Judy LewisBette Gebrian

INFORMATION SHARING TO CHANGE POLICY FOR CHILD

PNEUMONIA TREATMENT

Pneumonia still leading cause of death <5PAHO 1995:

In 2000, 40,000 children <5 diagnosed Almost 3000 died (7.4%)

PEDIATRIC PNEUMONIA IN HAITI

Mortality Rate (Children Under 5 Years)

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Haiti Dominican Republic United States of America

Dea

ths

per

100

,000

live

bir

ths

ARI Mortality Rate (1994)

Total Mortality Rate (1994)

Population based primary health careHHF initial program 1986

Public Health Program 1987200,000 population

Village Health Committees Community Selected Village Health Workers Mobile Health Teams Registered Population Family Data System Epidemiological Profi le

HAITIAN HEALTH FOUNDATION

DATA DRIVEN PARTICIPATORY PROGRAM IMPROVEMENT

Assessment

Communities

ProvidersResearcher

s

Feedback Planning

Implementation

Data Collection

Information System

JEREMIE TOWN AND VILLAGES

Method: scenarios, video interpretation, card sorts of symptoms and causal relationships

Results: Rapid breathing and inter-costal retraction believed to be

parasites Bwonch (pneumonia) vs grip (flu-like) Bwonch caused by bathing too late in the day or in cold

water, or an untreated cold Knowledge of symptoms low and only 26% identified rapid

infant breathing video as pneumonia Everyone knew at least one child who died of pneumonia

Information used by PAHO to launch national pneumonia program in 1993

1990 WHO ETHNOGRAPHIC STUDY

WHO treatment algorithms and training modules Translation to Haitian Creole by JSI 1994

USAID sponsored pilot implementationTools: battery-operated timer that emitted a sound at

30 and 60 seconds to assess breathing Two sequential recordings of rate above age group norm Questions and observation to help classify

Two week training Doctors and nurses Community health workers – had to demonstrate competence

Treatment documentationOngoing supervision

PNEUMONIA TREATMENT AND TRAINING

HHF has regular meetings with community leaders, healers and members

Community participation given equal weight in staff training seminars for community-based organizations creating songs about recognizing and treating pneumonia public demonstrations on the use of the timer, counting

respiratory rates medicine (cotrimoxazole), cost, first dose, length of rx and

home careTreatment

5 days for 5 Haitian gourdes (US$.04) Now 8 days for 10 gourdes (WHO)

COMMUNITY MOBILIZATION

RefrainMothers there is an il lness that is called pneumoniaThat kil ls children.If you see a child with rapid breathing or coughing, go to the dispensary.

I.Pneumonia is a severe il lness.If you wait to see you will lose your child.If you see the child gets worse after going to the dispensary you need to return quickly to the dispensary.Refrain

II.Fathers with children, help the mothers!Its not only mothers who seek care for childrenWhen they have pneumonia or another il lness, if they are not treated they will die more easily.

PNEUMONIA SONG

1997 CDC program impact evaluation 17,000 cases treated in first 3 years

CDC concluded: HHF ARI program is an important model for Haiti Reduction of baseline pneumonia-specific mortality from

6.2/1000/year to 3.1 CHWs with brief formal training, intensive supervision and

regular continuing education can effectively diagnose and treat ARI in Haiti

1998 CDC case control study of children with multiple episodes of pneumonia* Wheezing was found to be the significant contributor

CDC EVALUATION/RESEARCH

*Heffelfinger JD, Davis TE, Gebrian B, et al. Evaluation of children with recurrent pneumonia diagnosed by World Health Organization criteria. Pediatr Infect Dis J. 2002 Feb;21(2):108–12.

In 1993 CHWs in Haiti not allowed to dispense antibiotics USAID got MSPP approval for HHF CHWs Careful documentation of medication distribution and

outcomesBased on evidence and discussions with HHF, MSPP

approved CHW cotrimoxazole distribution in USAID sponsored NGOs

After HHF’s further advocacy and documentation Community based treatment of ARI became part of Haiti

national IMCI policy in 2005HHF collaborated with Haitian Pediatric Society 2011 World Pneumonia Day

GOVERNMENT POLICY

2002 HHF began training other organizations FOCAS child survival grant wanted to incorporate community

treatment for pneumonia2005 USAID designated HHF as a fi eld training site for

community based treatment of pediatric pneumonia 6 Haitian NGOs came for one week of training Teams of physicians, nurse managers and CHWs—teamwork

critical component HHF Community Based ALRI Treatment Manual revised based

on feedback Follow up with NGOs found that most had implemented—

major obstacle was timers5 additional NGO trainings after USAID2 publications and 4 graduate student research projects

DISSEMINATION AND TRAINING

Continue to track pneumonia episodes and treatment—93,000 episodes through 2013

January 2013 pentavalent vaccine became Haiti protocol Problems with stock outs Lack of storage space for so many individual vials

HHF will be able to demonstrate impact of having Hib vaccination on pneumonia rates and outcomes

Healthy children determining their future!

PRESENT AND FUTURE