Since December 2010, Malaria Consortium has been implementing an innovative approach to community management of severe acute malnutrition, together with an existing integrated community case management (ICCM) programme in South Sudan. This learning paper considers Malaria Consortium’s experience of this combined approach in a highly complex context and shows whether the management of severe acute malnutrition is an effective, acceptable and feasible component of ICCM programming.
Malnutrition refers to both undernutrition and overnutrition. Undernutrition is when the diet does not provide enough calories and protein for growth and maintenance. It can result in stunting, wasting, and micronutrient deficiencies. Overnutrition is consuming too many calories and can lead to overweight and obesity. Globally in 2013, 51 million children under 5 had wasting and 161 million had stunting, with most cases in Asia and Africa. While malnutrition rates have declined overall, they continue to rise in parts of Africa. Vulnerable groups like young children are most at risk.
Malnutrition refers to any imbalance between nutrient needs and intake that negatively impacts growth, development, and other bodily functions. It can be caused by inadequate food intake, early breastfeeding cessation, cultural food customs, poor sanitation, or chronic illness impairing digestion. The WHO classifies malnutrition as moderate or severe based on levels of stunting, wasting, and edema. The main types are marasmus marked by severe wasting, kwashiorkor shown by edema, and a combination of both. Treatment focuses on food distribution programs, supplements, breastfeeding support, and improving sanitation and healthcare access.
Presentation by Olivier Ecker at the event: “Tackling food security and nutrition in Egypt: challenges and opportunities” Launch of the findings from the Household, Income, Expenditure and Consumption Survey , Tuesday 21 May in Cairo, Egypt.
Chronic malnutrition is caused by long-term deficiencies in nutrients and can stunt physical and cognitive growth. It results from immediate factors like low birth weight, illness, and poor diet that are themselves influenced by underlying household determinants of food security, health care, and parenting quality, as well as basic socioeconomic determinants of a family's status, education, empowerment, and access to water/sanitation. Chronic malnutrition is clinically assessed and indicated by measurements of stunting, wasting, and underweight as well as physical signs. It requires preventive measures simultaneously targeting individuals, communities, and national policies.
Severe Acute Malnutrition (SAM) and Nutrition Rehabilitation Centre (NRC)- Dr...Yogesh Arora
A presentation on severe acute malnutrition and nutritional rehabilitation center. Various preventive, promotive, and curative aspects of SAM are discussed in this presentation.
Malnutrition and Micronutrients DeficiencyPao Rodriguez
The document discusses different types of malnutrition including undernutrition, overnutrition, and obesity. It defines undernutrition as not getting enough of the right foods, overnutrition as eating beyond nutritional needs, and obesity as an excessive amount of body fat. Effects of malnutrition are listed as slow growth, poor school performance, sluggishness, and poor nutrition in adulthood. Macronutrients and micronutrients are defined as the main nutrients from food, with macronutrients being carbohydrates, fats, and proteins, and micronutrients being vitamins and minerals needed in small amounts. Micronutrient deficiency is also discussed. Prevention of malnutrition is described as eating a healthy, balanced diet with variety.
The document discusses malnutrition in children, focusing on the first 1000 days of life from conception to age 2. It defines various forms of malnutrition like stunting, wasting, and underweight. Around 1/3 of under-5 mortality is due to undernutrition. The first 1000 days are critical for meeting nutritional needs. It provides global statistics on the prevalence of issues like stunting, underweight, low birth weight. It also discusses diagnostic criteria and interventions to address malnutrition.
Obesity and malnutrition an international perspective of the paradoxGianluca Tognon
Obesity and malnutrition can occur together due to economic and social factors. In low-income communities, obesogenic foods that are high in calories but low in nutrients are often most affordable and available. This can lead to weight gain while still being malnourished. Additionally, periods of food insecurity may cause people to overeat when food is available to store calories against future uncertainty. Overall, complex social and economic drivers can result in both obesity and malnutrition within the same family or community.
Malnutrition refers to both undernutrition and overnutrition. Undernutrition is when the diet does not provide enough calories and protein for growth and maintenance. It can result in stunting, wasting, and micronutrient deficiencies. Overnutrition is consuming too many calories and can lead to overweight and obesity. Globally in 2013, 51 million children under 5 had wasting and 161 million had stunting, with most cases in Asia and Africa. While malnutrition rates have declined overall, they continue to rise in parts of Africa. Vulnerable groups like young children are most at risk.
Malnutrition refers to any imbalance between nutrient needs and intake that negatively impacts growth, development, and other bodily functions. It can be caused by inadequate food intake, early breastfeeding cessation, cultural food customs, poor sanitation, or chronic illness impairing digestion. The WHO classifies malnutrition as moderate or severe based on levels of stunting, wasting, and edema. The main types are marasmus marked by severe wasting, kwashiorkor shown by edema, and a combination of both. Treatment focuses on food distribution programs, supplements, breastfeeding support, and improving sanitation and healthcare access.
Presentation by Olivier Ecker at the event: “Tackling food security and nutrition in Egypt: challenges and opportunities” Launch of the findings from the Household, Income, Expenditure and Consumption Survey , Tuesday 21 May in Cairo, Egypt.
Chronic malnutrition is caused by long-term deficiencies in nutrients and can stunt physical and cognitive growth. It results from immediate factors like low birth weight, illness, and poor diet that are themselves influenced by underlying household determinants of food security, health care, and parenting quality, as well as basic socioeconomic determinants of a family's status, education, empowerment, and access to water/sanitation. Chronic malnutrition is clinically assessed and indicated by measurements of stunting, wasting, and underweight as well as physical signs. It requires preventive measures simultaneously targeting individuals, communities, and national policies.
Severe Acute Malnutrition (SAM) and Nutrition Rehabilitation Centre (NRC)- Dr...Yogesh Arora
A presentation on severe acute malnutrition and nutritional rehabilitation center. Various preventive, promotive, and curative aspects of SAM are discussed in this presentation.
Malnutrition and Micronutrients DeficiencyPao Rodriguez
The document discusses different types of malnutrition including undernutrition, overnutrition, and obesity. It defines undernutrition as not getting enough of the right foods, overnutrition as eating beyond nutritional needs, and obesity as an excessive amount of body fat. Effects of malnutrition are listed as slow growth, poor school performance, sluggishness, and poor nutrition in adulthood. Macronutrients and micronutrients are defined as the main nutrients from food, with macronutrients being carbohydrates, fats, and proteins, and micronutrients being vitamins and minerals needed in small amounts. Micronutrient deficiency is also discussed. Prevention of malnutrition is described as eating a healthy, balanced diet with variety.
The document discusses malnutrition in children, focusing on the first 1000 days of life from conception to age 2. It defines various forms of malnutrition like stunting, wasting, and underweight. Around 1/3 of under-5 mortality is due to undernutrition. The first 1000 days are critical for meeting nutritional needs. It provides global statistics on the prevalence of issues like stunting, underweight, low birth weight. It also discusses diagnostic criteria and interventions to address malnutrition.
Obesity and malnutrition an international perspective of the paradoxGianluca Tognon
Obesity and malnutrition can occur together due to economic and social factors. In low-income communities, obesogenic foods that are high in calories but low in nutrients are often most affordable and available. This can lead to weight gain while still being malnourished. Additionally, periods of food insecurity may cause people to overeat when food is available to store calories against future uncertainty. Overall, complex social and economic drivers can result in both obesity and malnutrition within the same family or community.
Malnutrition continues to be a major problem in India, with over 50% of under-5 deaths contributed by malnutrition. The prevalence of undernutrition, as measured by wasted, stunted and underweight children under age 3, has declined slightly from NFHS-2 (1998-1999) to NFHS-3 (2005-2006) but remains very high. Multiple factors contribute to malnutrition, including improper feeding practices like non-exclusive breastfeeding, poor hygiene and sanitation, as well as inadequate care and support from families and communities. Addressing malnutrition requires interventions across pregnancy, birth to age 2, and adolescence focused on nutrition, health care, immunization, and behavioral change. Community participation is key to early detection,
Epidemiology of Childhood Malnutrition in India and strategies of controlsourav goswami
This presentation includes the epidemiology of childhood malnutrition in India. the problems and challenges that are being faced in the improvement of the condition and the different strategies for its control.
Malnutrition is a medical condition caused by an improper or inadequate diet that affects over 1 billion people worldwide. It is the biggest contributor to child mortality, present in half of all child deaths. Malnutrition reduces the world's IQ by an estimated 1 billion points due to iodine deficiency alone. While hunger can exacerbate other health issues, malnutrition itself can cause diseases and death. Improving nutrition, such as through food fortification and supplementation programs, is widely considered one of the most effective forms of humanitarian aid.
This document discusses undernutrition in young children in India. It provides statistics showing high levels of stunting, wasting, underweight, and anemia among children in India and the state of Bihar. The main causes of undernutrition discussed are early marriage and teenage pregnancy, low birth weight, poor infant and young child feeding practices, frequent births and short birth intervals, lack of maternal education, and issues of food security at both the national and household levels. Prevention efforts need to address these underlying determinants to reduce undernutrition in India.
This document discusses malnutrition in Indian children. It defines types of malnutrition according to the WHO as moderate acute malnutrition (MAM), severe acute malnutrition (SAM), and global acute malnutrition (GAM). It provides facts about malnutrition in India, including that India has the highest number of malnourished children in the world at 1/3 of the global total, and 44% of Indian children under 5 are underweight. The document also notes that malnutrition is inversely proportional to socioeconomic status and discusses the intergenerational cycle of malnutrition and health in India.
The document discusses malnutrition among children in India. It defines protein energy malnutrition and outlines the different types. It notes that India has a high proportion of malnourished children, with approximately 47% of children under 3 being undernourished. The main causes of malnutrition in India are inadequate food intake and infections like diarrhea, which increase nutrient needs and decrease absorption.
Linear growth retardation, or stunting, affects approximately one quarter of children under 5 globally. It is caused by repeated insults to the growth plate from chronic malnutrition and infections, resulting in reduced bone growth. Stunting can cause long term health consequences including impaired cognitive ability, higher risk of infectious disease, chronic conditions like cardiovascular disease later in life, and even intergenerational effects through lower birth weights in children of stunted mothers. Key micronutrients involved in growth include zinc, copper, manganese, vitamin D, calcium, iron, and vitamin A. Appropriate child feeding and care practices are also important to prevent stunting.
Malnutrition is a social problem in the Philippines that affects many children. The document discusses the different forms of malnutrition - underweight, wasting, and stunting - and provides data on the prevalence of each from national surveys. While stunting has decreased from 39% to 30% from 1993 to 2013, wasting has remained the same at around 7.9%. The causes of malnutrition are linked to poor nutrition, unhealthy conditions, and nutritional deficiencies. The effects of malnutrition can impair cognitive development in individuals and lead to low economic growth at the societal level. The government has committed to addressing malnutrition through programs that promote infant and young child feeding and the distribution of supplements.
Protein-energy malnutrition (PEM) is a form of malnutrition caused by a lack of protein and calories. It includes conditions like marasmus, kwashiorkor, and intermediate states. PEM is characterized by wasting of muscle and tissue in marasmus or edema and liver damage in kwashiorkor. Common causes are improper complementary feeding, lack of breastfeeding, poverty, and infection. PEM has a high prevalence in children under 5 years old and is a major public health problem in India due to high mortality and long-term health effects. Treatment involves resolving medical issues, restoring nutrition, and ensuring rehabilitation through dietary management and nutrition education.
This document defines malnutrition and identifies its types and preventative measures. Malnutrition is poor nutrition resulting from an insufficient or imbalanced diet, poor digestion, or inability to absorb foods. It affects infants, children, the elderly, disabled, and ill. There are two main types: undernutrition and overnutrition. Undernutrition includes protein-energy malnutrition and micronutrient deficiencies like iron deficiency anemia, rickets, and vitamin A deficiency. Overnutrition refers to excessive caloric intake leading to obesity. The document identifies at-risk groups and signs of various deficiencies. It emphasizes preventative measures like nutrition education, food fortification, and supplementation programs.
MALNUTRITION is more in India than in Africa . one in every three malnourished children in the world lives in India.
About 50% of all childhood death are because of malnutrition.
Child Malnutrition in the Developing WorldRoslynPunt
Child malnutrition is a major problem in developing countries, where over 1/3 of children under 5 are underweight. Poverty is the primary cause, limiting access to adequate food while lack of food security, maternal education and health, and poor environmental conditions are secondary factors. Malnourished children experience stunted growth and increased risk of diseases. While some children lack adequate nutrition, obesity is increasingly common in developed nations, raising issues of global equality and justice in access to food.
This document discusses nutrition, malnutrition, and the initial assessment and management of severely malnourished children. It defines nutrition and malnutrition. Malnutrition includes undernutrition from nutrient deficiencies and overnutrition from excess nutrients. Primary malnutrition results from direct causes like poor feeding practices while secondary malnutrition occurs due to underlying diseases. The assessment of malnourished children involves obtaining a medical history and performing a physical examination to evaluate signs of dehydration, infections, and deficiencies. Laboratory tests are also done. Management involves emergency treatment to correct dehydration, hypoglycemia and other complications, followed by rehabilitation through gradual feeding and micronutrient supplementation to support catch-up growth.
The poverty rate in India is impacting the economy and Malnutrition (Undernutrition) is a consequence of poverty. There are various ways to combat malnutrition including SAM management strategies along with various ongoing nutrition improvement programs focusing on maternal and child health.
Malnutrition, Causes,Framework, vicious cycle,Preventive measures,Policy and ...Dhirendra Nath
This document discusses various types of malnutrition including protein energy malnutrition (PEM) in Nepal. It outlines the immediate, underlying, and basic causes of PEM as inadequate dietary intake and infections which interact in a vicious cycle. Preventive measures proposed include promoting optimal infant and young child feeding practices, vaccination, food fortification, and treating diarrhea and intestinal parasites. The document also discusses iodine deficiency disorders, iron deficiency anemia, vitamin A deficiency and their prevention through salt iodization, food fortification, and supplementation programs.
Malnutrition results from eating a diet where nutrients are either not enough or too much, causing health problems. It can involve calories, protein, carbohydrates, vitamins or minerals. Undernutrition refers to not getting enough nutrients and overnutrition refers to getting too many. Malnutrition commonly refers to undernutrition and its causes include poverty, infectious diseases, and lack of breastfeeding. Treatment involves improving nutrition through food supplementation, therapeutic foods, and treating underlying illnesses. Globally in 2018, 821 million people experienced undernutrition.
