanding for the first time why their child was
admitted (or not) for malnutrition treatment in the past.
Furthermore, mass sensitization from trainings and re-
peat opportunities for health education activities will
help address these coverage barriers, especially in an
area like rural Niger where even in the dry season only
34 % of people live within 5 km of a functioning health
center [25].
There were several limitations and possible biases to
this study. The study only lasted eleven months and it
takes time for members of a community to develop new
health-seeking behaviors, so community mobilization is
likely to improve over time through periodic trainings and
MUAC tape renewals. Although it is likely that screening
by mothers contributed to the observed difference in
proportion of hospitalized cases in the two zones, this
is not certain as hospital referrals depend on many fac-
tors (e.g. clinicians’ level of training and/or experience).
Even though the two zones had similar demographics
and prevalence of malnutrition at baseline, a smaller
proportion of children receiving SAM treatment in the
Mothers Zone required inpatient care in a nine month
period prior to the study. The hospital in Mirriah is also
further away from the CHWs Zone than the Mothers
Zone, but the potential for bias was reduced by the fact
that transport for referrals from health centers was pro-
vided by ALIMA/BEFEN ambulances in both zones.
One would expect program lengths of stay to be shorter
in the Mothers Zone, but comparison was not possible
because the therapeutic supplementary feeding pro-
grams (i.e. programs treating MAM) in the zones were
Table 6 Comparison of referral source for children admitted to severe acute malnutrition treatment by MUAC <115 mm in health
zones where mothers or community health workers performed malnutrition screening, Mirriah District, Niger between June 2013
and May 2014
Mothers Zone Community Health Workers Zone Risk differencea
[95 % CI]
p-value
(n = 569) (n = 413)
Spontaneous 150 (26.36 %) 31 (7.51 %) 18.86 % [14.43; 23.28] <0.0001b
From MAM treatment 10 (1.76 %) 46 (11.14 %) −9.38 % [−12.60; −6.16] <0.0001b
MUAC by mother or CHW 300 (52.72 %) 264 (63.92 %) −11.20 % [−17.39; −5.01] <0.0005b
Otherc
76 (13.36 %) 55 (13.32 %) 0.04 % [−4.27; 4.35] 0.9856b
Not specified 33 (5.80 %) 17 (4.12 %) 1.68 % [−1.03; 4.40] 0.2368b
a
Risk Difference: The difference between the proportion referred in the Mothers Zone and the proportion referred in the CHWs Zone
b
Two-tailed p-value for Yates corrected chi-square test (referral source in Mothers Zone and referral source in CHWs Zone)
c
Surveys, vaccination, other non-governmental organization activities
Fig. 3 Distribution of MUAC at admission, children admitted for
severe acute malnutrition treatment by MUAC <115 mm, in health
zones where mothers or community health workers performed
malnutrition screening, Mirriah District, Niger between June 2013
and May 2014. For the box plots presented in Fig. 3, the box
extends between the upper and lower quartiles with the thicker line
in the box marking the position of the median. The whiskers extend
to 1.5 times the interquartile distance above and below the upper
and lower quartiles. The isolated points mark the positions more
extreme than the range of values covered by the whiskers. If the
notches around the medians for each zone do not overlap then
there is “strong evidence” that the two medians differ. [32]
Alé et al. Archives of Public Health (2016) 74:38 Page 8 of 12
9. operating at different levels of capacity, causing children
to be retained in the therapeutic feeding program longer
in the Mothers Zone than in the CHWs Zone. The differ-
ence in availability and quality of MAM services in the
two zones is another limitation to the overall analysis be-
cause it is difficult to determine the impact or influence of
MAM programming on the profile of SAM cases while
the presence of a well-functioning MAM program may
have influenced discharge decisions.
Screening by MUAC class itself also introduces error
in favor of sensitivity since it does not take much to
misclassify children near the 115 mm cut-off due to
pulling too tightly. This can be reduced by using
increased-width tapes. There were, however, few gross
errors when mothers or CHWs measured MUAC, and
most misclassifications in the both zones occurred either
at the boundary between SAM and MAM or children
screened as SAM determined to be MAM by health
center agents, in line with a previous study [11]. With a
condition such as SAM which has a high case-fatality rate
when untreated, an error in favor of sensitivity is more
acceptable than the opposite error provided that rejected
referrals do not undermine coverage.
