COMMMUNITY BASED MANAGEMENT OF ACUTE MALNUTRITION REPORT_ Dir.pdf · COMMMUNITY BASED MANAGEMENT OF ACUTE MALNUTRITION . 2 ... (IMNCI) was played to ... Components and Basic Principles

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TRAINING REPORT

December 2010

Table of contents

Relief Pakistan Three Days Training on Community Based Management of Acute Malnutrition (CMAM) & Infant Young Child Feeding (IYCF) for MoH Staff, District Dir Lower KPK

COMMMUNITY BASED MANAGEMENT OF ACUTE MALNUTRITION

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Table of Contents…………………………………………………………………2

Executive summery………………………………………………………….........3

Inter-Agency Coordination……………………………………………………….4

Venue……………………………………………………………………………...4

Logistics…..……………………………………………………………………….4

Workshop Objectives Contents………………………………………………..5-8

Action Planning…………………………………………………………………..8

Participant’s Feedback…………………………………………………………..9

Annexes

Training Agenda………………………………………………………………10-11

Participants List………………………………………………………………....12

Annexes

Annexes

Annex A- session plan/agenda………………………………………………………

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Executive Summery Host Agency

Relief Pakistan and UNICEF Organized this training in collaboration with District Health Department Dir Lower

Training Team

Technical Facilitation by Relief International Facilitators Mr.Kamran Khan , District Nutrition Coordinator Relief Pakistan Dr.Khaista Rehman ,facilitator Ms.Syeda Samia , Team Leader CMAM Swat, Relief Pakistan

Participants

Government health professionals from 20 government Health facilities of the project area

Contents

Training was based on the Four components of community based Management of Acute Malnutrition (CMAM) and infant young Child Feeding Practice (IYCF). Much focus was on CMAM protocols and procedures including admission and discharge criteria in supplementary Feeding Program, Out Patient Therapeutic program (OTP) , Community screening and Outreach activities, referrals, Follow up of admitted c children , Pregnant women and lactating mothers, Anthropometry practical and Reporting formats.

Evaluation

Overall impression of the training by participants was very good and they rated training quality training. The pre- test result showed a moderate knowledge, while the post –test exhibited more than 70% improvement.

Inter- Agency Coordination

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The Training was designed and organized by Relief Pakistan UNICEF Peshawar –Pakistan and District Health Department Dir Lower. Technical facilitation to design training material and training methodology was provided by Relief International. The entire training budget is sponsored by UNICEF. Executive Distract Officer Dir Lower extended excellent cooperation and coordination in the training arrangements and made availability of DoH staff as per training schedule.. As implementing partner of UNICEF, Relief Pakistan has been assigned thirteen (12) union councils in district Dir Lower to implement a quality CMAM Program in coordination with District Department of Health. Venue and logistic Training was conducted in DHQ hospital Dir Lower. A specious training hall with all training requirements including good lighting seating arrangements, Multimedia (Digital projector) Training participants were served with refreshment and lunch. They were also paid Travelling and daily allowance. To make the training more productive all the possible communication means, I.e., IEC material, Flip charts, Ministry of health CMAM guidelines were used and provided to the participants. Group work and presentation to make the participation more active was practiced. Training Objective and Goals The monsoon floods that recently hit Pakistan in July of 2010 have killed over 1,900 and affected more than 18 million people. The malnutrition situation in Pakistan is alarming. While no nutrition assessment specific to Dir Lower has been completed, global acute malnutrition rates were already close to or above the WHO emergency threshold before the crisis and are likely to be on a downward trend. Fourteen percent of the affected populations are younger than 5 years of age and 13.1 percent of them were suffering from global acute malnutrition before the crisis. Eight percent of the affected populations are expecting or lactating mothers and on average 16.1 percent of lactating women were malnourished before the crisis. Notable here are the coping strategies, which indicated that women reduce their food intake before men. Given these statistics, 260,000 children under five years of age and 180,000 pregnant and lactating women are in urgent need of supplementary feeding in KPK. However, given practical difficulties in nutrition screening, the already high levels of malnutrition and the likelihood of a further deterioration in the nutrition status of flood affected children and women, a blanket feeding strategy is recommended leading to much higher targeting numbers. To respond the situation UNICEF in collaboration with different national and international implementing partners implemented the Community based Management of Acute Malnutrition (CMAM) Program in the Flood Affected Districts of of KPK . The District Health Department is the Prime stakeholder in the CMAM Program implementation and UNICEF is very keen to integrate the CMAM in the Government Health Department PHC Component.

