Control of Diarrheal Disease. 35% level of effort. Objectives are to:
Control of Diarrheal Disease. Activities in CDD form an integral part of the IMCI strategy currently being implemented as part of MOH policy in Nicaragua. The CS Project focused on improving both clinical and home management of diarrhea cases, with the provision of ORS and chlorine tablets through community Base Houses. The results from the KPC Survey show increases for all the Control of Diarrhea Disease (CDD) objectives, indicating that project strategies were effective. There was a significant decrease in the number of mothers who gave less food or withhold food during diarrhea episodes, from 39% to 9.3%, far exceeding the goal of 15%. The number of children with diarrhea during the two weeks prior to the survey that received more liquids increased by 14.7% (from 24% to 34.7%), however fell short of the project goal of 50%. Regarding the number of mothers who can list 3 signs of dehydration and 2 signs of severe diarrhea, percentages rose by 16% and 67% respectively, a dramatic change from the baseline figure of 2.1%.
Control of Diarrheal Disease. In order to improve the control and management of Diarrheal disease MTI promoted key home practices at the household level, as described in the Grant Proposal for the Grand Cape Mount Child Survival Project: Washing hands with soap after defecation, after handling children's feces, before preparing food, and before feeding children or eating Sanitary disposal of human feces, including feces of young children Protection of drinking water from contamination Treatment of water in the household, e.g., with chlorine solution, filtration, or boiling Safe food handling and storage to prevent food-borne illnesses The early use of available home fluids, including rice water, coconut water, and ORS Continued breastfeeding, frequent feeding of small amounts of food, and catch-up feeding Recognition of danger signs of diarrhea that require immediate care from an appropriate provider (dehydration, dysentery, and persistent diarrhea) Project activities for malaria focused on the prevention of malaria with community education on, use of Insecticide Treated Nets (ITNs), Intermittent Preventative Treatment (IPT) for pregnant women, and adherence to treatment protocols. ITNs were distributed through the HFs. Malaria assessment, classification and treatment were included in clinical IMCI training and follow-up. Artemisinin-based combination therapies (ACTs) are the most effective drugs currently available for treating malaria. The project worked with the Ministry of Health and Social Welfare (MOHSW), National Drug Service (NDS) and GIK sources to ensure adequate pharmaceutical availability, and worked with the MOHSW to ensure that health care workers were trained in their use. In addition to the IMCI activities previously mentioned, the project is also focused on immunization through the following activities outlined in the Grant Proposal for the Grand Cape Mount Child Survival Project: Created demand for EPI services by supporting HHPs in mobilizing the community and include a message about bringing sick children for immunizations Provided logistical support during National Immunization Days (vehicle, fuel) Advocated for the implementation of routine (continuous) EPI services The project identified gaps in training to effectively use and maintain the cold chain. Strengthened the logistics system by training HF staff in inventory management and drug forecasting Reduced missed opportunities for updating immunizations through IMCI HHPs were traine...
