team 2 case study
TRANSCRIPT
Biyyoolessaii Ija Biyyoolessaii Ija MukaaMukaa
“Fruit of the “Fruit of the Land”Land”
Team 2Team 2Devin Broadwater, Karen Hamby, Devin Broadwater, Karen Hamby, Naomi Chen, Amanda Hasseltine, Naomi Chen, Amanda Hasseltine,
Bernice BoursiquotBernice BoursiquotOnline Image. 07 November 2009. EthioGardian.com
Presentation OutlinePresentation Outline
Demographics on OromiyaDemographics on Oromiya
Meet the Adabbos, an Average Oromo familyMeet the Adabbos, an Average Oromo family
Child Malnutrition and Its FactorsChild Malnutrition and Its Factors
Strategy to Combat Child Malnutrition Strategy to Combat Child Malnutrition Emergency Food AidEmergency Food Aid Comprehensive ApproachComprehensive Approach Allocation of FundsAllocation of Funds
SummarySummary
Oromiya Region Oromiya Region BackgroundBackground
DemographicsDemographics 27 Million People27 Million People 4.8 People Per Household4.8 People Per Household Ethnic GroupsEthnic Groups
87.8% Oromo87.8% Oromo 7.22% Amhara7.22% Amhara
ReligionReligion 48.2% Christian48.2% Christian
Orthodox and Orthodox and ProtestantProtestant
47.5% Muslim47.5% Muslim 88.7% Rural Inhabitants88.7% Rural Inhabitants
Current Health CrisisCurrent Health Crisis
34.4% of Children under 34.4% of Children under the age of five are the age of five are underweightunderweight
Estimated 126,000 Estimated 126,000 children are in need of children are in need of urgent therapeutic care urgent therapeutic care for severe malnutrition in for severe malnutrition in EthiopiaEthiopia This number is expected This number is expected
to climbto climb Ethiopia is rated the sixth Ethiopia is rated the sixth
worst country in terms of worst country in terms of nutritional outcomes nutritional outcomes worldwide.worldwide.
Central Statistical Agency (CSA) of Ethiopia, 2007
Meet the AdabbosMeet the Adabbos
The World Factbook 2009. Washington, DC: Central Intelligence Agency, 2009. https://www.cia.gov/library/publications/the-world-factbook/index.htmlOnline image. PBS.org
Online image. Current food shortages in Ethiopia. (2009) http://news.bbc.co.uk/2/hi/8319741.stm
Identifying Cases of Identifying Cases of Severe Acute Severe Acute MalnutritionMalnutrition
Children with mid-upper arm circumference (MUAC) <11cm or Children with mid-upper arm circumference (MUAC) <11cm or bilateral leg pitting edema referred to regional health centers bilateral leg pitting edema referred to regional health centers weight for height. Children with weight for height less than weight for height. Children with weight for height less than 85% of median national center for health statistics (NCHS) 85% of median national center for health statistics (NCHS) classified as having Severe Acute Malnutritionclassified as having Severe Acute Malnutrition Advantages:Advantages:
Practice currently in usePractice currently in use Independent of ageIndependent of age Simple, low cost technologySimple, low cost technology Low stress on children and caregiversLow stress on children and caregivers Accurate Accurate Highly sensitive and specific Highly sensitive and specific
Recommendation: increase usage of MUAC measurementsRecommendation: increase usage of MUAC measurements
Belachew, T, & Nekatibeb, H. (2007). Assessment of outpatient therapeutic programme for severe acute malnutrition in three regions of Ethiopia. East African Medical Journal. Amsalu, S & Tigabu, Z. (2008). Risk factors for severe acute malnutrition in children under the age of five: A case-control study. Ethiop.J.Health Dev.
Black. “Framework of the relations of poverty, food insecurities, and other underlying and immediate causes to maternal and child malnutrition and its short-term and long-term consequences” Maternal and Child Undernutrition.
Cholera Cholera OutbreakOutbreakAugust 8August 8thth 2009 2009
The shaded region The shaded region indicates the area of indicates the area of outbreak.outbreak.
Online image. Zones affected with the cholera are highlighted in red (the current map of Oromia). Ethiopia: Cholera and Severe Acute Malnutrition Ravage Oromia
The Three SectionsThe Three Sections
WestWest•Generally Food Stable Generally Food Stable •Without CholeraWithout Cholera
SouthSouth•Highly Food InsecureHighly Food Insecure•Without CholeraWithout Cholera
NorthNorth•Highly Food InsecureHighly Food Insecure•With CholeraWith Cholera
Current TrendCurrent Trend
The 1 million dollar The 1 million dollar question (USD)?question (USD)?