Undernutrition among children under 5 years old remains a major public health problem. It is defined as being underweight, stunted, wasted, or deficient in micronutrients. In India, 33% of children under 5 are underweight. The Integrated Child Development Services program aims to address undernutrition through supplementary nutrition, healthcare, and education for mothers and children. However, the program could be improved by increasing its focus on the most vulnerable groups like pregnant women and young children, strengthening nutrition education, and improving coordination between frontline workers. Addressing undernutrition requires coordinated efforts across sectors like health, agriculture, education, and community participation.
PRESENTATION GIVEN BY ME AT Central Food and Technology Research Institute (CFTRI), MYSORE WHICH ALSO FETCHED ME A PRIZE. THIS WAS ONE OF THE BEST AND PROUD MOMENTS IN MY CAREER
Immediate and underlying causes of malnutritionJoseph Njihia
Immediate causes of malnutrition in children under 5 include inadequate dietary intake and disease. Underlying causes include insufficient access to food, inadequate maternal and child care, poor water and sanitation, and inadequate health services.
For HIV-exposed or infected infants, the recommendations are to exclusively breastfeed for 6 months while providing ARVs to the mother and baby. For HIV-positive mothers who choose not to breastfeed, replacement feeding using formula is recommended if AFASS conditions are met, along with ARVs. Complementary foods should be introduced at 6 months regardless of feeding method. Growth monitoring and nutritional supplementation are important for HIV-positive children.
This document discusses nutritional problems affecting the Indian population and provides guidance on conducting nutritional assessments and counseling. It outlines several key nutritional problems in India including undernutrition, overnutrition, low birth weight, protein energy malnutrition, vitamin A deficiency, nutritional anemia, iodine deficiency disorders, endemic fluorosis, obesity, and cardiovascular diseases. It also describes indicators used to assess nutritional status, contributing factors to nutritional problems, conceptual frameworks, and guidelines for nutritional counseling, assessment, and several national community nutrition programs aimed at addressing malnutrition in India.
The document discusses approaches for addressing severe acute malnutrition (SAM) in children. It argues that while treatment of SAM is important, it is a less cost-effective use of limited health budgets than prevention through improved infant and young child nutrition. The epidemiological evidence shows that other preventable diseases cause more child deaths than SAM. Additionally, reducing mild and moderate malnutrition could have a greater impact on reducing malnutrition-related deaths since many more children suffer from these forms of malnutrition compared to SAM. The economic evidence indicates that the total costs of SAM treatment are high, around $200 per child in Malawi. From an ethical perspective, children still die even while undergoing treatment for SAM, so prevention is preferable to only
Dokumen tersebut berisi tentang materi pelajaran Teknologi Informasi dan Komunikasi mengenai Microsoft PowerPoint 2007 di SMP N 18 Semarang. Materi tersebut mencakup penjelasan tentang standar kompetensi, kompetensi dasar, indikator, cara membuat tabel, grafik, diagram organisasi, dan menambahkan animasi pada presentasi PowerPoint. Dokumen tersebut juga berisi contoh soal latihan dan kunci jawabannya.
Malnutrition continues to be a major problem in India, with over 50% of under-5 deaths contributed by malnutrition. The prevalence of undernutrition, as measured by wasted, stunted and underweight children under age 3, has declined slightly from NFHS-2 (1998-1999) to NFHS-3 (2005-2006) but remains very high. Multiple factors contribute to malnutrition, including improper feeding practices like non-exclusive breastfeeding, poor hygiene and sanitation, as well as inadequate care and support from families and communities. Addressing malnutrition requires interventions across pregnancy, birth to age 2, and adolescence focused on nutrition, health care, immunization, and behavioral change. Community participation is key to early detection,
Epidemiology of Childhood Malnutrition in India and strategies of controlsourav goswami
This presentation includes the epidemiology of childhood malnutrition in India. the problems and challenges that are being faced in the improvement of the condition and the different strategies for its control.
Malnutrition is a medical condition caused by an improper or inadequate diet that affects over 1 billion people worldwide. It is the biggest contributor to child mortality, present in half of all child deaths. Malnutrition reduces the world's IQ by an estimated 1 billion points due to iodine deficiency alone. While hunger can exacerbate other health issues, malnutrition itself can cause diseases and death. Improving nutrition, such as through food fortification and supplementation programs, is widely considered one of the most effective forms of humanitarian aid.
This document discusses undernutrition in young children in India. It provides statistics showing high levels of stunting, wasting, underweight, and anemia among children in India and the state of Bihar. The main causes of undernutrition discussed are early marriage and teenage pregnancy, low birth weight, poor infant and young child feeding practices, frequent births and short birth intervals, lack of maternal education, and issues of food security at both the national and household levels. Prevention efforts need to address these underlying determinants to reduce undernutrition in India.
This document discusses malnutrition in Indian children. It defines types of malnutrition according to the WHO as moderate acute malnutrition (MAM), severe acute malnutrition (SAM), and global acute malnutrition (GAM). It provides facts about malnutrition in India, including that India has the highest number of malnourished children in the world at 1/3 of the global total, and 44% of Indian children under 5 are underweight. The document also notes that malnutrition is inversely proportional to socioeconomic status and discusses the intergenerational cycle of malnutrition and health in India.
The document discusses malnutrition among children in India. It defines protein energy malnutrition and outlines the different types. It notes that India has a high proportion of malnourished children, with approximately 47% of children under 3 being undernourished. The main causes of malnutrition in India are inadequate food intake and infections like diarrhea, which increase nutrient needs and decrease absorption.
Linear growth retardation, or stunting, affects approximately one quarter of children under 5 globally. It is caused by repeated insults to the growth plate from chronic malnutrition and infections, resulting in reduced bone growth. Stunting can cause long term health consequences including impaired cognitive ability, higher risk of infectious disease, chronic conditions like cardiovascular disease later in life, and even intergenerational effects through lower birth weights in children of stunted mothers. Key micronutrients involved in growth include zinc, copper, manganese, vitamin D, calcium, iron, and vitamin A. Appropriate child feeding and care practices are also important to prevent stunting.
Malnutrition is a social problem in the Philippines that affects many children. The document discusses the different forms of malnutrition - underweight, wasting, and stunting - and provides data on the prevalence of each from national surveys. While stunting has decreased from 39% to 30% from 1993 to 2013, wasting has remained the same at around 7.9%. The causes of malnutrition are linked to poor nutrition, unhealthy conditions, and nutritional deficiencies. The effects of malnutrition can impair cognitive development in individuals and lead to low economic growth at the societal level. The government has committed to addressing malnutrition through programs that promote infant and young child feeding and the distribution of supplements.
Protein-energy malnutrition (PEM) is a form of malnutrition caused by a lack of protein and calories. It includes conditions like marasmus, kwashiorkor, and intermediate states. PEM is characterized by wasting of muscle and tissue in marasmus or edema and liver damage in kwashiorkor. Common causes are improper complementary feeding, lack of breastfeeding, poverty, and infection. PEM has a high prevalence in children under 5 years old and is a major public health problem in India due to high mortality and long-term health effects. Treatment involves resolving medical issues, restoring nutrition, and ensuring rehabilitation through dietary management and nutrition education.
This document defines malnutrition and identifies its types and preventative measures. Malnutrition is poor nutrition resulting from an insufficient or imbalanced diet, poor digestion, or inability to absorb foods. It affects infants, children, the elderly, disabled, and ill. There are two main types: undernutrition and overnutrition. Undernutrition includes protein-energy malnutrition and micronutrient deficiencies like iron deficiency anemia, rickets, and vitamin A deficiency. Overnutrition refers to excessive caloric intake leading to obesity. The document identifies at-risk groups and signs of various deficiencies. It emphasizes preventative measures like nutrition education, food fortification, and supplementation programs.
MALNUTRITION is more in India than in Africa . one in every three malnourished children in the world lives in India.
About 50% of all childhood death are because of malnutrition.
Child Malnutrition in the Developing WorldRoslynPunt
Child malnutrition is a major problem in developing countries, where over 1/3 of children under 5 are underweight. Poverty is the primary cause, limiting access to adequate food while lack of food security, maternal education and health, and poor environmental conditions are secondary factors. Malnourished children experience stunted growth and increased risk of diseases. While some children lack adequate nutrition, obesity is increasingly common in developed nations, raising issues of global equality and justice in access to food.
This document discusses nutrition, malnutrition, and the initial assessment and management of severely malnourished children. It defines nutrition and malnutrition. Malnutrition includes undernutrition from nutrient deficiencies and overnutrition from excess nutrients. Primary malnutrition results from direct causes like poor feeding practices while secondary malnutrition occurs due to underlying diseases. The assessment of malnourished children involves obtaining a medical history and performing a physical examination to evaluate signs of dehydration, infections, and deficiencies. Laboratory tests are also done. Management involves emergency treatment to correct dehydration, hypoglycemia and other complications, followed by rehabilitation through gradual feeding and micronutrient supplementation to support catch-up growth.
The poverty rate in India is impacting the economy and Malnutrition (Undernutrition) is a consequence of poverty. There are various ways to combat malnutrition including SAM management strategies along with various ongoing nutrition improvement programs focusing on maternal and child health.
Malnutrition, Causes,Framework, vicious cycle,Preventive measures,Policy and ...Dhirendra Nath
This document discusses various types of malnutrition including protein energy malnutrition (PEM) in Nepal. It outlines the immediate, underlying, and basic causes of PEM as inadequate dietary intake and infections which interact in a vicious cycle. Preventive measures proposed include promoting optimal infant and young child feeding practices, vaccination, food fortification, and treating diarrhea and intestinal parasites. The document also discusses iodine deficiency disorders, iron deficiency anemia, vitamin A deficiency and their prevention through salt iodization, food fortification, and supplementation programs.
Malnutrition results from eating a diet where nutrients are either not enough or too much, causing health problems. It can involve calories, protein, carbohydrates, vitamins or minerals. Undernutrition refers to not getting enough nutrients and overnutrition refers to getting too many. Malnutrition commonly refers to undernutrition and its causes include poverty, infectious diseases, and lack of breastfeeding. Treatment involves improving nutrition through food supplementation, therapeutic foods, and treating underlying illnesses. Globally in 2018, 821 million people experienced undernutrition.
Undernutrition among children under 5 years old remains a major public health problem. It is defined as being underweight, stunted, wasted, or deficient in micronutrients. In India, 33% of children under 5 are underweight. The Integrated Child Development Services program aims to address undernutrition through supplementary nutrition, healthcare, and education for mothers and children. However, the program could be improved by increasing its focus on the most vulnerable groups like pregnant women and young children, strengthening nutrition education, and improving coordination between frontline workers. Addressing undernutrition requires coordinated efforts across sectors like health, agriculture, education, and community participation.
PRESENTATION GIVEN BY ME AT Central Food and Technology Research Institute (CFTRI), MYSORE WHICH ALSO FETCHED ME A PRIZE. THIS WAS ONE OF THE BEST AND PROUD MOMENTS IN MY CAREER
Immediate and underlying causes of malnutritionJoseph Njihia
Immediate causes of malnutrition in children under 5 include inadequate dietary intake and disease. Underlying causes include insufficient access to food, inadequate maternal and child care, poor water and sanitation, and inadequate health services.
For HIV-exposed or infected infants, the recommendations are to exclusively breastfeed for 6 months while providing ARVs to the mother and baby. For HIV-positive mothers who choose not to breastfeed, replacement feeding using formula is recommended if AFASS conditions are met, along with ARVs. Complementary foods should be introduced at 6 months regardless of feeding method. Growth monitoring and nutritional supplementation are important for HIV-positive children.
This document discusses nutritional problems affecting the Indian population and provides guidance on conducting nutritional assessments and counseling. It outlines several key nutritional problems in India including undernutrition, overnutrition, low birth weight, protein energy malnutrition, vitamin A deficiency, nutritional anemia, iodine deficiency disorders, endemic fluorosis, obesity, and cardiovascular diseases. It also describes indicators used to assess nutritional status, contributing factors to nutritional problems, conceptual frameworks, and guidelines for nutritional counseling, assessment, and several national community nutrition programs aimed at addressing malnutrition in India.
The document discusses approaches for addressing severe acute malnutrition (SAM) in children. It argues that while treatment of SAM is important, it is a less cost-effective use of limited health budgets than prevention through improved infant and young child nutrition. The epidemiological evidence shows that other preventable diseases cause more child deaths than SAM. Additionally, reducing mild and moderate malnutrition could have a greater impact on reducing malnutrition-related deaths since many more children suffer from these forms of malnutrition compared to SAM. The economic evidence indicates that the total costs of SAM treatment are high, around $200 per child in Malawi. From an ethical perspective, children still die even while undergoing treatment for SAM, so prevention is preferable to only
Dokumen tersebut berisi tentang materi pelajaran Teknologi Informasi dan Komunikasi mengenai Microsoft PowerPoint 2007 di SMP N 18 Semarang. Materi tersebut mencakup penjelasan tentang standar kompetensi, kompetensi dasar, indikator, cara membuat tabel, grafik, diagram organisasi, dan menambahkan animasi pada presentasi PowerPoint. Dokumen tersebut juga berisi contoh soal latihan dan kunci jawabannya.
Integrating mRDTs into the health system in Uganda: preparing health workers ...Malaria Consortium
In 2010, the World Health Organization (WHO) changed its guidelines to state that all suspected malaria cases should be tested for the presence of malaria parasites by microscopy or malaria rapid diagnostic tests (mRDTs) prior to treatment. A number of countries have now adopted these guidelines and begun to integrate mRDTs into routine service delivery.
With funding from Comic Relief, Malaria Consortium supported the first sustained, district-wide introduction of mRDTs to health facilities in Uganda, starting in December 2010. A number of health workers from public lower-level health facilities have been trained under this programme. A national-level consultative process was also undertaken to revise the national training curriculum for use in country-wide scale-up.
This learning paper presents the lessons drawn from this experience. It discusses the critical training requirements of health workers and what needs to be addressed. The paper also reviews approaches for the successful integration of mRDTs into health service delivery and how best to support health workers adapt to changes in policy.
