How To Improve Pregnancy Outcomes In Minia Governorate

Transcription

1 Improving Pregnancy Outcomes Through Positive Deviance in Egypt Ministry of Health/Egypt Save the Children Saving Newborn Lives Tufts University

2 Project Goal Design and Test a PD program in Minia Governorate to improve pregnancy outcomes

3 Importance of this project in Egypt 10% Low Birth Weight (LBW) (<2.5kg) 30% Newborns weight < 3 kg 45% Children under 2 (U2s) in El-Minia are moderately malnourished (<-2SD) Improving health and nutrition is a government priority and development objective

4 Implications of LBW 40-fold greater risk of dying in the 1st year 50% risk of serious developmental problems and other illnesses (including CVD & Diabetes) in later years

5 Implications of LBW Poor school achievement ( IQ) Decreased work capacity and productivity LBW females at risk of IUGR in their own subsequent pregnancies

6 Programmatic Goals Maternal malnutrition & Depletion Child Survival & Growth

7 Indicators BIRTH WEIGHT PREGNANCY WEIGHT GAIN CHILD GROWTH DURING 1ST YEAR OF LIFE (WT/HT) MATERNAL DEPLETION (BMI)

8 Research & Operational Plans

9 STEP 1: PDI (Positive Deviance Inquiry) Identifying women with successful pregnancy outcomes Assessing and comparing their pregnancy behaviors with other women

10 PDI Results Frequency of antenatal care ANC visits Rest (amount of rest) Absence of symptoms of Urinary Tract Infections (UTI)

11 In poorer areas: PDI Results Tap water use Latrine ownership Meat & vegetable consumption

12 PDI Results Eating down during pregnancy High exposure to second hand smoke High parity (risk factor for inadequate pregnancy weight gain) Primiparity (risk factor for LBW)

13 STEP 2 Design and initiation of a carefully monitored and evaluated pilot study/intervention to improve pregnancy outcomes utilizing the PDI results

14 Study involves: Monthly weighing and counseling of all pregnant women Weekly IMPRESS sessions targeted to women at greatest risk first time pregnancies

15 IMPRESS Session Components Intensive Counseling/Education of women Exposure of mothers-in-law to new ideas Food provision

16 IMPRESS Entry Criteria Low BMI (<22.6) Inadequate pregnancy wt gain (<1kg/month) First pregnancies

17 Special attention within Highest Risk Women first pregnancies high parity very poor IMPRESS to no assistance within household

18 Project Features: Identified women remain in IMPRESS through time of delivery Birthweights recorded for all women Data collection on actual behaviors practiced and actual services received. Data collection on survival & growth of offspring for the first 12 months of life.

19 Prior to initiation of activities 1. Upgrading of MCH clinics in project and control areas: quality ANC micronutrient supplementation facilities for UTI testing and treatment Followed by one month trial and assessment 2. Social mobilization and training

20 As a Result. Women in project and control areas now receive monthly high quality ANC and UTI testing While one year ago, pregnant women in these areas were receiving minimal ANC often consisting only of TT injections

21 UTI Testing is Proving Valuable

22 UTI Testing and Treatment Al-Ghatousha Women in Project 142 Tested 142 Tested Positive or Received Treatment* 42 *Treatment is provided when test result is +2 or +3.

23 In Dagouf, of 209 pregnant women in the project, 119 tested positive (+2 or +3) and were treated

24 Accordingly this project will permit us to compare the effect of the entire package with that of improved ANC services alone

25 Step 3 Systematic analysis of results with recommendations for program improvement and large scale replication

26 PRELIMINARY RESULTS

27 Birthweight (KG) Village Name Baseline mean ± SD (n) Results to Date mean (n) Al-Ghatousha 2.99 ± (Project) (42) (60) Dar-Samalout (Project) Daghouf (Control) 2.54 ± 0.32 (88) 2.77 ± 0.39 (55) 3.35 (96) 2.82 (100)

28 Birthweight (KG) Baseline Result Al-G(proj) D-S(proj) Dag(con)

29 Low Birthweight Prevalence* Village Name Baseline Results to Date % (n) Al-Ghatousha (Project) 8.3 % (n) 0 (3) (0) Dar-Samalout (Project) 34.3 (24) 3.1 (3) Daghouf (Control) Birthweight < 2.5 kg 19.6 (9) 13.0 (13)

30 Low Birthweight Prevalence* Al-G(proj) D-S(proj) Dag(con) Baseline Result

31 Pregnancy Food Intake* Village Name More than Usual Less than Usual Baseline MRTD* Baseline MRTD* %(n) %(n) %(n) %(n) Al-Ghatousha (Project) 15.0 (15) 49.3 (75) 42.0 (42) 18.4 (28) Dar-Samalout (Project) 13.1 (16) 48.1 (38) 45.1 (55) 6.3 (5) * MRTD= Monitoring results to date; Relative to Pre-pregnancy

32 Pregnancy Meat Intake* Village Name More than Usual Less than Usual Baseline MRTD* Baseline MRTD* %(n) %(n) %(n) %(n) Al-Ghatousha (Project) 22.0 (22) 50.0 (76) 16.0 (16) 9.2 (14) Dar-Samalout (Project) 13.9 (17) 40.5 (32) 22.1 (27) 5.1 (4) * MRTD= Monitoring results to date; Relative to Pre-pregnancy

33 Pregnancy Vegetable Intake* Village Name More than Usual Less than Usual Baseline Al-Ghatousha (Project) 53.0 MRTD* Baseline MRTD* %(N) %(N) %(N) %(N) (53) Dar-Samalout (Project) 49.2 (60) 55.9 (85) 72.2 (57) 21.0 (21) 19.7 (24) 9.9 (15) 2.5 (2) * MRTD= Monitoring results to date; Relative to Pre-pregnancy

34 Daytime Rest 1.5 hours/day* Village Name Baseline %(n) MRTD %(N) Al-Ghatousha (Project) (37) (125) Dar-Samalout (Project) 41.0 (50) 68.6 (48) * As percentage of pregnant women taking daytime rest

35 Receiving Help with Chores Village Name Al-Ghatousha (Project) Baseline %(n) 67.0 (67) MRTD* %(n) 73.0 (111) Dar-Samalout (Project) * Monitoring results to date 63.9 (78) 75.9 (60)

36 Exposure to Second hand Smoke Village Name Baseline %(n) MRTD* %(n) Al-Ghatousha (Project) 71.0 (71) 19.0 (27) Dar-Samalout (Project) * Monitoring results to date 65.6 (80) 16.5 (13)

37 Project Costs

38 Annual Project Cost Breakdown* Category Cost in Egyptian Pounds (EL) IMPRESS Activities 18,280 Local Staff 7,370 Supervisor (one for 10 villages) 1,532 Equipments 2,955 Training, Data Collection and Documentation 4,700 TOTAL 34,837 Cost per 300 pregnancies in one village per year. Does not include health center up-grading, health center staff, or supervisor transport prices.

39 Cost per Pregnant Woman Reached 116 EL (US $ 19)

40 Cost Effectiveness* Cost Per 100 gm Gain in Birthweight 27.6 EL (US$ 4.60) * Based on results to date.

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