Wilford R.,Concern Worldwide |
Golden K.,Concern Worldwide
Health Policy and Planning | Year: 2012
This study assessed the cost-effectiveness of community-based management of acute malnutrition (CMAM) to prevent deaths due to severe acute malnutrition among children under-five. The analysis used a decision tree model to compare the costs and effects of two options to treat severe acute malnutrition: existing health services with CMAM vs existing health services without CMAM. The model used outcome and cost data from a CMAM programme in Dowa district, Malawi and a set of key assumptions regarding treatment-seeking behaviour and mortality outcomes. Under our 'base case' scenario, we found that CMAM cost US$42 per disability-adjusted life year (DALY) averted (2007 US$) and US$493 per DALY averted under an assumed 'worst case' scenario for each variable. The results suggest that CMAM was highly cost-effective in the 'base case' as defined by the World Health Organization, as the cost per DALY falls well below Malawi's 2007 gross national income (GNI) per capita of US$250, and is within the range of DALYs reported for other child health interventions. Under a hypothetical 'worst case' for all variables, the model indicates CMAM is still cost-effective. The results indicate the decision to scale-up CMAM within essential health services in Dowa was a cost-effective one and that scaling up CMAM in similar contexts is also likely to be cost-effective. However, several contextual and programmatic factors should be considered when generalizing to diverse contexts. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2011; all rights reserved.2011 © Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2011; all rights reserved.
Sarriot E.G.,ICF International |
Kouletio M.,U.S. Embassy |
Jahan S.,Uttara University |
Rasul I.,Concern Worldwide |
Musha A.K.M.,House 15 SW D
Health and Quality of Life Outcomes | Year: 2014
Background: Starting in 1999, Concern Worldwide Inc. (Concern) worked with two Bangladeshi municipal health departments to support delivery of maternal and child health preventive services. A mid-term evaluation identified sustainability challenges. Concern relied on systems thinking implicitly to re-prioritize sustainability, but stakeholders also required a method, an explicit set of processes, to guide their decisions and choices during and after the project. Methods: Concern chose the Sustainability Framework method to generate creative thinking from stakeholders, create a common vision, and monitor progress. The Framework is based on participatory and iterative steps: Defining (mapping) the local system and articulating a long-term vision, describing scenarios for achieving the vision, defining the elements of the model, and selecting corresponding indicators, setting and executing an assessment plan, and repeated stakeholder engagement in analysis and decisions. Formal assessments took place up to 5 years post-project (2009). Results: Strategic choices for the project were guided by articulating a collective vision for sustainable health, mapping the system of actors required to effect and sustain change, and defining different components of analysis. Municipal authorities oriented health teams toward equity-oriented service delivery efforts, strengthening of the functionality of Ward Health Committees, resource leveraging between municipalities and the Ministry of Health, and mitigation of contextual risks. Regular reference to a vision (and set of metrics (population health, organizational and community capacity) mitigated political factors. Key structures and processes were maintained following elections and political changes. Post-project achievements included the maintenance or improvement 5 years post-project (2009) in 9 of the 11 health indicator gains realized during the project (1999-2004). Some elements of performance and capacity weakened, but reductions in the equity gap achieved during the project were largely maintained post-project. Conclusions: Sustainability is dynamic and results from local systems processes, which can be strengthened through both implicit and explicit systems thinking steps applied with constancy of purpose. © 2014 Sarriot et al.
Dent N.,CMAM Forum |
Deconinck H.,CMAM Forum |
Golden K.,Concern Worldwide |
Brown R.,CMAM Forum |
Walsh A.,Valid International
Food and Nutrition Bulletin | Year: 2014
Background. Severe acute malnutrition (SAM) affects 19 million children worldwide annually. The community-based management of acute malnutrition (CMAM) approach was first piloted in 2000. Endorsed by the United Nations in 2007, the approach has been introduced in over 60 countries. Current coverage and quality of services need further strengthening and key stakeholders have expressed the need for improved information-sharing. Objective. To report on an information-sharing initiative that was established to support scale-up of quality services for CMAM by collecting existing technical guidance, evidence, and learning. Methods. Routine website monitoring, country case studies, and surveys were used to assess the profiles of CMAM Forum users and the reach and use of information for improved health outcomes. Results. The number of information products and services and their use have steadily increased. Country case studies have identified ways to adapt information better to the needs of those involved in managing acute malnutrition, particularly at the country level. An urgent need has been identified for more resources in additional languages, especially French and Arabic, and expanded production and use of audiovisual material and social media. Conclusions. Improved information-sharing can have an impact on health outcomes, but further innovation and support are needed to improve access to, and use of, the information. © 2014, The Nevin Scrimshaw International Nutrition Foundation.