The length threshold for MUAC eligibility that is part
of many protocols in West and Central Africa (and
which changed in Niger from 65 cm to 67 cm during
the study) introduced an additional bias. It systematically
excludes young, stunted children who are at consider-
able risk of death if left untreated, which is especially
problematic in an area of high stunting and in light of
previous work showing such children respond well to
treatment [26, 27]. There is no way of knowing how
many low MUAC children were excluded because they
were below the height cut-off. Removing the length re-
striction for MUAC at triage and screening, and
instructing mothers to simply use MUAC on children
older than 6 months, would end this exclusion and sim-
plify MUAC trainings.
Some areas were identified for improvement or fur-
ther exploration. Because resource-poor mothers in a
rural community were shown to better identify malnu-
trition in their infants through pictorial rather than ver-
bal descriptions, integrating more pictorial descriptions
into the trainings would be beneficial [28]. Future mes-
sages can also more explicitly convey that bringing a
child at the earliest sign of nutritional deterioration
could reduce, though not eliminate, the risk of their
child needing to be hospitalized. Care must be taken,
though, to assure mothers do not stop treatment once
they start to see a noticeable improvement in their
child’s MUAC status.
While mothers and CHWs were trained to screen for
edematous malnutrition, prevalence is low in Niger and
the small number of referrals for edema in either zone
means that the analysis here lacks statistical power.
Nevertheless, more children were referred for edema
and agreement was higher in the Mothers Zone, suggest-
ing that mothers are in a better position to detect poten-
tial cases of a deadly condition with rapid onset and
resolution in either death or spontaneous recovery. In
Table 7 Comparison of hospitalizations for children admitted to severe acute malnutrition treatment in health zones where mothers
or community health workers performed malnutrition screening, Mirriah District, Niger between June 2013 and May 2014. Patients
requiring inpatient care at admission
Mothers Zone Community Health
Workers Zone
Risk Ratioa
Risk Difference p-value
[95 % CI] [95 % CI]
All admissions 32/1371 (2.33 %) 89/988 (9.01 %) 0.26 [0.17; 0.38] −6.67 % [−8.63; −4.72] <0.0001b
Admissions by MUAC < 115 mm 4/569 (0.70 %) 32/413 (7.75 %) 0.09 [0.03; 0.25] −7.05 % [−9.71; −4.38] <0.0001b
MUAC mid-upper arm circumference, CHW Community Health Worker
a
Risk Ratio: The ratio of the proportion hospitalized in the Mothers Zone to the proportion hospitalized in the CHW’s zone
Risk Difference: The difference between the proportion hospitalized in the Mothers Zone and the proportion hospitalized in the CHWs Zone
b
Two-tailed p-value for Yates corrected chi-square test (hospitalizations in Mothers Zone and hospitalizations in CHWs Zone.)
Table 8 Comparison of hospitalizations for children admitted to severe acute malnutrition treatment in health zones where mothers
or community health workers performed malnutrition screening, Mirriah District, Niger between June 2013 and May 2014. Patients
requiring inpatient care at any point in the treatment episode
Mothers Zone Community
Health Workers
Zone
Risk Ratioa
Risk Difference p-value
[95 % CI] [95 % CI]
All admissions 99/1371 (7.22 %) 117/988 (11.84 %) 0.61 [0.47; 0.79] −4.62 % [−7.06; −2.18] <0.0001b
Admissions by MUAC <115 mm 44/569 (7.73 %) 55/413 (13.32 %) 0.58 [0.40; 0.85] −5.58 % [−9.53; −1.64] 0.0021b
MUAC mid-upper arm circumference, CHW Community Health Worker
a
Risk Ratio: The ratio of the proportion hospitalized in the Mothers Zone to the proportion hospitalized in the CHW’s zone
Risk Difference: The difference between the proportion hospitalized in the Mothers Zone and the proportion hospitalized in the CHWs Zone
b
Two-tailed p-value for Yates corrected chi-square test (hospitalizations in Mothers Zone and hospitalizations in CHWs Zone.)