How can severe acute malnutrition be How can severe acute malnutrition be sustainably reduced in the Oromiya region of sustainably reduced in the Oromiya region of
Ethiopia with 1 USD million?Ethiopia with 1 USD million?
The Two-Pronged The Two-Pronged StrategyStrategy
Emergency Food AidEmergency Food Aid Comprehensive Comprehensive ApproachApproach
Emergency Food AidEmergency Food Aid
Ready to use therapeutic foods (RUTFs) are currently distributed in Ethiopia
•High rate of acceptance•Distributed by government, Doctors Without Borders, and other non-governmental organizations (NGOs)
Immediate response to current Ethiopia conditions•Results:
•Point of entry•Local acceptance
•Requirement:•Using available infrastructure to deliver RUTFs•Coordinate with work of NGO’s within the region
Belachew, T, & Nekatibeb, H. (2007). Assessment of outpatient therapeutic programme for severe acute malnutrition in three regions of Ethiopia. East African Medical Journal.
Comprehensive Targeted Comprehensive Targeted ApproachApproach
Develop local RUTF’s—”Fruit of the land”Develop local RUTF’s—”Fruit of the land” Local farmersLocal farmers
Training of CHA’sTraining of CHA’s Community membersCommunity members
Radio Soap OperaRadio Soap Opera Mass communication, disseminationMass communication, dissemination
Time Emergency /Imported
RUTFs
Local RUTFs Community Health
Advisors
Soap Opera Accountability and Evaluation
1-3 months Evaluate current
partner NGO efforts
Focus groups
Identify farmers, formulas
Stockpile food-secure area crops
Recruit CHA’s
-- Ethics clearance
Assess distrib.
Adapt local RUTF “chain”
3-6 months Start efficacy trial
Start efficacy trial with several
formulas
Create curriculum
-- Baseline statistics
Local distribution
feasibility
6-9 months Analyze results
Discontinue
Analyze results
Plant for next season
Training -- Intervention impact
AssessmentAssessment
Time Emergency /Imported
RUTFs
Local RUTFs Community Health
Advisors
Soap Opera Accountability and Evaluation
9-12 months -- Local crop farming,
production
Educating community
Local economic initiatives
Identify radio
stations, recruit talent
Harvest trends
Economic stability
indicators
12-18 months -- Same as above
Same as above
Quality assurance
Training new CHA’s
Preliminary scripts
Same as above
Fidelity of CHA training
Concept testing
18-24 months -- Same as above
Same as above
Recording Same as above
ImplementationImplementation
ReplicationReplicationTime Emergency /
Imported RUTFs
Local RUTFs Community Health
Advisors
Soap Opera Accountability and Evaluation
3 years -- Local crop farming,
production
Educating community
Local economic initiatives
Training new CHA’s
Broadcast Evaluate media reach,
impact
Crop sustainability
Child nutrition indicators
5 years -- Same as above
Same as above Fundraising to record
new episodes
Same as above
10 years -- Same as above
Same as above Syndication Same as above
Expected InterventionExpected Intervention
Allocation Of FundsAllocation Of FundsShort Term – 15%Short Term – 15%
Import Tax 20-50% of cost
Short Term
$150,000
RUFTs $77,700
Cost of RUTFs $77,700
Internal Shipment $22,300
Internal travel & distribution $20,000
Efficacy evaluation/ research $30,000
Allocation Of Funds Allocation Of Funds Long Term – 85%Long Term – 85%
Long Term
$850,000
Education/ CHAs $340,000
Acceptance of paying for supplements
Sanitation
Breastfeeding/ Child feeding practices
Family Planning
Female Empowerment
Malnutrition screening (bangle)
Soap Opera
$85,000
Accountability & Evaluation
$85,000
Local RUTFs
$340,000
SummarySummary
Child malnutrition is a multi-faceted issueChild malnutrition is a multi-faceted issue Requires:Requires:
Comprehensive, long-term approachComprehensive, long-term approach Community involvement Community involvement
Four components :Four components : Initial importation of RUTF’sInitial importation of RUTF’s Training Oromiyan farmers to produce local Training Oromiyan farmers to produce local
RUTFsRUTFs Training CHA’s to educate mothers on proper Training CHA’s to educate mothers on proper
feeding practicesfeeding practices Health soap opera broadcastingHealth soap opera broadcasting