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 ProjectLocation: 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

Implementation

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 Hearth

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

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 90 (2.5 months after intensive phase, three months since

Day 1)

Graduation Criteria: MUAC > 125 mm and Wt gain of 600 g over 3 months

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

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) rounds of implementation in Nyamagabe District

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

Nutrition Weeks InnovationTangiraneza SP (2012-2016)

World Relief Rwanda Tangiraneza Innovation CSP

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

Target Beneficiaries: 79,559 Women 15-49 years of age54,949 Children 0-59 months

Project Goal: To reduce morbidity, mortality and underlying malnutrition of children under five and pregnant women in Nyamagabe District of Rwanda.

Intermediate Results:IR 1. Improved geographic access to and demand for high quality MNCH servicesIR 2. Improved coordination of and impact of community health activitiesIR 3. Innovation tested to improve the effectiveness of the Community Based

Nutrition Weeks InnovationTangiraneza SP (2012-2016)

World Relief Rwanda Tangiraneza Innovation CSP

General problem to be addressed by OR: Malnutrition in children <2.

Strategic relevance within the country:Rwanda has 5th highest stunting rate in the world; MOH wants treatment of malnutrition to be addressed by health

facilities.

Research location: Selected villages in Nyamagabe District

Innovation based on PD/Hearth: Nutrition Weeks

Expected outcomes: Improved feeding practices, reduced malnutrition and assessment of feasibility for MOH implementation and scale up.