Lata Medical Research Foundation Cell Phone Counseling to Improve Implementation of Appropriate Nutrition Practices a pilot of cross-sectoral intervention between a research NGO, public hospitals and cell phone companies. Dr.Archana Patel 1,2 1 Lata Medical Research Foundation, Nagpur, India 2 Indira Gandhi Government Medical College, Nagpur, India Lata Medical Research Foundation, Nagpur, INDIA 30 th Oct, 1
Background Inappropriate infant feeding practices contribute significantly to India's high prevalence of child malnutrition. Cell phones (CPs) provide an innovative community-based platform nutritional education and behaviour change needed to improve nutrition practices. We report the first trial that evaluated the efficacy of CP communication between providers and beneficiaries to improve appropriate feeding practices of infants up to 6 months of age. Together for Nutrition - 30th Oct 2
Cross sectorial approach LMRF An NGO Conducted Trial Setting up cell phone counseling systems 4 Public Hospitals BFHI retraining of their staff Participant recruitment Vodafone Essar Pvt Ltd. Provided cell phone services Training of LCs in use of handsets Together for Nutrition - 30th Oct 3
Intervention- Lactation counseling using cell phones Data base of all mothers Call transfer facility 70-80 calls/day & send 500-600 bulk SMSes daily Beneficiaries - Mother - Baby dyads Speed dialing and call back Together for Nutrition - 30th Oct 4
Methodology and Study design 4 Public hospitals in Nagpur district Hospitals Lata Medical Research Foundation An NGO Vodafone Essar Pvt Ltd. Cell phone company Intervention Cluster - 2 (BFHI training & Cell phone counseling) ( n = 519) Control Cluster - 2 (BFHI training & Existing standard of care) ( n = 518) 1. Hb% less than 6gm% (severe anemia) and presence of sickle cell anemia 2. Eclampsia / Preeclampsia 3. Taking medicines which are harmful during breast feeding 4. HIV positive Outcomes - EBF, TIBF, TICF - Bottle Feeding - Neonatal / infant hospitalizations - Infant Weight & length - Maternal hospitalizations - Maternal satisfaction In Intervention group - Cell phone counseling satisfaction Visit 1, 2 : Third trimester SCREEN for participant s inclusion in study Exclusion criteria Inclusion criteria Visit 3 : Within 24 hrs. of delivery Visit 4, 5, 6: Postnatal 6,10,14 wks Together for Nutrition - 30th Oct 1. ANC lady of 32-36 wks gestation. 2. Registered at the study site for her current issue. 3. Willing to deliver and willing to follow up at the same hospital till 1 week after 6 months of infant age. 4. Willing to receive and give calls to the lactational counselor. 5. Willing to sign the informed consent form. Visit 7 : Postnatal 6 months Visit 8 : Postnatal 6 months + 1 wk 5
% of participants Outcomes in Neonates 45 36 P-value < 0.001 36.9 27 23.6 18 9 12.5 P-value < 0.01 6.8 0 Timely initiation of breastfeeding Baby Require hospitalization Control (N=513) Intervention (N=518) Together for Nutrition - 30th Oct 6
Exclusive Breastfeeding (%) Rates of Exclusive Breast Feeding 120 100 97.0* 97.6* 96.2* 97.3* 80 73.7 74.3 80.9 78.1 70.7 60 48.5 40 20 0 Within 24 hours after delivery At 6th week At 10th week At 14th week At 6th month Visit time points Control Intervention * - Represents p-value < 0.001 Together for Nutrition - 30th Oct 7
% of participants Introduction of Semi- Solid Feeds 120 P-value < 0.001 97.9 90 60 63.6 P-value < 0.001 30 26.9 0 0.4 Incorrectly introduced semi solid food before 6 months Control Timely introduction of semi solid food Intervention Together for Nutrition - 30th Oct 8
Bottle feeding (%) Bottle Feeding Rates on Follow Up Visits 25 20 18.3 21.6 15 10 5 0 0.8 Within 24 hours after delivery 5.7 9.2 11.8 0.2 0.8* 0.6* 0.6* 1.2* 7.0* At 6th week At 10th week At 14th week At 6th month At one week after 6th Visit time points month Control Intervention * - Represents p-value < 0.001 Together for Nutrition - 30th Oct 9
Key findings CP intervention resulted in significantly higher rates of Early initiation of BF (37% vs. 24%), Exclusive BF (6 months pp: 97% vs. 49%), Appropriate introduction of semi solid foods at 6 months, and Lowered rates of bottle feeding (6 months pp: 1% vs. 18%) It was well accepted by the clients and significantly improved rapport with the providers Standard operating procedures that helped monitor the trial can help establish services at public and private hospitals Together for Nutrition - 30th Oct 10
Significance This innovative intervention was successfully implemented by the tripartite partnership of public hospitals, CP companies, and an NGO. The results have contributed to develop CP interventions in 5 member countries of the South Asian Infant Feeding Research Network (SAIFRN). Cross-sectoral engagement of community health workers, CP companies and social enterprises such as CommCare, Dimagi has been initiated to transform maternal and infant nutrition practices in the South Asian region Together for Nutrition - 30th Oct 11
Implications Public private partnership and corporate social responsibility can ensure sustainability. Scalability - front line health workers (Auxiliary nurse midwives) can successfully implement cell phone lactational counseling so can scaled up in public and private health care system Together for Nutrition - 30th Oct 12
Recognitions Received 1. 2009 grant competition South Asia Regional Development Marketplace (4-6 th Aug, 2009 Dhaka, Bangladesh) 2. Chairman s distinction for Manthan Award 2011: http://manthanaward.org/section_full_story.asp?id=1093 3. Finalist certificate for WIN Awards (Women & Innovation for mobile awards 2011) http://www.vodafone-foundation.in/wpcontent/uploads/documents/win_awards.2011.pdf 4. Finalist at Vodafone mobiles for Good Grant Fund 2011 http://mobilesforgood.mbillionth.in/m4g-2011/nominees/ 5. Audience vote prize at the lightening round presentation of the South Asia Regional Development Marketplace (SAR DM) on nutrition presentations June 2012 6. Certificate of participation for successfully conducting the World Breast Feeding Week 2012, for World Alliance for Breastfeeding Action (WABA ) Together for Nutrition - 30th Oct 13
Our sincere thanks to: Acknowledgements Sponsors: World Bank and Alive & Thrive Collaborating institutions / Organisations: Lata Medical Research Foundation (India) was the lead organization and planned, implemented, monitored, and coordinated the study, including re-training in BFHI, data collection and analysis, and setting up of the cell phone counseling systems. Indira Gandhi Government Medical College & Hospital (IGGMC), Daga Memorial Government Hospital, Matru Seva Sangh Mahal Hospital, and Matru Seva Sangh Buldi Hospital (India) granted permission for conducting BFHI retraining of the staff and enrolling participants from the respective study sites. Vodafone Essar Pvt Limited,Nagpur, India for provision of handsets, calling plans, SIM cards and recharge vouchers at subsidised rates. Project staff and Study participants Together for Nutrition - 30th Oct 14
Together for Nutrition - 30th Oct 15