The challenge of reaching the highest levels of quality through a unique reality in Oltrepò Pavese is just the beginning of an amazing journey. Only with great care and passion in every stage of the work we can obtain a valuable product. From process machines to wine. We are glad to share with you the first recognition of Fedegari collaboration with Ballabio Winery, awarded 3 bicchieri di Gambero Rosso!
Building capacity for creating demand in support of malaria prevention and co...Malaria Consortium
Demand creation is the strategic combination of advocacy, communication and mobilisation approaches that seek to achieve increased community awareness of, and demand for, effective malaria prevention and treatment services.
Malaria Consortium's Support to National Malaria Programme (SuNMaP) demand creation strategy for prevention currently focuses on promoting the correct use of long lasting insecticidal nets (LLINs) and the use of intermittent preventive therapy (IPT) in pregnant women. For malaria treatment, demand creation focuses on promoting improved testing, prompt and proper use of artemisinin combination therapy (ACT) treatment for individual cases of malaria, and effective home management of fever, together with referrals of severe cases to a higher-level health facility.
This learning paper discusses SuNMap's experiences of planning and implementing demand creation in Nigeria, including SuNMaP's development of a comprehensive malaria communications plan. It presents what worked well and the challenges that remain to scale up demand creation activities and to consolidate the work already done.
Tara Versteeg has over 26 years of experience in IT and customer service roles, including 8 years as an IT supervisory leader. She has strong technical skills as well as abilities in training, coaching employees, communication, and project management. Her experience includes leadership positions at Royal Victoria Regional Health Centre and Georgian College, as well as roles at IBM Canada and Honda of Canada Manufacturing.
This document provides a list of character traits and their translations. It includes positive traits like "intelligent", "sociable", and "brave" as well as negative traits like "stupid", "naughty", and "rude". It also lists potential hobbies and careers.
The Prototype of Standalone Diagnostic Report Editor as a Proof-of-Concept for an Interoperable Implementation of Health Level Seven Clinical Document Architecture Standard (HL7 CDA) not Integrated with Electronic Health Record (EHR) System
Developing Grassroots Campaigns to Build Your Social Presence - Mary Leschper...Energy Digital Summit
This presentation was written by Mary Leschper, Social Media Analyst at the American Petroleum Institute. Mary was invited to present as a breakout speaker for the inaugural Energy Digital Summit in June 2014. She presented on the topics of grassroots marketing and social media.
Communicating in Constellations - Steve Rubel [Energy Digital Summit 2015]Energy Digital Summit
This presentation was written by Steve Rubel, Chief Content Strategist at Edelman. Steve was invited to present as a keynote speaker for the Energy Digital Summit in January 2015.
Invest in Real Estate What you should think about first how to get startedcvergaraamigo
These are some things you should be thinking about when you want to get started in investing in Real Estate. There are many ways to get into the market and many things that you have to take into account before becoming an investor, landlord or developer. Area is important but not the only thing. The main topics are financing - mortgages, area, and your own personality.
Content Creation in Social Media - Kelley Brown [Energy Digital Summit 2014]Energy Digital Summit
This presentation was written by Kelley Brown, Director of Social Media, BP America. Kelley was invited to present as a keynote speaker for the inaugural Energy Digital Summit in June 2014.
Search and Social: A Happy Marriage - Cara Wiggins Gray [Energy Digital Summi...Energy Digital Summit
This presentation was written by Cara Wiggins Gray, Manager, Digital Marketing Analytics and SEO at Reliant Energy. Cara was invited to present as a keynote speaker for the inaugural Energy Digital Summit in June 2014. She presented on the subjects on the influences of SEO, Social Media, and Content Marketing.
Key factors for developing a pharmaceutical cleaning strategy - Part 2Fedegari Group
This article discusses the removal of bacterial endotoxins in a washing process and the need for a
continuous monitoring activity according to common cleaning validation practices. Results of washing
tests performed with different load materials following an effective cleaning strategy to remove
microbiological soil are presented. In addition, this paper compares two different online assay methods:
conductivity analysis and Total Organic Carbon analysis.
Keywords: Cleaning, Microbiological Soil, Bacterial Endotoxins, Conductivity Analysis, Total Organic
Carbon Analysis.
Positive deviance: an innovative approach to improve malaria outcomes in MyanmarMalaria Consortium
This presentation is one of a series prepared for the Malaria Consortium symposium Taking the resistance out of elimination at the Joint International Tropical Medicine Meeting (JITMM) in Bangkok on 11 December 2013. It presents a pilot positive deviance project in a remote island, Kyun Su Township in Myanmar, and describes the positive deviance process being implemented in two phases.
A video of this presentation is available to watch here: http://www.malariaconsortium.org/pages/joint_international_tropical_medicine_meeting_bangkok_december_2013.htm
This document provides instructions for making a basic stir fry in 11 steps. It instructs the reader to purchase common vegetables like peppers, carrots, onions, mushrooms and broccoli and to cut them into uniform sizes. It then guides the cooking process of first browning beef in sesame oil before adding vegetables to sauté until slightly underdone. Finally, stir fry sauce and previously cooked beef are added to finish cooking and combine all ingredients before serving over rice.
Case study- Implementing fully integrated solutions for the food industryFedegari Group
The canned food sterilization faces a great challenge: to minimize the quality losses while providing an adequate process to achieve the desired degree of sterility. Temperature deviations are costly while representing under or over processed food, waste of energy and low productivity. This paper describes the implementation of a fully integrated solution for the sterilization process in one of the biggest European tuna can manufacturers.
Brands and Identity: The Power of StoryTelling - Scott Stone [Energy Digital ...Energy Digital Summit
This presentation was written by Scott Stone, Director, Brand, Digital & Social at ConocoPhillips. Scott was invited to present as a keynote speaker for the Energy Digital Summit in January 2015.
Somalia is not well prepared for a disease outbreak such as Ebola based on several factors:
1) The country has a lack of suitable health education and promotion as well as poor data collection and health infrastructure.
2) High rates of malnutrition and disease have weakened the population's immune systems, increasing their susceptibility to illness.
3) There is limited access to healthcare and a lack of awareness around infectious diseases, which could facilitate the rapid spread of an outbreak with few resources available to properly respond. Somalia would require immediate assistance and resources from international organizations to have a chance of containing an outbreak.
Malaria in under five children and help seeking behavior of mothers in calaba...Alexander Decker
This document summarizes a study on malaria in children under five years old and the help-seeking behavior of mothers in Calabar, Nigeria. The study found that most mothers brought their children to health facilities due to fever, but many had waited over a week to seek care. While most mothers were aware of malaria, many initially treated their children at home with remedies like sponging or herbal enemas. The study concluded that a mother's help-seeking behavior impacts the outcome of a child's illness, and that addressing factors like cost, transportation, and the role of fathers could help reduce child mortality from malaria.
6Malaria and Malnutrition NURS 4115Malaria an.docxblondellchancy
6
Malaria and Malnutrition
NURS 4115
Malaria and Malnutrition in Climate Change
Climate change along with other natural and human-made health stressors influences human health and disease in numerous ways (CDC, 2018). Considerations include age, economic resources, and location. The United States will feel some strain from climate change, but under-developed countries will be affected even more. This paper will discuss the effects of malaria and malnutrition health care concerns in climate change in both developed and under-developed nations. It will also describe health promotion strategies that can be implemented to reduce these climate changes from occurring.
Malaria and Malnutrition
Climate changes can affect social and environmental determinates of health such as clean air, safe drinking water, adequate food and shelter (WHO, 2018). One concern that affects climate changes is the spread of malaria. Malaria is a life-threatening disease which is transmitted by the bites of the Anopheles mosquitoes and kills over 400,000 people every year (WHO, 2018). The population affected most by this disease is children under age 5 in developing countries such as Africa and some Philipines. Safe, effective, affordable vaccines could help in the spread of the disease. According to WHO, 2018, many more lives could be saved if more funds are secured. Countries with weak infrastructure like Africa are likely unable to cope or respond without assistance from other stronger nations who can offer support like the United Nations (UN) government agency. Partnerships with agencies like the UN help to establish awareness, scientific evidence and promote health interventions to reduce the spread of disease like malaria.
In the United States, malaria was officially eradicated in the 1950s. The role of the CDC became one of surveillance within the U.S. and of assistance in the worldwide efforts to eliminate or control malaria in the economically underdeveloped areas of the world. The 1,500 or so cases of the disease seen in the U.S. are due to overseas travel (CDC, 2012). Quick treatment, personal protective measures (such as screening houses) and vector control quickly control any outbreaks.
In countries like sub-Saharan Africa, malaria is the leading cause of death for children under five (WHO, 2018). Sub-Saharan Africa is a site of malaria transmission due to is the geographical location in the tropical zone. Tropical areas with large amounts of rainfall create vast breeding grounds for mosquitos carrying malaria. The focus must be put on prevention and providing the basic needs such as clean water, food, and shelter. Participation from all levels of the community and government, in Africa and non-local, will be needed for community programs that can benefit the communities' infrastructure and the well-being of the people.
In the Philippines, there is an 86% decrease in reported malaria cases since 2000 and procedures for evaluation and declaration ...
Developing and implementing training materials for integrated community case ...Malaria Consortium
In South Sudan, ICCM – or integrated community case management – is carried out by trained community volunteers called community drug distributors (CDDs) or community based distributors. These operate like community based (volunteer) health workers in other parts of Africa but are known differently as, in South Sudan, a community health worker operates within the Ministry of Health (MoH) structure, receiving around nine months training to provide health services at the PHCC / PHCU levels. This paper shows how best practices for delivering training of Community Drug Distributors (CDDs) in the implementation of integrated community case management (ICCM), that have been shown to be successful in some countries and contexts, needed to be adapted to fit a more complex environment in South Sudan.
This document summarizes healthcare challenges in South Africa. It notes that while South Africa has made efforts to provide universal healthcare since 1994, key health indicators have stagnated or declined. South Africa faces a major challenge from HIV/AIDS, with the highest prevalence in the world. Nearly half of TB cases are co-infected with HIV. Other issues include high infant, child, and maternal mortality rates. The document calls for integrated primary healthcare services that address the needs of vulnerable populations and achieving health-related UN Millennium Development Goals.
This document summarizes a board meeting discussing strategies to address tropical diseases in underdeveloped areas like Malawi. It outlines key tropical diseases like malaria and cholera, their symptoms, treatments, and prevention methods. It discusses factors exacerbating tropical diseases like poverty and sanitation. The meeting proposes a comprehensive strategic plan from APOH to deliver relief, promote health education, and build local capacity through partnerships with groups like CDC and WHO.
Tropical Disease And Wellness Promotion Healthful InterventionsSusan Sanner
This document summarizes a board meeting discussing strategies to address tropical diseases in underdeveloped areas like Malawi. It outlines key tropical diseases like malaria and cholera, their symptoms, treatments, and prevention methods. It discusses factors exacerbating tropical diseases like poverty and sanitation. It also summarizes the purpose and strategic approaches of A Project of Hope (APOH) to deliver relief and promote health in developing nations through partnerships and a comprehensive strategic plan.
Infectious minds canadian institutes of health research, international infect...Gordon Otieno Odundo
Canadian Institutes of Health Research, International Infectious Disease and Global Health Training Programme (CIHR, IID & GHTP).This is a scholarship program run across four countries: Canada, Colombia, Kenya and India where advanced level students (PhD, Post Doctoral and Clinical fellows) undertake additional training on Infectious Diseases all geared towards being experts in matters pertaining to Global Health. Every month an 'Infectious Minds' sessionis held for two hours via a videoconference link across the four sites. On 15th May 2014 Gordon Otieno Odundo was the Guest Speaker presenting on infectious diseases in children the venue was at the University of Nairobi Institute of Tropical and Infectious Diseases, College of Health Sciences, Kenyatta National Hospital. The audience was primarily Doctoral (PhD) and Post-Doctoral students across the four sites; from Basic Science and Social Science disciplines.
website: http://www.iidandghtp.com/
Implementing integrated community case management: stakeholder experiences an...Malaria Consortium
Malaria Consortium’s involvement in iCCM has spanned inputs to facilitate policy development, project design, implementation from start-up phase; ongoing support to the public health system in continued implementation; the trial of specific supportive interventions to boost effectiveness; monitoring and evaluation; costing analysis work; and advocacy.
This paper discusses a participatory evaluation on iCCM implementation in South Sudan, Uganda and Zambia. The findings, challenges and lessons learned are presented in 11 key components of iCCM implementation.
SCIP_Factors Associated with Mosquito Bed Net Use_Malaria JMelanie Lopez
- The document summarizes two cross-sectional household surveys conducted in Zambézia Province, Mozambique in 2010 and 2014 to assess mosquito bed net possession and factors associated with their use.
- The surveys found that 64.3% of households possessed at least one mosquito bed net in 2010 and 2014, with higher possession in Namacurra district (90% in 2014) compared to Alto Molócuè (77%) and Morrumbala (34%).
- Use of mosquito nets increased from 2010 to 2014 among pregnant women (58.6% to 68.4%) and children under 5 (50% to 60%), but intensified focus is still needed to improve equity
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.
This research grant proposal seeks funding to evaluate the effects of a randomized microcredit lending and health education program on malaria preventative behavior in Mali. The program, run by Medicine for Mali, will offer microfinance loans and health education to villages in Mali. Some villages will receive both interventions, some only microfinance, and some only health education. The researchers hypothesize that offering both microfinance and health education will lead to higher uptake of insecticide-treated bednets compared to the other conditions. The goal is to study how microfinance and health education individually and jointly impact malaria preventative knowledge and behaviors.
The document discusses the importance of addressing gender equality in Global Fund proposals and responses to HIV, TB, and malaria. It notes that women often have less access to health services and information than men due to social and economic inequalities. It provides examples of how diseases like HIV, malaria, and TB disproportionately impact women. The document advises applicants to involve gender experts and conduct a gender analysis to ensure their proposals address the specific needs of women, men, girls and boys. It also recommends integrating gender-sensitive and transformative interventions that promote human rights and reduce health inequalities.
The document discusses the role of the National Service Scheme (NSS) in preventing HIV/AIDS among adolescents in India. The NSS was launched in 1969 to promote community service among students. It now has over 3.2 million student volunteers involved in community development activities. Some of the NSS's activities aimed at preventing HIV/AIDS include health education programs, AIDS awareness campaigns, and providing healthcare. The document also notes that adolescents are particularly vulnerable to HIV due to risky behaviors and lack of access to information. Expanding prevention programs that use a combination of strategies, including education and healthcare access, could significantly reduce new HIV infections among youth.
