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Ida Ppd Final Presentation

An example of my ability to identify potential needs in the community, conduct program planning, and budget management.

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Ida Ppd Final Presentation

  1. 1. Iron Deficiency Anemia & Postpartum Depression: Is there a link? Evidence, consequences, and interventions Tricia Heidelbaugh April 23, 2009 GCH 530 Dr. Constance Gewa George Mason University
  2. 2. Introduction and Causes <ul><li>According to the World Health Organization (WHO, 1992), iron deficiency is the most common single nutrient deficiency in the world affecting approximately over 50% of women of reproductive age. </li></ul><ul><li>This places women in a precarious health situation as they often enter pregnancy with low levels of iron in their blood. </li></ul><ul><li>During pregnancy, the growing fetus’ needs can decrease the blood iron level. This leaves less hemoglobin circulating and available for brain function and less iron for the body to absorb. </li></ul><ul><li>Blood loss during childbirth and the time it takes for the body to return to normal levels of hemoglobin could cause anemia. </li></ul>
  3. 3. Introduction and Causes Continued <ul><li>Infection can inhibit the body’s ability to absorb the iron even if the diet has adequate nutrients. </li></ul><ul><li>Conversely, anemia can be attributed to poor diets where food security is compromised and access to iron rich foods is an issue. </li></ul><ul><li>Not surprisingly, research has shown a correlation between families of low socio-economic status and the consumption of a diet that lacks nutrients the body requires (Darmon, 2008). </li></ul><ul><li>Additionally, postpartum women of low socioeconomic status have a higher prevalence and duration of iron deficiency anemia versus postpartum women living above the poverty line (Bodnar et al., 2001). </li></ul><ul><li>Note: About 97% of the records used in the above retrospective study consisted of data from women in the WIC program. </li></ul>
  4. 4. Links <ul><li>According to the National Anemic Action Council (NAAC, 2008), mothers with postpartum anemia are at increased risk for postpartum depression compared to non-anemic mothers. </li></ul><ul><li>This position is supported by a study where the results suggest that early postpartum anemia is a significant risk factor for postpartum depression (Corwin, Murray-Kolb, Beard, 2003). </li></ul><ul><li>Interestingly, iron deficiency anemia and postpartum depression present similar symptoms such as fatigue and apathy. </li></ul>
  5. 5. Consequences <ul><li>In a study consisting of a cohort of depressed mothers, biochemical, psychological, and behavioral impairment affected the ability to interact with their infants (Field, 1998). Furthermore, the infants of the depressed mothers, showed developmental and growth delays at one year of age. </li></ul><ul><li>The infant does not form a bond with the depressed mother and in later years, misconduct, aggression, and cognitive and attention deficits can occur in the exposed children (Ryan, 2005). </li></ul>
  6. 6. Consequences Continued <ul><li>These conditions can affect a woman’s ability to return to full functionality socially and in the workplace (Troy, 2007) </li></ul><ul><li>Economically, this can affect the ability to meet the basic needs of the family. </li></ul><ul><li>If these depressive symptoms continue long-term, it can become a cycle of poverty that continues for subsequent generations (Wickrama, 2008). </li></ul>
  7. 7. Interventions <ul><li>Zlotnick et al. (2001) studied the effectiveness of a group intervention program for women with postpartum depression who were on public assistance; in particular, the Women, Infants, Children (WIC) program. </li></ul><ul><li>The group consisted of only thirty-seven women and the group therapy lasted for four weeks with one session per week. However, the results showed a significant difference in the outcomes. Of the women who were not assigned to a therapy group, six had developed a major postpartum depression. Of the women who were in a therapy group, none of the women were developed depression. </li></ul><ul><li>Although this study has its limitations, it does show that positive change can take place when there is the support of others in a group situation. </li></ul><ul><li>This group of low-income women may be much more responsive to group intervention as many may feel they do not have much support in their daily lives. </li></ul>
