Transcript Presentation Vera Hernandez

Pesquisa Científica na Área de Cuidado de
Saúde Primários
Scientific Research in Primary Healthcare
IGC – Workshop, July 2015
Maputo
Marcos Vera-Hernández
University College London
• Improving child nutrition through information
provision
– Malawi, Kenya, Nepal, India
• Health insurance as the centerpiece of effective
integrated healthcare
– Colombia
Importance of nutrition 0-2 years old
• Difficult to catch up any deficit that occurs in the
early years
• Future resilience to illness
• Brain formation
Causes of malnutrition are complex
•Common “unhealthy practices and norms”:
– Misinformation, lack of knowledge
– Social and family pressure
Examples of “unhealthy norms”
Michinji (Malawi)
• It is not good to give eggs to children
• The soup broth is more nutritious than the
vegetable and meat
Examples of “unhealthy norms”
Western Kenya
• Belief that if children eat eggs, their speak will be
delayed
• Meat causes allergy to children
• Small children are better off eating plain and clear
porridge without other foods
Effective and intensive communication
• Deeply rooted beliefs
• A leaflet will not solved the problem
• More elaborated communication is necessary
Home visiting in Michinji (Malawi)
• Maimwana Infant Feeding Intervention:
– A female counselors are trained to visits mothers of
young children
– Up to six visits to deliver nutrition messages with help of
a picture book
Picture 6
Picture 7
Recognizing and feeding a sick baby
A sick baby may present with the following danger
signs;
o feeling cold,
o fever,
o weakness and sleepy ,
o abnormal sleeping,
o crying for long times,
o High pitched cry,
o fast breathing,
o difficulties in breathing,
o Jaundice,
o Irritability and refusing to feed.
Visit you nearest health facility if you see any of
these danger signs
Feeding a sick baby
When a baby is sick feeding becomes difficult;
she/he may not eat at times and may even fail to
breast feed;
The mother should express breast milk and give it
to the baby.
(To express you need a clean cup, wash hands and
then press your two fingers around the dark part of
the breast where there are milk storage tanks, the
milk will flow freely
Using a smaller cup, feed the baby regularly, in
small amounts, until when the baby is able to breast
feed.
Breast feed the child frequently and provide small
nutritious feeds with other nutritious fluids like fruit
juice, yoghurt and milk;
Picture 4
To prepare small dried fish (omena)
Take small fish, wash, dry and roast them properly
Allow to cool then pound in a mortar and sieve
Add a table spoon to the porridge; allow it to boil for
5-minutes.
Cool and feed the baby
Keep the rest in a clean closed container for future
use
To prepare meat
Cut meat in small parts cook till tender
Choose a boneless piece put on a plate to cool then
pound in a mortar until it is smooth
Add it to porridge allow it to boil for 5-minutes.
Cool and feed the baby (you can also prepare liver
in the same way remember to remove the skin
from the liver)
Picture 5
To prepare groundnut powder
Crush nuts pound in a mortal and sieve you can add
this to porridge
To prepare vegetables
Wash the leaves, chop them and cook as normal, do
not over cook…..
Home visiting in Michinji (Malawi)
Randomized Controlled Trial showed improvement
in:
•Mother’s knowledge on nutrition
•Diet variety
•Exclusive breastfeeding
•Child’s height
Idea taken up in Western Kenya
• Evidence Action
• Chlorine dispensers for water treatment
Idea taken up in Western Kenya
• Promoter in the community takes care of chlorine
dispenser
• Promoter could be trained to deliver nutrition
messages
• Variation: a random group will deliver the
information to mother, another random group to
mother + father
Home visiting not a panacea
• It depends on the effort of the promoter
• Quite time consuming
• Might not be the best approach to change widely
followed norms
Women’s groups
•Women’s groups have worked well in Nepal and
India but they have been done for birth
preparedness
•Might allow for stronger collective action to change
widely followed norms
•But might not have high take up in the community
•Not all women might receive information/advice
A study that needs to be done:
•Home visiting
•Women’s groups
•Which one does better? And for whom?
Health insurance
• Route to effective and responsive integrated
health system
• % population with health insurance is increasing
very rapidly in China, Thailand, Colombia, India,
Ghana
China. Population coverage by the three health insurance schemes, 2003–2011.
Meng Q, Xu L (2014) Monitoring and Evaluating Progress towards Universal Health Coverage in China. PLoS Med 11(9): e1001694.
doi:10.1371/journal.pmed.1001694
http://127.0.0.1:8081/ploscollections/article?id=info:doi/10.1371/journal.pmed.1001694
Insurance based system
Zero fee system
• Money follows the patient
• Money follows the facility
• Patient is empowered
• Where are they going to
go?
• Facility is interested in
having more patients:
more patients, more
money
• Facility gets the some
money, no matter how
many patients they have
Colombian experience
• One of the largest reforms. Implemented this
system
• Moreover, health facility receives the same
amount of money per patient, no matter how
expensive the patient is
• Large increases in preventive care, curative care
visits, and decrease in health expenditure
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