Malnutrition eLearning Newsletter April 2015

Welcome to the 7th newsletter

The Malnutrition eLearning Course, developed by the University of Southampton and the International Malnutrition Task Force (IMTF), is a freely available course to train health workers across the world in the management of Severe and Acute Malnutrition (SAM) in infants and children.The course is available at: www.som.soton.ac.uk/learn/test/nutrition/

Evaluation Study News:-

The effectiveness of the Malnutrition Course is currently being evaluated by a 2-year research project. The first phase of the study has begun with a survey for students and health workers who have already done the course. It is important to discover if the course is making a significant impact, providing information and changing practice in the treatment and management of childhood malnutrition.

The second phase of the evaluation will take place in Ethiopia, Ghana and Guatemala. Dr. Demeke Mekonnen Mengistie the Principal Investigator for the Ethiopia Team recently visited the project team based at University of Southampton to help plan the study. It was a great opportunity to meet Demeke and find out more about the progress of the study in Ethiopia.

If you have used the malnutrition course, (even if you did not finish) please help us by filling in the questionnaire. Click here for the link to the survey

For more information regarding the study, please visit our website: www.som.soton.ac.uk/learn/test/nutrition/mele/about/

Thank you if you have already completed

About the Course

The aim of the Malnutrition Course is to provide training to Health Care Workers across the world in the management of Severe Acute Malnutrition. We believe that with the correct training we can make a significant difference to the plight of children internationally. The course is used in the teaching of undergraduate and MSc students, and in-service health professionals. The benefit of this course is the fact that it can be completed on-line and in your own time. Content is based on the World Health Organisation guidelines and assessment and feedback are provided throughout the course. A certificate is provided upon completion.

A summary from Professor Ann Hill

Ann Hill is Professor of Community Nutrition in the Public Health Nutrition Unit at the London School, of Hygiene and Tropical Medicine. She has been working with Malnutrition since 1964 and assisted in the writing and development of this Course. Having been promoting the need for effective training for many years. Read the great account of what challenges she has faced over the years and how she sees the future (see page 3).

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the questionnaire.

COMMUNITY:-

Certificate Giving Ceremony

These photos of students receiving their Malnutrition eLearning Certificates were sent to us by Xolile Mkhize, Senior Lecturer at Mangosuthu University Of Technology, Durban, South Africa. These students and community workers are part of food security project in South Africa.

Worth a look:-

Double Burden MapThe Global Alliance for Improved Nutrition (GAIN) has just launched the Double Burden Map which is an online tool showing the true scale of malnutrition globally.To view visit:-  http://bit.ly/1Ds99GyIt provides data from over 30 countries both developing and developed countries, whether that is under-nutrition or obesity.

The first ever Global Nutrition Report was published earlier this year. This is a review of the progress being made. To download the report, click here.

Scaling up Nutrition is a movement based on the principle all people have a right to food and good nutrition. They work to bring together people in a collective effort to improve nutrition. To find out more pleasevisit their website: -http://scalingupnutrition.org and see their efforts towards Scaling Up Nutrition.

The CMAM forum have produced this detailed key resources on the management of acute malnutrition, a valuable set of documents for specialists:- http://www.cmamforum.org/Pool/Resources/Key-Resources-for-mgmt-of-acute-malnutrition-CMAM-Forum-Dec-2014.pdf

Unicef in Bangladesh have been using the Malnutrition eLearning Course to train their Nutrition Consultants. Feedback so far has been positive with one participant telling us they have incorporated what they learnt on the course in to their daily work. We hope to bring you more news on this in our next

Join us on Facebook & LinkedInThe Facebook page “Malnutrition eLearning Course” has over 1350 followers. Please “like” the page so your friends will get the details. In addition, the better known the page is, the more people will find it.www.facebook.com/MalnutritionELearningCourseLinkedIn: uk.linkedin.com/in/trevorpickup/

We would like to hear your experiences of using the Malnutrition eLearning Course. If you would like to share your news with us, please contact: - Sally Hickman at

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newsletter. S.A.Hickman@soton.ac.uk. We would love to hear from you!

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Spreading the word: some personal reflectionsBy Ann AshworthInternational Malnutrition Task Force

The malnutrition eLearning course is the result of a very long journey. My reflections relate to some of this journey.

In 1964, I joined a Unit in Jamaica renowned for its pioneering research on the treatment of severe malnutrition. When it was first established, about 25% of children admitted to the Unit died but the research helped reduce this to <5%. In 1970, whilst collecting data about the nutrition situation in Jamaica, I discovered that none of the island’s district hospitals had any knowledge about the correct treatment of severe malnutrition, although there were many cases. In one hospital, 50% of cases died. So despite the Unit’s respected position internationally, and publications in prestigious journals, the local impact was zero. So we wrote a treatment manual and held training sessions and eventually all hospitals in Jamaica followed the Unit’s approach. Later the treatment guidelines were adopted by all countries of the Commonwealth Caribbean and became part of the medical curriculum; they also formed the basis for the 1981 WHO treatment guidelines.

Rather naively, we expected that treatment would improve worldwide following publication of authoritative guidelines by WHO, but this was not the case. When I moved to the London School of Hygiene & Tropical Medicine it became clear that high mortality among severely malnourished children still existed in most hospitals of the world, so in May 1993 a colleague and I organised a small workshop to review the situation and make a plan. The participants (representatives from WHO, UNICEF, Save the Children, and academics) agreed that I) mismanagement persisted worldwide, ii) there was little awareness of the WHO guidelines, iii) action was needed. Actions that were emphasised were: -

• presenting treatment in a practical, user-friendly and memorable form (such as ‘10 steps’)

• making this accessible through

• multiple and wide distribution• documenting the evidence for

mismanagement and high mortality rates (as this would be needed to justify the need for action)

• videos for advocacy and training, and support materials.

Following the workshop, we developed ‘10 steps’. Treatment was summarised in 3 pages and disseminated by Child Health Dialogue with a circulation of over a million, with French, Spanish and Chinese translations. PAHO published the ‘10-steps’ as a leaflet in Portuguese. We surveyed health workers’ knowledge and practice, and reviewed the literature, and these provided important evidence of mismanagement and high mortality.

WHO produced a second manual in 1999 and a 6-day training course. Although excellent, and always evaluated highly by trainees, this course can take only 25 people and is expensive to run. Only one or two people per institution can be released for a course like this and, to have an impact on treatment practices, the trainees must re-skill their colleagues when they return back to base. Training the entire team can be difficult unless everyone is fully committed.

So the eLearning course is the new engine on the journey, allowing many more trainees to be reached than previously. Large numbers of health practitioners can study on their own or in groups, and medical, nursing, health science and nutrition students can equip themselves with the knowledge needed to treat severely malnourished children successfully. University and college tutors find the course helpful in preparing lectures.

Putting knowledge into practice can be a challenge but is the vital reward. My hope is that you will be one of the champions who will motivate and help others achieve best practice in the care of severely malnourished children. It can be life-changing for you, and life-giving to the children. I wish you success. If enough people take the course and apply the knowledge they acquire, then the journey’s destination (low child mortality and full recovery) will be reached.

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