The document describes two projects in Rwanda - Kabeho Mwana from 2006-2011 which implemented PD/Hearth in two districts to treat moderate acute malnutrition, rehabilitating over 88% of children, and Tangiraneza from 2012-2016 which piloted "Nutrition Weeks" based on PD/Hearth to address high rates of stunting and assess feasibility for scale up by the Ministry of Health. Both projects aimed to reduce malnutrition in children under five through community-based nutrition interventions.

1. PD/Hearth and Nutrition Weeks in Rwanda
Experiences from Kabeho Mwana EIP and Tangiraneza I-CSP
Melanie Morrow & Melene Kabadege
CORE Group Spring Meeting
April 24, 2013

2. Kabeho Mwana Expanded Impact Project
Location: 6 of 30 Districts in Rwanda
Total Population: 1.8 Million people
~18% of national pop.
Interventions: iCCM for Malaria, Pneumonia and Diarrhea
& BCC for C-IMCI, using government CHWs
Added PD/Hearth in two districts with Scottish Govt. sub-grant thanks
to Concern Worldwide, the lead agency for Kabeho Mwana
PD/Hearth in Kabeho Mwana
Expanded Impact Project 2006-2011

3. Pd/H Training & Expansion Oct 2009-Feb 2011
PD/Hearth in Kabeho Mwana
Expanded Impact Project 2006-2011
Workshops in 2 sep. districts with HC staff, sector head of Social Affairs, and EIP
staff. PDIs conducted in conjunction with workshops, not every village.
Menus developed during PD/H workshop with HC staff, Social Affairs In-Charge and
EIP staff. Finalized after technical review and follow-up meetings.
Nyamagabe District; 3 HC Catchment Areas (73 Hearth sites)
• 1 Nutrition Officer, and 1 Promoter per Health Center worked with the HC
Nutritionist trained local leaders and government CHWs in PD/Hearth.
Added Nyamasheke District in final year; 7 HC Catchment Areas (70 Hearth sites)
• 1 Nutrition Officer worked with HC nutritionists to train local leaders and
government CHWs in PD/Hearth. Promoters from Nyamagabe helped with initial
training but not ongoing supervision. Support from Hospital Director.
286 CHWs (2 per site) received 4 days of training as Light Mothers in Total

4. Implementation
PD/Hearth in Kabeho Mwana
Expanded Impact Project 2006-2011
Screening
Monthly Growth Monitoring (both Wt for Age & MUAC per MOH)
• Anthropometry done by trained CHWs
• SAM  Refer to Health Center
• MAM (MUAC 115-125 mm) and/or moderate malnutrition based on
Wt. for Age  Hearth
143 PD/H sites in the community (73 in Nyamagabe, 70 in Nyamasheke)

5. Screening and Measurement
PD/Hearth in Kabeho Mwana
Expanded Impact Project 2006-2011
Screening: Monthly Growth Monitoring (both Wt for Age & MUAC per MOH)
• Anthropometry done by trained CHWs
• SAM  Refer to Health Center
• MAM (MUAC 115-125 mm) and/or moderate malnutrition based on
Wt. for Age Z Scores  Hearth
Intervention: Two weeks of daily participation (6 days per week, 12 days total)
2.5 months of follow-up at home.
Weights and MUAC measured 4 times after preliminary screening:
Day 1
Day 12 (End of two-week intensive phase, technically Day 13)
Day 45 +/- (One month after intensive phase)
Day 90 (2.5 months after intensive phase, three months since Day 1)
Graduation Criteria: MUAC > 125 mm and Wt gain of 600 g over 3 months

6. Implementation
PD/Hearth in Kabeho Mwana
Expanded Impact Project 2006-2011
143 PD/H sites in the community (73 in Nyamagabe, 70 in Nyamasheke)
Total of 2,884 Children admitted to Hearth:
• 2,204 in Nyamagabe, 91% rehabilitated
• 680 in Nyamasheke, 83% rehabilitated

7. Results using MUAC and Weight Gain
PD/Hearth in Kabeho Mwana
Expanded Impact Project 2006-2011
Data from first 3 (of four) rounds of implementation in Nyamagabe District
Cured Not-cured
Children
Admitted
Lost MUAC Wt gain
of 600g
MUAC
& Wt
MUAC Wt gain
of 600g
MUAC
& Wt
1) 728 0 656
(90.1%)
673
(92.4%)
641
(88.0%)
72
(9.8%)
55
(7.6%)
87
(12%)
2) 583 0 481
(82.5%)
497
(85.2%)
432
(74.1%)
102
(17.5%)
86
(14.8%)
151
(25.9%)
3) 482 2 445
(92.3%)
456
(94.6%)
435
(90.2%)
35
(7.2%)
24
(4.9%)
45
(9.3%)
Total 1793 2 1,582
(88.2%)
1,626
(90.7%)
1,508
(84.1%)
209
(11.6%)
165
(9.2%)
283
(15.8%)

8. Results using MUAC only
PD/Hearth in Kabeho Mwana
Expanded Impact Project 2006-2011
Data from first 3 (of four) rounds of implementation in Nyamagabe District
Cured Not-
Cured
Children
Admitted
Lost MUAC
> 125
MUAC
< 125
1) 725 0 653
(90.1%)
72
(9.8%)
2) 582 0 480
(82.5%)
102
(17.5%)
3) 480 2 443
(92.3%)
35
(7.2%)
Total:
1787
2 1,576
(88.2%)
209
(11.6%)

9. PD/Hearth in Kabeho Mwana
Expanded Impact Project 2006-2011

10. Nutrition Weeks Innovation
Tangiraneza SP (2012-2016)
World Relief Rwanda Tangiraneza Innovation CSP
Project Catchment Area:
Nyamagabe District in Southern Rwanda,
Total population 337,116 people in 536 Villages.
Target Beneficiaries:
79,559 Women 15-49 years of age
54,949 Children 0-59 months
Project Goal: To reduce morbidity, mortality and underlying malnutrition of children under
five and pregnant women in Nyamagabe District of Rwanda.
Intermediate Results:
IR 1. Improved geographic access to and demand for high quality MNCH services
IR 2. Improved coordination of and impact of community health activities
IR 3. Innovation tested to improve the effectiveness of the Community Based

11. Nutrition Weeks Innovation
Tangiraneza SP (2012-2016)
World Relief Rwanda Tangiraneza Innovation CSP
General problem to be addressed by OR: Malnutrition in children <2.
Strategic relevance within the country:
Rwanda has 5th highest stunting rate in the world;
MOH wants treatment of malnutrition to be addressed by health facilities.
Research location: Selected villages in Nyamagabe District
Innovation based on PD/Hearth: Nutrition Weeks
Expected outcomes: Improved feeding practices, reduced malnutrition and assessment of
feasibility for MOH implementation and scale up.