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) Malaria and the Management of Febrile Illness 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. EPI 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 upda...
Control of Diarrheal Disease. In 1996, an unexpectedly high proportion, 38.9% of the mothers surveyed stated that their child had experienced an episode of diarrhea with the two weeks prior to survey, compared to 23.9% in 2001. Of these children, only 47.3% were given the same or more amounts of fluids than usual. By 2001, 66% of mothers/caregivers reported giving the child same or more amounts of fluids than usual during the diarrheal episode. Of these mothers/caregivers, 73.0% correctly described how to mix sugar-salt solution compared to 60.3% in 1996.
Control of Diarrheal Disease. Diarrhea has been chosen as one of the project’s main interventions because of its high incidence and community concern. The project’s level of effort for this intervention will be 20%, the same as during the NDCSP’s first Phase. The national government estimates that in South Africa overall, gastrointestinal diseases are responsible for slightly more than one-quarter of infant deaths among the African and “colored” peoples. Diarrheal diseases are one of the most common sources of infant and child morbidity in the project area, and two dysentery epidemics have been reported in Ndwedwe District during the last two years. According to the Ndwedwe District Health Information System, there were 5,692 new cases of diarrhea among children under 5 years of age during 2001. Sporadic outbreaks of cholera occurred in the Project area in January 2001 and at total of 8200 cases were reported in 2001. The project’s objectives for meeting these diarrhea case management challenges are: 1) 85% of mothers will give the same or extra liquids during diarrhea, 2) 90% of mothers/caregivers will 11 UNAIDS/WHO Hail Consensus on Use of Contrimoxizole for Prevention of HIV-Related Infections in Africa. Press Releases 2000. xxxx://xxx.xxxxxx.xxx/whatsnew/press/eng/geneva050400.html. give oral rehydration solution (ORS) to the child under their care during diarrheal episodes, and
Control of Diarrheal Disease. (20%) The CDD (Control of Diarrheal Disease) intervention was implemented in accordance with MOH and international standards and essentially as outlined in the DIP. The indicators for this intervention, baseline and final results follow with discussion related to each.
Control of Diarrheal Disease. Mothers of children 0-23 months who correctly describe how to prepare ORS - 77.1 80 Improving Immunization Coverage 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 Indicators Baseline (October, 2001) Achievement (To Date) Target (September 2006) 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 Improving Immunization/Other Service Coverage 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 Indicators Baseline (October, 2001) Achievement (To Date) Target (September 2006) 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. Pneumonia Case Management. 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. Nutrition and Micronutrients 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. Nutrition and Micronutrients ❑ 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.
