Early Childhood Development and Nutrition: Experiences promoting holistic nurturing care in nutrition services - Shared screen with speaker view
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Katia Vieira de Moraes LaCasse
Dr. Katia Vieira de Moraes, Emergency Health Unit, Save the Children
Hi every body , I am Ali Abdulhusain from UNICEF-IRAQ
Megan Piccirillo, USAID/Global Health
Geoffrey Babughirana-Health and Nutrition manager World Vision Sudan
Nancy Adero, Nutrition Advisor. USAID-JSI, RHITES-North, Lango. Uganda.
Riaze Rafik,ASSISTANT RESEARCH MANAGER,MIHER
Hello, Karen Calani with Food for the Hungry in Guatemala
Dr. Gertrude Namazzi, Makerere University, Uganda
Hello, Selam Tadesse from CRS, Baltimore
Dr. Catherine Gana. I work as Consultant with a NGO in Nigeria
Erik Champenois, Sr. Business Development Specialist, Abt Associates
Scott LeFevre, Director for Health, Social Services and Education for Catholic Relief Services
Dr. Ibrahim Kirunda, WHO Uganda Maternal, Newborn, Child Quality of Care
Tobias Opiyo, ECD Project Manager, CRS Kenya
Hi all, Melanie Picolo, MNCHN Program Manager, PATH Mozambique
Riaze Rafik,ASSISTANT RESEARCH MANAGER,MIHER, from MOZAMBIQUE
Hello, Lana Drivdal, ECD Specialist, PATH
Hello, am Dina Rwamuhinda, Refugee response, Save the children-Rwanda
Mary Okumu, Kenya
Debjeet Sen, Regional ECD & Nutrition Specialist, PATH
Hi all, Glad to be here! I am Rana Mokhtar, Research Fellow at Ariadne Labs, Better Birth team
Caroline Nerima, Peadiatrician; Uganda
Welcome everyone! If you have just joined feel free to introduce yourself in the chat.
Josie Ferla ECD Senior Manager EGPAF Tanzania
Shaimaa Ibrahim Health Specialist / UNICEF Iraq
fadumo osman save the children
Hi everyone. Angela Osei-Bonsu- Paediatric Society of Ghana
Hello all, Omolola Adebayo, Nutrition Manager, International Institute of Tropical Agriculture-Yola, Nigeria
Hi Everyone.Peninah Kamau from Health NGOs Network
Hi Everyone, Santa Engol-Senior Clinical Coordinator -CHAI Uganda
Hello Everyone, Rita Anaba from Nigeria
Hello Everyone, Brad Strickland from USAID Africa Bureau in Washington DC
Greetings everyone, Amanda Murungi, Nutritionist MoH Uganda.
@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
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
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.
I kindly request for presentation or recording.I dint get the one for the last meeting .email@example.com
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).
The recording and full presentation will be emailed to everyone within the next couple days.
@Peninah feel free to email us at firstname.lastname@example.org for the slides and recording that you missed
Noticed that most of the volunteers were males - was their visit approved by families?
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.
Thanks - my question referred to home visits
Malawi has a great tool called M-DAT- Malawi Development Assessment Tool
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?
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
Afghanistan needs more efforts in regards to inclusion of ECD in Nutrition programs
Allison, how long after the intervention did you do the assessment with MDAT? Sorry if it was presented and I missed it.
No problem! We followed up caregivers and children six months after discharge, and completed MDAT assessments then.
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
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
@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
Thanks @ Colleen!
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…
@Yared - for MAM non-recovery, or worsening clinical condition, children were referred to the health facility for SAM treatment.
To Elena, How effective is the home visits by lead mother in the wake of Corona?
@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
@Tobias, who is paying the Lead Mothers?
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.
Elena, could you share which Care Group modules were covered? How did you decide which topics to prioritize?
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'
@Elena, good results, how are the counties engaged for sustainability of the gains?
how do you address the aspect of intimate partner violence?
@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
Same question as Nsofwa:)
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.
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 Nutritionist save the children-kenya
@Betzabe - I agree...the how is a challenge for sure
Thank you all for your questions! Feel free to continue posting questions to the chat and we will address them during the Q&A.
@ 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.
@Bridget - yes, very good point - and something that we are considering
Any panelists. What effects would you like to see of the THRIVE ACT on your capacity for integration of ECD into your programs?
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).
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?
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.
Thank you for a very informative webinar.
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…
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
Thank all for your informative presentations and discussion.
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
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.
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
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: email@example.comfirstname.lastname@example.orgI appreciate the guidance on evidence based scale up of such work
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!
Thank you, Ibrahim! We will share the presentations after the call. Feel free to reach out to us at email@example.com or to the subgroup co-chairs - Akriti and Bridget - directly (who will be copied on the follow-up email)
Thank you Ms. Sita for the prompt guidance
These programmes are rarely sustainable only using volunteers and I agree. Some are asking for too much for free!