Health education program on prevention of tuberculosis

PRECEDE PROCEED Model planning of health education program on Tuberculosis as a part of class work

1. Health Education Program on prevention of Tuberculosis Using PRECEED PROCEED Framework 439. Dip Narayan Thakur 440. Gauri Shankar Mandal

2. Objectives of the presentation To share planning of a health education program on prevention of Tuberculosis so as to develop presentation skills 2015-10-08 Dip n Gauri 2

3. Presentation’s Map Introduction: Tuberculosis Baseline Information Introduction to PRECEDE PROCEED Framework PRECEDE Social Assessment Epidemiological Assessment Behavioural and Environmental Assessment Educational Assessment Administrative and policy assessment PROCEED Program Design Objectives (Different levels) Detail plan of Action Monitoring and supervision planning Plan for Evaluation References 2015-10-08 3 Dip n Gauri

4. Tuberculosis: Introduction An infectious disease caused by Mycobacterium tuberculosis . It primarily affects lungs (Pulmonary TB) but can affect other tissues (Extra-pulmonary TB). It can also affects other animals like cattle (Bovine TB) which may sometime be communicated to human. MOT: Air-borne (Droplet infection through cough, sneeze, etc.) IP: Weeks to years but Tuberculin test is positive within 3 to 6 weeks 2015-10-08 4 Dip n Gauri

5. Tuberculosis: Introduction Signs and Symptoms A bad cough that lasts 3 weeks or longer pain in the chest coughing up blood or sputum (phlegm from deep inside the lungs) weakness or fatigue weight loss no appetite chills fever sweating at night Diagnosis Tuberculin test Sputum Microscopy Chest X-Ray 2015-10-08 5 Dip n Gauri

6. Baseline Information : From VDC profile Madhopur, Rautahat Total households: 1035 Total Population: 7609 (M:03932; F:3677) Literacy Rate: 37.43% (Male-49.45%; Female-24.53%) Ethnicity distribution: Yadav (27.80%) Koiri (10.53%) Teli (9.29%) Kanu (7.93%) Dalit (15.40%) Others (29.05%) 2015-10-08 6 Dip n Gauri

7. PRECEDE PROCEED Framework 2015-10-08 7 Dip n Gauri

8. Social Assessment Lower quality of life (1) ( Women feel the intense social impacts) Cuts down in economic production ( ↓GDP 4-7% (3 ); ↓Average monthly income; etc.) Cost related to treatment (Medicine, travel, etc.) Reduced interpersonal communication School and job absenteeism (54% among diseased people) ↑ Unemployment (3.6%) and underemployment 2015-10-08 8 Dip n Gauri

9. Epidemiological Assessment About 45% of population is infected with TB bacteria. (National data) Every year 45000 people develop active tuberculosis, Out of which, 51% has infectious pulmonary tuberculosis. (National data) Case finding rate- 59% Prevalence of TB among HIV patient- 17% (5) Annual 1-2 deaths due to tuberculosis Childhood tuberculosis case- 2.2% Treatment success rate: 91% Malnutrition: 0.1% 2015-10-08 9 Dip n Gauri

10. Behavioural and Environmental Assessment List of significant behavior to be addressed which are related to tuberculosis Practice of using safety masks (About 1%*) Health Care utilization (poor, particularly government health services) Tobacco use (30% : >12 yrs. age) Substance abuse (HIV-TB co-infection) Dietary and life style: poor (Malnutrition ) BCG coverage: 97 % Environmental factors Overcrowding (public places/ FS:6.44) Poor housing and Indoor air pollution (use of firewood as main cooking fuel ) Occupational settings 2015-10-08 10 Dip n Gauri

11. Behavioural prioritization Behaviour Importance Changeability Total Score Practice of using safety mask 3 4 7 Tobacco and substance abuse 4 1 5 Health care utilization (Vaccines and DOTS) 4 3 7 Dietary and lifestyle 5 3 8 Prioritized Behavior for health education intervention : Dietary and lifestyle Score : Very high-5, High-4, Neither high nor low-3, low-2, Very low-1 2015-10-08 11 Dip n Gauri

12. Educational Assessment Predisposing factors: Knowledge on TB, its causes, signs & symptoms, mode of transmission, preventive measures . Tuberculosis: Communicable (80%); Non-Communicable(14%); Didn’t know (6%) Transmission of TB : Coughing(82%); Blood(9%); Direct contact(2%); Eating leftover foods(25%) Treatment: Possible(90%); Not possible(3%) and Didn’t know (7%) Availability of treatment: Government health institution(84%); private hospital and clinic (28%) and Didn’t know (2%) Malnutrition makes prone to TB: 25% Treatment cost: Totally free (70%); Should pay money (22%); Others didn’t know Only about ten percent people have heard technical term ‘DOTS’. 2015-10-08 12 Dip n Gauri