Bliss J.R.,Cornell University |
Njenga M.,Concern Worldwide |
Stoltzfus R.J.,Cornell University |
Pelletier D.L.,Cornell University
Maternal and Child Nutrition | Year: 2016
Acute malnutrition affects millions of children each year, yet global coverage of life-saving treatment through the community-based management of acute malnutrition (CMAM) is estimated to be below 15%. We investigated the potential role of stigma as a barrier to accessing CMAM. We surveyed caregivers bringing children to rural health facilities in Marsabit County, Kenya, divided into three strata based on the mid-upper arm circumference of the child: normal status (n=327), moderate acute malnutrition (MAM, n=241) and severe acute malnutrition (SAM, n=143). We used multilevel mixed effects logistic regression to estimate the odds of reporting shame as a barrier to accessing health care. We found that the most common barriers to accessing child health care were those known to be universally problematic: women's time and labour constraints. These constituted the top five most frequently reported barriers regardless of child acute malnutrition status. In contrast, the odds of reporting shame as a barrier were 3.64 (confidence interval: 1.66-8.03, P<0.05) times higher in caregivers of MAM and SAM children relative to those of normal children. We conclude that stigma is an under-recognized barrier to accessing CMAM and may constrain programme coverage. In light of the large gap in coverage of CMAM, there is an urgent need to understand the sources of acute malnutrition-associated stigma and adopt effective means of de-stigmatization. © 2016 John Wiley & Sons Ltd.
PubMed | Concern Worldwide and Cornell University
Type: Journal Article | Journal: Maternal & child nutrition | Year: 2016
Acute malnutrition affects millions of children each year, yet global coverage of life-saving treatment through the community-based management of acute malnutrition (CMAM) is estimated to be below 15%. We investigated the potential role of stigma as a barrier to accessing CMAM. We surveyed caregivers bringing children to rural health facilities in Marsabit County, Kenya, divided into three strata based on the mid-upper arm circumference of the child: normal status (n = 327), moderate acute malnutrition (MAM, n = 241) and severe acute malnutrition (SAM, n = 143). We used multilevel mixed effects logistic regression to estimate the odds of reporting shame as a barrier to accessing health care. We found that the most common barriers to accessing child health care were those known to be universally problematic: womens time and labour constraints. These constituted the top five most frequently reported barriers regardless of child acute malnutrition status. In contrast, the odds of reporting shame as a barrier were 3.64 (confidence interval: 1.66-8.03, P < 0.05) times higher in caregivers of MAM and SAM children relative to those of normal children. We conclude that stigma is an under-recognized barrier to accessing CMAM and may constrain programme coverage. In light of the large gap in coverage of CMAM, there is an urgent need to understand the sources of acute malnutrition-associated stigma and adopt effective means of de-stigmatization.
Speizer I.S.,University of North Carolina at Chapel Hill |
Fotso J.C.,Concern Worldwide |
Okigbo C.,University of North Carolina at Chapel Hill |
Faye C.M.,University of North Carolina at Chapel Hill |
And 2 more authors.
BMC Public Health | Year: 2013
Background: Although the majority of postpartum women indicate a desire to delay a next birth, family planning (FP) methods are often not offered to, or taken up by, women in the first year postpartum. This study uses data from urban Senegal to examine exposure to FP information and services at the time of delivery and at child immunization appointments and to determine if these points of integration are associated with greater use of postpartum FP. Methods. A representative, household sample of women, ages 15-49, was surveyed from six cities in Senegal in 2011. This study focuses on women who were within two years postpartum (n = 1879). We also include women who were surveyed through exit interviews after a visit to a high volume health facility in the same six cities; clients included were visiting the health facility for delivery, post-abortion care, postnatal care, and child immunization services (n = 794). Descriptive analyses are presented to examine exposure to FP services among postpartum women and women visiting the health facility. Logistic regression models are used to estimate the effect of integrated services on postpartum FP use in the household sample of women. Analyses were conducted using Stata version 12. Results: Among exit interview clients, knowledge of integrated services is high but only a few reported receiving FP services. A majority of the women who did not receive FP services indicated an interest in receiving such information and services.Among the household sample of women up to two-years postpartum, those who received FP information at the time of delivery are more likely to be using modern FP postpartum than their counterparts who also delivered in a facility but did not receive such information. Exposure to FP services at an immunization visit was not significantly related to postpartum FP use. Another key finding is that women with greater self-efficacy are more likely to use a modern FP method. Conclusion: This study's findings lend strong support for the need to improve integration of FP services into maternal, newborn, and child health services with the goal of increasing postpartum women's use of FP methods in urban Senegal. © 2013 Speizer et al.; licensee BioMed Central Ltd.
Protecting and improving breastfeeding practices during a major emergency: Lessons learnt from the baby tents in Haiti [Protéger et améliorer les pratiques d'allaitement maternel au cours d'une situation d'urgence majeure: Les leçons tirées des tentes pour bébés en haïti]
Ayoya M.A.,Port-au-Prince University |
Golden K.,Concern Worldwide |
Ngnie-Teta I.,Port-au-Prince University |
Mamadoultaibou A.,Port-au-Prince University |
And 5 more authors.