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Keeping in view this worth mentioning aspect of the Program it is imperative to involve and get facilitation of the Government health professionals in the Program implementation and the key objectives and goals are as under;

⊕ To introduce and understand the importance of nutrition and CMAM ⊕ To understand basic concepts used in nutrition and CMAM ⊕ To understand the burden of malnutrition in Pakistan. ⊕ To understand the etiology of malnutrition ⊕ To know various options available for treatment of malnutrition ⊕ To know strategies available for preventing malnutrition ⊕ To know regarding importance of Infant and Young Child Feeding in emergency (IFE).

A comprehensive training program for government health professionals was arranged in consultation with District health department and UNIOCEF Office Peshawar. A training micro plan was prepared and submitted for approval to EDI (H) Dr.Mushtaq Ahmad. After some adjustment, he gave his consent as per schedule.

Thanks to MS DHQ Hospital Temergara who, permitted to use the training hall but also facilitates the training sessions. The main facilitators of the workshop for IYCF sessions from government side were:

• Dr.Wakeel Ahamad

• Dr.Saleem ur Rehman and the CMAM components were facilitated by Nutrition Coordinator and Manager Health & Nutrition of Relief International.

The Training for Government Health Professionals was conducted in two groups, each group comprising 25 participants.

Training duration for each group was five (05) days and the following topics were discussed and practiced:

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• Introduction of CMAM Project ,objectives and implementing methodologies

• Basic concepts of Nutrition, Malnutrition, food groups

• Cause and consequences of Malnutrition

• Anthropometry

• Supplementary Feeding Program ( Admission, discharge, and treatment criteria and UNICEF Protocols

• Outpatient therapeutic program (OTP) ( Admission, discharge, and treatment criteria and UNICEF Protocols

• Community outreach program (Nutritional screening, referral, follow up and health education sessions)

• Infant Young Child Feeding Practices and Promotion

DAY –ONE As usual the day one started to welcome the participants, introduction, registration and inaugural remarks by the Executive District Health Officer Dr. Shoukat Ali. In his r introductory remarks she emphasized the importance of collective efforts of all the partners to combat the malnutrition problem in the district\. She emphasized on the involvement of health professionals being the major and prime stakeholders and ultimately they will own the Nutrition component through CMAM interventions. She also pledged to extend every possible support and cooperation to implement the projects in the District Dir Lower KPK.

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The Relief Pakistan District Nutrition Coordinator,Mr.Kamran Khan discussed the basic concepts of the Nutrition and menaces of malnutrition that engulf hundred thousand lives as well create lifelong disabilities. Ms Syeda Samia from Khyber Pakhtoon Khwa did a demonstration on the Anthropometry and the participants overwhelmingly showed their involvement. In addition to this the community outreach components was discussed in its perspective. The

day done was wrapped up by Mr. Kamran khan and Dr. Kaista Rehman took the responsibility to review the day 1 session on Day second.

