2. Pneumonia still leading cause of death <5
PAHO 1995:
In 2000, 40,000 children <5 diagnosed
Almost 3000 died (7.4%)
PEDIATRIC PNEUMONIA IN HAITI
Mortality Rate (Children Under 5 Years)
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Haiti Dominican Republic United States of America
Deathsper100,000livebirths
ARI Mortality Rate (1994)
Total Mortality Rate (1994)
3. Population based primary health care
HHF initial program 1986
Public Health Program 1987
200,000 population
Village Health Committees
Community Selected Village Health Workers
Mobile Health Teams
Registered Population
Family Data System
Epidemiological Profile
HAITIAN HEALTH FOUNDATION
4. DATA DRIVEN PARTICIPATORY
PROGRAM IMPROVEMENT
Assessment
Communities
Providers
Researchers
Feedback Planning
Implementation
Data
Collection
Information
System
6. Method: scenarios, video interpretation, card sorts of
symptoms and causal relationships
Results:
Rapid breathing and inter-costal retraction believed to be parasites
Bwonch (pneumonia) vs grip (flu-like)
Bwonch caused by bathing too late in the day or in cold water, or an
untreated cold
Knowledge of symptoms low and only 26% identified rapid infant
breathing video as pneumonia
Everyone knew at least one child who died of pneumonia
Information used by PAHO to launch national
pneumonia program in 1993
1990 WHO ETHNOGRAPHIC STUDY
7. WHO treatment algorithms and training modules
Translation to Haitian Creole by JSI 1994
USAID sponsored pilot implementation
Tools: battery-operated timer that emitted a sound at 30 and
60 seconds to assess breathing
Two sequential recordings of rate above age group norm
Questions and observation to help classify
Two week training
Doctors and nurses
Community health workers –
had to demonstrate competence
Treatment documentation
Ongoing supervision
PNEUMONIA TREATMENT AND TRAINING
8. HHF has regular meetings with community leaders, healers
and members
Community participation given equal weight in staff training
seminars for community-based organizations
creating songs about recognizing and treating pneumonia
public demonstrations on the use of the timer, counting respiratory
rates
medicine (cotrimoxazole), cost, first dose, length of rx and home care
Treatment
5 days for 5 Haitian gourdes (US$.04)
Now 8 days for 10 gourdes (WHO)
COMMUNITY MOBILIZATION
9. Refrain
Mothers there is an illness that is called pneumonia
That kills children.
If you see a child with rapid breathing or coughing, go to the dispensary.
I.
Pneumonia is a severe illness.
If you wait to see you will lose your child.
If you see the child gets worse after going to the dispensary you need to
return quickly to the dispensary.
Refrain
II.
Fathers with children, help the mothers!
Its not only mothers who seek care for children
When they have pneumonia or another illness, if they are not treated they
will die more easily.
PNEUMONIA SONG
10. 1997 CDC program impact evaluation
17,000 cases treated in first 3 years
CDC concluded:
HHF ARI program is an important model for Haiti
Reduction of baseline pneumonia-specific mortality from
6.2/1000/year to 3.1
CHWs with brief formal training, intensive supervision and regular
continuing education can effectively diagnose and treat ARI in Haiti
1998 CDC case control study of children with multiple
episodes of pneumonia*
Wheezing was found to be the significant contributor
CDC EVALUATION/RESEARCH
*Heffelfinger JD, Davis TE, Gebrian B, et al. Evaluation of children with recurrent pneumonia diagnosed by World
Health Organization criteria. Pediatr Infect Dis J. 2002 Feb;21(2):108–12.
11. In 1993 CHWs in Haiti not allowed to dispense antibiotics
USAID got MSPP approval for HHF CHWs
Careful documentation of medication distribution and outcomes
Based on evidence and discussions with HHF, MSPP approved
CHW cotrimoxazole distribution in USAID sponsored NGOs
After HHF’s further advocacy and documentation
Community based treatment of ARI became part of Haiti national
IMCI policy in 2005
HHF collaborated with
Haitian Pediatric Society
2011 World
Pneumonia Day
GOVERNMENT POLICY
12. 2002 HHF began training other organizations
FOCAS child survival grant wanted to incorporate community
treatment for pneumonia
2005 USAID designated HHF as a field training site for
community based treatment of pediatric pneumonia
6 Haitian NGOs came for one week of training
Teams of physicians, nurse managers and CHWs—teamwork critical
component
HHF Community Based ALRI Treatment Manual revised based on
feedback
Follow up with NGOs found that most had implemented—major
obstacle was timers
5 additional NGO trainings after USAID
2 publications and 4 graduate student research projects
DISSEMINATION AND TRAINING
13. Continue to track pneumonia episodes and treatment—93,000
episodes through 2013
January 2013 pentavalent vaccine became Haiti protocol
Problems with stock outs
Lack of storage space for so many individual vials
HHF will be able to demonstrate impact of having Hib
vaccination on pneumonia rates and outcomes
Healthy
children
determining
their future!
PRESENT AND FUTURE
Hinweis der Redaktion
In 2000, 40,183 children under five were diagnosed as having pneumonia. Of these, 2,987 (7.4%) died. http://www.unicef.org/infobycountry/haiti_statistics.html#122 5 3 14
Dr. Jeremiah Lowney, FounderUCHC and University Board of TrusteesHHF BEGAN with public healthHealth and development
A one-page pictorial home-care set of instructions was developedthat included important activities such as keeping the child warm, increasing foods andfluids, giving the medicine as prescribed, clearing the nose, and returning to the clinicfor care if symptoms persisted or worsened. The CHW reviewed each action photowith the caregiver and suggested posting the pictorial where everyone could see it asa reminder of these important home-based activities.
6 organizations included HAS, big system, to small NGOsFeedbackTimers were not good qualityFiches Techniques shortage???All found training useful and appropriate (many wished for one more field day)Used HHF songs and mobilization techniques and community response positive4/6 fully implemented program (1 CBP because referred to own hospital)No Family Left Behind: The Example of Community-Based Pneumonia Care in Haiti Journal of Health Care for the Poor and Underserved, Volume 20, Number 4, November 2009 Supplement, pp. 22-30 (Article) Published by The Johns Hopkins University PressHAS I knowSADA I knowBut what about AEADMA, A PRIVATE ORGANIZATION IN DAME MARIE (RURAL)Claire Heureuse A HAITIAN ORGANIZATION CANNOT REMEMBER WHERECDS I CANNOT REMEMBER WHAT IT STANDS FOR. AN ORGANIZATION IN THE NORTH AND WAS IN CITE SOLEILCBP PIGNON IN THE NORTH. GUY THEODORE HAS A HOSPITAL AND A PUBLIC HEALTH PROGRAM (RURAL)
Think have reduced disease specific mortality by more than half again…January 2013 pentavalent includeshflu (pneumonia), hepb,dip, per, tetanus same schedule as dpt, have to get before one year of age (maybe not give after one because of shortages, etc.) 1.5 months all except bcg3 doses before 12 mos agestockouts because volume is one vial per child, can’t physically store as many vialsAdded rotavirus for diarrhea 1.5 months 5months onlyOnly booster is polio, everything else not given after age 1Measles and german measles? Newborn pneumonia is different/sepsisHaemophilusinfluenzae type b (Hib) disease is a serious disease caused by bacteria.