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Early Childhood Development and Nutrition: Experiences promoting holistic nurturing care in nutrition services - Shared screen with speaker view
Katia Vieira de Moraes LaCasse
16:55
Dr. Katia Vieira de Moraes, Emergency Health Unit, Save the Children
Ali Abdulhusain
17:14
Hi every body , I am Ali Abdulhusain from UNICEF-IRAQ
Megan Piccirillo
17:25
Megan Piccirillo, USAID/Global Health
Geoffrey Babughirana
17:32
Geoffrey Babughirana-Health and Nutrition manager World Vision Sudan
Nancy Adero
17:48
Nancy Adero, Nutrition Advisor. USAID-JSI, RHITES-North, Lango. Uganda.
Riaze Rafik
17:50
Riaze Rafik,ASSISTANT RESEARCH MANAGER,MIHER
Karen Calani
17:59
Hello, Karen Calani with Food for the Hungry in Guatemala
Gertrude Namazzi
18:12
Dr. Gertrude Namazzi, Makerere University, Uganda
Selam Tadesse
18:27
Hello, Selam Tadesse from CRS, Baltimore
Catherine Gana
18:27
Dr. Catherine Gana. I work as Consultant with a NGO in Nigeria
Erik Champenois
18:30
Erik Champenois, Sr. Business Development Specialist, Abt Associates
Scott LeFevre
18:33
Scott LeFevre, Director for Health, Social Services and Education for Catholic Relief Services
Ibrahim kirunda
18:34
Dr. Ibrahim Kirunda, WHO Uganda Maternal, Newborn, Child Quality of Care
Tobias Opiyo
18:37
Tobias Opiyo, ECD Project Manager, CRS Kenya
Melanie Picolo
18:49
Hi all, Melanie Picolo, MNCHN Program Manager, PATH Mozambique
Riaze Rafik
18:58
Riaze Rafik,ASSISTANT RESEARCH MANAGER,MIHER, from MOZAMBIQUE
Svetlana Drivdal
18:59
Hello, Lana Drivdal, ECD Specialist, PATH
dina Rwamuhinda
19:00
Hello, am Dina Rwamuhinda, Refugee response, Save the children-Rwanda
Mary Okumu
19:34
Mary Okumu, Kenya
Debjeet Sen
19:39
Debjeet Sen, Regional ECD & Nutrition Specialist, PATH
Rana Mokhtar
19:57
Hi all, Glad to be here! I am Rana Mokhtar, Research Fellow at Ariadne Labs, Better Birth team
Caroline Nerima
20:23
Caroline Nerima, Peadiatrician; Uganda
Sita Strother
22:10
Welcome everyone! If you have just joined feel free to introduce yourself in the chat.
Josie Ferla
22:38
Josie Ferla ECD Senior Manager EGPAF Tanzania
Shaimaa Ibrahim
23:28
Shaimaa Ibrahim Health Specialist / UNICEF Iraq
Fadumo Osman
23:32
fadumo osman save the children
Angela Osei-Bonsu
23:49
Hi everyone. Angela Osei-Bonsu- Paediatric Society of Ghana
Omolola Adebayo
24:02
Hello all, Omolola Adebayo, Nutrition Manager, International Institute of Tropical Agriculture-Yola, Nigeria
Peninah Kamau
25:05
Hi Everyone.Peninah Kamau from Health NGOs Network
Santa Engol
26:43
Hi Everyone, Santa Engol-Senior Clinical Coordinator -CHAI Uganda
Rita Anaba
27:16
Hello Everyone, Rita Anaba from Nigeria
Bradford Strickland
28:54
Hello Everyone, Brad Strickland from USAID Africa Bureau in Washington DC
Amanda Murungi
29:35
Greetings everyone, Amanda Murungi, Nutritionist MoH Uganda.
Svetlana Drivdal
30:46
@Allison, was counseling individual or in a group? If in group, how many caregivers in a group? And in terms of content - demo, practice etc (following CCD approach)? Would be helpful to have a bit more granual understanding of the intervention, to interpret the results
Devendra Yadav
33:01
in most of the settings we are getting problem to demonstrate our impact especially for 0-3 age. Does there any problem with our tool and measurement methodology
Svetlana Drivdal
33:39
Additionally, would be interesting to understand the reasoning behind choosing nurses as implementers. As opposed to paramedical staff or other hospital workers for example. Nurses are usually quite busy, at least in our experience, to dedicate time to intensive counseling. Would love to hear your thoughts.