  8. 8. Proposed Intervention <ul><li>Based on studies showing the correlation among low income women and anemia and postpartum depression, WIC participants seem the logical choice for an intervention. </li></ul><ul><li>Therefore, provide a program in addition to and builds upon what is currently offered by WIC. </li></ul><ul><li>WIC has permanent federal funding, is based on education of the participants, and creates additional programs if the need arises. </li></ul>
  9. 9. The Program <ul><li>I propose an on-going, self-contained program that would consist of (50) one hour sessions/classes a year taking place once a week allowing two weeks off for holidays. </li></ul><ul><li>The assumption is that there is a perfect space available to offer this program in light of the variety of office spaces where the WIC centers are located. </li></ul><ul><li>As WIC relies on federal funds and the money is movable among WIC centers, this program can expand to more centers so it is convenient for all of the WIC participants. </li></ul><ul><li>This goal of this program is to not only address reducing and detecting postpartum depression and anemia, but incorporating other activities that contribute to a woman and her family’s well-being. </li></ul>
  10. 10. Screening and Evaluation-Anemia <ul><li>Currently, a woman applying for the WIC program is required at the initial meeting to submit to a finger prick to test for anemia. </li></ul><ul><li>Approximately six months later, the woman will have a blood sample taken again during the recertification process. </li></ul><ul><li>For my proposed program, a blood sample would be required once a month to track changes in the woman. It could be an early indicator of postpartum depression that might otherwise not be detected. </li></ul><ul><li>Studies have shown that low hemoglobin and serum ferritin levels can be associated with the development of PPD (Vahdat et al., 2007; Corwin, 2003) </li></ul>
  11. 11. Screening and Evaluation-PPD <ul><li>Currently, there is no formal screening that takes place for postpartum depression for a woman applying for and participating in the WIC program. </li></ul><ul><li>That is, except for a question asking if the woman has a history of depression. </li></ul><ul><li>If the counselor determines that a woman is depressed, an immediate referral is required. </li></ul><ul><li>I propose that the Edinburgh Postnatal Depression Scale (EPSD) could be completed when registering for the program on the first visit to detect for depression. This questionnaire could be completed once a month in addition to the blood sample. </li></ul><ul><li>For something so problematic, there should be a formal screening tool assist the counselors as they see the WIC participants on a more regular basis than a woman’s primary care team. </li></ul>
  12. 12. Sessions/classes <ul><li>These class topics should be based on the empowerment, education, and ability to bring positive change into the lives of the postpartum WIC participant. </li></ul><ul><li>The classes could be determined by the team of experts in regular meetings. </li></ul><ul><li>Topics could include, cooking classes and meal plans based on iron rich foods from a variety of cultures depending of the target population, stress management, parenting, relationships, meditation, gentle fitness classes. </li></ul><ul><li>Since the program is on-going, there should be some predictability especially if results are being achieved. However, there should also be room for variety and presenting new topics based on the need. </li></ul>
  13. 13. Tracking Participants <ul><li>Each postpartum woman would have her own file which be held at the WIC center. </li></ul><ul><li>Since this is different and separate from the food instrument program, the paperwork would be completed by the participant and the person leading the session that week. </li></ul><ul><li>The necessary paperwork includes, but is not limited to: health history, informed consent, chart for tracking blood chemistry, EPSD questionnaires, chart for tracking session attended and the date attended, class evaluation completed by participants. </li></ul>
  14. 14. Personnel <ul><li>Since this program is separate from the regular WIC food incentive program, requires the maintenance of paperwork, and supervising of employees, it would be recommended to have a program administrator to complete these duties. </li></ul><ul><li>This person would oversee the employees who present the weekly classes. Depending on the topic, the expertise could vary. Examples of class presenters are a chef, a fitness specialist, a yoga teacher, a life coach, psychiatrist, etc. </li></ul>
