cell phone counseling to improve implementation of...

Cell Phone Counseling to Improve Implementation of Appropriate Nutrition Practices – a pilot of cross-sectoral

intervention between a research NGO, public hospitals and cell phone companies.

Lata Medical Research Foundation,

Nagpur, INDIA

30th Oct, 2014

Dr.Archana Patel1,2

1 – Lata Medical Research Foundation, Nagpur, India 2 – Indira Gandhi Government Medical College, Nagpur, India

Lata Medical Research

Foundation

1

Background

• Inappropriate infant feeding practices contribute significantly to India's high prevalence of child malnutrition.

• Cell phones (CPs) provide an innovative community-based platform

– nutritional education and

– behaviour change needed to improve nutrition practices.

• We report the first trial that evaluated the efficacy of CP communication between providers and beneficiaries to improve appropriate feeding practices of infants up to 6 months of age.

2Together for Nutrition 2014 - 30th Oct 2014

Cross sectorial approach

Together for Nutrition 2014 - 30th Oct 2014

3

LMRF

An NGO

• Conducted Trial

• Setting up cell phone counseling systems

4 Public Hospitals

• BFHI retraining of their staff

• Participant recruitment

Vodafone Essar Pvt

Ltd.

• Provided cell phone services

• Training of LCs in use of handsets

Intervention- Lactation counseling using cell phones


70-80 calls/day & send 500-600 bulk SMSes daily

Beneficiaries - Mother - Baby dyads

Call transfer facilityData base of all mothers

Speed dialing and

call back

Methodology and Study design


5

Visit 1, 2 :

Third trimester

Visit 3 :

Within 24 hrs.

of delivery

Visit 4, 5, 6:

Postnatal 6,10,14 wks

Visit 7 :

Postnatal 6 months

Visit 8 :

Postnatal 6

months + 1 wk

Intervention Cluster - 2

(BFHI training & Cell phone

counseling)

( n = 519)

Control Cluster - 2

(BFHI training & Existing standard

of care)

( n = 518)

SCREEN for participant’s

inclusion in study

Lata Medical Research Foundation

An NGO

1. Hb% less than 6gm% (severe

anemia) and presence of sickle

cell anemia

2. Eclampsia / Preeclampsia

3. Taking medicines which are

harmful during breast feeding

4. HIV positive

1. ANC lady of 32-36 wks

gestation.

2. Registered at the study site

for her current issue.

3. Willing to deliver and willing

to follow up at the same

hospital till 1 week after 6

months of infant age.

4. Willing to receive and give

calls to the lactational

counselor.

5. Willing to sign the informed

consent form.Outcomes

- EBF, TIBF, TICF

- Bottle Feeding

- Neonatal / infant hospitalizations

- Infant Weight & length

- Maternal hospitalizations

- Maternal satisfaction

In Intervention group

- Cell phone counseling satisfaction

Exclusion criteria Inclusion criteria

Vodafone Essar Pvt Ltd.

Cell phone company

4 Public hospitals

in Nagpur district Hospitals

Outcomes in Neonates


6

23.6

12.5

36.9

6.8

0

9

18

27

36

45

Timely initiation of breastfeeding Baby Require hospitalization

% o

f p

arti

cip

ants

Control (N=513) Intervention (N=518)

P-value < 0.001

P-value < 0.01

Rates of Exclusive Breast Feeding


73.780.9 78.1

70.7

48.5

74.3

97.0* 97.6* 96.2* 97.3*

0

20

40

60

80

100

120

Within 24 hoursafter delivery

At 6th week At 10th week At 14th week At 6th month

Excl

usi

ve B

reas

tfe

ed

ing

(%)

Visit time points

* - Represents p-value < 0.001

Control Intervention

Introduction of Semi- Solid Feeds


8

26.9

63.6

0.4

97.9

0

30

60

90

120

Incorrectly introduced semi solid foodbefore 6 months

Timely introduction of semi solid food

% o

f p

arti

cip

ants


P-value < 0.001

P-value < 0.001

Bottle Feeding Rates on Follow Up Visits

9Together for Nutrition 2014 - 30th Oct

2014

0.8

5.7

9.2

11.8

18.3

21.6

0.2 0.8* 0.6* 0.6* 1.2*

7.0*

0

5

10

15

20

25

Within 24hours after

delivery

At 6th week At 10th week At 14th week At 6th month At one weekafter 6thmonth

Bo

ttle

fe

ed

ing

(%)

Visit time points

* - Represents p-value < 0.001


Key findings

• CP intervention resulted in significantly higher rates of

– Early initiation of BF (37% vs. 24%),

– Exclusive BF (6 months pp: 97% vs. 49%),

– Appropriate introduction of semi solid foods at 6 months, and

• Lowered rates of bottle feeding (6 months pp: 1% vs. 18%)

• It was well accepted by the clients and significantly improved rapport with the providers

• Standard operating procedures that helped monitor the trial can help establish services at public and private hospitals


2014

Significance

• This innovative intervention was successfully implemented by the tripartite partnership of public hospitals, CP companies, and an NGO.

• The results have contributed to develop CP interventions in 5 member countries of the South Asian Infant Feeding Research Network (SAIFRN).

• Cross-sectoral engagement of community health workers, CP companies and social enterprises such as CommCare, Dimagi has been initiated to transform maternal and infant nutrition practices in the South Asian region


11

Implications


• Public private partnership and corporate social responsibility can ensure sustainability.

• Scalability - front line health workers (Auxiliary nurse midwives) can successfully implement cell phone lactational counseling so can scaled up in public and private health care system

Recognitions Received


13

1. 2009 grant competition South Asia Regional Development Marketplace

(4-6th Aug, 2009 Dhaka, Bangladesh)

2. Chairman’s distinction for Manthan Award 2011:

http://manthanaward.org/section_full_story.asp?id=1093

3. Finalist certificate for WIN Awards (Women & Innovation for mobile awards 2011) http://www.vodafone-foundation.in/wp-content/uploads/documents/WIN_Awards.2011.pdf

4. Finalist at Vodafone ‘mobiles for Good’ Grant Fund 2011

http://mobilesforgood.mbillionth.in/m4g-2011/nominees/

5. Audience vote prize at the lightening round presentation of the South Asia

Regional Development Marketplace (SAR DM) on nutrition presentations –

June 2012

6. Certificate of participation for successfully conducting the World Breast

Feeding Week 2012, for World Alliance for Breastfeeding Action (WABA )

http://manthanaward.org/section_full_story.asp?id=1093

http://www.vodafone-foundation.in/wp-content/uploads/documents/WIN_Awards.2011.pdf

http://mobilesforgood.mbillionth.in/m4g-2011/nominees/

AcknowledgementsOur sincere thanks to:

Sponsors: World Bank and Alive & Thrive

Collaborating institutions / Organisations:

• Lata Medical Research Foundation (India) was the lead organization and planned, implemented, monitored, and coordinated the study, including re-training in BFHI, data collection and analysis, and setting up of the cell phone counseling systems.

• Indira Gandhi Government Medical College & Hospital (IGGMC), Daga Memorial Government Hospital, Matru Seva Sangh Mahal Hospital, and Matru Seva Sangh Buldi Hospital (India) granted permission for conducting BFHI retraining of the staff and enrolling participants from the respective study sites.

• Vodafone Essar Pvt Limited,Nagpur, India for provision of handsets, calling plans, SIM cards and recharge vouchers at subsidised rates.

Project staff and Study participants


2014


15

cell phone counseling to improve implementation of...

Documents