An assessment of the causes of malnutrition in Ethiopia: A ...
An assessment of the causes of malnutrition in Ethiopia: A ...
An assessment of the causes of malnutrition in Ethiopia: A ...
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Table 6.6: (cont<strong>in</strong>ued)<br />
Agency<br />
Intervention<br />
Status<br />
Relief Society <strong>of</strong> Tigray (REST)<br />
Community based health care promotion.<br />
Active<br />
Timeframe 2000-2007<br />
Ma<strong>in</strong> areas<br />
Prevention <strong>of</strong> illness.<br />
Objectives Increase access <strong>of</strong> targeted communities to basic health services .<br />
Activities<br />
Target<br />
Sites<br />
• <strong>An</strong>tenatal care: physical exam<strong>in</strong>ation, health education, iron/folic acid distribution<br />
(depend<strong>in</strong>g on availability, <strong>in</strong> fact rarely conducted), breastfeed<strong>in</strong>g counsel<strong>in</strong>g.<br />
• Delivery care: delivery by health pr<strong>of</strong>essionals, Traditional Birth Attendants (TBAs)<br />
tra<strong>in</strong><strong>in</strong>g and kits supply, with gloves distribution for HIV prevention.<br />
• Post-natal care: consultation <strong>in</strong>clud<strong>in</strong>g family plann<strong>in</strong>g, child and mo<strong>the</strong>r exam<strong>in</strong>ation,<br />
Vitam<strong>in</strong> A with<strong>in</strong> 6 weeks from delivery, breast-feed<strong>in</strong>g counsel<strong>in</strong>g, complementary<br />
feed<strong>in</strong>g, food preparation demonstrations, and growth monitor<strong>in</strong>g and promotion<br />
(weigh<strong>in</strong>g, plott<strong>in</strong>g, evaluation, counsel<strong>in</strong>g).<br />
• Vacc<strong>in</strong>ation: EPI, tetanus toxoid (rout<strong>in</strong>e and monthly outreach).<br />
• Healthy child consultation: Health facility-based growth monitor<strong>in</strong>g, maternal and child<br />
health and nutrition education, vacc<strong>in</strong>ation.<br />
• Sick child consultation: health facility-based and outreach (case screen<strong>in</strong>g and referral<br />
to health facility), physical exam<strong>in</strong>ation, laboratory <strong>in</strong>vestigation, essential drugs<br />
provision, growth monitor<strong>in</strong>g, EPI vacc<strong>in</strong>ation status check.<br />
• Nutritional surveillance: growth monitor<strong>in</strong>g for under-fives (rout<strong>in</strong>e and outreach),<br />
population survey twice a year and <strong>in</strong> case <strong>of</strong> drought or o<strong>the</strong>r emergency, contribut<strong>in</strong>g<br />
factors are discussed with <strong>the</strong> community to identify solutions.<br />
• Food distribution: Supplementary feed<strong>in</strong>g for demonstration purposes , <strong>in</strong>clud<strong>in</strong>g 3 kg<br />
monthly ration for moderately malnourished child until recovery. Provided with<br />
maternal education on locally available foods (eggs, milk) and <strong>the</strong>ir preparation.<br />
Mo<strong>the</strong>rs and under-fives , adolescent girls.<br />
Five woredas <strong>in</strong> Tigray. Health facility-based and monthly outreach <strong>in</strong> communities that<br />
are located more than 5 km from a health facility.<br />
Roles def<strong>in</strong>ition Health bureau, woreda coord<strong>in</strong>ation <strong>of</strong>fice, and health structures (both static and<br />
outreach). Community health agents, community reproductive health agents, TBAs<br />
Partners<br />
Tra<strong>in</strong><strong>in</strong>g<br />
Tools<br />
developed<br />
Achievements<br />
Challenges<br />
Susta<strong>in</strong>ability<br />
Communities, MOH (woreda health <strong>of</strong>fice and Family Health Department)<br />
TBAs receive 30 days <strong>of</strong> tra<strong>in</strong><strong>in</strong>g, Community Reproductive Health agents - 15 days,<br />
Community Health Volunteer (CHV) - 45 days. CHVs also undertake an annual needs<br />
<strong>assessment</strong> exercise lead<strong>in</strong>g to refresher tra<strong>in</strong><strong>in</strong>g (3-7 days practical, on-<strong>the</strong>-job tra<strong>in</strong><strong>in</strong>g).<br />
Tra<strong>in</strong><strong>in</strong>g manuals, posters, and flip charts for CHVs on nutrition; STIs, <strong>in</strong>clud<strong>in</strong>g HIV<br />
prevention; environmental health; maternal and child health; and breastfeed<strong>in</strong>g.<br />
N/A<br />
• Resource constra<strong>in</strong>ts.<br />
• Lack <strong>of</strong> <strong>in</strong>tegrated service package: fragmentation <strong>in</strong> activity f<strong>in</strong>anc<strong>in</strong>g due to donor<br />
constra<strong>in</strong>ts .<br />
Acti vities are more susta<strong>in</strong>able where <strong>in</strong>tegrated. Conversely, lack <strong>of</strong> <strong>in</strong>tegration leads to<br />
un<strong>in</strong>terested communities, as <strong>the</strong>y do not see results.<br />
Lessons learnt • Integrated nutrition-focused <strong>in</strong>terventions br<strong>in</strong>g impact on <strong>the</strong> household. Integration<br />
def<strong>in</strong>ed as <strong>the</strong> same service package regularly available to all target population <strong>in</strong><br />
target territory.<br />
• Child growth monitor<strong>in</strong>g as effective entry po<strong>in</strong>t for vacc<strong>in</strong>ation and nutrition education.<br />
189