13. Educational Assessment Reinforcing factors : Health Education on nutrition, dietary habits and tuberculosis: -Not integrated -Components in school level curriculum not taught effectively -Mothers group session conducted by FCHV Social support : -Good for people who is in touch with family and community whereas bad for displaced, abandoned Peer support: Not good ( Molysmophobia )* 2015-10-08 13 Dip n Gauri

14. Educational Assessment Enabling factors: Resources (nutritious food ) availability and accessibility: poor due to poverty (though the area fall in granary of Nepal) Skills of having balanced diet- not good Programs on nutrition by different NGOs and INGOs: focused mainly on children (good) but post disease requirement of nutrition is not addressed C ommunity interest: people thinks that TB is individual problem. Dietary habit and lifestyle are individual issue 2015-10-08 14 Dip n Gauri

15. Administrative and policy assessment HE program supported by National health policy 2071. No health education corner in SHP. Training on Tuberculosis and DOTS received by 80% Health Workers. Free distribution of drugs to the infected population as DOTS therapy. Supportive program from local clubs and NGO working in nutrition. *Data mentioned in the assessment section are not all real for the given VDC . Most of the data are based on our assumption. 2015-10-08 15 Dip n Gauri

16. Health Education program design Goal Improve health related QoL of people attributed by tuberculosis in Madhopur VDC of Rautahat district Program Objective Reduce incidence of tuberculosis by one fourth after three years of health education program. 2015-10-08 16 Dip n Gauri

17. Behavioural Objectives : To modify eating habits of 80% people of Madhopur after three year of health education program on dietary habits and lifestyle. To improve cooking habits of 55% of households of Madhopur after three year of health education program on dietary habits and lifestyle. To promote the use kitchen garden for growth of different crops, vegetables and fruits in Madhopur after three year of health education program on dietary habits and lifestyle . 2015-10-08 17 Dip n Gauri

18. Objectives cont.… Educational Objectives: To aware local people and health workers on relationship between malnutrition and tuberculosis Develop knowledge and skills of mothers on cooking food without deteriorating nutritious component. Develop knowledge and skills of health workers and local communities on balanced diet and dietary habits. 2015-10-08 18 Dip n Gauri

19. Objectives cont … Organizational and Policy objectives: To establish health education corner at local health facility for integrated health education. To coordinate with agriculture related organization for assistance in the kitchen garden. 2015-10-08 19 Dip n Gauri

20. Resource Assessment Resource Source IEC materials District health office Human resource Local health facility, local clubs, FCHV Funding USAID (Kathmandu), VDC office- Madhopur Infrastructure Local community 2015-10-08 20 Dip n Gauri

21. Program design 2015-10-08 21 Dip n Gauri

22. Objectives Activities Indicators/ Targets Means of verification Overall Goal Improve health related QoL of people attributed to tuberculosis HE program on nutrition, dietary and lifestyle. HDI, HPI PCI, Literacy rate, Life expectancy Program Objective Reduce incidence of tuberculosis by one fourth HE program on nutrition, dietary and lifestyle. Tuberculosis Incidence Case Finding Rate HMIS, Annual Report of the district Planning Matrix T itle: Health Promotion and Education program on nutrition, dietary habits and life style to prevent tuberculosis. Duration : 2016-2018 AD Location : Madhopur, Rautahat , Nepal 2015-10-08 22 Dip n Gauri

23. Objectives Activities Indicators/ Targets Means of verification Educational Objectives To aware local people and health workers on relationship between malnutrition and tuberculosis Meeting and discussion on malnutrition and tuberculosis with health workers and FCHVs 100% of the participants could reply the link between tuberculosis and malnutrition. Post meeting questions. Integrated health education at Health facility by health worker and in community by FCHVs. 70% of local people will know the relationship between malnutrition and tuberculosis. Questionnaire survey at the end of project. To Develop knowledge and skills of mothers on cooking food without deteriorating nutritious component. Mothers group discussion on importance and ways of saving nutrients while cooking. 80% of participants would be able to recall the ways of saving nutrients while cooking. Post meeting questions Demonstration on healthy cooking techniques. 76% of participants will be able to demonstrate the healthy cooking techniques. Randomly some participants will be asked to demonstrate. 2015-10-08 23 Dip n Gauri

24. Objectives Activities Indicators/ Targets Means of verification Educational Objectives Develop knowledge and skills of FCHVs and local communities on balanced diet and dietary habits Training to the FCHVs on balanced diet and dietary habits. 100% of FCHVs should understand about balanced diet and dietary habits. Post training evaluation Discussion on balanced diet and dietary habits in mothers group meeting by FCHVs. 80% of participants will be able to recall content of discussion. Post discussion questions. Wall painting through out the VDC in public places with different related information (pictorial) 40% people of the VDC will be able to understand the message Post painting survey Integrated School health program on tuberculosis and malnutrition and balanced diet. 68% of the students will be able to recall the information given. Post program questionnaire survey. Radio program on tuberculosis, malnutrition and balanced diet. (with early information) 40% of the listener will be able to understand the message on the radio Post program evaluation. 2015-10-08 24 Dip n Gauri