How Africa turned AIDS around By Michel Sidibé Celebrating 50 Years of Africa...Dr Lendy Spires
Michel Sidibé Executive Director UNAIDS At the May 2013 African Union Summit celebrating the 50 years of African unity, a new commission will be launched to explore HIV and global health in the post-2015 debate. “The UNAIDS and Lancet commission: from AIDS to sustainable health” will be co-chaired by Malawi President Joyce Banda, African Union Commission Chairperson Nkosazana Dlamini Zuma and London School of Hygiene and Tropical Medicine Director Peter Piot.
The pace of progress is quickening in Africa. Nowhere have we seen this more clearly than in the AIDS response. Fewer people are dying from AIDS. The number of HIV infections is coming down, with young Africans leading the prevention revolution. There is true hope that in a matter of years, Africa will reach an AIDS-free generation. It has taken a massive shift in how we work together. It has required leaders to show immense courage, passion and action from all sectors. It has taken a united Africa. I am not saying it has been easy— but it has happened. We have a shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.
And today there is an African Union endorsement of a new Roadmap to accelerate progress in HIV, Tuberculosis and Malaria—through shared responsibility and global solidarity. Given the extraordinary history of the AIDS response in Africa—in terms of both galvanizing political support and mobilizing resources and communities—the Roadmap sees AIDS as a pathfinder for tuberculosis, malaria and other diseases affecting the continent that require African-sourced solutions. Leadership, it turns out, was that elusive magic bullet. It is the “disruptive innovation” that has irrevocably changed the course of AIDS and now can do even more. As we look to our future goals, I am confident that African leadership can be UNAIDS | Special report with vision and action we can change the world
This document is a special report from UNAIDS highlighting progress and challenges in the AIDS epidemic in Africa. It features statistics and facts about the status of the AIDS epidemic in different African countries, profiles of individuals living with HIV, and articles on various topics related to the AIDS response in Africa, including innovations, the role of the private sector, using sports to raise awareness, and challenges and successes in preventing mother-to-child transmission of HIV.
MDG Countdown 2013 Case Studies HandoutLadan Fakory
Women in Bangladesh are being helped out of extreme poverty through a program that identifies the poorest 10% of women and provides mentoring, business skills training, and assistance starting businesses. Over 400,000 women have participated, with 95% achieving stable incomes and 98% accumulating savings. In Indonesia, healthcare teams are stationed in remote islands to address maternal health needs and ensure universal access to care. They work with communities to improve education, nutrition, sanitation and address myths that hinder women's healthcare. In Afghanistan, the number of girls in school has nearly doubled since 2002 due to new schools and teachers being established with help from USAID, though girls still face barriers to education from cultural norms.
Ghia foundation strategy document v4.dec.17.2015 (ab)Ghia Foundation
GHIA FOUNDATION WAS FOUNDED IN 2013 by a team of kind-heated Professionals.
VISION: A World where women in developing Countries live healthier , longer lives
MISSION – To reduce morbidity and mortality among women in developing Countries by strengthening Health Systems to deliver high quality, comprehensive health services.
This document summarizes a research study that assessed the knowledge, attitudes, and practices of reproductive age women regarding antenatal care services at Dr. Khalid MCH in Hargeisa, Somaliland. The study used a descriptive cross-sectional design and questionnaire to collect data from 112 women. The results found that most women (66.2%) had good knowledge of antenatal care services, while 20% had poor knowledge. Most respondents (72.3%) had a positive attitude, while 23.4% had a negative attitude. The study concludes that health workers should provide more information to women on the benefits of antenatal care and community programs are needed to improve attitudes.
Farmers Adaptive Capacities to Poverty-Related Diseases in Riverine Communiti...BRNSSPublicationHubI
This document summarizes a research article about farmers' adaptive capacities to poverty-related diseases in riverine communities in Kogi State, Nigeria. The study found that using mosquito nets was a common adaptation measure to reduce diseases like malaria. Off-farm business activities and gender positively impacted malaria occurrence. The determinants of adaptive capacity included education, farming experience, off-farm income, access to credit, and environmental sanitation. The study recommends involving communities in health-related policy decisions affecting them.
Similar to Integrating severe acute malnutrition into the management of childhood diseases at community level in South Sudan (20)
Community-based management of acute malnutrition in South SudanMalaria Consortium
Download the Learning Brief at: http://www.malariaconsortium.org/resources/publications/846/
Malaria Consortium has been implementing an integrated community case management (iCCM) programme for the diagnosis and treatment of malaria, pneumonia and diarrhoea in children 6-59 months in South Sudan since 2010. A nutrition component was integrated into this programme in 2011 in recognition of the inextricable link between health and nutrition.
This learning brief describes the model Malaria Consortium is currently implementing to deliver community-based management of acute malnutrition (CMAM) using the iCCM structures in Aweil Centre county in Aweil state and Aweil West county in Lol state.
The learning from the evaluation of this model serves as the basis for recommendations for future programming, in an effort to improve and sustain the delivery of CMAM in Aweil and Lol states.
The document summarizes a malaria prevention event at Iyolwa Primary School where community health workers and teachers performed a drama for students to teach them how to protect themselves and their families from malaria. Students sang along to help remember key prevention messages. Nets were then distributed to students in grades one and four by Malaria Consortium as part of efforts to increase coverage in the Tororo district. Teachers and parents spoke about how the nets have helped reduce malaria and absenteeism at the school.
Developing a long lasting insecticidal net retail market in nigeriaMalaria Consortium
The document summarizes Malaria Consortium's experience developing a long-lasting insecticidal net (LLIN) retail market in Nigeria. It discusses Malaria Consortium's original strategy to support the commercial sector through price support, which faced challenges around documentation. A market analysis identified key challenges as LLINs being a slow-moving product and competition from leaked or subsidized nets. Malaria Consortium's revised strategy uses a "total market approach" and "Making Markets Work for the Poor" principles to facilitate arrangements improving market access to LLINs.
Since 2008, the Malaria Consortium programme, Support to the Nigeria Malaria Programme (SuNMaP), has been working in Nigeria to strengthen the national effort to control malaria. Among the programme’s activities is the harmonisation of malaria control – which means working with supporting partners locally, nationally and internationally, for the common purpose to reduce the burden of malaria in Nigeria. The paper describes some of SuNMaP’s successes in rolling out harmonisation – such as leading a unified approach to the rollout of a nationwide LLIN campaign rollout, and developing standardised modules for the training of health workers in service delivery and programme management.
Positive deviance: an asset-based approach to improve malaria outcomesMalaria Consortium
The positive deviance project in Cambodia used an asset-based approach to improve malaria outcomes. It identified "positive deviant" individuals within communities in Cambodia who successfully prevented malaria despite limited resources. The project had two phases: 1) A one-week process to identify positive deviant behaviors and individuals through community dialogues. 2) A six-month implementation phase where positive deviant role models shared their behaviors with community members through meetings and other interactive activities. The project aimed to determine if promoting existing successful behaviors within communities could change malaria-related social norms and behaviors.
Malaria Consortium’s experiences on mHealth in CambodiaMalaria Consortium
This presentation is one of a series prepared for the Joint International Tropical Medicine Meeting (JITMM) in Bangkok on 11 December 2013.This presentation shows how Malaria Consortium supported the surveillance system to National Malaria Centre of Cambodia since 2009. It summarises the surveillance systems used: the malaria information system; day 3 positive alert system; malaria alert system (Day 0); referral system; and stock out alert system.
A video of this presentaion is available to watch here: http://www.malariaconsortium.org/pages/joint_international_tropical_medicine_meeting_bangkok_december_2013.htm
Read more of Malaria Consortium's experiences on mHealth in Cambodia in the Learning Paper, Moving towards malaria elimination: developing innovative tools for malaria surveillance in Cambodia.
Malaria Consortium was founded in 2003 by a small team of people with a vision - to build the capacity of malaria-endemic countries worldwide to deal with a common and treatable disease that was devastating the lives of poor and vulnerable communities.
This presentation celebrating Malaria Consortium at 10 reflects on Malaria Consortium’s engagement with work to eliminate malaria - particularly in Asia. This has been driven by the push for Plasmodium falciparum elimination as quickly as possible in areas of artemisinin resistance; establishing much better surveillance systems and capacity to provide the detailed timely information needed for elimination; and advocating for continued high quality, highly intense efforts against malaria even when the burden declines.
Watch the presentation here: http://www.youtube.com/watch?v=VV2zXQNdd40
ICCM impact in four African countries: project monitoring & evaluationMalaria Consortium
A presentation by Geoffrey Namara from Malaria Consortium, which looks at the results and highlights of integrated community case management projects implemented in four African countries. The presentation examines routine data collection methods, the scale and duration of data collection, results & highlights from routine data, project evaluations, evaluations conducted (methods & timelines), and results & highlights.
To see the live presentation, watch the YouTube video: http://www.youtube.com/watch?v=d2UQkhUqbP8
Building capacity for universal coverage: malaria control in NigeriaMalaria Consortium
Support to the Nigeria Malaria Programme – is a £50 million five-year UK aid funded programme that works with the government and people of Nigeria to strengthen the national effort to control malaria. The programme began in April 2008, and runs to March 2013. This learning paper describes, in detail, the programmes approach to malaria control and explores the reasons for the programmes success from the perspective of health workers trained by the programme, community members and others.
Community dialogues for healthy children: encouraging communities to talkMalaria Consortium
Integrated community case management (ICCM) – an approach where community-based health workers are trained to identify, treat and refer children under-five with pneumonia, diarrhoea and malaria – is increasingly being used across sub-Saharan Africa to supplement the gaps in basic healthcare provision. ICCM programmes have been endorsed by major international organisations and donors, and many African Ministries of Health as a key strategy for reducing child mortality. This learning paper describes Malaria Consortium’s approach to and experience of engaging local communities in integrated community case management (ICCM) in three African countries.
Developing intervention strategies: innovations to improve community health w...Malaria Consortium
During the last decade child mortality has reduced significantly in a number of African countries, largely due to the scale up of appropriate management of diarrhoea, pneumonia and malaria, three leading causes of death among young children. As a way of increasing access to treatment for sick children, several African countries are investing in community health workers (CHWs) to deliver integrated community case management (ICCM). This paper summarises the process adopted by one Malaria Consortium project, inSCALE, for identifying the barriers to CHW motivation and performance in Uganda and Mozambique. It documents innovative solutions to these challenges that are potentially acceptable and feasible, including the rationale for the design of the two interventions developed.
Insecticide treated nets: the role of the commercial sectorMalaria Consortium
This learning paper takes a detailed look at the approaches of direct support to the commercial insecticide treated net (ITN) market that were implemented by Malaria Consortium and its partners as part of mixed models of malaria prevention in three sub-Sahara African countries.
Moving towards malaria elimination: developing innovative tools for malaria s...Malaria Consortium
In collaboration with the national malaria control programme in Cambodia (CNM), Malaria Consortium developed a diverse set of tools to improve malaria surveillance and to provide the information needed by national and district staff to manage the national malaria programme, respond to malaria outbreaks and individual cases and monitor in real-time the levels of critical malaria supplies at health facilities.
The surveillance tools developed were a mix of routine reporting systems using eHealth and mobile phone-based (mHealth) solutions that would enable resource constrained environments to provide real-time data for immediate action. This learning paper documents the lessons learned in developing an appropriate tool and the specific considerations in the implementation of mHealth solutions.
It’s all in the detail developing effective health-related job aidsMalaria Consortium
Malaria Consortium has extensive experience developing job aids for community health workers and health facility workers in several countries. They have identified six key criteria for effective job aids based on this experience: 1) communicate complex information simply, 2) ensure accurate and up-to-date content aligned with health policies, 3) provide clear decision pathways, 4) describe tasks aligned with training and practice, 5) use appropriate language, illustrations and symbols, and 6) produce durable, cost-effective materials. The response provides examples from Mozambique, Uganda and other countries of applying these lessons to design simplified job aids that health workers can easily understand and use to improve performance.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Integrating severe acute malnutrition into the management of childhood diseases at community level in South Sudan
1. L EARN I N G PA P E R
Integrating severe
acute malnutrition
into the management of childhood diseases at community level in South Sudan
2. BACKG ROUN D
Learning paper series
Since starting operations in 2003, Malaria Consortium
has gained a great deal of experience and knowledge
through technical and operational programmes and
activities relating to the control of malaria and other
infectious childhood and neglected tropical diseases.
Organisationally, we are dedicated to ensuring our
work remains grounded in the lessons we learn
through implementation. We explore beyond current
practice, to try out innovative ways – through research,
implementation and policy development – to achieve
effective and sustainable disease management and
control. Collaboration and cooperation with others
through our work has been paramount and much of
what we have learned has been achieved through our
partnerships.
This series of learning papers aims to capture
and collate some of the knowledge, learning and,
where possible, the evidence around the focus and
effectiveness of our work. By sharing this learning,
we hope to provide new knowledge on public health
development that will help influence and advance both
policy and practice.
South Sudan
Malaria Consortium Office
Capital
Active projects
SUDAN
Upper Nile
AWEIL
Unity
Northern
Bahr el
Ghazal
Warrap
ETHIOPIA
Western Bahr el Ghazal
Jonglei
Lakes
CENTRAL AFRICAN
REPUBLIC
Western Equatoria
JUBA
Eastern Equatoria
KENYA
DEMOCRATIC REPUBLIC
OF CONGO
UGANDA
4. BACKG ROUN D
Introduction
Despite several advances towards Millennium Development Goal 4 (MDG4)
to reduce childhood mortality, the diseases of poverty – pneumonia,
diarrhoea and malaria, together with under-nutrition – remain among the
leading causes of child mortality across the world.
It is estimated that globally there were 6.9 million
deaths in children under five in 2011.1 Of these deaths,
it has been recognised that over a third are due to
under-nutrition. Children suffering with severe acute
malnutrition (SAM), a particular form of undernutrition, are some of the most vulnerable and have
a greater than nine-fold increased risk of dying than
children who are well nourished.
South Sudan ranks 15th highest in the world in terms
of mortality rates for children under five1. Malaria is
the leading cause of illness in all age groups, with 100
percent of the population at risk. It also accounts for
approximately 30 percent of all hospital admissions.