Peninah Kamau
34:45
I kindly request for presentation or recording.I dint get the one for the last meeting .peninahkm2008@gmail.com
Allison Daniel
36:34
Thanks very much for your question, Svetlana. We aimed to recruit groups of caregivers and children (up to 6 dyads per group). However, the admissions to this NRU have gone down, and therefore in many cases the groups were only 1-3 dyads. In terms of the delivery of the program, it involved counselling but we also incorporated other BCC techniques/items including materials (one toy/play item given to each child), media (take-home images given to caregivers), and performance (practicing hand-washing).
Sita Strother
37:00
The recording and full presentation will be emailed to everyone within the next couple days.
Sita Strother
37:35
@Peninah feel free to email us at childhealthtaskforce@jsi.com for the slides and recording that you missed
Peninah Kamau
38:02
Thank you
Patricia Jodrey
38:11
Noticed that most of the volunteers were males - was their visit approved by families?
Allison Daniel
39:32
We chose nurses because at this particular site, there are few additional other staff members. We undertook a feasibility study including nurses and other health workers at this site to evaluate barriers and enablers to implementation. We had initially designed the program to be 90 minutes per day and following this reduced the duration to 75 minutes to make it more feasible for nurses.
Patricia Jodrey
40:29
Thanks - my question referred to home visits
Svetlana Drivdal
40:32
Thanks, Allison!
Amanda Murungi
40:37
Malawi has a great tool called M-DAT- Malawi Development Assessment Tool
Debjeet Sen
40:48
Re the Sudan intervention/study, are one-hour monthly home visits and 1.5 group sessions feasible for scale-up in real-world settings? And how could the model be made more likely to be implemented in a real-world setting where CHWs have very little time for home visits and there aren't necessarily trained + paid facilitators to facilitate group sessions?
Allison Daniel
41:51
Devendra, the tool that we used (Malawi Developmental Assessment Tool) is designed for assessing development in children up to six years of age. It has been validated and has good reliability, and therefore I think the lack of effect is likely to be true and not due to any issue with the tool itself.
Dr Mohammad Homayoun Ludin
42:01
Afghanistan needs more efforts in regards to inclusion of ECD in Nutrition programs
Svetlana Drivdal
42:58
Allison, how long after the intervention did you do the assessment with MDAT? Sorry if it was presented and I missed it.
Allison Daniel
43:39
No problem! We followed up caregivers and children six months after discharge, and completed MDAT assessments then.
Svetlana Drivdal
44:44
thank you!
Devendra Yadav
47:24
Allison, I agree with your response but actually we are not getting significant impact in emergency setting. I have gone through many impact study and getting the same answers as no impact. so how could we justify our intervention effectiveness for external validity. I am trying to explore in the area more and would be happy to hear from you
Yared Abera
47:25
Great job, both presenters! What kind of referral linkages it was created or identified for next higher level management - for bad MAM RX outcome and developmental challenges identified? Thanks
Colleen Emary
47:37
@Debjeet - thank you for your question. You raise a very good point. Personally, I do not think it is feasible for CHWs to implement a comprehensive ECD intervention on top of their already very full workload. To do this, I think we need to use other volunteer cadres beyond CHWs - who need to be trained and supported. CHWs can likely provide some light-touch ECD support for families, via the health promotion counselling that is often provided, but in my opinion this won't be sufficient
Debjeet Sen
48:48
Thanks @ Colleen!
Svetlana Drivdal
49:17
Unfortunately many countries (like Mozambique) have very few community actors that are gov supported and could be leveraged, besides CHVs. Then you need to go beyond public health and rely on nongovernmental and private partners, basically…
Colleen Emary
49:49
@Yared - for MAM non-recovery, or worsening clinical condition, children were referred to the health facility for SAM treatment.
Mary Okumu
50:18
To Elena, How effective is the home visits by lead mother in the wake of Corona?
Tobias Opiyo
50:18
@Colleen, We at CRS had the same challenge, and opted to use the care group model where below the CHV is a lower cadre of Lead Mothers (Care Group Volunteers) who does the group session facilitation and home visits
Svetlana Drivdal
52:26
@Tobias, who is paying the Lead Mothers?
Allison Daniel
54:09
Devendra, I think what I would say is that results from this trial indicate that an inpatient-focused program of this intensity and duration is not sufficient to address long-lasting problems such as poor developmental outcomes in children admitted for SAM with complications. I think programs need to be longer in duration (i.e. continued in community settings) for one. However, I think there are still questions that remain in terms of how much children with SAM can respond in terms of development. I should note that although I believe we used an appropriate tool, we also did have a wide age range which may have impacted the results. More should be done to evaluate response to intervention at different ages in this group of children.
Karen Calani
54:45
Elena, could you share which Care Group modules were covered? How did you decide which topics to prioritize?
Colleen Emary
54:47
Thanks @Tobias...good to know....we are also just starting to use Care Groups more widely in WV - we've developed a new curriculum and are calling them 'Nurturing Care Groups'
Mary Okumu
55:02
@Elena, good results, how are the counties engaged for sustainability of the gains?
