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Nutritional Support for Children Born to Mothers living with HIV Kara, Togo, West Africa Jennifer Schechter, Andrea Hobby, Jen Taylor, Amy Baisden March 15, 2011. Photo credit: Jared Macary. Overview. Background Problems and Plan Objectives and Training

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slide1

Nutritional Support for Children Born to Mothers living with HIV

Kara, Togo, West Africa

Jennifer Schechter, Andrea Hobby, Jen Taylor, Amy Baisden

March 15, 2011

Photo credit: Jared Macary

slide2

Overview

  • Background
  • Problems and Plan
  • Objectives and Training
  • Supervision, Monitoring and Evaluation
slide3

Meet Irene

Photo credit: Jared Macary

slide5

Background

Demographics: 6.8 million people

Political: Long history of political corruption; Major donor governments withdrew 1990’s; Non-violent coup 2005; Presently transition to democracy

Socioeconomic: GDP per capita $900; 65% employed in agriculture; 60% have access to water (compared to 82% in neighboring Ghana)

Foreign Assistance: Financial development assistance for Health $23, compared to $202 in Ghana in 2007

Photo credit: Wikipedia

slide7

Kara Region

  • Northern Togo
  • Population:  669,000
  • Association Espoir pour Demain (AED-Lidaw)
  • Clinics in 4 of 7 sub-regions in cities of 
    • Kara -- pop: 100,400
    • Bafilo -- pop: 18,400
    • Ketao -- pop: unknown
    • Kande -- pop: 9, 600
slide8

Association Espoir pour Demain

Photo credit: Jared Macary

community structure
Community Structure

Photo credit: Jared Macary

slide11

Needs Assessment

Photo credit: Jared Macary

slide12

HIV Positive Mothers

and their Infants

  • HIV can be transmitted through breast milk
  • Studies have shown poor outcomes for non-breastfed newborns of HIV positive mothers
  • Prenatal transmission of HIV is associated with decreased body weight, length and head circumference
  • 48% of children are Exclusively breastfed (<6 months)
  • 70% of children are breastfed with complementary food (6-9 months)
slide14

Problems

  • HIV positive women fear transmitting HIV through breastfeeding.
  • Togo MOH recommendations do not match the WHO guidelines and women receive conflicting counseling
    • ARV'sare provided by the government
  • If a woman is going to stop breastfeeding she needs to be able to provide for the nutritional needs of her child
    • Formula and milk are expensive
    • Pumping, heat treating and storing milk is difficult and often unsanitary
  • Risks to infants associated with early breastfeeding cessation:
    • Neglect, Distress, Loss of appetite, Diarrhea, Malnutrition
  • In Togo, 20% of children under 5 are undernourished
    • 21% are underweight
    • 6% suffer from wasting
    • 27% suffer from stunting
slide16

Our Plan

  • nutrition training
  • enriched flour
  • nutrition assessments
    • children < 2 years
slide17

Objectives

Training Mothers/Families/Caregivers

  • By the end of the project 75% of HIV positive pregnant women and mothers/caregivers with children under 24 months participating in the pMTCT HIV program will attend a half-day community training session each month at the clinic regarding nutrition and other revolving pertinent topics.
    • Output indicator - # in attendance
slide18

Objectives continued

Training Providers and Health Workers

  • By the end of the project, 95% of the facility providers/health workers interacting with HIV positive pregnant women/mothers of children under the age of 2 years will attend a 3-day training regarding the importance of proper nutrition for children.
    • Output indicator - # of providers/health workers in attendance
  • By the end of the project, 95% of the facility providers/health workers interacting with HIV positive pregnant women/mothers of children under the age of 2 years will effectively counsel women on the on the importance of proper nutrition for children.
    • Output indicator - # of women reporting having received counseling
slide19

Objectives continued

Nutrition

  • By the end of the project 90% of HIV positive mothers participating in the pMTCT HIV program with children 6-24 months will serve their children enriched flour porridge. 
    • # of women reporting serving porridge
  • By the end of the project 90% of fewer children born to HIV positive mothers enrolled in the pMTCT program will show physical signs of undernourishment.
    • # of children with signs of undernourishment
slide20

Inputs

Outputs

Activities Participation

Outcomes – Impact

Short Term Long Term Impact

# of trained mothers/families

Training

Mothers/Families

# of women correctly making porridge

# of women/families and health workers recognizing the benefits of proper nutrition

Reduced infant/under 2 morbidity and mortality

Staff Time

Classroom and Demo Supplies

Incentives for Participation

Ingredients for Porridge

# of trained health workers

# of women receiving nutrition counseling

Supervision

Health Workers

# of women/families and health workers recognizing signs of

under-nourishment

Empowered Women

# of women serving porridge to their children

Assessment

Children < 2

Reduced # of children with signs of

under-nourishment

# of children assessed in clinic

slide21

Training – Mothers and Other Caregivers

  • Participants will meet monthly
  • A nutritional topic will be discussed at each monthly meeting including: 
      • fluid needs 
      • nutrient rich local food sources
      • feeding frequency 
      • breastfeeding duration
      • weaning techniques
  • Demonstration - every six months including making nutrient rich porridge.
  • Monthly meeting with doctor where women are given fortified flour for porridge and baby assessed.
slide22
3 day in-service to train medical staff regarding:

Current breastfeeding recommendations

Nutritional needs of breastfed and non-breastfed infants.

Follow-up workshop every 6 months to address additional questions and issues that may arise.

Training – Providers and Health Workers