Up to 35 percent of children under five had suffered
from a fever during the two weeks preceding the 2009
Malaria Indicator Survey (MIS). Broadly speaking, the
leading disease pattern contributing towards deaths
in children under five in South Sudan is similar to
global trends, with pneumonia, diarrhoea and malaria
being the leading causes. Malnutrition is widespread
throughout the country with 28 percent of children
under five being underweight, 31 percent stunted and
23 percent wasted.2
Since December 2010, Malaria Consortium has been
implementing an innovative approach to community
management of SAM, ‘piggy-backing’ onto an
existing integrated community case management
(ICCM) programme in the Republic of South Sudan.
This learning paper considers Malaria Consortium’s
experience of this combined approach in a highly
complex context and shows whether the management
of SAM is an effective, acceptable and feasible
component of ICCM programming.
Integrated community
case management
The term integrated community
case management (or ICCM)
generally refers to an integrated
approach for assessing and
classifying signs and symptoms
of pneumonia, diarrhoea, and
malaria in children under five
years old, and providing homebased treatment or referral for
these diseases. The approach
also normally includes health
promotion and preventive
activities such as sleeping under
a net and hand washing. This
care is provided by volunteers in
the community who are trained
by health workers on the ICCM
approach
A mother and her son wait
their turn at a community
outpatient therapeutic
feeding centre in Hong
village, Aweil West
1. Levels Trends in Child Mortality Report 2012
www.unicef.org.uk/Documents/UNICEF%20Child%20mortality%20report%202012.pdf
2. South Sudan Household and Health Survey, 2010
2 Learning Paper
6. SECTION 1
Childhood diseases
and malnutrition
In an extremely resource-limited setting such as South Sudan, there is a double challenge: a high burden of childhood disease
and death, coupled with limited healthcare services to treat these diseases. There is a clear association between under-nutrition
and the leading diseases (malaria, diarrhoea and pneumonia) causing deaths in children under five. Children suffering from
these diseases are more likely to enter into a vicious cycle of becoming malnourished through poor absorption of nutrients,
while those already malnourished are more likely to die from these diseases due to a compromised immune system. These
challenges require innovation in programme delivery models in order to address the needs with the resources that are available.
Context
Decades of conflict have led to collapse of basic
infrastructure across the country including health clinics,
schools, roads, government offices, communication
systems and water and sanitation supply. Despite
the efforts of the government, donors, international
and national non-governmental organisations, South
Sudan still faces numerous challenges. The lack of
infrastructure is overlaid with a range of acute crises
resulting from flooding, disease outbreaks and renewed
localised and international conflicts resulting in large
population movement and displacement.
The Government of the Republic of South Sudan’s
austerity measures has also required a re-prioritising
of limited national financial resources and already
low commitments to basic services have been further
reduced. Renewed hostilities with the Republic of Sudan,
driven by a stalemate on post-secession arrangements,
led to the decision at the end of January 2012, to shut
down oil production, which the World Bank suggested
would force economic collapse, as oil revenue accounted
for 98 percent of the government’s budget.
Health facility use is low in South Sudan. Outpatient
visits are only 0.2 visits per person per year despite 44
percent of the population being settled within a fivekilometre radius of a functional health facility3. Even
five kilometres can be an impossible journey in parts of
the country, especially in the rainy season where floods
and swollen rivers may make any access to services
impossible. Access to treatment for common childhood
disease still remains low. Only 39.6 percent of children
under five have access to anti-malaria treatment within
24 hours of fever onset; 54.6 percent of the children
with diarrhoea are treated with oral rehydration salts4
and 38.5 percent treated with appropriate antibiotics
according to treatment guidelines.5 This low service use
is the result of lack of human resources and qualified
staff, shortage of drugs and medical supplies, cultural
3. South Sudan Health Facility Mapping 2011
4. EPI Coverage survey 2011/2012
5. Lot quality assurance sampling community-based survey 2011
4 Learning Paper
and financial barriers, long distances to health facilities
with poor roads and transport, a dysfunctional referral
system and limited or no ambulance service.
While pneumonia, diarrhoea and malaria are still the
main cause of death for children under five, they result
from a range of causes closely linked to poverty and are all
preventable. Pneumonia, diarrhoea and under-nutrition
can result from a lack of access to health services, poor
hygiene practices, poor infant and child feeding practices.
These include low exclusive breast feeding practices for
six months, lack of suitable nutritious weaning food for
infants and young children, a poor care environment, living
conditions, lack of access to vaccination, safe drinking
water and basic sanitation. The lack of availability and use
of long lasting insecticidal nets (LLINs) is another factor
contributing to the malaria burden.
Current interventions
Integrated community case management
In South Sudan, where health facility access and use
is so low, ICCM is a complementary and appropriate
strategy for the delivery of lifesaving curative
interventions for common childhood illnesses. ICCM
should not ‘stand alone’ as a community intervention
outside of the formal health service delivery system but
should, instead, support the skills of existing cadres of
community health workers (CHWs) at the facility level.
Community health worker
terminology
ICCM is carried out by
community drug distributors
in South Sudan, also known as
community based distributors.
CDDs receive six days’ initial
training and operate like
volunteer community health
workers in other parts of Africa.
It is important to note that in
South Sudan, community health
workers are not volunteers, but
rather fits within the Ministry
of Health and are mostly based
at health facilities after having
received nine months’ training
Community management of acute
malnutrition
Since the early 2000s there has been a growing
accumulation of global evidence from a variety of
contexts (emergency, transitional, development)
showing that community management of severe acute
malnutrition (CMAM) is an effective and safe public
health approach. This marks a shift from the resource
intensive inpatient care that was previously practiced.
A child suffering from severe
acute malnutrition receives
a nutritional supplement at
an outpatient therapeutic
feeding site in Aweil West
8. SECTION 1
Combined approach
While ICCM and CMAM were previously being
implemented in South Sudan as separate interventions,
Malaria Consortium was the first organisation to
combine these approaches. There are five overall aims
of both programmes and, owing to the interdependent
nature of infectious diseases and SAM on mortality,
they need to be addressed simultaneously for this to be
achieved. .
Maximum coverage and access
Both CMAM and ICCM programmes are designed to
achieve the greatest possible coverage by making
services accessible to the highest possible proportion
of a population in need. Both approaches aim to reach
the entire target population (children with malaria,
pneumonia, diarrhoea and SAM), especially including
those in hard-to-reach areas
Timeliness
Both approaches rely on treating conditions rapidly
before they progress and complications develop. ICCM
aims to treat cases early in the onset of the symptoms
of diseases while CMAM aims to begin case finding
and treatment before the malnutrition escalates and
additional medical complications occur.
Appropriate care
CMAM and ICCM both provide simple, effective
outpatient care for those who can be treated at
home and referral to clinical care for those who have
complications.
Task shifting
The majority of cases are identified and treated in
the community using simple protocols. This allows a
lower cadre of health workers, including community
volunteers, to deliver care for the majority of cases. This
is particularly needed in a context where there are low
numbers of formally trained health staff within the
health system.
The four components of
CMAM
1. Community mobilisation
stimulating the understanding,
engagement and participation
of the target population
2. Supplementary feeding
programmes (SFP) providing
dry take-home food rations
and routine basic treatment
for children with moderate
acute malnutrition without
complications
3.
Outpatient therapeutic
programmes (OTP) providing
ready to use therapeutic foods
and routine treatment using
simple medical protocols
for children with severe
acute malnutrition without
complications
4. Stabilisation centres
providing inpatient care for
acutely malnourished children
with medical complications
Shared key health promotion and
messaging
As there is a shared causality between malnutrition
and these infectious diseases, the same population
is targeted with relevant health interventions. These
include optimal infant and young child feeding, hand
washing with soap, safe preparation of water, sleeping
under a LLIN, etc.
Policy environment
As both management of childhood disease and severe
acute malnutrition are cross-cutting between health
facility and community based interventions, aspects
of the programme are included within several different
policies at various stages of evolution in South Sudan.
At the time of writing there was no explicit policy to
support the model of delivery Malaria Consortium is
implementing, however Malaria Consortium’s approach
complemented the following aspects of existing policies
and guidelines including The Basic Package of Health
and Nutrition Services (BPHNS) – updated in 2011,
the Government of South Sudan MoH Integrated
Management of Severe Acute Malnutrition (IMSAM)
Guideline – 2009 and the Child Survival Strategy – 2009.
South Sudan is currently in the process of developing
the Home Health Promoters (HHP) – 2012 (draft) and
ICCM Policy and Implementation guidelines. In June
2012 the Ministry of Health renewed its support for
ICCM programming in South Sudan and formed an
ICCM taskforce.
Community base
Both approaches rely on strong community
involvement and ownership. They are dependent
on community confidence in the CMAM and ICCM
providers for effective mobilisation, referral and followup, and need to work through the same community
networks for the programme to succeed.
Community nutrition worker
Simon Deng Garrang
assesses a malnourished child
at his OTP site in Aweil West
6 Learning Paper
10. SECTION 2
The volunteers
CDDs are volunteer community members, predominantly women, trained to provide basic health education messages
to communities as well as ICCM. Each CDD is responsible for approximately 40 households. CDDs are supervised by
CDD supervisors, who are also community volunteers, preferably with additional training in community health and are
literate. Each CDD supervisor is responsible for overseeing the work of 15 CDDs. CDD supervisors are, in turn, supervised
by Malaria Consortium staff. The NBeG programme had 1,683 CDDs across two counties (Aweil West and Centre) and
112 CDD supervisors. Supervisors supply commodities and collect data for central analysis and follow up of perceived
problems. The intention is for the nutrition aspects of the programme to be integrated into the existing community
child survival or ICCM programme, rather than creating an additional, separate vertical programme.
AIM
AIM
To maximise the community coverage of the
nutrition programme for early detection and
referral of SAM cases and provision of prevention
messaging
To have sufficient nutrition technical capacity
to supervise and support the CNW volunteers to
deliver quality SAM treatment at the OTPs
The ICCM programme is designed to maximise the
coverage and access to treatment for malaria, pneumonia
and diarrhoea and to cover the counties of operation.
Based on the extremely low literacy rates of the majority
of CDDs, it was not deemed feasible that the CDDs could
also provide treatment for SAM as the protocol requires
numeracy and detailed record-keeping. However,
community screening using mid upper arm circumference
(MUAC) and oedema screening is feasible for volunteers
without literacy or numeracy, as the coloured bands on
the MUAC tape can be used to decide whether or not to
refer a child to an Outpatient Therapeutic Site where
trained Community Nutrition Workers (CNWs) following
defined algorithms can manage the care of children with
uncomplicated SAM . The CDDs, therefore, added an
initial screening and referral of SAM cases to the role of
mobilising the community and their ICCM case work.
RECOMMENDATION
Use the ICCM CDD volunteer network to provide
screening, referral, follow up and counselling
for infant and young child feeding practices in
the community
When the programme was initially implemented, CDD
supervisors took a dual role: supervising CDDs as part of the
ICCM programme and to run the outpatient therapeutic
programme (OTP) site as a community nutrition worker
two days a week. CDD supervisors generally ran their OTP
sites from their homes, carrying out clinical management
of the identified cases according to the OTP treatment
guidelines and coordinating follow-up of cases.
The CDDs added
an initial screening
and referral of SAM
cases in addition to
their ICCM case work
and mobilising the
community
However CDD supervisors who had this dual role reported
having insufficient time to complete both duties. CDD
supervision required them to be mobile to supervise the
CDDs in their network whereas SAM treatment at the OTP
sites required them to stay at home. In addition, some OTPs
saw more than 100 beneficiaries per week. This resulted
in CDD supervisors/CNWs feeling overstretched and
beneficiaries having to wait a long time to receive treatment.
In response to these challenges, additional volunteers
were selected to act as CNWs. The involvement of the
community and MoH in selection of the volunteers
improved mechanisms for accountability. This allowed the
CDD supervisors to return to their original roles, moving
around providing support to their network of CDDs, while
the CNWs remained at their OTP sites to provide treatment.
The number of children receiving treatment at OTP sites
was reviewed and thresholds for the maximum number of
beneficiaries that can be managed by one individual were
established. In the busiest sites, additional volunteers were
trained to ensure that manageable beneficiary-to-CNW
ratios were maintained.
RECOMMENDATION
Have nutrition specific, trained and experienced
staff to supervise the nutrition treatment
programme.
8 Learning Paper
CDD Supervisor, John Uguak
Deng, Aroyo, Aweil Centre
12. SECTION 2
Programme HR structure - Phase 1
Programme manager
22 CDD supervisors / Community nutrition workers
(CNWs) for each Field officer
Field officer
*
CDD Sup
CDD
CDD
CDD
**
CDD Sup
CDD Sup /
CNW
CDD
CDD
CDD
CDD
CDD
CDD
CDD
CDD
CDD
CDD
CDD
CDD
CDD Sup /
CNW
CDD
CDD
CDD
CDD
CDD
CDD
CDD
* 15 CDDs for each CDD supervisor
** Each CDD is responsible for 40 households
Programme HR structure - Phase 2
Programme manager
Each Project /
Field officer
is responsible
for approx
17 CDD
supervisors,
118 CDDs
ICCM
programme officer
ICCM
programme officer
Nutrition
programme officer
ICCM
field officer
CDD Sup
Each CDD supervisor is
responsible for 15 CDDs
CDD Sup
Each CDD is responsible
for 40 households
CNW
CDD Sup
CNW
CDD Sup
CDD
CDD
CDD
CDD
CDD
10 Learning Paper
Each OTP officer
is responsible for
10-11 CNWs
OTP
officer
Some CNWs will receive referrals from
more than one group of CDD Sup
CDD
CDD
CDD
CDD
CDD
CDD
CDD
CDD
13. AIM
AIM
To have sufficient qualified volunteers resources
to deliver SAM treatment effectively
To ensure coverage of OTP services at health
facilities is complemented by additional
community level treatment in remote areas
In the initial phase of implementation, field officers
(Malaria Consortium staff with clinical training) also
had a dual role, providing supportive supervision to CDD
supervisors, collecting reports and providing supplies
for both the ICCM and nutrition programmes.