  15. 15. Other Considerations <ul><li>Currently, as mentioned before, a woman is immediately referred if she has PPD. If a psychiatrist was on staff, there could be close monitoring of a woman and her mental condition. Furthermore, she might be more inclined to adhere to a referral if it is “in house” versus making an extra visit to an outside doctor. </li></ul><ul><li>Further increasing the likelihood of participation would be to have childcare available at the WIC center at the same time as the sessions. This would be an opportunity to affect the next generation in a positive way. The sessions with children would have to be age appropriate, but could be nutrition education, exercise through play, positive self-esteem education, stress management, and yoga, to name a few. </li></ul>
  16. 16. Budget <ul><li>Program manager- 15 hours a week at $30 per hour for 50 weeks……………………………………………………………………………………...$22,500 </li></ul><ul><li>Weekly sessions-2 hours a week (class and admin time) </li></ul><ul><li>at $20 per hour for 50 weeks…………………………………………..…………..$2,000 </li></ul><ul><li>Psychiatrist- 2 hours a week at $200 per hour for 50 weeks plus staff meetings…………………………………………………………………………………..$24,800 </li></ul><ul><li>Paperwork and miscellaneous supplies/equipment…………………….…...$3,000 </li></ul><ul><li>Training of experts/presenters and meetings- based on 10 staff members </li></ul><ul><li>at $20 per hour meeting once a month for 2 hours………….……………..$2,400 </li></ul><ul><li>Cushion for unforeseen supplies/ideas/staff………….…………………….…$4,000 </li></ul><ul><li> </li></ul><ul><li> Total...$58,700 </li></ul>
  17. 17. Budget Continued <ul><li>Note: If WIC chooses to offer childcare that has to be added to the program budget on the previous slide. </li></ul><ul><li>Two childcare employees at $15 per hour for 2 hours per week </li></ul><ul><li>for 50 weeks…………………………….………………………………………………..…$300 </li></ul><ul><li>Staff meetings for 2 hours a month for 10 months at $15 per hour </li></ul><ul><li>for the two childcare employees……………………………..…………………..….$600 </li></ul><ul><li>Total…....$3600 </li></ul><ul><li>Adult program total…….…$58,700 </li></ul><ul><li> Adjusted total……….$62,300 </li></ul>
  18. 18. Questions for consideration <ul><li>Should the program be voluntary or conditional to increase participation? </li></ul><ul><li> Perhaps voluntary initially until feedback is received. </li></ul><ul><li>Should significant others/partners/family members be able to attend? </li></ul><ul><ul><li>If space allows, this could increase adherence and the participants’ </li></ul></ul><ul><ul><li>success. </li></ul></ul><ul><li>Should anemic women with no signs of PPD be allowed to participate in the program? </li></ul><ul><ul><li>Although a woman receives nutritional education from a counselor </li></ul></ul><ul><ul><li>if identified as anemic, if space is available, she should be allowed </li></ul></ul><ul><ul><li>if interested. </li></ul></ul>
  19. 19. References <ul><li>Bodnar, L.M., Scanlon, K.S., Freedman, D.S., Siega-Riz, A.M., Cogswell, M.E. (2001) </li></ul><ul><li>High Prevalence of Postpartum Anemia Among Low-Income Women in the United States. Am. J. Obstet. Gynecol., 185 (2): 438-443. </li></ul><ul><li>Corwin, E., Murray-Kolb, L., Beard, J. (2003) Low Hemoglobin Level is a Risk Factor </li></ul><ul><li>for Postpartum Depression. J. Nutr. 133 , 4139-4142. </li></ul><ul><li>Damon, N., Drewnowski, A. (2008) Does Social Class Predict Diet Quality? Am. J. Clin. Nut. 87 , 1107-17. </li></ul><ul><li>Field, T. (1998). Early Interventions for Infants of Depressed Mothers. Pediatrics, 102 (5):1305-10. </li></ul><ul><li>National Anemia Action Council. (NAAC) (2008, October 9). Women and anemia- Childbirth and postpartum anemia. Retrieved February 22, 2009, from patients/feature-articles/content.php?contentid = 000276&amp;sectionid=00015 </li></ul><ul><li>Troy, N.W. (2003) Is the Significance of Postpartum Fatigue Being Overlooked in the </li></ul><ul><li>Lives of Women? MCN Am. J. Matern. Child. Nurs ., 28 , 252-257. </li></ul><ul><li>Vahdat Shariatpanaahi, M., Vahdat Shariatpanaahi, Z., Moshtaaghi, M., Shahbaazi, S.H., Abadi, A.  (2007) The Relationship Between Depression and Serum Ferritin Level.  Eu. J. Cl. Nutr . , 61, 532-535.   </li></ul><ul><li>Wickrama, K.A., Conger, R.D., Lorenz, F.O., Jung, T. (2008) Family Antecedents and Consequences of Trajectories of Depressive Symptoms from Adolescence to Young Adulthood: A Life Course Investigation. J. Health Soc. Behav., 49 (4), 468-83 </li></ul><ul><li>World Health Organization. (WHO) (1992) The prevalence of anemia in women: A tabulation of available information , 2nd ed. Retrieved February 22, 2009, from </li></ul><ul><li> </li></ul><ul><li>Zlotnick, C., Johnson, S.L., Miller, I.W., Pearlstein, T., Howard, M. (2001) Postpartum Depression in Women Receiving Public Assistance: Pilot Study of an Interpersonal-Therapy-Group Intervention. Am. J. Psy. 158(4), 638-640. </li></ul>