Alé et al. Archives of Public Health (2016) 74:38 Page 9 of 12
10. the Mothers Zone, however, fewer children were admit-
ted to the treatment program for edema than those
who were determined to be in agreement with an
edema referral. Because most of the children admitted
for edematous malnutrition in both zones were classi-
fied as having mild edema (in both feet, according to
WHO definitions [5]), this discrepancy was likely due
to subjective assessor judgment between health agents
and nutrition assistants, as even trained nurses have been
shown to have difficulty reliably identifying edematous
malnutrition in low prevalence settings [29]. It will be
particularly important to further study mothers’ ability to
detect edema in an area of high prevalence.
CHWs provide valuable contributions to improved
health outcomes in a community, and are being relied
upon to do more and more, from diagnosis to delivery
in areas as varied as malaria, malnutrition, vaccination,
or childbirth assistance [30]. These activities are in
addition to their normal work and family responsibilities,
and are sometimes expected to be performed without
pay. CHWs will continue to play an important role in
community-based interventions, but shifting some tasks
such as screening for malnutrition to mothers can pre-
vent CHWs from becoming overburdened. CHWs, for
example, might be better utilized as MUAC trainers.
Conversely, providing mothers with simple tools to en-
courage their active involvement need not be restricted
to screening for malnutrition. Mothers in a similar con-
text, for example, were shown to be capable of identify-
ing and classifying respiratory tract infections in their
children [31].
Even with the study’s limitations, preliminary analysis
of the benefits and few risks associated with the
household-level screening strategy led ALIMA to train
tens of thousands of additional mothers elsewhere in
Niger as well as in Burkina Faso, Mali and Chad. Thus
from an operational perspective integrating household-
level screening into pre-existing programs was relatively
straightforward.
Conclusion
Involving mothers in screening their own children by
MUAC and checking for edema is a key step in increas-
ing access to care for children in any area where malnu-
trition poses a high risk of death or illness and can
reduce cost per child treated. Making mothers the focal
point of MUAC screening strategies should be included
in regular CMAM programming. As mothers are taught
how to screen their own children in countries where
malnutrition is highly prevalent, important information
will be gained by practitioners about how to most effect-
ively extend the strategy.
Table 9 Comparison of point coverage estimator for severe acute malnutrition treatment programsa
in health zones where mothers
or community health workers performed malnutrition screening, Mirriah District, Niger between June 2013 and April 2014
June 2013 Aug 2013 Dec 2013 April 2014
Mothers Zone 76/258 (29.46 %) 130/325 (40.00 %) 48/168 (28.57 %) 26/74 (35.14 %)
Community Health Workers Zone 54/190 (28.42 %) 44/92 (47.83 %) 23/102 (22.55 %) 11/34 (32.35 %)
Risk Difference [95%CI] 1.04 % [−7.45 %; 9.53 %] −7.83 % [−19.34 %; 3.68 %] 6.02 % [−4.58 %; 16.63 %] 2.78 % [−16.34 %; 21.90 %]
p-value 0.8938b
0.2214b
0.3435b
0.9484b
a
Criteria for inclusion: children between 6 and 59 months of age, residing in the zone for at least three months with mid-upper arm circumference <115 mm and/
or presence of bilateral edema
b
Two-tailed p-value for Yates corrected chi-square test (point coverage in Mothers Zone and point coverage in Community Health Workers Zone.)
Table 10 Comparison of costs in health zones where mothers
or community health workers performed malnutrition screening,
Mirriah District, Niger between May 2013 and April 2014a
Mothers Zone Community
Health Workers
Zone
Trainings $4,883 $826
For mothers: cash incentives and
travel for 16 trainers and evaluation
of the first training
For community health workers: 1
initial training with materials, and
per diem for participants
Supervision costs and fees $1,958 $1,958
For both groups: occasional
supervision from Community
Manager + per diem for the District
Supervisor
Materials
For mothers: 12,900 mid-upper arm
circumference tapes distributed
estimated at $0.14/tape (0.10
centimes/tape)
For community health workers:
Notebooks, pens, 2 mid-upper arm
circumference tapes per, community
health worker
$1,759 $611
Cash incentives $0 $18,585
For community health workers only:
36 community health workers for
12 months at a total of $1,584 USD/
month (1,136 €/month)
Total Costs $8,600 $21,980
Cost per child < 5 years $1.04 $3.00
a
In $USD converted from €Euros at May 2014 international exchange rate of
€1 Euro = 1.36333 $USD
Alé et al. Archives of Public Health (2016) 74:38 Page 10 of 12
11. Abbreviations
MUAC, mid-upper arm circumference; CHW, community health worker;
CMAM, Community Management of Acute Malnutrition; GAM, global acute
malnutrition; SAM severe acute malnutrition; MAM, moderate acute malnutrition;
WHZ, weight for height Z-score; RUTF ready-to-use therapeutic food; WHO World
Health Organization
Acknowledgements
The authors thank village chiefs, leaders and families of Dogo and Takieta
villages, the mothers of the children who participated in the study, and
the ALIMA and BEFEN teams for their enthusiasm, help and support
without which this study could not have taken place.