Again, the work practices for effective supervision and
technical knowledge in the ICCM programme and the
nutrition treatment programme were different. Ideally
the field officers should be observing and supporting
the CDD supervisors in their supervision duties to
CDDs, as well as giving direct supportive supervision to
the CDDs. Although field officers had received formal
medical training, they had varying levels of training in
nutrition. It was challenging for field officers to provide
effective supervision to OTP sites without having
much experience in running them. In addition, it was
recognised that the field officer to CDD supervisor ratio
was too high to ensure quality supervision. This was
made worse by the fact that the CDD supervisors were
often spread over large areas.
In order to provide specialised OTP supervision to the
CNWs, Malaria Consortium recruited extra staff to act
as OTP officers. This allowed the ICCM field officers
(and newly recruited project officers) to focus fully on
supervision of ICCM activities.
RECOMMENDATION
Have additional numerate and literate CDDs
and community nutrition workers to deliver
treatment of SAM at the outpatient therapeutic
programme sites, with close linkages to CDD
supervisors and the CDD network
health and nutrition services in line with BPHS and
Government of South Sudan strategy and improves
access to services in remote areas.
It was initially envisaged that all CDD supervisors would
be trained in recognition and management of severe
acute malnutrition (SAM). However, it was recognised
that not all CDD supervisors had the capacity to perform
the treatment protocol effectively. As a result, only the
most skilled CDD supervisors were selected to act as
both CNWs and provide SAM treatment. The majority
of OTP sites (27 of 33) were concentrated in Aweil West
a smaller geographical area than Aweil Centre, but with
a much larger population. Concern Worldwide was also
operating in Aweil West with health facility-based OTP
sites; Malaria Consortium therefore targeted those areas
not covered by Concern Worldwide.
Malaria Consortium received additional funding which
allowed for the expansion of the programme in Aweil
Centre, where the majority of the health facilities were
run by the MoH without any additional NGO support
for OTP services. Twelve new OTP sites were opened,
nine health facility-based and three communitybased. The addition of these new sites ensured that all
functional health facilities in Aweil Centre had an OTP
site delivering treatment for uncomplicated SAM cases.
These sites opened in September 2012. The expansion
resulted in a dramatic increase in admissions into the
OTP programme, indicating that many more children
were being reached by services.
RECOMMENDATION
Place a CNW in health facilities that were not
providing OTP services. This allows integrated
health and nutrition services in line with BPHS
and Government of South Sudan strategy and
improves access to services in remote areas
Learning Paper 11
14. SECTION 2
Incentives and motivation
AIM
AIM
To ensure that volunteers perform to expected
standards in the OTP sites and are incentivised
to do so
To enable CDDs to have a healthy household
and to provide examples to community
members
CDD supervisors/CNWs are not salaried staff. In Phase 1
of implementation, CDD supervisors were provided with
cash incentives of approximately US$40 per month
for operating the OTP sites for treatment two days per
week. This was in addition to the US$40 per month for
supervising the ICCM programme. CDD supervisors were
also provided with bicycles and bags to carry reports,
allowing them to cover the area that their CDDs serve.
However, despite these cash and in-kind incentives, the
volunteers showed varying degrees of motivation to
perform their expected duties. Some CDD supervisors/
CNWs were absent from the OTPs on treatment days
or would not conduct supervision activities within
the programme reporting timetables. Some CDD
supervisors/CNWs would complete reports, but to an
extremely low standard. This suggested that they were
more focused on completing the reports than ensuring
that they were of an acceptable quality.
In order to address these issues, in Phase 2 a
performance-based element was introduced into
CNWs’ incentives with the aim of improving the quality
and consistency of their service provision. CNW cash
incentives became dependent on the provision of
completed reports within the expected timeframe to
the expected standard. In an attempt to encourage and
support excellence, additional ‘bonuses’ are now being
offered for CNWs who achieve beyond expectations.
In addition to the incentives provided by Malaria
Consortium, the community also gives feedback,
which adds to volunteers’ motivation. Volunteers are
recognised as having skills and as providing services
within their community and in some cases have been
given formal recognition for this, for example being
allowed to jump the queue at a water point. Conversely,
where volunteers have not been performing their duties,
the community reports to Malaria Consortium about
poor performance and in extreme cases will request
that volunteers are replaced.
12 Learning Paper
In both phases of implementation, CDDs received
non-cash incentives to motivate them. In Phase 1 the
items were largely focused on supporting them in
their role as CDDs (T-shirt, cap, torches, drug boxes).
In Phase 2, there was an attempt to provide them with
additional items that would assist them in creating
a healthy environment in their homes: soap for hand
washing, jerry cans for safe water storage, and LLINs.
It is anticipated that these items will help CDDs
demonstrate healthy behaviour and practices in their
communities which will back up the health messages
they are providing.
RECOMMENDATION
Provide CDD volunteers with in-kind
incentives that enable them to have a healthy
environment at home and demonstrate it to
community members
CDD supervisors/
CNWs are not salaried
staff. In Phase 1 of
implementation,
CDD supervisors
were provided with
cash incentives of
approximately $40 for
operating the OTP sites
for treatment two days
per week. This was
on top of the $40 per
month for supervising
the ICCM programme
15. Case study #1
Name Pual Malong
Personal info Community nutrition worker, trained by Malaria Consortium
Address Gueng Village in Mariem East Payam, Aweil West County
Pual Malong is a community
nutrition worker in Gueng Village
in Mariem East Payam, Aweil West
County. He has been a community
nutrition worker since 2011 when
he was first trained by Malaria
Consortium. Previously he had been
a supervisor for 133 community
drug distributors.
“When the nutrition programme
was introduced to treat severe
malnutrition cases, the community
again selected me to be the
community nutrition worker. I was
then trained again by Malaria
Consortium, after I had received
the initial ICCM programme
training. So far I have received
two ICCM and three nutrition
trainings and I have got all the
skills for carrying out ICCM and
as a community nutrition worker.”
Malong’s training has meant he
is able to not only help his
community with ICCM care, but
he is also able to help tackle
malnutrition, which is a common
problem for children in the area,
increasing the risk of disease
and mortality. Malong screens
children brought to his outpatient
therapeutic feeding (OTP) site,
where he provides general health
education. He screens the children
for severe acute malnutrition and
provides nutritional supplements
(Plumpy’nut) to those who need it
and refers more complex cases to
the nearest health facility or
Aweil Hospital. He has enrolled 32
children in the malnutrition and
ICCM programme at his OTP site.
Malong’s work has been wellreceived by his community,
especially by community leaders
and caregivers, who are now
able to access malaria and
malnutrition treatment, recognise
common disease symptoms and seek
appropriate healthcare for their
children.
“The caregivers like the programme
and they use the service,
especially now they are able to
recognise some danger signs in
their children and immediately go
to health facility or to the OTPs.
The treatment they receive at the
OTP site and the daily Plumpy’nut
supply for malnourished children
helps so much.”
Malong was concerned, however
about delays in the supply
of Plumpy’nut and some of the
drugs used for ICCM. He also
commented that the lack of storage
facilities for the supplies
needed to be improved as they are
currently stores at his house. A
simple shelter for OTP days in the
rainy season would also be good,
he added hopefully. His usual
location is under a tree.
But despite these concerns, he is
generally very pleased with how
his work is going.
“The nutrition and ICCM programmes
work well based on my experience
as an ICCM supervisor and
community nutrition worker. We
refer most of the cases that might
be beyond the capacity of the ICCM
and nutrition programmes, based on
the danger signs.”
“The programme is liked by all
in the community and the leaders
appreciate it and encourage
the programme’s continuity in
the community to serve their
children.”
Community nutrition workers
fill out detailed patient
records to ensure clear
reporting
Learning Paper 13
16. SECTION 2
Training
AIM
AIM
The pilot had four stages
To ensure that CNWs are supported and
trained to perform OTP protocols adequately
To ensure that health facilities understand
services delivered in the OTPs, are able to
provide referral services and have strengthened
capacity to deliver OTP services
1. Needs assessment:
Before the initial implementation of the programme,
Malaria Consortium used regional technical experts to
design and implement a training package. This would
enable selected CDD supervisors and other volunteers
selected by their communities to become CNWs based
on the integrated CMAM training package, but adapted
for the protocol agreed with the MoH. CDDs/CNWs were
given a rapid training in MUAC screening and referral
early in 2011. CDD supervisors were given a refreshertraining course in OTP protocols soon after the initial
training to ensure that the concepts and skills from the
initial training were understood and applied correctly.
Recognising that refresher training is essential to
ensure that community health workers retain the
skills that they have gained in initial training, Malaria
Consortium expanded staff capacity to ensure
this would take place. A senior national nutrition
programme officerand four OTP officers have been
recruited to provide technical support and supervision
to the CNWs. With an expanded nutrition team, it will
be possible to deliver refresher training quarterly,
based on identified particular training needs.
RECOMMENDATION
Ensure there is sufficient capacity within the
programme management team to conduct
refresher trainings at least once every three
months
Health facility staff were, in many cases, overstretched
with their existing responsibilities and did not have the
additional capacity to directly implement treatment for
SAM, but it was important for them to understand the
treatment delivered in the OTPs. In many cases, health
facility staff had not had experience or received training
in OTP services.
RECOMMENDATION
Provide short course, on-the-job training for
health facility staff on OTP protocols
AIM
To have an effective system of referral of
complicated SAM cases from the community/
out-patient services to in-patient/stabilisation
centre care
As part of the medical assessment and screening at OTP
sites, CNWs are expected to identify the small number
of cases of SAM which have medical complications and
require specialised in patient care delivered through a
stabilisation centre. In the first phase of implementation
there was little information on the referrals that had
been made; programme staff and volunteers were too
overstretched to perform adequate follow-up. The children
who have been identified as having complicated SAM are
the most vulnerable and at increased risk of mortality
and, therefore, in particular need of follow-up.
In order to understand better the outcome of referrals
and the barriers to achieving referral, Malaria Consortium
designed a referral pilot to address this gap.
14 Learning Paper
to collect quantitative and
qualitative information on
referral outcomes, barriers
to referral and community
identified solutions to
support referral
2. Intervention design:
based on the outcomes of the
needs assessment Malaria
Consortium worked closely
with partners (community,
Ministry of Health, agencies
providing in-patient
stabilisation centre care)
to design an intervention
to support community
referrals from the OTP to the
stabilisation centre
3. Intervention
implementation:
to be implemented for at
least six months.
4. Intervention
evaluation:
to understand if the
intervention has been
successful in supporting
community referrals of
complicated SAM cases and
if so, if it could be replicable
and scaled-up
17. Service delivery
Treatment, referrals and Ministry of Health
County Health Department
Civil Hospital
Ministry of Health
Stabilisation centre
Complicated severe acute malnutrition (SAM) cases
Danger signs
Primary Health Care
Centre/Unit
Ministry of Health
Outpatient therapeutic
feeding programme
Outpatient therapeutic
feeding programme
SAM cases
CDD Sup
CDD Sup
CDD Sup
Any other condition
CDD
CDD
CDD
CDD
CDD
CDD
CDD
CDD
CDD
CDD
CDD
CDD
CDD
Treatment for malaria, pneumonia, diarrhoea and screening for SAM
Learning Paper 15
18. SECTION 2
Treatment protocol
AIM
AIM
To have a feasible and technically appropriate
treatment protocol for the treatment of SAM
based on national guidelines
To integrate management of MAM into the
implementation model
The programme adopted the government’s IMSAM
approach in line with the South Sudan nutrition
strategies and standards. However, as the programme
was being implemented in a specific context, some
specific modifications to the treatment protocol were
discussed and agreed with the Directorate of Nutrition
in the MoH. These were as follows:
1.
Admission to OTP on MUAC and oedema
criteria only.
2.
Treatment of children with uncomplicated
malaria, pneumonia or diarrhoea and SAM
without further complications at the OTP.
3.
Discharge ‘cured’ criteria altered from 15
percent to 20 percent weight gain for two
consecutive visits and/or green MUAC.
4.
All asymptomatic children with SAM will
be treated for malaria routinely using a full
treatment course of anti-malaria drugs.
Cure: a beneficiary who
reaches the programmedefined discharge criteria
l efaulter: a beneficiary who
D
is lost to the programme before
reaching discharge criteria,
and whose actual status
(dead, recovered, other) is not
known. If the beneficiary has
not attended the OTP for three
consecutive visits they will be
considered a defaulter
l eath: a beneficiary lost-toD
follow-up who is reported dead
by the family or by home
visitors
l on-response: a beneficiary
N
who did not meet the
discharge criteria after four
months in treatment. During
the treatment, these children
would have shown signs of
non-response to treatment
and should be referred to
inpatient care or for medical
investigation
l
Throughout both phases of implementation, treatment
has focused on treatment of SAM, community
mobilisation and referral of complicated SAM cases
to stabilisation centres. It excludes the management
of moderate acute malnutrition (MAM). The adequate
management of MAM is vital to prevent and lessen
the incidence of SAM, and increased risk of morbidity
and mortality. Historically, partners in South Sudan
have found it difficult to achieve good programme
outcomes with traditional food based approaches for
MAM management without the presence of a general
food distribution. However, the Ministry of Health South
Sudan together with the Nutrition Cluster has formed a
working group, which is producing guidelines for MAM
management. This has shown some promising results.
Malaria Consortium plans to implement a Targeted
Supplementary Feeding Programme pilot in two sites.
One site in the community is at the returnee camp site
of Apada. This site has extreme food insecurity and
extremely high rates of malnutrition. The other site will
be based in a health facility (primary health care centre)
with a high patient load. The approach will be evaluated
for its effectiveness and will compare the experience
of community and facility-based sites. Based on the
outcomes of the pilot the programme may be scaled up.
RECOMMENDATION
RECOMMENDATION
Implement a modified version of the
Government of South Sudan’s IMSAM that
takes into account the limitations of the
community delivery model
Pilot some initiatives for management of MAM
using the MoH recommended approach and
consider linkages with other programmes
(food security,livelihoods, WASH, etc) for other
innovative approaches
16 Learning Paper
CMAM discharge outcomes
explained
19. ICCM implementation roll out - Northern Bahr el Ghazal
Sept 2009
2010
2011
2012
2013
Malaria (ACTs)
Global Fund to Fight AIDS, Tuberculosis and Malaria funding
112 CDDs
supervisors and
1,610 community
drug distributors
(CDDs)
Canadian International Development Agency
Common Humanitarian Funds
USAID/ ADRA SSHINE funding
Pneumonia (amoxicillin)
Diarrhoea (ORS and zinc)
33 CDD Sup acting also as community nutrition workers (CNWs)
45 independent CNWs
Malnutrition (Plumpy’nut) Phase 1
Phase 2
Common Humanitarian Fund funding
Children will only be
discharged from the OTP
if they show a 20 percent
weight gain over two
consecutive visits or have a
green MUAC measurement
Learning Paper 17
20. SECTION 2
Coverage
More than 90 percent of the target population is within
less than one day’s return walk (including time for
treatment) of the programme site. Coverage is greater
than 50 percent in rural areas, and 70 percent in urban
areas and more than 90 percent in camp situations.
