Evaluation of Family Health Program (FHP) on Vaccines, Nutrition, and Diarrheal Disease in Vespasiano, Minas Gerais, Brazil

Amina Khawja1, Regina Holan1,2, and Urmy Shukla3

1- Rollins School of Public Health, 2 – Emory Medical School, PA Program, 3 – Laney Graduate School of Arts and Sciences

AbstractBackground: The FHP is made up of health teams comprised of a physician, a nurse, a nurse assistant, and 5-7 community health workers. Each health team aims to serve health beneficiaries through household visits and primary care services. Goal: To determine nutritional status, vaccine coverage, and diarrhea prevalence in children under 5 and assess knowledge and practices of FHP health professionals around these topics.

Project Objectives: 1)Estimate vaccine coverage of children ≤ 52)Examine nutritional status of children ≤ 5.3)Evaluate FHP professionals’ knowledge, attitudes, and practices related to nutritional status and vaccine coverage of children ≤ 5.4)Determine the prevalence of child visits that had anthropometric measurements recorded

Populations/Communities Served10 peri-urban regions covered by the FHP:Celvia, Jardim da Gloria, Vila Esportiva, Morro Alto I, Morro Alto II, Morro Alto III, Oeste, Nova York, Nova Pampulha, Suely FHP Healthcare professionals

Project Partners-Emory Global Health Institute Fund-FASEH Medical School-Vespasiano Secretariat of Health -Dr. Juan Leon-Dr. José Antonio Ferreira-FHP Unit Staff-FASEH Medical Students

Community Engagement• Presented results to FASEH directors, the individual FHP units, and the Secretariat of Health

Preliminary ResultsCommunity Results

Professional Results

•40 (53.3 %) correctly identified normal growth “0”whereas 22 (29.3%) responded incorrectly “1” /“2”, and 13 (17.3%) stated that they did not know. •76.4% of child visits had weight, height, and age recorded

Next Steps •Prepare and submit manuscripts for publication•Continue developing opportunities for Emory and FASEH students

Project Timeframe January -April 2010: Established project goals, developed survey interests, and worked with Brazilian collaborators on survey instruments June 2010: Traveled to Brazil, met with in-country partners to finalize and translate research instruments and provided training to FASEH Student Team on anthropometric measurements July 2010 : Collected data, conducted preliminary data analysis, developed draft report for project partners, held final meeting with in-country partners, and presented to each individual Family Health Program units (10 total)

Community Methods• Proportionally allocated stratified random sample of n=265 households selected (completed 219, 82% response rate)• Height and Weight taken of one child with nearest birthday in household (obtained measurements from 217 children)

Professional Methods• Surveys administered to FHP doctors, nurses, nurse aids, and Community Health Agents (completed 75 surveys) • Double data entry of surveys in Epi Info• Proportionally allocated stratified random sample of n=404 medical records selected to undergo review (reviewed 363 medical records, 90% response rate)

Trainings for non-doctor PSF professionals

Training

Topic

Nurses

n (%)

Nurse

Aids

n (%)

Community

Agents

n (%)

All non-

doctor

professionals

n (%)

Infant

feeding

practices

5 (50.0) 3 (27.3) 29 (61.7) 37 (54.4)

Child growth

monitoring

3 (30.0)

3 (27.3)

31 (66.0)

37 (54.4)

Vaccines

9 (90.0)

9 (81.8)

32 (68.1)

51 (68.9)

Vaccine Coverage

Pneumo10 (1 dose) 36.3%

Meningitis (1 dose) 46.9%

Meningitis (2 dose) 27.3%

H1N1 (2 dose) 66.8%

H1N1 (1 dose) 86.2%

Rotavirus 86.8%

MMR 96.6%

Hepatitis B 98.0%

Tetravalent 98.5%

Yellow Fever 99.5%

BCG 100.0%

Polio 100.0%

Nutritional Status of Children Under-5

Emory/FASEH Vespasiano 2010 Ages 0-5

(n=213)

Sisvan-Vespasiano 2009

Ages 0-3

(n=476)

National Brasil

2007*

Ages 0-5

(n=4414)

Height X Age Stunting

<15% (Z score < -2) 22.1% 7.1%

Weight X Height Underweight

<15% (Z score < -2)

5.2% 3.8%

Overweight

≥85% (Z score > +2) 28.2% 19.3%

Weight X Age Wasting

<15% (Z score < -2)

10.3% 11.6%

Obesity

≥85% (Z score > +2)

18.7% 5.88%

*Monteiro et. al. Narrowing the socioeconomic inequality in child stunting: the Brazilian experience, 1974-2007. Abstract