TPS MCH Final

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Final Presentation - TPS MCH Team on July 21, 2011 in Chennai on the Concluding Day of the Trans Disciplinary Problem Solving Course: co-taught by Washington University in St. Louis and ICTPH.

Health & Medicine

Maternal & Child Health:
Healthy Families Initiative

Eprise Armstrong, Dessa Shuckerow & Audra Tafoya

July 21, 2011

Overview

The Healthy Family Initiative (HFI) is designed
to lower the prevalence of maternal nutrition-
related anaemia through social marketing
and the early introduction of a maternal
micronutrient supplement (MMS).

Overview

Background

Intervention

Implementation

Evaluation

Maternal Anaemia

Tamil Nadu Statewide
- 53% maternal anaemia1
ICTPH Catchment Area
- 59.3% of pregnant women were anaemic 2

- 50.3% of non-pregnant women were
anaemic3

Sources: NHFS-3, NHFS-2, ICTPH Epidemiological Baseline Survey

Burden of Disease

Anaemia costs an estimated 6% of
India’s GDP4
$320 in GDP/capita 5

153 million deaths world-wide6
16.152 million Daily Adjusted Life Years
(DALYs) worldwide 7

Main Determinants

Health System
- Diagnostics
- Education
Population
- Lack of access to Vitamin B/Iron rich foods
Household
- Worm infestations
- Diet

Intervention Strategies

Preparation
Education & Training
Procurement & Distribution
Diagnostics

Strategy 1: Preparation

Formative Research
- Knowledge, Attitudes, and Practices (KAPS)
- Acceptability of UN Multiple Micronutrient
International Preparation (UNIMAP)
- Development of education & marketing
materials

Strategy 2: Education & Training

Educate SVGs/CHWs
- Anaemia
- Early Pregnancy Detection
- UNIMAP/MMS
- Incentives Program
- Diagnostics
Educate women & families in their homes

Strategy 3: Procurement &
Distribution
RMHC (by nurses/staff)
- Diagnostics
- Photo calendar making equipment
- UNIMAP/MMS
- Container/Scoop
Household (by SVGs/CHWs)
- Pregnancy tests
- Educational materials
- Photo calendar

Strategy 4: Diagnostics

Early detection of pregnancy with in-home
pregnancy tests
Peripheral Blood Smears to identify specific
micronutrient deficiency
Antenatal diagnostics in 1st trimester
Woman is educated and given a copy of her
diagnostics to take to PHC

Prospective Cohort Evaluation

Phase I: includes intervention strategies occurring prior to
a woman giving birth
Phase II: includes follow up for the purposes of continued
education, training, and evaluation.

Primary Impact Objective

Lower prevalence of maternal nutrition
related anaemia by end of 2nd trimester
of pregnancy
- Measure: HGL and Peripheral Blood Smear
Test

Secondary Client Outcomes and
Indicators
Outcomes Indicators
Infant birthweight Weight at birth (self-
report)
Maternal weight gain Weight at monthly check-
ups
Infant malnutrition Height, weight, arm-
circumference
Preterm delivery Earlier than-expected
delivery
Infant anaemia HGL Levels

Process Objectives

Improved KAPs regarding early
pregnancy detection and MMS
More complete antenatal diagnostics
More complete picture of anaemia
prevalence and causes

Acknowledgements
ICTPH Staff
Vani Priya, Sangeetha Lakshmanan,
Subhalakshmi Ganguly, Deepak Rajanna,
Sabyasachi Das, Selva Swetha, and Dr. Zeena
Johar
SVGs and RMHC Staff
Residents of Karambayam

Contact Information
Eprise Armstrong, MSW
earmstrong@wustl.edu

Dessa Shuckerow, MPH/MSW
shucked@wustl.edu

Audra Tafoya, MPH
audratafoya@wustl.edu

Washington University in Saint Louis
George Warren Brown School of Social Work
One Brookings Drive - Saint Louis, MO 63130

References

1. National Family Health Survey 2005-2006 (NHFS-3: Tamil Nadu State Report). (2008). Mumbai:
International Institute for Population Sciences (IIPS) and Macro International.

2. ICTPH Epidemiological and Needs Assessment Census Survey in three villages of Rural Tamil Nadu.
(2010-2011).

3. Ibid.

4. Horton, S. (2003). The Economics of Iron Deficiency. Food Policy, 28(1), 51-75. doi: 10.1016/s0306-
9192(02)00070-2

5. Ibid.

6. The World Health Organization. (2004). WHO Annex A: Death and DALYs 2004. Annex Tables. Accessed
on 6/15/2011:
http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_AnnexA.pdf