Admissions
The OTP sites in NBeG were established in late 2010 to
early 2011. The programme began to gain momentum
after the referendum period in January 2011. In South
Sudan there are also seasonal trends in malnutrition
patterns. There is a ‘lean period’ before the harvest, which
generally runs from March to June in which malnutrition
rates reach their peak. The ‘post harvest’ period is from
October to December where malnutrition rates are
generally expected to drop. Established OTP programmes
usually see this trend in admissions.
In the first year of implementation, 1,204 children
were admitted to the programme. The majority of
admissions were new admissions, with only two percent
of admissions overall being readmissions. High numbers
of readmissions would not be expected, though, as it was
a new programme.
In the second year of implementation, 3,564 children
were admitted, more than double those admitted in the
first year, with two months of data yet to be collected.
Six percent of cases were readmissions, suggesting that
there are children who have been discharged from the
programme relapsing into SAM. Admissions peaked
dramatically in September 2012 as 12 new OTP sites
were opened in Aweil Centre. This indicated that the
previous eight OTP sites alone were not adequate.
Quality of Treatment
Delivered in the Programme
In Phase 1, the programme
performance quality was
extremely high, with an
overall cure rate for the year
of 94 percent, death one
percent and defaulter rate of
two percent, well within the
SPHERE standards. In Phase 2,
the overall performance was in
line with the first year, with an
overall cure rate of 89 percent,
death rate of one percent and
default rate of six percent
Programme admissions and reporting
rates, Phase 1 and 2, NBeG
2011
Total admissions 1,204% Reporting rate 42%
2012
Total admissions 3,564 Reporting rate 90%
Note: 2012 figures are missing November and December data
Discharge outcomes programme
performance indicators. Phases 1 and
2, NBeG
2011
94% Cured
1% Died
2% Defaulter
2% Non Respondent
2012
89% Cured
1% Died
6% Defaulter
3% Non Respondent
Note: 2012 figures are missing November and December data
18 Learning Paper
21. Monitoring and evaluation
AIM
To support the development of policy relating
to community health, child survival and
nutrition, based on the evidence gained
through implementing the ICCM and nutrition
programme
In the initial start-up phase of the programme, Malaria
Consortium conducted the majority of the programme
supervision and management with little involvement of
the SMOH (State Ministry of Health) or CHD (Community
Health Department). However, in order to build ownership,
oversight and capacity within the MoH, a greater
involvement in monitoring and management of the
programme was required.
Malaria Consortium has developed a supervision
framework for the ICCM teams that details key guidance
including the frequency, content and approach for
supervision visits. Learning from this, the programme is also
developing a supervision framework for the nutrition team
involving the CHD and SMoH in periodic supervision visits.
This should also provide a bridge for greater integration
between the health services delivered by MoH staff and
nutrition treatment delivered by the CNW volunteers.
RECOMMENDATION
Advocate to the Ministry of Health, donors and
ICCM partners that SAM management is an
effective and feasible aspect of ICCM delivery
and should be included in policy frameworks
where appropriate
In the lean period before the
harvest in Northern Bahr elGhazal state (March to June),
malnutrition rates are at their
highest
Learning Paper 19
22. SECTION 2
Routine reporting
AIM
To integrate nutrition programme data through
the same platform as the ICCM programme
In the first phase of implementation, the Malaria
Consortium ME team developed a database to collect
key performance indicators for the programme: cure,
death, defaulter and non responder rate, length of stay and
weight gain. This allowed Malaria Consortium to report
at a County level the performance of the programme to
the MoH, UNICEF and the Nutrition Cluster using the
standardised reporting tool developed by the Cluster.
After a period of implementation, the programme
staff found that it would be useful to have additional
information recorded and reported such as proportions
of returnee or host population admissions. Also, a
District Health Information System (DHIS) database
had been developed by the consortium of ICCM
partners, which allowed community level treatments
to be reported to the MoH and donors using the same
platform as the facility-based Health Management
Information System (HMIS).
Following the success of the ICCM DHIS database,
Malaria Consortium set about developing a DHIS
database for the nutrition programme. This supported
a higher level of analysis of programme data than
previously possible with the original database. It could
also potentially be used by other partners who are
hoping to report at the facility/OTP level.
RECOMMENDATION
Develop a DHIS database for nutrition
programme monitoring
AWEIL
Aweil - state capital
Outpatient therapeutic Feeding Centres
20 Learning Paper
23. Case study #2
Name Ayak Mangok
Personal info Care giver whose child received treatment
Address Malithbuol Village, Gumjur East Payam, Aweil West County
Ayak Mangok, the mother of
two-year old Akol Bol from
Malithbuol village in Aweil
West County, describes the
care her child received at the
Malaria Consortium outpatient
therapeutic feeding site.
Can you describe what led you to
seek treatment for Akol Bol at
the OTP site?
The first symptoms he had were a
cough and convulsions. I took
the child to Aweil Hospital for
treatment, but he fell sick
again. I returned with him to
Aweil Hospital and was referred
by Medecin Sans Frontiers staff
to the Malaria Consortium OTP
site.
Can you describe the changes
in your child since he started
receiving treatment?
There has been a very big
improvement in my son since he
started receiving the treatment.
The changes include improved
appetite, playing again and
generally looking healthy.
There are many patients seeking
care during OTP days and this
delays treatment for patients
with more serious cases at
home. The lack of examination
facilities at the OTP site to
review some sicknesses and
sometimes there not enough
supplies for the patients.
How long does it take you to
travel from your home to the OTP
site?
It is a 30 minute walk.
What impact do you think
malnutrition has on your
community?
Malnutrition is a problem. It
is why our children are getting
sick and the time we spend
caring for them interrupts our
business and work activities.
Have you experienced any
challenges in accessing
treatment?
How was your child before they
started to receive treatment?
Before receiving treatment my
son was sick, very weak and
thin, and couldn’t play. But
now after getting the treatment
he is very healthy and playing
actively, he looks strong and
eats well.
How long has your child been in
the treatment programme?
My child has been enrolled in
the treatment programme for
three months.
Community based OTP
sites are usually under a
convenient tree
Learning Paper 21
24. SECTION 2
Surveys
At the time of writing, the South Sudan Nutrition
Cluster and UNICEF encourage partners implementing
nutrition programmes to conduct bi-annual SMART
survey assessments using a standardised tool with two
primary and three secondary objectives:
Survey results –
post harvest 2011
As Concern Worldwide was conducting a survey in
Aweil West during this period, Malaria Consortium
focused on Aweil Centre. The results showed extremely
concerning malnutrition and mortality rates: the global
acute malnutrition (GAM) rate was 17.7 percent - well
above the WHO emergency threshold of 15 percent -
and the SAM rate was 5.3 percent. Similarly mortality
rates were of great concern with the crude mortality
rate extremely close to the emergency threshold for
sub-Saharan Africa (0.78 per 10,000 per day compared
to 0.8 per 10,000 per day). The under-five mortality
rate was above the threshold for sub Saharan Africa
(2.23 per 10,000 per day compared to 2.1 per 10,000 per
day). These rates of malnutrition and mortality would
not generally be expected to be so high during the
post-harvest period, when it is normally expected that
food security should be at its highest and malnutrition
at its lowest rate. Aweil Centre had experienced a large
influx of returnees from Sudan during the referendum
and independence period. They were living in camp-like
situations and so had particular difficulties with food
insecurity and vulnerabilities to infectious diseases.
Nineteen year old Akek Akol
Maehol is a returnee from
Sudan to Aweil West. Her two
year old daughter is severely
malnourished
22 Learning Paper
25. Survey results – pre harvest 2012
The primary objectives
are to estimate:
m
alnutrition rates through
anthropometric surveys
l nfant and crude mortality
i
rates through retrospective
mortality surveys
l
The secondary objectives
are to assess key
behaviours in the study
group relating to:
h
ealth and infant and
young child feeding
practices (IYCF)
l ood security and
f
livelihoods (FSL)
l ater, sanitation and
w
hygiene (WASH)
l
The surveys are intended to cover
the whole county with the aim of
capturing the variation between preand post-harvest malnutrition rates.
This evidence should then provide
information to assess the need
for any alterations in programme
approach.
After the initial Aweil Centre survey, it became apparent
that the majority of the returnees were unlikely to move
in the near future. Their underlying characteristics were
fundamentally different from the host population. In
the first survey they had been treated as one group but
additional analysis showed that malnutrition rates and
food security were different between the groups. Malaria
Consortium conducted two different assessments. The
results showed that both populations had malnutrition
rates well in excess of the WHO emergency threshold
of 15 percent for GAM (21.6 percent in Aweil Centre
and 27.4 percent in Apada), providing clear justification
that therapeutic programming is required to control
excess mortality. Apada returnee camp in particular
showed a worryingly high rate of SAM with almost
one in 10 children having SAM (9.3 percent) and very
poor food security indicators suggesting the need for
a comprehensive emergency nutrition intervention
including a general food distribution.
The results of these surveys were validated by the
Nutrition Cluster’s Technical Working Group and
were widely shared with partners, including the MoH,
UNICEF, World Food Programme and other NGOs
operating in the state.
AIM
To build organisational and Ministry of Health
capacity to conduct surveys
Recognising that specialised skills involving both
experience and technical training are required to
conduct SMART surveys, Malaria Consortium recruited
an external national consultant for the first post-harvest
survey in 2011. However, as periodic assessments and
surveys are required to monitor programme performance,
Malaria Consortium invested in strengthening the
organisation’s ability to conduct surveys.
RECOMMENDATION
Provide in-house training to conduct surveys and
involve the county and state Ministry of Health
in all aspects of the process
AIM
To evaluate the performance of the programme
as a whole
Malaria Consortium was conducting a new programme
approach that other partners had not yet conducted
in South Sudan, combining ICCM and nutrition. It was
realised that it was necessary to have an evaluation of the
effectiveness of the approach and to identify areas which
needed improving.
Malaria Consortium conducted a two-week incountry programme evaluation to review the design,
implementation and results of the programme over its
first 18 months. The aim was to determine its efficiency,
effectiveness, impact, sustainability and the relevance of
its objectives. A programme evaluation report with clear
recommendations was discussed with the in-country team
for follow-up action. External programme evaluations will
also be considered in the future.
RECOMMENDATION
Conduct periodic programme evaluations
at defined intervals to assess the overall
effectiveness of the programme and identify
areas that need to be improved
Malaria Consortium has worked with the MoH at county
and state level for the planning and coordination of
the surveys. Representatives from the MoH have also
been involved in sensitising the communities about
the survey and sharing survey results. There was a
recognition that, in future, there is a need for greater
involvement of the MoH in the data collection, data
entry and analysis of surveys.
Learning Paper 23
26. SECTION 2
Prevention strategies
AIM
AIM
To provide appropriate and targeted preventive
health and nutrition messaging through the
community volunteers
To improve Vitamin A and deworming coverage
in children under five in the areas of operation
The initial focus of both the ICCM and nutrition
programmes was to ensure that treatment was delivered
successfully. There was less focus on the preventive
aspects of the programme, although simple health and
nutrition messaging was delivered to caregivers while
their children were receiving treatment in the programme.
When Malaria Consortium revised the training materials
for ICCM6 in early to mid-2012, significant focus was put
on strengthening the prevention messages that CDDs
delivered to caregivers during consultation.
Moving forward, there will be qualitative assessments
providing a better understanding of the barriers to
healthy behaviour among individuals, communities and
community structures. In addition to the messages at the
point of treatment, there will be outreach services and
messaging to reach the community before disease and
malnutrition develop. As the diseases targeted through
ICCM and malnutrition have similar and shared causes,
there is value in addressing prevention in an integrated way.
South Sudan’s Lot Quality Assurance Sampling survey
showed low micronutrient supplementation (Vitamin A)
and deworming coverage in Malaria Consortium’s areas
of operation despite the routine immunisation services
delivered through the formal health system. Vitamin A
supplementation for under-fives is one of the ‘scale up
nutrition’ supported interventions and is included in the
South Sudan Nutrition Cluster’s strategy.
Malaria Consortium’s ICCM programme design is
to have full coverage in the counties of operation. It
therefore presents greater potential for delivering
biannual Vitamin A supplementation and deworming
than other approaches. As the target group is children
under five, it is also an ideal opportunity to conduct
MUAC screening, and to refer children with SAM for
treatment and to identify children with MAM for
preventive interventions. Community volunteers
with low levels of literacy are able to conduct the
supplementation and basic reporting using pictorial
based tally sheets.
RECOMMENDATION
RECOMMENDATION
Conduct qualitative assessments to understand
the barriers to healthy behaviours and develop
the most effective mechanism to deliver
integrated preventive health messaging using
the ICCM community volunteer network
Use the community volunteer network supported
through the ICCM programme to deliver Vitamin A,
deworming and MUAC screening to under-fives
6. Malaria Consortium Learning Paper: Developing and implementing training materials for integrated community case management in South Sudan 2012
http://www.malariaconsortium.org/resources/publications/182/developing-and-implementing-training-materials-for-integrated-community-case-management-in-south-sudan
24 Learning Paper
27. Stock and supply management
AIM
To avoid stock-outs of ready to use therapeutic
foods (RUTF) in the programme
In both Phase 1 and 2, the programme experienced
stock-outs of RUTF. Stock-outs have serious
implications for the programme, interrupting the
treatment of children enrolled in the programme and
jeopardising community trust and acceptance. Malaria
Consortium introduced a series of measures based to
lessen the risk of stock-outs.
l Establishing minimum stock levels at the OTP sites.
