PD/Hearth and Nutrition Weeks in Rwanda Experiences from Kabeho Mwana EIP and Tangiraneza I-CSP

Melanie Morrow & Melene KabadegeCORE Group Spring Meeting

April 24, 2013

Kabeho Mwana Expanded Impact ProjectJoint project of Concern Worldwide, the IRC and WR

Location: 6 of 30 Districts in Rwanda

Total Population: 1.8 Million people ~18% of national pop.

Interventions: iCCM for Malaria, Pneumonia and Diarrhea & BCC for C-IMCI, using government CHWs

Added PD/Hearth in two districts with Scottish Govt. sub-grant thanks to Concern Worldwide, the lead agency for Kabeho Mwana

PD/Hearth in Kabeho Mwana Expanded Impact Project 2006-2011

Pd/H Training & Expansion Oct 2009-Feb 2011

PD/Hearth in Kabeho Mwana Expanded Impact Project 2006-2011

Workshops in 2 sep. districts with HC staff, sector head of Social Affairs, and EIP staff. PDIs conducted in conjunction with workshops, not every village.

Menus developed during PD/H workshop with HC staff, Social Affairs In-Charge and EIP staff. Finalized after technical review and follow-up meetings.

Nyamagabe District; 3 HC Catchment Areas (73 Hearth sites)•1 Nutrition Officer, and 1 Promoter per Health Center worked with the HC Nutritionist trained local leaders and government CHWs in PD/Hearth.

Added Nyamasheke District in final year; 7 HC Catchment Areas (70 Hearth sites) •1 Nutrition Officer worked with HC nutritionists to train local leaders and government CHWs in PD/Hearth. Promoters from Nyamagabe helped with initial training but not ongoing supervision. Support from Hospital Director.

286 CHWs (2 per site) received 4 days of training as Light Mothers in Total

Screening and Measurement

PD/Hearth in Kabeho Mwana Expanded Impact Project 2006-2011

Screening: Monthly Growth Monitoring (both Wt for Age & MUAC per MOH)• Anthropometry done by trained CHWs

• SAM Refer to Health Center• MAM (MUAC 115-125 mm) and/or moderate malnutrition based on Wt.

for Age Z Scores Hearth

Intervention: Two weeks of daily participation (6 days per week, 12 days total) 2.5 months of follow-up at home.

Weights and MUAC measured 4 times after preliminary screening:Day 1Day 12 (End of two-week intensive phase, technically Day 13)Day 45 +/- (One month after intensive phase) Day 75-90

Graduation Criteria: MUAC > 125 mm and Wt gain of 600 g

Implementation

PD/Hearth in Kabeho Mwana Expanded Impact Project 2006-2011

143 PD/H sites in the community (73 in Nyamagabe, 70 in Nyamasheke)

Total of 2,884 Children admitted to Hearth:•2,204 in Nyamagabe, 91% rehabilitated•680 in Nyamasheke, 83% rehabilitated

Results using MUAC and Weight Gain

PD/Hearth in Kabeho Mwana Expanded Impact Project 2006-2011

Data from first 3 (of four) rounds of implementation in Nyamagabe District

*Total children admitted double counts children who participated in more than one cycle.

Cured Not-cured

Children Admitted

Lost MUAC Wt gain of 600g

MUAC & Wt

MUAC Wt gain of 600g

MUAC & Wt

1) 728 0 656 (90.1%)

673 (92.4%)

641 (88.0%)

72 (9.8%) 55 (7.6%) 87 (12%)

2) 583 0 481 (82.5%)

497 (85.2%)

432 (74.1%)

102 (17.5%)

86 (14.8%)

151 (25.9%)

3) 482 2 445 (92.3%)

456 (94.6%)

435 (90.2%)

35 (7.2%) 24 (4.9%) 45 (9.3%)

Total* 1793

2 1,582 (88.2%)

1,626 (90.7%)

1,508 (84.1%)

209 (11.6%)

165 (9.2%)

283 (15.8%)

Results using MUAC only

PD/Hearth in Kabeho Mwana Expanded Impact Project 2006-2011

Data from first 3 (of four) cycles of implementation in Nyamagabe District

*Total double-counts children who participated in more than one cycle.

Cured Not-Cured

Children Admitted

Lost MUAC > 125 MUAC < 125

1) 725 0 653 (90.1%) 72 (9.8%)

2) 582 0 480 (82.5%) 102 (17.5%)

3) 480 2 443 (92.3%) 35 (7.2%)

Total*: 1787 2 1,576 (88.2%) 209 (11.6%)

PD/Hearth in Kabeho Mwana Expanded Impact Project 2006-2011

A fraction of the most impoverished families also benefitted from rabbits and kitchen gardens, in addition to PD/Hearth.

Nutrition Weeks InnovationTangiraneza I-CSP (2012-2016)

World Relief Rwanda Tangiraneza Innovation CSP

Project Catchment Area: Nyamagabe District in Southern Rwanda, Total population 337,116 people in 536 Villages.

Interventions: Nutrition, Maternal & Newborn Care, Diarrhea Prev. & Tx, Pneumonia Case Management

Nutrition Weeks Innovation (Based on lessons from PD/Hearth)• Targets 1000 days period (pregnant women and children <2 yrs)• Used preventively - not limited to malnourished children (who are referred to HC)• Each Nutrition Week meets for 6 consecutive days with hands-on sessions patterned after

PD/Hearth, using locally available foods provided by participants• Implemented by govt. CHWs, repeated in each village 3x/year

Stay tuned for results on OR comparing the standard Community Based Nutrition Protocol (CBNP) used by MOH vs. CBNP plus Nutrition Weeks

Nutrition Weeks InnovationTangiraneza I-CSP (2012-2016)

World Relief Rwanda Tangiraneza Innovation CSP

Project Catchment Area: Nyamagabe District in Southern Rwanda, Total population 337,116 people in 536 Villages.

Interventions: Nutrition, Maternal & Newborn Care, Diarrhea Prev. & Tx, Pneumonia Case Management

Nutrition Weeks Innovation (Based on lessons from PD/Hearth)• Targets 1000 days period (pregnant women and children <2 yrs)• Used preventively - not limited to malnourished children (who are referred to HC)• Each Nutrition Week meets for 6 consecutive days with hands-on sessions patterned after

PD/Hearth, using locally available foods provided by participants• Implemented by govt. CHWs, repeated in each village 3x/year

Stay tuned for results on OR comparing the standard Community Based Nutrition Protocol (CBNP) used by MOH vs. CBNP plus Nutrition Weeks