Funding
The study was funded in part by the Alliance for International Medical Action
(ALIMA), UNICEF, The Humanitarian Aid and Civil Protection Department of
the European Commission (ECHO), and the USAID Office of U.S. Foreign
Disaster Assistance (OFDA).
Availability of data and materials
The Alliance for International Medical Action (ALIMA) and its field partners
have an open data sharing policy. (As an example of putting this policy in
action, all data from ALIMA’s treatment of patients confirmed with Ebola
Virus Disease has been shared with the Ebola Data Sharing Platform, of
which ALIMA is a Steering Committee member.) ALIMA will provide raw
data that maintains participant confidentiality from this study to
interested researchers upon request. To make a request, please send a
written expression of interest to Kevin Phelan (k.phelan@alima-ngo.org)
that includes the researcher’s ethical policy, a list of previous published or
unpublished work, and the main research question the data would be
helpful in addressing.
Authors’ contributions
The study was conceived and designed by NB, ID, TAD, GH, GLD, FGBA, HI, ABr,
NO, IY; the study was performed by FGBA, HI, SSa; KI, ID, GLD, GH, NB, IY; the
data were analyzed by FGBA, MM, KPQP, GH, SSh, NB, ABr; the manuscript was
written and edited by KPQP, FGBA, MM, HI, ID, GLD, GH, SSa, KI, ABr SSh, TAD,
NB, NO, IY. All authors read and approved the final manuscript.
Authors’ information
FGBA, KPQP, HI, KI, GH, ID, GLD, TAD, SSh: Alliance for International Medical
Action (ALIMA), Dakar, Senegal. SSa: Bien Etre de la Femme et de l’Enfant
au Niger (BEFEN), Niamey, Niger. MM: Brixton Health, Llawryglyn, Wales, UK.
ABr: Department of International Health, University of Tampere School of
Medicine, Tampere, Finland and Department of Nutrition, Exercise and
Sports, Faculty of Science, University of Copenhagen, Denmark. NB:
Alliance for International Medical Action, ALIMA Dakar, Senegal, and
Department of Critical Care, University of Queensland, Brisbane, Australia.
NO, IY: Ministry of Health, Niamey, Niger.
Competing interests
The authors have no conflict of interest to declare.
Consent for publication
Not applicable.
Ethics approval and consent to participate
This pragmatic interventional, non-randomized efficacy study was conducted
according to the guidelines laid down in the Declaration of Helsinki. The
study protocol was given ethical approval by the National Consultative Ethics
Committee of Niger’s Ministry of Public Health on April 10, 2013 (Deliberation
Number 006/2013/CCNE.) Written informed consent was obtained from all
mothers or heads of households. The trial is registered with clinicaltrials.gov
(Trial number NCT01863394).
Author details
1
Alliance for International Medical Action (ALIMA), ALIMA ,Fann Residence,
BP155530 Dakar, Senegal. 2
Bien Être de la Femme et de l’Enfant (BEFEN),
Niamey, Niger. 3
Ministry of Public Health, Niamey, Niger. 4
Brixton Health,
Llawryglyn, Wales, UK. 5
Tampere Centre for Child Health Research, University
of Tampere and Tampere University Hospital, Tampere, Finland. 6
Department
of Nutrition, Exercise and Sports, Faculty of Science, University of
Copenhagen, Copenhagen, Denmark. 7
Department of Critical Care, University
of Queensland, Brisbane, Australia. 8
Médecins Sans Frontières (MSF), Paris,
France.
Received: 9 February 2016 Accepted: 10 June 2016
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