7. Ibid.

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Medically Complex Pregnancies and Early Breastfeeding Behaviors: A Retrospective Analysis Katy B. Kozhimannil1*, Judy Jou1, Laura B. Attanasio1, Lauren K. Joarnt2, Patricia McGovern3 1 Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America, 2 Harvard University, Cambridge, Massachusetts, United States of America, 3 Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America Abstract Background: Breastfeeding is beneficial for women and infants, and medical contraindications are rare. Prenatal and labor- related complications may hinder breastfeeding, but supportive hospital practices may encourage women who intend to breastfeed. We measured the relationship between having a complex pregnancy (entering pregnancy with hypertension, diabetes, or obesity) and early infant feeding, accounting for breastfeeding intentions and supportive hospital practices. Methods: We performed a retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011–2012 in a US hospital (N = 2400). We used logistic regression to examine the relationship between pregnancy complexity and breastfeeding. Self-reported prepregnancy diabetes or hypertension, gestational diabetes, or obesity indicated a complex pregnancy. The outcome was feeding status 1 week postpartum; any breastfeeding was evaluated among women intending to breastfeed (N = 1990), and exclusive breastfeeding among women who intended to exclusively breastfeed (N = 1418). We also tested whether breastfeeding intentions or supportive hospital practices mediated the relationship between pregnancy complexity and infant feeding status. Results: More than 33% of women had a complex pregnancy; these women had 30% lower odds of intending to breastfeed (AOR = 0.71; 95% CI, 0.52–0.98). Rates of intention to exclusively breastfeed were similar for women with and without complex pregnancies. Women who intended to breastfeed had similar rates of any breastfeeding 1 week postpartum regardless of pregnancy complexity, but complexity was associated with .30% lower odds of exclusive breastfeeding 1 week among women who intended to exclusively breastfeed (AOR = 0.68; 95% CI, 0.47–0.98). Supportive hospital practices were strongly associated with higher odds of any or exclusive breastfeeding 1 week postpartum (AOR = 4.03; 95% CI, 1.81– 8.94; and AOR = 2.68; 95% CI, 1.70–4.23, respectively). Conclusions: Improving clinical and hospital support for women with complex pregnancies may increase breastfeeding rates and the benefits of breastfeeding for women and infants. Citation: Kozhimannil KB, Jou J, Attanasio LB, Joarnt LK, McGovern P (2014) Medically Complex Pregnancies and Early Breastfeeding Behaviors: A Retrospective Analysis. PLoS ONE 9(8): e104820. doi:10.1371/journal.pone.0104820 Editor: Katariina Laine, Oslo Uni ...

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TPS MCH Final

1. Maternal & Child Health: Healthy Families Initiative Eprise Armstrong, Dessa Shuckerow & Audra Tafoya July 21, 2011

2. Overview The Healthy Family Initiative (HFI) is designed to lower the prevalence of maternal nutrition- related anaemia through social marketing and the early introduction of a maternal micronutrient supplement (MMS).

3. Overview Background Intervention Implementation Evaluation

4. Background

5. Maternal Anaemia Tamil Nadu Statewide - 53% maternal anaemia1 ICTPH Catchment Area - 59.3% of pregnant women were anaemic 2 - 50.3% of non-pregnant women were anaemic3 Sources: NHFS-3, NHFS-2, ICTPH Epidemiological Baseline Survey

6. Burden of Disease Anaemia costs an estimated 6% of India’s GDP4 $320 in GDP/capita 5 153 million deaths world-wide6 16.152 million Daily Adjusted Life Years (DALYs) worldwide 7

7. Main Determinants Health System - Diagnostics - Education Population - Lack of access to Vitamin B/Iron rich foods Household - Worm infestations - Diet

8. Intervention

10. Intervention Strategies Preparation Education & Training Procurement & Distribution Diagnostics

11. Strategy 1: Preparation Formative Research - Knowledge, Attitudes, and Practices (KAPS) - Acceptability of UN Multiple Micronutrient International Preparation (UNIMAP) - Development of education & marketing materials

12. Strategy 2: Education & Training Educate SVGs/CHWs - Anaemia - Early Pregnancy Detection - UNIMAP/MMS - Incentives Program - Diagnostics Educate women & families in their homes

13. Strategy 3: Procurement & Distribution RMHC (by nurses/staff) - Diagnostics - Photo calendar making equipment - UNIMAP/MMS - Container/Scoop Household (by SVGs/CHWs) - Pregnancy tests - Educational materials - Photo calendar

14. Strategy 4: Diagnostics Early detection of pregnancy with in-home pregnancy tests Peripheral Blood Smears to identify specific micronutrient deficiency Antenatal diagnostics in 1st trimester Woman is educated and given a copy of her diagnostics to take to PHC

15. Prospective Cohort Evaluation Phase I: includes intervention strategies occurring prior to a woman giving birth Phase II: includes follow up for the purposes of continued education, training, and evaluation.

16. Primary Impact Objective Lower prevalence of maternal nutrition related anaemia by end of 2nd trimester of pregnancy - Measure: HGL and Peripheral Blood Smear Test

17. Secondary Client Outcomes and Indicators Outcomes Indicators Infant birthweight Weight at birth (self- report) Maternal weight gain Weight at monthly check- ups Infant malnutrition Height, weight, arm- circumference Preterm delivery Earlier than-expected delivery Infant anaemia HGL Levels

18. Process Objectives Improved KAPs regarding early pregnancy detection and MMS More complete antenatal diagnostics More complete picture of anaemia prevalence and causes

19. Acknowledgements ICTPH Staff Vani Priya, Sangeetha Lakshmanan, Subhalakshmi Ganguly, Deepak Rajanna, Sabyasachi Das, Selva Swetha, and Dr. Zeena Johar SVGs and RMHC Staff Residents of Karambayam

20. Contact Information Eprise Armstrong, MSW earmstrong@wustl.edu Dessa Shuckerow, MPH/MSW shucked@wustl.edu Audra Tafoya, MPH audratafoya@wustl.edu Washington University in Saint Louis George Warren Brown School of Social Work One Brookings Drive - Saint Louis, MO 63130

21. References 1. National Family Health Survey 2005-2006 (NHFS-3: Tamil Nadu State Report). (2008). Mumbai: International Institute for Population Sciences (IIPS) and Macro International. 2. ICTPH Epidemiological and Needs Assessment Census Survey in three villages of Rural Tamil Nadu. (2010-2011). 3. Ibid. 4. Horton, S. (2003). The Economics of Iron Deficiency. Food Policy, 28(1), 51-75. doi: 10.1016/s0306- 9192(02)00070-2 5. Ibid. 6. The World Health Organization. (2004). WHO Annex A: Death and DALYs 2004. Annex Tables. Accessed on 6/15/2011: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_AnnexA.pdf 7. Ibid.

22. Thank you

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