Project Medishare commits to reduce the rate of malnutrition in the Central Plateau community of Haiti by scaling up the treatment of underweight children with appropriate nutritional supplementation. To assure the sustainability of the intervention, a holistic approach consisting of educating community members is key. Education and awareness activities will target family members and inform them how to feed children at different ages appropriately, inform them of the importance of bringing ill/starving children to the health center promptly and further communicate to the community the need to prioritize childrens healthcare.
The malnutrition program will create linkages between community and medical systems through surveillance activities (rally posts, mobile clinics and household visits) where children will be referred for follow-up for further appointments at the health center. Through this commitment, the capacity of 55 community caregivers, which are already employed by Project Medishare, will reinforce the care of each at-risk or malnourished children according to their needs and will provide approximately 15,000 home visits in the catchment area. Service provision will be improved by increasing the number of access points for care and by targeting interventions in areas where healthcare is currently unavailable. Through these activities, Project Medishare commits to eliminate severe acute malnutrition in these areas of intervention in the Central Plateau and reduce moderate malnutrition under the age of five by 50% by 2017.
To do so, Project Medishare will treat uncomplicated cases of severe acute malnutrition (i.e. non HIV positive) in the community and households where the children live, perform trainings with clinic and community staff about how to care for severely malnourished children, develop plans for the prevention of severe malnutrition (targeting moderately malnourished children) and add more screening for vulnerable children to identify at risk children with moderate and severe malnutrition. Children with complicated cases (children infected with HIV and other infections) will be referred to an inpatient facility in Hinche, the capital of the Central Plateau.
Project Medishares malnutrition monitoring program covers an area of 70,000 people in the Central Plateau of Haiti. In 2015, 40 children were identified with severe acute malnutrition and referred to Hinche (a 40 minute to two hour drive away). With a cost of $100 to treat one case in the community, and assuming food access remains consistent, Project Medishare expects to treat more cases by strengthening its monitoring program and estimates to handle approximately 120 non-complicated cases of severe acute malnutrition in community-based treatment annually, through home visits and rally posts, as well as monitoring moderately malnourished children in the community to ensure that their condition doesnt worsen to severe acute malnutrition. It is expected that at-risk children in the catchment areas will also receive regular visits in addition to children who are identified as severe acute cases.
By October 2016: Project Medishare will train 55 Project community health workers in the Thomonde area in nutrition with the Haitian Ministry of Health on growth monitoring and nutritional care for malnourished, underweight children, as well as educate mothers and families about their childrens nutritional needs. There will also be female empowerment training that will take place in the household during home visits with the families. The nutrition training for community health workers is provided in coordination with the Haitian Ministry of Health. Other activities will include the purchase fortified food, screening children at community rally posts to identify candidates for treatment, and logging baseline data.
By November 2016: Families will officially enroll in program. Project Medishare will target the most urgent cases with severe acute malnutrition.
December 2016/January 2017: Provide ongoing treatment to children with severe acute malnutrition by enrolling identified cases in community-based treatment with fortified food. The fortified food is known as Plumpy-nut, a peanut butter based formula that offers high fat and vitamin content. It is developed locally and will be purchased locally which will further support Haitian agricultural efforts (the peanuts are grown locally). Severe cases will be enrolled in the program, screened by physicians (medical team) and monitored during the duration of the treatment by a Medishare community team such as field coordinator, health agent supervisor or health agent. The household will then be checked frequently and household members educated in health generally and specifically about the nutritional needs of children with a focus on children under five years old.
January 2017: Health screenings will be provided for children enrolled in program for quarterly progress report.
February 2017: Progress will be tracked for children identified as moderately malnourished to ensure no child has entered SAM phase.
May 2017: Health screenings will be provide for children enrolled in program for quarterly progress report.
September 2017: Final health screenings and data collection to assess success of the commitment.
October 2017: Final report will be completed.
The World Food Programs 2015 report found that one in 10 children in Haiti are malnourished, one in five are acutely malnourished, and one in three children are stunted, or irreversibly short for their age. A severely malnourished child can suffer lifelong mental and physical risks, as it greatly compromises a childs immune system, making them more susceptible to infectious diseases such as pneumonia and other complications. The World Health Organization reported in 2015 that malnutrition and neonatal complications place the biggest health burden on Haiti today, and around seven percent of Haitian children will die before they reach their fifth birthday. Mortality among the children in Haitis Central Plateau is 68 per thousand.
With over half of the population living on less than one dollar per day, and about 80% living on less than two dollars per day, poverty is a root cause of malnutrition in Haiti. In addition, decades of underinvestment in infrastructure, poor natural resource management, limited governance, and the toll of natural disasters and environmental degradation has challenged Haitis agricultural sector, which, even though it is an important sector of the countrys economy, fails to produce enough food to feed Haitis population. As a result, the island nation imports more than 50% of its populations needs, including 80% of its main staple: rice. This contributes to high food prices, making it difficult for many families to feed their children.
Nutrition programs worldwide show the effectiveness of community and household level treatment of malnutrition. Mothers who need to travel to the hospital with a sick child are often leaving other vulnerable children behind and are unable to care for other members of the family or work. This community-based program will educate mothers on good nutritional practices and offer supplementary feeding as needed. It will also assure family unity during a childs treatment.