25. Detail Plan of Action 2015-10-08 Dip n Gauri 25

26. Activities Contents Target group Methods and medias Responsible persons Venue Date/ Time Meeting and discussion on malnutrition and tuberculosis with health workers and FCHVs Tuberculosis Malnutrition Relationship Burden Future actions FCHVs Health workers Group discussion/ Flip chart Electronic medias Program coordinator (BPH graduate) Madhopur Sub-Health Post 2016 Jan 6 and 7 10 am- 2 pm Integrated health education at Health facility by health worker and in community by FCHVs. Tuberculosis Malnutrition Relationship Dietary habits Community people Patients and their family Counselling Group discussion / Flip chart Poster SHP Incharge FCHVs of respective wards. Madhopur Sub-Health Post Each wards 2016 Jan 10 onwards Training to the FCHVs on balanced diet and dietary habits. Tuberculosis Malnutrition Relationship Dietary habits Kitchen garden Healthy cooking habits FCHVs Workshop Program coordinator (BPH graduate) Madhopur Sub-Health Post 2016 Jan 14 To Jan 20 2015-10-08 26 Dip n Gauri

27. Activities Contents Target group Methods and medias Responsible persons Venue Date/ Time Discussion on balanced diet and dietary habits in mothers group meeting by FCHVs. Dietary habits Kitchen garden Healthy cooking habits Balanced diet Mothers group Group discussion / Flip chart FCHVs of respective wards Each ward Jan 22- Feb 13 Wall painting through out the VDC with different related information (pictorial) Tuberculosis Malnutrition Healthy cooking habits Kitchen garden Community people Wall painting Hired painter Each ward Feb 1- Mar 29 Integrated School health program on tuberculosis and malnutrition and balanced diet. Tuberculosis Malnutrition Healthy cooking habits Kitchen garden Balanced diet School children Mini-lecture Postures Executive team All schools of the VDC Feb 15- Mar 30 Radio program on tuberculosis, malnutrition and balanced diet. (with early information) Tuberculosis Malnutrition Healthy cooking habits Kitchen garden Balanced diet Community people Interview Audio tape Ad type short message Communication team Madhopur FM Mar 31 onwards Weekly (Interview) Ad- Daily 2015-10-08 27 Dip n Gauri

28. Activities Content Target group Methods and medias Responsible persons Venue Date/ Time Mothers group discussion on importance and ways of saving nutrients while cooking. Balanced diet Ways of healthy cooking Mothers group Group discussion Demonstration FCHVs Each wards in mothers group meeting Mar 31 – Apr 16 Demonstration on healthy cooking techniques. Cooking techniques Mothers group Demonstration FCHVs Each wards in mothers group meeting Mar 31 – Apr 16 2015-10-08 28 Dip n Gauri

29. Risk Management Risks Risk Management The willingness of the community may decrease during the program Community will be involved in all stages of the program: planning, implementation and evaluation Seasonal busyness of local people Program will be conducted in off time. 2015-10-08 29 Dip n Gauri

30. Plan for Supervision and monitoring of the program There will be one monitoring and evaluation sub-committee for the programme. The members will be one VDC Secretary, one BPH graduate, one target group representative and one SHP representative. The focal person for the program monitors and advise where required, and will ensure that there is good accountability and also act as process facilitator. The Monitoring committee will monitor in line with log framework of the programme. The committee will monitor the programme one time a month. Each monitoring will produce a report and the monitoring findings will be utilised to modify and strengthen the health education programme 2015-10-08 30 Dip n Gauri

31. Plan for Evaluation of the program Will be done at all level of program phases Process evaluation – Evaluation of implementation of detail plan of action and educational objectives and indicators Impact evaluation – Evaluation of behavioral objectives and indicators Outcome evaluation – Evaluation of epidemiological and social indicators and objectives. 2015-10-08 31 Dip n Gauri Why tuberculosis is important?

32. Limitation of the plan The situation analysis for the planning is based on secondary data from various sources so it may not reflect the real situation of the VDC. The plan has been developed for learning process only and may not be practical. 2015-10-08 Dip n Gauri 32

33. References: Impact of Tuberculosis on the Quality of Life Dhuria M, Sharma N, Ingle G K - Indian J Community Med." Impact of Tuberculosis on the Quality of Life Dhuria M, Sharma N, Ingle G K - Indian J Community Med. N.p ., n.d. Web. 14 Mar. 2013. National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 14 Mar. 2013. <http://www.ncbi.nlm.nih.gov/pubmed/20565494>."TB Alliance: Putting Science to Work for a Faster TB Cure." Economic Impact of TB. N.p ., n.d. Web. 14 Mar. 2013. <http://www.tballiance.org/why/economic-impact.php>. Patient Medical Costs for Tuberculosis Treatment and Impact on Adherence in China: A Systematic Review." BMC Public Health. N.p ., n.d. Web. 14 Mar. 2013. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731868/ 2015-10-08 33 Dip n Gauri

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