Bulletin of the World Health Organization | Year: 2013
Problem The 2010 earthquake in Haiti displaced about 1.5 million people, many of them into camps for internally displaced persons. It was expected that disruption of breastfeeding practices would lead to increased infant morbidity, malnutrition and mortality. Approach Haiti's health ministry and the United Nations Children's Fund, in collaboration with local and international nongovernmental organizations, established baby tents in the areas affected by the earthquake. The tents provided a safe place for mothers to breastfeed and for non-breastfed infants to receive ready-to-use infant formula. Such a large and coordinated baby tent response in an emergency context had never been mounted before anywhere in the world. Local setting Baby tents were set up in five cities but mainly in Port-au-Prince, where the majority of Haiti's 1555 camps for displaced persons had been established. Relevant changes Between February 2010 and June 2012, 193 baby tents were set up; 180 499 mother-infant pairs and 52 503 pregnant women were registered in the baby tent programme. Of infants younger than 6 months, 70% were reported to be exclusively breastfed and 10% of the "mixed feeders" moved to exclusive breastfeeding while enrolled. In 2010, 13.5% of registered infants could not be breastfed. These infants received ready-to-use infant formula. Lessons learnt Thanks to rapid programme scale-up, breastfeeding practices remained undisrupted. However, better evaluation methods and comprehensive guidance on the implementation and monitoring of baby tents are needed for future emergencies, along with a clear strategy for transitioning baby tent activities into facility and community programmes.
Kimani-Murage E.W.,African Population and Health Research Center |
Fotso J.C.,Concern Worldwide |
Egondi T.,African Population and Health Research Center |
Abuya B.,African Population and Health Research Center |
And 4 more authors.
Health and Place | Year: 2014
Background: We describe trends in childhood mortality in Kenya, paying attention to the urban-rural and intra-urban differentials. Methods: We use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR). Results: Between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban-rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya. Conclusions: The narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums. © 2014 Elsevier Ltd.
McCallion P.,Concern Worldwide
Appropriate Technology | Year: 2012
Technology systems made in the developing world offer much more scope to enhance technologies and add a long term, more sustainable result. With electrical installations such as micro hydro, generators, photovoltaic in schools and clinics, critical severs and inverter systems, there needs to be a good low resistant system for making an electrical connection to the earth which is essential for user safety and equipment integrity. Across Africa and Asia, information and know-how on all aspects of earthing is long established. In most regions local electricians or technicians will augment the earthing process, using locally trusted solutions. These solutions may seem unusual. When these materials are mixed with the soil and water, a highly effective low resistance earth can be created. This method is an artificial process, maintenance is required and the entire process will have to be repeated every five years.
Agency: GTR | Branch: NERC | Program: | Phase: Research Grant | Award Amount: 153.69K | Year: 2015
Science cannot predict where, when and what size the next earthquake will be but the University of Ulster Geophysics group have, with Concern Worldwide, an active NGO partner, co-produced approaches that promise to give useful, near real-time probabilistic forecasts of the intensity and spatial distribution of aftershocks. Such a tool could be used by the wider humanitarian and Disaster Risk Reduction (DRR) communities, to guide decisions on prioritising humanitarian response activities, (such as where to site displacement camps and offices and accommodation for staff) and well as improve advice and awareness of survivors. The University of Ulster Geophysics Group in partnership with Concern Worldwide delivered a NERC PURE Associates (NPA) project that: 1. Developed prototype software tools to make a near real-time assessment of aftershock hazard during the emergency response phase of earthquake disaster. 2. Used this tool to explore: a. the scientifically answerable questions of use to humanitarian organisations b. The training and support needs of the humanitarian practitioners c. The protocols that could guide tool use within emergency planning and response processes d. The most appropriate user interface and ways of communicating risk and uncertainty. To move from a theoretical, to a real working approach that will guide humanitarian decision making in life and death situations, four things MUST be done: 1. Appropriate statistical tools developed, and used to rigorously test the approach over an extended period of time 2. Tool validity must be guaranteed through intensive peer review by a panel of leading international scientists 3. A strategy developed to deliver wider buy-in by humanitarian and government actors and the mainstreaming of the approach 4. Continue to develop the approach in response to the particular needs of the humanitarian sector identified in the NPA project. To address these issues we here propose the Aftershock Forecasting Tool for Emergency Response (AFTER) project. In AFTER we will develop the ideas in the original projects to full proof of concept status including the production of a research grade programme which is specifically taylored with both the limitation so of the science and the operational needs of the user in focus. During the project we will have the science, the protocols through which it is applied and the contexts in which we ensure accurate understandings of the uncertainties which form a central part of any earthquake forecasting scheme as well as the humaitarian utility, examined by an international expert panel convened regularly throughout the project. We will also work to mainstream this protocol to the wider humaitarian community. We have already several expressions of interest from important players in the humanitarian field. The project will have a significant impact on Humanitarian and DRR policy and operations in post earthquake situations. It will introduce a new area of evidence-based decision making into existing emergency planning and response and DRR interventions. It will create a new tool to be incorporated in holistic hazard and vulnerability analysis, management and planning. It will inform life and death decisions, and make a real contribution to the core humanitarian aims to save lives and alleviate suffering.