prevention of pre-term birth_10.16.13
TRANSCRIPT
Carolyn Kruger, Ph.D.Sr. Advisor MNCH, PCI
Community Approaches to Underutilized and
Evidence-based Interventions
Prevention of Pre-term Birth
CORE GROUP FALL MEETING 2013
Evidence-based PTB/LBW Interventions
Use of antenatal corticosteroids (ACS) for pre-term birth
Use of appropriate drug regimens for premature rupture of membranes and infectious diseases (STIs, malaria, newborn infections)
Resuscitation methods to help babies breatheKangaroo Mother Care for LBW babiesChorhexidine – cord care
Additional InterventionsEvidence-based –applied at community
level
Comprehensive Antenatal Care – early and regular visits
Maternal nutrition and weight gain
Birth preparation and early recognition of complications
Clean/Skilled care deliveryEssential newborn careHome-based Life Saving
Skills and HBB© 2011 Save the Children. All Rights Reserved
Interventions Applied at Community Level
Prevention of infection – especially for PTBDomestic violence- global violence- stressMental Health- assessment of depressionPregnancy spacing and family planning
Community Strategies: Newborn
Utilize existing platforms ( vulnerable groups, HIV, MCH maternal and newborn, child health) and integrate PTB evidenced-based interventions
Strengthen access, quality and equity
of health services through communityadvocacy- tracking vulnerable groups
Build capacity of health servicesin emergency care, Helping Babies to Breathe and PTB
Community Strategies: Newborn/PPTB
Ensure Essential Commodities- advocacy by community health committees
Build community leadership (tribal, religious, community/civil committees) and capacity to prevent PTBs
Overcome bottlenecks ( distance, referral systems, poverty)
Mother/Father Care Groups and home visits to promote early ANC, birth preparation, recognition of complications and skilled care delivery
Bangladesh “Trio” Care Groups- -Mother, Father and Grandmother influence behavior change-Fathers commit to providing food for malnourished mothers and children-Grandmothers commit to caretaking children so that mother can “rest”
Promising Practices
© UNICEF/NYHQ20102330/ Olivier Asselin, Mali, 2010
Trio Care Groups
Each Care Group Trio consists of 12 leaders each. Mother CGs meet monthly. Grandmothers & Father CGs will meet every three months with the
mother CGs.
(162 Care Group Trios total)
Each paid promoter oversees
approximately 10 Care Group Trios
(12 promoters total)
Each supervisor oversees
approximately three paid promoters
(4 supervisors total)
Supervisor
PromoterGrandmothers
Mothers Fathers
Promoter
Promoter
PROSHAR TRIO CARE GROUP APPROACH
Each leader will meet with approximately 14 peers regularly (monthly/mothers & quarterly/ fathers & grandmothers) reaching
81,648 HH decision-makers
Trios Care Groups
31.438.2
32.3 34.629.2
56
88.7
53
73
40.9
0
10
20
30
40
50
60
70
80
90
100
Exclusive BreastFeeding
Early Initiationof BF
3+ ANC Visits Post Partum Vit-A
3 Correct IYCFBehaviors
Baseline Sept 2012 Results
BEHAVIOR CHANGE TRENDS
Promising Practices
Adolescent and mother-friendly reproductive health services- youth corners and teaching centers
School and community advocacy for prevention of early marriage and pregnancy- PTAs, teacher training, youth groups
Community referral/ transportation systems- community planned and owned
Respectful maternity care- cultural sensitivity, equity supportEconomic and social empowerment groups- mothers group
that include a micro-credit component that increased their sense of decision-making and household resources; WE groups – Women’s Empowerment groups
Feeding support- extra support for PTB
Promising Practices
Kangaroo Mother Care – health facility and community outreach
Maternal Waiting Homes for high-risk pregnant women
Social shifting to prevent early marriagePromotion of girls’ and women’s
educationCommunity Health Committees that advocate for essential commodities at primary health clinics
Overcome Bottlenecks
Formative research- Barrier Analysis/doer-non-doer
Promote culture of respectful and equitable careKnowledge sharing among community leaders –
championsInter-family dialoguesUtilize community leaders to advocate for improved careCommunity ownership of the problem and solution
Photo property of CARE, Nov 2011
DISCUSSION
Are you integrating prevention of PTBs? If so, HOW?
What is working? And if so WHY?What are the barriers to integration?What are the facilitating factors to integration?Community ownership- ideas?Are you aware of Newborn/PTB opportunities
and resources to share?Have you visited your representative lately?