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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
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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
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