Figure 2&3 Hight and measurement exercise DAY TWO Training workshop session on CMAM day two begun with recitation of verses from Holy Quran. Dr .Tehreem and Dr. Moazzem delivered a brief on the day one sessions. Ms Qurat ul Ain conducted a morning session on ⊕ The objectives of Supplementary

Feeding Program(SFP) ⊕ Admission Criteria in SFP ⊕ Discharge criteria from SFP ⊕ Objectives of Out Patient

Therapeutic Program (OTP) ⊕ Admission criteria in OTP ⊕ Discharge criteria from ORTP The sessions were followed by practical sessions and group work activities

The final day of the training as usual begin with recitation of verses from the Hoy Book Quran. The Day two review was done and the third day session plan was discussed with the participants. The sessions were remained focused on the OTP registration form for children (6-59 months). To make the participants more conversant with the OTP protocol and the physical examination techniques were

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facilitated through videos. In addition to this a video on Integrated Management of New born and Childhood Illness

(IMNCI) was played to enhance the participant’s skill to assess the malnourished child .In the last session the Infant Young Child Feeding Practices were discussed in special context of emergencies. Ten key points of IYCF were discussed and the importance of each point was highlighted. Before concluding the three days training workshop, the post- Test was conducted and training evaluation form were served to training participants for their comments. DAYD Action Planning One of Immediate objective of training workshop on CMAM was to have a well prepared Relief Pakistan and Government health staff to respond a six day community based screening of children 6-59 months of age, pregnant women and lactating mothers. That forum provided opportunity to decide a joint strategy to treat the community referrals by Lady Health Workers (LHW’s) effectively and efficiently. Training Evaluation and Feedback Training was evaluated by different methods mainly a test before and after the training was given to all the training participants. a. Impact Assessment: Pre and Post Test Results

(5= Excellent, 4= Good, 3 = Average, 1&2 = un satisfactory

5 (84-100%)

4 (68-83%)

3 (55-67%)

2 (40-54%)

1 (1-39%)

Pre- Test 1 0 8 7 14

Post - Test 7 8 12 3 0

Total number of Participants who filled in Feed back forms( Sheets)= 30

b. Participants Feedback: Training participants in their views appreciated the training in all respects and thanked to Relief Pakistan that provided them opportunity to learn new things in a more interactive way and refreshed their knowledge about the protocol and procedures of community Based Management of Acute malnutrition.

Agenda for Five Days Training Workshop on “Community Management of Acute Malnutrition” (CMAM) & “Infant and Young Child Feeding in Emergencies” (IFE) Venue: Venue: DHQ Hospital Dir Lower , KPK Timing: 09:00 AM to 04:00 DAY – 1

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Date Time Frame Subject Facilitator

DAY 1

09:00–09:30

Opening Registration, Introduction,

Nutrition Coordinator

opening remarks EDO(H) Shoukat Ali

10:00–10:30 Program objectives, Course objectives, modules nutrition program and its components

Mr. Kamran

10:30–10:45 Pre Test Mr. rooh ullah 10:45–11:00 Tea Break

11:15–12:15

Overview of CMAM Nutrition, Food, Nutrients, Malnutrition, under-nutrition and Acute Malnutrition -Basic Concepts Components and Basic Principles of CMAM

Mr Kamran

12:15–13:15 CMAM and Importance of Community Outreach Key Elements of Community Assessment Key Steps in CMAM Outreach

Dr.Khahista

13:15–14:00 Lunch and Prayers Break

14:00–15:15

Measuring Acute Malnutrition (Anthropometry) Assessing age, Bilateral Pitting Oedema, MUAC, Weight and Height Using Weight and Height Tables

Dr.Khahista

15:15–15:45 Anthropometry Practical Exercise Dr.Khahista

15:00–16:00 Wrap up of session Participants

Agenda for Three Days Training Workshop on “Community Management of Acute Malnutrition” (CMAM) & “Infant and Young Child Feeding in Emergencies” (IFE) Venue: Venue: DHQ Hospital Dir Lower , KPK Timing: 09:00 AM to 04:00 DAY – 2 Date Time Frame Subject Facilitator