Control of Diarrheal Disease. Mothers of children 0-23 months who correctly describe how to prepare ORS - 77.1 80 Children 0-23 months who are fully vaccinated 51 69.5 71
Control of Diarrheal Disease. Mothers of children 0-23 months who correctly describe how to prepare ORS - 77.1 80 Children 0-23 months who had diarrhea within the last 2 weeks who had received ORS or other home fluids 25.2 - 75 Improving Immunization/Other Service Coverage Children 0-23 months who have an Immunization Card 49 90.7 80 Mothers of children 0-23 months who reported attending at least three ante-natal consultations during their last pregnancy 14 55.9 60 Mothers of children 0-23 months who reported having been attended by a trained health worker during the last childbirth/assisted Childbirth. 68.6 65.1 80
Control of Diarrheal Disease. Mothers of children 0-23 months who correctly describe how to prepare ORS - 77.1 80 Children 0-23 months who are fully vaccinated 51 69.5 71 Mothers of children 0-23 months who reported receiving at least 2 doses of TT during their last pregnancy 24.1 79.0 60 Mothers of children 0-23 months who reported attending at least three ante-natal consultations during their last pregnancy 14 55.9 60 Mothers of children 0-23 months who reported having been attended by a trained health worker during the last childbirth/assisted Childbirth. 68.6 65.1 80 Mothers of children 0-23 months who reported having received Vitamin A within 40 days of birth of the last child - 40.1 60
Control of Diarrheal Disease. Among women of children age 0-23 months, knowledge of oral rehydration therapy (ORT) has increased by 13% (from 45% to 58%). Of the 58% of women who had heard of ORT, 92% expressed an understanding of how to use it, 75% know how to prepare it, and 72% stated that they had used ORT recently. The two geographic areas that collect mortality data from census information, Carabuco and Ancoraimes, report a decreasing trend in infant mortality due to diarrheal disease, from a total of 5 deaths (combined figure for both sites) in 1998 and to no deaths reported in 2001 for either site. Data from the final KPC indicate that 53% of mothers seek appropriate treatment for children with signs of pneumonia, an increase of 14% as compared to the baseline, which exceeds the Project’s original goal of 51%. Knowledge of chest in-drawing and recognition of rapid breathing increased from 30% to 46%, but was less than the project goal of 62%. The two geographic areas that collect mortality data from census information, Carabuco and Ancoraimes, report a decreasing trend in infant mortality due to pneumonia, from a high of 11 deaths in 1998 and to a low of 4 deaths reported in 2001. 1 Comparison of baseline and final KPC results is based on surveys conducted in 1998 and 2001. See Attachment D for a comparison of indicators by geographic area. A comparison of baseline and final KPC data regarding growth monitoring show a significant improvement in the proportion of children who have a growth card (from 72% to 94%), children who are weighed 6 times a year (from 51% to 73%), and children who are weighed during the first month of life (from 35% to 56%). Feeding practices have also improved with exclusive breastfeeding increasing from 61% to 74%, and an increase in appropriate complementary feeding from 78% to 85%.
Control of Diarrheal Disease. ❑ An integrated behavior change strategy is necessary, if improvements are to be forthcoming in the home management of diarrhea and prompt care seeking based on the recognition of danger signs. ❑ The only way that the nutritional rehabilitation program can be effective is if health personnel commit themselves 100% to counseling and home visits. One reason this did not happen is that MOH staff does not think it is part of their job to spend extra time on home visits. MOH staff expects financial compensation for extra work, and this is one area that CSRA has had difficulty
Control of Diarrheal Disease. ❑ Strengthen linkages between the health facilities and communities to decrease barriers and improve practices in the home and prompt care seeking to address community mistrust and lack of shared values. Emphasize the results of the study on inter-cultural relationships with new MOH staff, and screen candidates for rural positions based on cultural sensitivity indicators. Identify specific behaviors that health personnel should demonstrate in their dealings with patients from rural communities, and include these in yearly performance evaluations. ❑ Prioritize home visits to children who have diarrhea, and train HVs to provide counseling and to make agreements with mothers regarding improved feeding practices and ORT. ❑ Continue supporting local governments to sponsor water and sanitation projects. ❑ Continue to expand the census to other communities, along with growth monitoring of all children under age 2, and strengthen the nutritional rehabilitation program. ❑ Use the nutrition intervention as an entry point for community IMCI, and reinforce behavior change in the other CS interventions as part of the home visit and counseling strategy. ❑ Improve the registration process to track child weights, follow-up activities and results, and the administration and record keeping of Vitamin A and iron sulfate. ❑ Improve the supply system for micronutrients. ❑ Make agreements and action plans with each family that has a child with negative growth tendencies, to prevent moderate and severe malnutrition. ❑ Continue efforts to engage men and local authorities in an analysis of nutrition indicators and creative planning to improve nutritional status, such as home gardens and crop diversification, among others. ❑ Include follow-up of women who have unwanted pregnancies to prevent low birth weight and poor feeding practices, emphasizing self-esteem and values identification. ❑ Make an effort to hire more female health workers and to recruit female health volunteers to enhance educational activities with mothers.
