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A Nutrition Intervention in the Development Context Judiann McNulty CTC Inter-Agency Meeting 28 February 2005

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A Nutrition Intervention in the Development Context Judiann McNulty CTC Inter-Agency Meeting 28 February 2005

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    1. A Nutrition Intervention in the Development Context Judiann McNulty CTC Inter-Agency Meeting 28 February 2005

    3. % of Child Deaths Due to Effects of Malnutrition

    4. Effects of Malnutrition ?Infant & child mortality ?Morbidity ?Growth ?Psychomotor & cognitive development ?Academic performance ?Adult health & productivity ?Maternal/neonatal mortality Tim: The key words here are that LINKAGES has ‘RESULTS’ at both the mmunity & national levels Tim: The key words here are that LINKAGES has ‘RESULTS’ at both the mmunity & national levels

    5. Positive Deviance/Hearth PD/Hearth is a community-based approach to reducing malnutrition (in non-emergency settings)

    6. History Hospital treatment or none ? Mothercraft Centers ? Ti Foyer or Hearth in Haiti ? Positive Deviance/Hearth

    8. PD/Hearth Goals Prevent future malnutrition in the community Rehabilitate malnourished children Enable families to sustain improved nutritional status of child

    9. Where to do PD/Hearth? Community level Differing environments Homes in close proximity Available primary health care >30% malnutrition (weight for age) Availability of affordable food

    10. What Happens in PD/Hearth? Mobilize the community Nutritional “census” of all children <2 or 3 yrs. Identify well-nourished children of very poor families – Positive Deviants Investigate good health, feeding and caring practices of PD families Share those practices through Hearth sessions Hearth held daily for 12 days with follow-up for 2 weeks

    11. What happens at a Hearth session? On-site meal of local foods – an extra meal Caregivers bring the foods and materials Caregivers practice new feeding & hygiene behaviors, and food preparation Caregivers learn about local, affordable foods Health education Informal support group

    12. Why the Positive Deviance study? Implementers learn what is possible in that particular context Tool for local volunteers and leaders to learn that there are local solutions to malnutrition

    13. Results of PD/Hearth: About 50% of children achieve “normal” status after one session. Another 35% recover after 2 sessions

    14. Costs Staff and transport, volunteer incentives, training, equipment (cooking utensils, scales) Community contribution – site, materials, time, food Range $1.85 to $12.00 per recovered child

    15. Similarities of CTC and PD/Hearth More cost-effective rehabilitation than TFCs Increased coverage and access Community participation Use of volunteers Caregiver and child are at home Link to other essential health services Synergy with other programs to improve health and food security

    16. Contrasts

    17. Levels of Community Participation Level 4: Communities identify priorities and lead the resource seeking, action planning, implementation, and evaluation. They determine own technical support needs. Level 3: Communities and external agents jointly define priorities, identify problems, implement, and evaluate. Community members lead while external agents provide technical and organizational support. Level 2: External agents define priorities. Community members involved in problem analysis, strategy development, implementation, and evaluation. Lead role is played by external agent. Level 1: Programs are developed entirely by external agents. Communities are involved at the implementation stage as recipients of program activities.

    18. Potential of CTC for non-emergency settings Use of CTC for rehabilitation of severely acute malnourished prior to entering Hearth CTC for immuno-compromised children who can’t attend Hearth sessions

    20. Issues with Scale-up and Replication of PD/Hearth Keeping it cost-effective Maintaining the focus on behavior change Reinforcing integration within IMCI, Essential Nutrition Actions & other health interventions Maintaining quality

    21. Addressing Quality for PD/Hearth Formation of informal Technical Advisory Group Listserve PD/Hearth Implementation Guide “Essential Elements” Field training curriculum HQ staff training, TOT Consultant network and data base Integration with Primary Health Care programming Development of standard indicators for monitoring and evaluation

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