UAB Global Health Challenge

Team 8

February 20, 2010

UNICEF Conceptual Framework of Malnutrition

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Prevention

Case for Prevention

• Epidemiological Argument

– Direct Causes of Child Deaths

• Economic Argument

– Prevention vs. Treatment

• Ethical Argument

– Reliance on Treatment is Unethical

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Case for Prevention

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Women are a critical link, biologically and socially,in the well-being of households and communities.

Objective

To develop a sustainable community health program for prevention of severe acute malnutrition in the Borena Zone of the Oromiya Region, Ethiopa

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Why the Borena Zone?

• Major drought affected area

– Resulting in food shortage shortages and an increase in SAM-related disorders

• Aid organizations currently facilitating SAM treatment

– RUTFs, in clinic treatment

• Data is available for SAM within region for comparison and analysis

• Infrastructures available

– Health centers, clinics

• Communities and Universities are easily accessible

Collaborative Partners

• Ministry of Health

• Hawassa University

• VodaFone

• Hospitals and Clinics in Borena Zone:

– Negele Hospital, Yabello Health Center, Moyale Health Center

• NGOs in Borena Zone

8

Qualitative research

Certification Program

Community Health Workers-Continuing Education (2 times per year)

Certification Program Certification Program

Community Leaders

Grant given to University and Clinics

Student Training

Community Mobilization

Clinics ChurchesSchoolsWoman

Organizations

CHW Certificate:Identification and Diagnosis of SAM

• Identification and Diagnosis of SAM

– TALC Insertion Tape

• Green More than 135mm– Reasonably Nourished

• Yellow 125-135mm– Probably malnourished

• Red Less than 124mm– Almost certainly malnourished

CHW Certificate:Identification and Diagnosis of SAM

• Identification and Diagnosis of SAM

– Little energy

CHW Certificate:Prevention

• Breastfeeding– Exclusive breastfeeding for six months and continued

breastfeeding for the first year could avert 13% of the more than 10 million deaths among children ever year

– Why exclusive breastfeeding• Formula increases risk of illness and death

– Protection of the many essential

infection-fighting components of human milk

– Possible contamination of water and formula

– Diluting Formula

CHW Certificate:Prevention

• Breastfeeding

– Diarrheal Control

• Needs assessment

– Asset mapping

Timeline Proposal

• Year 1:

– Qualitative Research

– Creation of Certification Program through HU

– Application processing of 30 CHW

– Training program for CHW

– Begin field work

– Monitoring

• Year 2 and 3:

– Continue field work

– Monitoring

– Continuing Education

– Assessing Model & Data Evaluation

– Recruiting & Training for 30 additional CHWs

Budget Proposal

• $200,000- Grant for the Hawassa University• $150,000- Oromiya Regional Health Bureau for Funding to Clinics and

Hospitals in the Borena Zone• $108,000- Community Health Workers Funding:

– Year 1: $18,000– Year 2: $36,000– Year 3: $54,000

• $100,000- Equipment and Supplies– TALC Bands and Awareness Material, Mobiles

• $150,000- Costs For Initial Referrals• $100,000-Evaluations

– Formative, Process, Outcome• $92,000-Domestic Operating Costs • $100,000- Discretionary Funding

Feasibility & Sustainability

• Partner with Local Organizations, NGOs, and facilities already on ground

• Simple, focused, & not overly ambitious

• Employs locals and promotes community involvement and mobilization

• Promotes education

• Easily expandable to include more areas and could be applied to other diseases

References:

• http://www.path.org/files/IYCN_the_case_prev_mal.pdf

• http://www.unicef.org/nutrition/files/Community_Based_Management_of_Sever_Acute__Malnutirtion.pdf

• http://www.unicef.org/sowc08/docs/sowc08_panel_4_1.pdf

• http://www.ajcn.org/cgi/reprint/81/4/864

• http://www.concernusa.org/media/pdf/2007/10/Sustainability%20of%20CTC_Gatchell_WHO.pdf

• http://www.fantaproject.org/downloads/pdfs/FNB_27_3_2006_d.pdf

• http://www.ajcn.org/cgi/content/full/78/2/302

• http://heapol.oxfordjournals.org/cgi/reprint/12/2/115

• http://heapol.oxfordjournals.org/cgi/reprint/12/2/115

• http://fex.ennonline.net/34/effectiveness.aspx

• http://fex.ennonline.net/34/effectiveness.aspx

• http://www.maqweb.org/miniu/presentations/LCriglerCHW%20MiniU%202009v3.pdf

• http://www.plusnews.org/report.aspx?ReportID=85743

• http://www.most.gov.et/Health.htm#Hl6

Thank you for your attention! Questions?

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