DAY 2

09:00–9:30 Recitation, Review of Day 1 Participants

9:30–11:00

Modul1 -6 Supplementary Feeding Program for the Management of MAM in emergencies Admission and discharge Criteria from SFP for Management of MAM Medical Treatment and Nutrition Rehabilitation

Dr.Khahista

11:00–11:15 Tea Break

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11:15–13:00 Practice Making Referrals from SFP to OTP/SC Group Work Dr.Khahista


14:00–15:00 SFP Documentation (Registers/referrals/ration cards/Reporting) Dr.Khahista

15:00–15:30

Outpatient care for the Management of SAM without Medical Complications Admission Criteria, Entry Categories, Process and Follow on Session

Dr.Khahista

15:30–16:00 Wrap up of the session Participants

Agenda for Four Days Training Workshop on “Community Management of Acute Malnutrition” (CMAM) & “Infant and Young Child Feeding in Emergencies” (IFE) Venue: DHQ Hospital Dir Lower , KPK Timing: 09:00 AM to 04:00 DAY – 3 Date Time Subject

DAY 3

09:00–09:30

Recitation, Review of Day 2 Participants

09:30–11:00 Recording and completing OTP Registration Book (Basic Demography, Anthropometry, History, Physical Examination and Routine Medication)

Dr.Khahista

11:00–11:15 Tea Break

11:15–12:30

Outpatient care for the Management of SAM without Medical Complications Outpatient care for the Management of SAM without Medical Complications Admission Criteria, Entry Categories, Process and Follow on Session Recording and completing OTP Registration Book (Basic Demography, Anthropometry, History, Physical Examination and Routine Medication) Medical Treatment (Routine and Supplemental) Nutrition Rehabilitation (RUTF) Counseling of Mothers/Caregivers Recognizing when further action is needed, Referrals to SC and follow up home visits Discharge Criteria and procedure and Exits from OTP

Dr.Khahista

12:30-13:00 OTP Documentation (registers/referrals/ration card/transfer slips Dr.Khahista

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14:15–16:15 Infant and Young Child Feeding in Emergencies Follow on Session

Dr.Khahista

16:15–16:30 Wrap up and Module Evaluation Participants

Venue: DHQ Hospital Dir Lower , KPK Timing: 09:00 AM to 04:00 DAY – 4 Date Time Subject

DAY 4

09:00–09:30



Dr.Khahista

11:00–11:15 Tea Break

11:15–12:30


Dr.Khahista Revision




Dr.Khahista


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Venue: DHQ Hospital Dir Lower , KPK Timing: 09:00 AM to 04:00 DAY – 5 Date Time Subject

DAY 5

09:00–09:30



Dr.Khahista

11:00–11:15 Tea Break

11:15–12:30


Dr.Khahista Revision




Dr.Khahista


S/N Name Designation

1 Muhammad Rahim Health Technician 2 Naik Zada Health Technician 3 Sabir rehman Health Technician 4 Ibrar Hussain Health Technician

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5 Behrawar Health Technician 6 Humayun Health Technician 7 Muhammad Sadiq Health Technician 8 Rukhsan a Staff nurse 9 Saleem Health Technician 10 Ayesha Staff nurse 11 Zainab Habib Nutrition Assistant 12 Salma Charge nurse 13 Ubaida Bibi Health Technician 14 Nighat Shaeen LHV 15 Ulfat Ayaz LHV 16 Khurshid Disp 17 Fuad Ullah Disp 18 Ahmed Shah Health technician 19 Jehangir Khan Medical Technician 20 Amjad Ali Medical Technician 21 Dr.Khaista SMO 22 Dr. Shoukat EDO(H)

Documents

COMMMUNITY BASED MANAGEMENT OF ACUTE MALNUTRITION REPORT_ Dir.pdf · COMMMUNITY BASED MANAGEMENT OF ACUTE MALNUTRITION . 2 ... (IMNCI) was played to ... Components and Basic Principles