In the first phase of implementation there was limited
storage space (for one month) at the community
OTP sites. In many cases, these were the homes of
the CNWs. This meant the CNWs would only be
provided with one month’s stock which provided
no buffer against limited access to the sites due to
environmental factors such as floods or a sudden
increase in beneficiaries. In the second phase, Malaria
Consortium invested in developing improved storage
facilities at the sites to allow for additional buffer
stock to be stored.
l Improved mechanisms for reporting stock levels
using the DHIS system. CNWs experienced great
challenges in reporting on stock levels. In the first
phase of implementation there was limited supportive
supervision and training to support the development
of these skills. This resulted in poor information
being provided to the programme management team
about the stock levels at the OTP sites. Following
the introduction of the DHIS database and improved
reporting tools, programme staff were better able to
monitor stock usage and levels.
l Prepositioning supplies ahead of the rainy season. In
South Sudan there are many challenges in reaching
remote rural areas. The counties where Malaria
Consortium operates experience extreme seasonal
flooding for four to six months a year. Malaria
Consortium used staff who had good local knowledge
and local authorities to work in areas that were likely
to be cut off by flooding. RUTF and other supplies
were brought in to these areas ahead of the rainy
season.
l Procurement of RUTF using alternative funds. In
South Sudan RUTF is procured centrally through
UNICEF and is provided to implementing partners. In
late 2011, due to the influx of returnees and multiple
humanitarian disasters in South Sudan, the RUTF
supply in country was insufficient. This was resolved
in 2012. To mitigate against the risk of national
stock-outs, Malaria Consortium has now procured
additional RUTF as a buffer stock.
RECOMMENDATION
Ensure adequate storage at community level to
accommodate minimum stock levels, together
with swift and accurate reporting systems
that allow spikes in admissions to be detected.
Malaria Consortium introduced a series of
measures based to lessen the risk of stock-outs.
AIM
To minimise leakage and misuse of RUTF
Following the scaling-up of community treatment of SAM
in South Sudan there have been reports of RUTF being
sold in the local markets and not used for treatment
as intended. The leakage of RUTF in to the markets is
extremely damaging to the CMAM programming. In both
phases of implementation, Malaria Consortium received
some reports of RUTF being sold and misused by CNWs.
In these cases Malaria Consortium worked closely with
the local communities to replace the CNW concerned
and reported these occurrences to the county health
department and state MoH. Malaria Consortium worked
with the state MoH to make a statement about the
gravity and consequences of selling RUTF. The improved
stock management reporting introduced through the
DHIS database means there are now additional methods
for monitoring stock usage.
RECOMMENDATION
Work with local communities and the MoH to
monitor, report on and take action if RUTF is
being sold or misused
Learning Paper 25
28. SECTION 3
Key lessons learned
1.
OVERALL PROGRAMME STRATEGY AND
IMPLEMENTATION IS RECOGNISED AND
SUPPORTED BY PARTNERS IN COUNTRY
Since the inception of the programme, the MoH at
all levels has been supportive of the addition of SAM
management into the ICCM model. Other partners
implementing ICCM will be adding on the component
of SAM management as part of the existing package for
treatment of diarrhoea, pneumonia and malaria.
2.
THE MODEL DELIVERS HIGH QUALITY
INDICATORS FOR TREATMENT
In both years of implementation, the quality of treatment
provided has been consistently high and within the
acceptable SPHERE minimum standards. Although
coverage has not yet been evaluated it is expected
that this will also be high because of the decentralised
approach and high levels of community involvement.
3.
THE INCREASED HEALTH FACILITYBASED OTP SITES HAVE LED TO THE
PROGRAMME REACHING MANY MORE
CHILDREN
In a context where the MoH is unable to implement SAM
treatment directly through their supported facilities,
adding this component into the current health system
using support from international NGOs has been effective.
4.
SUFFICIENTLY WELL TRAINED,
EXPERIENCED NUTRITION STAFF
AT ALL LEVELS OF PROGRAMMING
IMPROVES PROGRAMME
PERFORMANCE
While the community and treatment aspects of the
nutrition programme are relatively simple, and capacity
to deliver these services can be quickly built, it is vital to
have in-country experience and expertise in nutrition
for the management aspects of the programme. The
introduction of a senior national nutritionist to the
programme and OTP officers trained and experienced
in SAM treatment has resulted in improved supervision,
treatment compliance and reporting.
26 Learning Paper
5.
REGULAR (QUARTERLY) REFRESHER
TRAINING RESULTING IN BETTER
COMPLIANCE WITH THE TREATMENT
PROTOCOL AND REPORTING
Increased regularity of refresher training has resulted
in improved compliance with treatment protocols and
a massive increase in programme reporting rates, also
linked to the increased supportive supervision. In a
post conflict/low education context, it is extremely
important to continue to provide a combination of ‘on
the job’ and classroom refresher training.
6.
The Ministry of Health
at all levels has been
very supportive of
the inclusion of SAM
management into the
existing community
package for treatment of
diarrhoea, pneumonia
and malaria (ICCM)
REGULAR MONITORING AND
ASSESSMENT OF THE NUTRITION
SITUATION IS FEASIBLE IN THIS
CONTEXT AND VALUABLE FOR
DIRECTING PROGRAMME APPROACHES
Based on the new bi-annual SMART survey data, there
is growing evidence about the ranges of malnutrition
rates experienced in programme implementation
sites. This is valuable as the area of operation involves
a chronic emergency overlaid with spasmodic acute
emergencies. It is necessary to have this background
of evidence in order to decide if additional emergency
intervention is required.
7.
DEVELOPMENT OF THE HMIS SYSTEM
HAS RESULTED IN EASY-TO-USE TOOLS
FOR MONITORING PROGRAMME
QUALITY AND HAS THE POTENTIAL TO
BE INTEGRATED IN TO THE MOH SYSTEM
As the ICCM programme already reports using the HMIS
system it would be beneficial to have nutrition data
processed through the same platform. As nutrition is
not yet included in the MoH’s routine HMIS reporting
system, the reporting system developed by Malaria
Consortium could be integrated into this.
8.
INDEPENDENT PROCUREMENT OF
RUTF BUFFER STOCK PROVIDES THE
PROGRAMME WITH PROTECTION
AGAINST BREAKAGES IN THE
NATIONAL SUPPLY CHAIN
Owing to the numerous logistical and access challenges
in South Sudan, it is beneficial to have emergency stock
prepositioned in programme implementation sites.
Cooperation with the MoH and local communities is
essential to ensure appropriate security and correct use
of these supplies.
ICCM trained community
drug distributor, Nyidumo
Uthur Uguak, is based in
Aroyo, Aweil Centre. She
shows her timer and beads
for assessing child patients
for pneumonia, but she also
knows how to assess and
refer children with SAM to
the OTP
30. SECTION 3
BACKG ROUN D
Conclusion
This Learning Paper has highlighted the synergy and complementary nature of
ICCM and nutrition programme approaches. While ICCM and the IMSAM have
been implemented separately in South Sudan, Malaria Consortium’s experience
of combining the two approaches has proved an effective means of reaching more
malnourished children in the community.
The addition of SAM assessment using the MUAC
tape and oedema of the feet has been shown to be
an acceptable additional activity for CDDs who are
already carrying out ICCM activities. This has meant
that these simple and quick techniques can benefit
from the strong community base already in place,
allowing large numbers of children to be screened,
admitted to the programme and treated, with
extremely promising outcomes.
The community base for ICCM and nutrition also
provides a strong foundation for establishing
preventive measures towards ensuring child survival.
To date, this base has not yet been fully developed.
More work is needed on how to build those linkages
with BCC and other health interventions (e.g.
vaccination and micronutrient supplementation
vitamin A). Pre-hunger season or six-monthly regular
house to house screening by CDDs could also be done.
Malaria Consortium’s
approach to integrate
ICCM and nutrition at
the community level
has been successful in
strengthening preventive
treatment that has
helped save lives
The approach of delivering SAM treatment as part of
the ICCM model has proven successful and supportive
to the health system, by ensuring that health facilities
are able to provide OTP services, while supplementary
community-based treatment sites improve the reach
of the programme to more remote areas. It has been
embraced by the MoH at national, state and county level
and fits within existing policy frameworks. There is
potential for this approach to be included in new policy
development currently underway in South Sudan.
Based on lessons learned by Malaria Consortium
through integrating its ICCM and SAM programmes in
South Sudan, this model has proven feasible, effective
and acceptable, saving many lives of children under
five. It is a model that can be replicated by other ICCM
partners in South Sudan and elsewhere with sufficient
government and donor support for implementation.
Community based OTP
treatment site in a remote
village in Aweil West
28 Learning Paper
32. SECTIO N 3
Recommendations
1.
MALNUTRITION RATES
In a context such as South Sudan that experiences
chronic emergency malnutrition rates, community
management of SAM should be considered as an
integral part of the ICCM delivery model. ICCM partners
in South Sudan should consider scaling up their
programmes to include community SAM management
based on Malaria Consortium’s experience.
2.
COMMUNITY TREATMENT
Community treatment of SAM through ICCM should be
included in the current policy development in South
Sudan, specifically: ICCM Guideline and Strategy,
Home Health Promoters and the final version of the
government’s IMSAM/CMAM guidelines. Careful
consideration should be paid to investigating the most
effective and sustainable way to motivate home health
promoters.
3.
MULTI-YEAR NUTRITION
In order to build and sustain capacity for the
programme there is a need for longer term, multiyear nutrition funding for this approach. To date, the
programme has only received short term, emergency
funding which impedes the opportunity for sustained
capacity building. Funding mechanisms should take
a more developmental approach, in line with ICCM
funding timeframes rather than short emergency
funding. SAM may be considered by some donors as
a response to famine situations but in the context of
political instability, and chronic and recurrent food
shortages such as exist in the Sahel belt of Africa, SAM
will occur with high prevalence even when there is no
acute emergency, such as in the Sahel region of Nigeria.
4.
MINISTY OF HEALTH
In order to support the Ministry of Health in the scale
up of this approach there should be research conducted
into the cost effectiveness of the programme and the
relative cost compared to other implementation models
currently practiced in South Sudan. This will help
decision makers decide where to allocate resources.
5.
MAM MANAGEMENT
Further exploration is required on how management of
MAM could be incorporated into the model. This should
be done through a series of evaluated pilots using food
and non-food interventions both in the community and
at health facilities.
6.
KEY PROGRAMME QUALITY INDICATOR
Programme coverage should be evaluated for access and
coverage as a key programme quality indicator showing
if the programme is actually reaching those in need. It is
expected that the decentralised delivery model will result
in high coverage, a presumption supported in part by the
low defaulting rates and death rates and high cure rate.
7. Malaria Consortium Learning Paper: Community dialogues for healthy children: encouraging communities to talk 2012
www.malariaconsortium.org/resources/publications/180/community-dialogues-for-healthy-children-encouraging-communities-to-talk
30 Learning Paper
33. 7.
BUILDING LINKS
Further work is required to build links that can be made
with cross sectoral preventive interventions including
WASH (especially improved hygiene), education, food
security and livelihoods. This should be informed by
conducting a nutrition causal analysis to understand the
factors that lead to malnutrition which can, in turn, be
targeted by interventions.
8.
REFERRAL PILOT
Based on the findings of the referral pilot, there is a need
to scale up support for a community referral system
linking outpatient to inpatient treatment for SAM and
other serious and life threatening diseases.
9.
RELAPSES
With growing numbers of relapses being admitted into
the programme in the second year, there is a need to
conduct research into the longer-term outcomes of SAM
treatment and possible related health or behavioural
factors in the family by following up on patients post
discharge.
11.
COMMUNITY LINKS
In order to maintain strong links with the community
and to ensure continued acceptance and support for
the programme, there is a need to develop systems for
community feedback and accountability.
12.
COLLABORATION
Implementing organisations need to work collaboratively
with the Ministry of Health to strengthen its capacity to
monitor and manage the SAM programme and to plan a
strategy for the handover of responsibilities.
13.
ICCM IMPLEMENTAION
This approach should be considered and adapted
for other country contexts where ICCM is being
implemented and acute malnutrition is of public health
significance.
10.
COMMUNICATION PROGRAMMES
Behaviour change communication programmes need
to be developed, perhaps using a community dialogue
approach7 to see how much of the malnutrition is due to
poor infant and young child feeding practices.
Learning Paper 31
34. BACKG ROUN D
Malaria Consortium
Malaria Consortium is one of the world’s leading non- profit organisations
specialising in the comprehensive control of malaria and other communicable
diseases – particularly those affecting children under five.
Malaria Consortium works in Africa and Southeast Asia
with communities, government and non-government
agencies, academic institutions, and local and
international organisations, to ensure good evidence
supports delivery of effective services.
Areas of expertise include disease prevention, diagnosis
and treatment; disease control and elimination; health
systems strengthening, research, monitoring and
evaluation, behaviour change communication, and
national and international advocacy.
An area of particular focus for the organisation is
community level healthcare delivery, particularly
through integrated case management. This is a
community based child survival strategy which
aims to deliver life-saving interventions for common
childhood diseases where access to health facilities
and services are limited or non-existent. It involves
building capacity and support for community level
health workers to be able to recognise, diagnose, treat
and refer children under five suffering from the three
most common childhood killers: pneumonia, diarrhoea
and malaria. In South Sudan, this also involves
programmes to manage malnutrition.
Malaria Consortium is
committed to a practical
approach that integrates
engagement between
the community and
health services, and
national and global
policy makers. It is
an approach that is
underpinned by a
strong evidence base
and driven by shared
learning within and
between countries
Malaria Consortium also supports efforts to combat
neglected tropical diseases and is seeking to integrate
NTD management with initiatives for malaria and other
infectious diseases.
With 95 percent of Malaria Consortium staff working in
malaria endemic areas, the organisation’s local insight
and practical tools gives it the agility to respond to
critical challenges quickly and effectively. Supporters
include international donors, national governments and
foundations. In terms of its work, Malaria Consortium
focuses on areas with a high incidence of malaria and
communicable diseases for high impact among those
people most vulnerable to these diseases.
www.malariaconsortium.org
Aknot Aleu Wol and her
son return home from visiting
the community OTP site,
Aweil West
32 Learning Paper
36. Malaria Consortium
Development House
56-64 Leonard Street
London EC2A 4LT
United Kingdom
Tel: +44 (0)20 7549 0210
Email: info@malariaconsortium.org
www.malariaconsortium.org
This material has been funded by UK aid from the UK government,
however the views expressed do not necessarily reflect the UK
government’s official policies