Pesquisa Científica na Área de Cuidado de Saúde Primários Scientific Research in Primary Healthcare

IGC – Workshop, July 2015

Maputo

Marcos Vera-Hernández

University College London

• Improving child nutrition through information provision– Malawi, Kenya, Nepal, India

• Health insurance as the centerpiece of effective integrated healthcare– Colombia

Importance of nutrition 0-2 years old

• Difficult to catch up any deficit that occurs in the early years

• Future resilience to illness

• Brain formation

Causes of malnutrition are complex

•Common “unhealthy practices and norms”:

– Misinformation, lack of knowledge

– Social and family pressure

Examples of “unhealthy norms”

Michinji (Malawi)

•It is not good to give eggs to children

•The soup broth is more nutritious than the vegetable and meat

Examples of “unhealthy norms”

Western Kenya

•Belief that if children eat eggs, their speak will be delayed

•Meat causes allergy to children

•Small children are better off eating plain and clear porridge without other foods

Effective and intensive communication

• Deeply rooted beliefs

• A leaflet will not solved the problem

• More elaborated communication is necessary

Home visiting in Michinji (Malawi)

•Maimwana Infant Feeding Intervention:

– A female counselors are trained to visits mothers of young children

– Up to six visits to deliver nutrition messages with help of a picture book

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Recognizing and feeding a sick babyA sick baby may present with the following danger signs;

o feeling cold, o fever, o weakness and sleepy ,o abnormal sleeping, o crying for long times,o High pitched cry, o fast breathing, o difficulties in breathing,o Jaundice, o Irritability and refusing to feed.

Visit you nearest health facility if you see any of these danger signs  Feeding a sick babyWhen a baby is sick feeding becomes difficult; she/he may not eat at times and may even fail to breast feed;The mother should express breast milk and give it to the baby. (To express you need a clean cup, wash hands and then press your two fingers around the dark part of the breast where there are milk storage tanks, the milk will flow freelyUsing a smaller cup, feed the baby regularly, in small amounts, until when the baby is able to breast feed.Breast feed the child frequently and provide small nutritious feeds with other nutritious fluids like fruit juice, yoghurt and milk;  

  

Picture 7

Picture 4

To prepare small dried fish (omena) Take small fish, wash, dry and roast them properly Allow to cool then pound in a mortar and sieve Add a table spoon to the porridge; allow it to boil for 5-minutes.Cool and feed the babyKeep the rest in a clean closed container for future use  To prepare meat Cut meat in small parts cook till tenderChoose a boneless piece put on a plate to cool then pound in a mortar until it is smooth Add it to porridge allow it to boil for 5-minutes.Cool and feed the baby (you can also prepare liver in the same way remember to remove the skin from the liver) To prepare groundnut powder Crush nuts pound in a mortal and sieve you can add this to porridge To prepare vegetables Wash the leaves, chop them and cook as normal, do not over cook…..

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Home visiting in Michinji (Malawi)

Randomized Controlled Trial showed improvement in:•Mother’s knowledge on nutrition

•Diet variety

•Exclusive breastfeeding

•Child’s height

Idea taken up in Western Kenya

• Evidence Action

• Chlorine dispensers for water treatment

Idea taken up in Western Kenya

•Promoter in the community takes care of chlorine dispenser

•Promoter could be trained to deliver nutrition messages

•Variation: a random group will deliver the information to mother, another random group to mother + father

Home visiting not a panacea

•It depends on the effort of the promoter

•Quite time consuming

•Might not be the best approach to change widely followed norms

Women’s groups•Women’s groups have worked well in Nepal and India but they have been done for birth preparedness

•Might allow for stronger collective action to change widely followed norms

•But might not have high take up in the community

•Not all women might receive information/advice

A study that needs to be done:

•Home visiting

•Women’s groups

•Which one does better? And for whom?

Health insurance

• Route to effective and responsive integrated health system

• % population with health insurance is increasing very rapidly in China, Thailand, Colombia, India, Ghana

China. Population coverage by the three health insurance schemes, 2003–2011.

Meng Q, Xu L (2014) Monitoring and Evaluating Progress towards Universal Health Coverage in China. PLoS Med 11(9): e1001694. doi:10.1371/journal.pmed.1001694http://127.0.0.1:8081/ploscollections/article?id=info:doi/10.1371/journal.pmed.1001694

Insurance based system

• Money follows the patient

• Patient is empowered

• Facility is interested in having more patients: more patients, more money

Zero fee system

• Money follows the facility

• Where are they going to go?

• Facility gets the some money, no matter how many patients they have

Colombian experience

• One of the largest reforms. Implemented this system

• Moreover, health facility receives the same amount of money per patient, no matter how expensive the patient is

• Large increases in preventive care, curative care visits, and decrease in health expenditure

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