Poster presentation health promotion

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REDUCING DIARRHEAL MORBIDITY AND MORTALITY IN CHILDREN BELOW AGE 5 YEARS IN NIGERIA University of Iowa Omotoyosi Soniyi INPUTS OUTPUTS OUTCOMES - Time - Resources - Money -Community health workers (CHWs) - Research, expert opinion - Program staff -Recruit and train CHWs - Train teachers -Train nurses, primary care providers - Provide soap in sanitation facilities - S ocial media and television adverts to promote hand washing - Conduct teachings in the local governments -CHWs -Nurses , primary care physicians -Children below age 5 years and older children -Breastfeeding mothers and mothers, caregivers -Teachers -Local communities and Organizations -Mothers increase knowledge on breastfeeding practices -Caregivers/mothers increase knowledge on sanitation and household treatment of water -Improved hand washing practices in children - Improved community awareness on diarrheal disease, prevention, and care -Mother behavior increase to practicing exclusive breastfeeding in the first 6 months of baby life. -Children improve behavior to hand washing -Mother/caregiver skill increases in the treatment and storage of water -Reduced missed school days associated with diarrheal disease -Reduce morbidity and mortality associated with diarrhea in children below age 5 years - Improved productivity and quality of life in children. Short Medium Long Activities Participation LOGIC MODEL - Globally, diarrhea kills more children than AIDS, malaria, and measles combined. - Diarrhea accounts for over 15% of under five child deaths in Nigeria . - Approximately one million children in Nigeria die each year before their 5 th birthday - Diarrhea can lead to a 10 IQ point decrease in children by the time they reach 7-9years of age -Children who do not die experience long term effects of impaired development and do not reach full potential. -Children miss school for an average of two days during diarrheal episodes . -Parents/guardians spend an average of two hours daily caring for children with diarrhea. - Studies suggest that children with repeated bouts of diarrhea, whose growth become stunted are at increased risk of obesity and associated health effects. BACKGROUND RISK FACTORS/DETERMINANTS Modifiable V accination, poor hygiene, HIV infected children Exclusive breastfeeding, knowledge of mothers, poor hygiene Poor housing and living conditions Low SES Inadequate health infrastructure Contaminated weaning food Non modifiable Low birth weight Age GOALS - Reduce missed school days, morbidity and mortality associated with diarrhea in children under five . - Improve hand washing and personal hygiene behavior in children under five. OBJECTIVES PROCESS; -By 6 months, recruit and train 200 community health workers to provide continuous counseling to mothers on exclusive breastfeeding - By 1 year, train teachers in 10 schools per state to educate young children and older school children on hand washing. - By the end of 2017, conduct teachings in each local government (community) on point of use water treatment and storage. IMPACT; - By the end of 2016, the amount of schools in Nigeria that carry out a hand-washing program will increase by 20% - Increase in a year the amount of mothers who have been educated on exclusive breastfeeding by 10% OUTCOME; - By 2020, the rate of missed school days in children below age 5 years in school will have decreased by 25% TARGET BEHAVIOR AND REVIEW OF LITERATURE Target behavior : Personal hygiene and hand washing, point of use water treatment, exclusive breastfeeding. Literature review : Breastfeeding interventions are cost effective, studies show that interventions that promote exclusive breastfeeding and continue to train/counsel mothers after birth reduce diarrheal prevalence by almost 15%. Studies show that interventions to promote hand washing behavior in schools, provide soaps and use peer monitors significantly reduce missed schools days and morbidity associated with diarrhea. Children were also more likely to practice the behaviors at home and teach their friends, siblings, and parents. Interventions that teach mothers/caregivers on point of use water treatment and storage have been found to prevent diarrheal disease by as much as 43%. INTERVENTION STRATEGIES AND ACTIVITIES Interpersonal level - Education on exclusive breastfeeding for mothers Activities; Primary care providers, nurses and community health workers will be trained During prenatal care, knowledge on exclusive breastfeeding is assessed Mothers will receive education on the importance of breastfeeding and brochures that match language skills Community health workers will then continue the visits at 3 months and at 6 months. Community level - Education on household treatment of water with chlorine and storage Activities; Community health workers will be trained to carry out this intervention Community assessment to determine those who do not have access to water and those who have access to water. Conduct trainings in local governments and household on water treatment and storage. Institution/Organizational level - School -based programs on hand washing and hygiene Activities; Teachers will be trained to deliver hand washing program Teachers will hold sessions that educate children on hygiene and hand washing before eating and after toilet use S oaps will be provided and facilities will be improved to facilitate the intervention Senior students will also go through the program and serve as mentors to younger children in schools H and washing images on toilet and bathroom doors, and give posters to children to put on toilet/bathroom doors in their homes. EVALUATION Process, Impact and Outcome evaluation Pre intervention baseline survey Post intervention survey Process evaluation using program records, in depth interviews at 6 months, year 1 and year 2. Impact evaluation using short questionnaires on hand washing practices, caregiver survey on knowledge on household treatment and storage of water at baseline and annually. Outcome evaluation using interviews, surveys, school attendance records, and hospital records at baseline, annually, and at the end of program. Data collection: Quantitative and Qualitative methods Limitations: Contamination, Participants dropping out of program, Interference of multiple treatments. Assumptions; Mothers will go to the hospital for prenatal care, funds will be available for the provision of soaps, schools will include hand washing program in curriculum, children will teach peers and family hand washing. External factors ; Health infrastructure and insurance, priorities in schools and communities, religious beliefs to seeking care ANTICIPATED CHALLENGES AND REMEDIES Funding and Resources (NGOs, organizations, government) Time (provide compensation to participants) Access to water (policy level) Religious, Cultural beliefs (Education and training to improve knowledge) REFERENCES - Bhandari , N., Bahl , R., Mazumdar , S., Martines , J., Black, R. E., & Bhan , M. K. (2003). Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomised controlled trial. Lancet, 361 (9367), 1418-1423. doi : 10.1016/s0140-6736(03)13134-0 - Bowen, A., Ma, H., Ou , J., Billhimer , W., Long, T., Mintz , E., . . . Luby , S. (2007). A cluster-randomized controlled trial evaluating the effect of a handwashing -promotion program in Chinese primary schools. Am J Trop Med Hyg , 76 (6), 1166-1173 - GLORIA VILLAREAL, L. A. L., KATHERINE JIMÉNEZ, KARINA MARTÍNEZ, ETILVIA MARTÍNEZ, CAROLINA OJEDA, . (2011). Educational intervention for the prevention of diarrheal diseases in the Mano de Dios neighborhood, Sincelejo, Colombia: A success experience. Colombia Médica , 42 , 8. - O'Reilly, C. E., Freeman, M. C., Ravani , M., Migele , J., Mwaki , A., Ayalo , M., . . . Quick, R. (2008). The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006. Epidemiol Infect, 136 (1), 80-91. doi : 10.1017/ s0950268807008060 - -Organization, W. H. (March, 2004). Water, Sanitation and Hygiene Links to Health FACTS AND FIGURES. from http://www.who.int/water_sanitation_health/en/factsfigures04.pdf?ua=1 - - Sobsey , M. D., Handzel , T., & Venczel , L. (2003). Chlorination and safe storage of household drinking water in developing countries to reduce waterborne disease. Water Sci Technol , 47 (3), 221-228