Nsofwa Sukwa
55:11
how do you address the aspect of intimate partner violence?
Tobias Opiyo
55:38
@Svetlana, the role is voluntary, and the project only provides incentives in form of transport reimbursement when the lead mothers meet twice a month to submit reports and practice key messages for the next session to ensure fidelity
Svetlana Drivdal
55:39
Same question as Nsofwa:)
Betzabe Butron
56:13
I believe there is evidence on the efficacy of combining nutrition and responsive caregiving, but the challenge is how to do it - given an specific context. This may require an implementation research design to better understand the how's and why's. Some elements may be more critical than others. or some elements can be implemented as expected while others can not - and why. For some contexts, some elements may work well, but not for others. More nuanced research designs are needed.
Dyness Kasungami
56:14
From the Task Force Secretariat: Great to see the diversity of participants on this call. Please join the Task Force, if you are not a member. This is a platform you can use to share your program approaches and improve them by getting feedback from other practitioners. Let's take our learning back to the field to improve programming and impact. Thank you for being part of the network.
Benedicto Esekon
57:58
Benedicto Esekon Nutritionist save the children-kenya
Colleen Emary
58:01
@Betzabe - I agree...the how is a challenge for sure
Sita Strother
01:02:56
Thank you all for your questions! Feel free to continue posting questions to the chat and we will address them during the Q&A.
Bridget Aidam
01:07:30
@ Colleen have we thought about engaging other caregivers including grandmothers, aunties etc who tend to have more time and can support the mother in caring and nurturing.
Colleen Emary
01:08:02
@Bridget - yes, very good point - and something that we are considering
Judy Canahuati
01:11:48
Any panelists. What effects would you like to see of the THRIVE ACT on your capacity for integration of ECD into your programs?
Svetlana Drivdal
01:18:57
In Mozambique this is exactly what our MOH is currently working on - reinforcing ECD in C-IMAM, after having developed a model for inpatient ECD (which is still being rolled out by nutrition program with Ped Association’s support).
Patricia Taylor
01:20:29
Thank you very much to the Task Force and the presenters. Very important topic and some great program interventions. In the spirit of multi-sectorality, I'm curious to know if any of the programs were able to make connections between their client families and other social and ECD services?
Emily Vargas-Baron
01:21:41
The inclusion of infant and child development and family support in nutrition (and health) interventions is very important; however, I think lessons learned from research in Early Childhood Intervention programmes would be of major help to improving the design of more effective programmes. We must recognize that overcoming major SAM is always challenging; however, original research in these areas showed that earlier intervention that is more intensive and individualized is more effective.
Bernadette Daelmans
01:22:12
Thank you for a very informative webinar.
Svetlana Drivdal
01:25:45
Emily’s point is well taken, however, I would expand our thinking on inclusion of ECD to nutrition promotion and not just treatment of malnutrition. So as we counsel on nutrition we counsel on ECD…
Devendra Yadav
01:26:09
home visit intervention is expensive particularly for large population. Do we have any low cost intervention example to scale up in large population?
Pyae Phyo Aung
01:27:55
Thank all for your informative presentations and discussion.
Benedicto Esekon
01:28:52
How is challenge of CHV incentive and the renumeration been addressed through out the intervention since CHVs have been instrumental in service delivery and also through the study
Saul Kamukama
01:29:24
a resergence of health care at adolescence makes it appear like nuturing is never a priority. if you consider absence of school meals in kindergartens and primary schools where children would benefit from good nuturing.
Svetlana Drivdal
01:29:25
Agree with Allison - understanding as much as possible what touchpoints exist and leveraging them to the extent feasible, through MOH advocacy, is definitely a key
Ibrahim kirunda
01:32:27
Thank you for the deliberations. I hope he presentations will be shared. I'm interested in starting similar work like in Kenya, Tanzania, and Malawi. My email: kirundai@who.int/ibrahimkirunda40@gmail.comI appreciate the guidance on evidence based scale up of such work
Patricia Jodrey
01:38:12
I appreciate the rich experience that has been put together for this webinar - congratulations to all organizations engaged in this important (and previously neglected) work. It has been very informative to learn of these experiences. Thanks so much!
Sita Strother
01:38:55
Thank you, Ibrahim! We will share the presentations after the call. Feel free to reach out to us at childhealthtaskforce@jsi.com or to the subgroup co-chairs - Akriti and Bridget - directly (who will be copied on the follow-up email)
Ibrahim kirunda
01:40:15
Thank you Ms. Sita for the prompt guidance
Emily Vargas-Baron
01:41:44
These programmes are rarely sustainable only using volunteers and I agree. Some are asking for too much for free!