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Pediatric Development Clinic: An integrated Model to Support Nutrition and Early Childhood Development of Vulnerable Infants and Children --- Presenter Hema Magge of Partners In Health:
Forty percent 40% of child deaths occur in the neonatal period according to RDHS 2010. The project goal is to create a clinic to provide needed services targeting low birth weight children and track and evaluate the outcome. The services include follow-up clinic for early intervention for the nutritional, medical and developmental needs of at-risk infants. An objective is to provide high-quality care through screening, simple interventions, and caregiver counseling to support ECD. The project aims to demonstrate feasibility of model implementation with potential for national scale-up
The primary population served includes infants with prematurity/low birth weight and birth asphyxia. Secondary population includes those withTrisomy21, Cleft lip/palate, Hydrocephalus and other developmental delay, neuromuscular disorder, suspected genetic syndrome
Monitoring indicators include program monitoring, growth and feeding, medical danger signs, developmental screening and counseling, alerts, reminders and automated patient-level and aggregate reports generated from the EMR system. Outcomes of at-risk neonates after 1 year of implementation will be compared to those at baseline and results will be used to inform potential national scale-up with NCD service expansion.
Pediatric Development Clinic
An Integrated Model to Support Nutrition and
Early Childhood Development of Vulnerable
Co-Authors
• Hema Magge, MD, MS, Partners In Health
• Jean Claude Uwamungu, MD, Partners In Health • Leonce Mwizerwa, MD, Rwanda Ministry of Health
• Thacien Twagirumukiza, MD, Rwanda Ministry of Health • Evrard Nahimana, MD, Partners In Health
• Gedeon Ngoga, Partners In Health
• Francis Mutabazi, Rwanda Ministry of Health • Cheryl Amoroso, MPH, Partners In Health
Improving Neonatal Survival in
Rwanda
• Significant neonatal mortality with 40% of childhood deaths occurring in neonatal period (RDHS 2010) • Since 2010, national strategies focus on improving
immediate neonatal survival with neonatal special care units
• Emerging group of vulnerable infants at higher
nutritional, medical and developmental risk (ex. LBW, preterm)
• No systematic way of providing long term nutritional support, medical care, or ECD opportunities for these at-risk infants
Early Childhood
Development in Rwanda
• Early childhood (0-5 years) is critical period of brain growth and affects long-term outcomes
• Adequate nutrition is essential to ensuring healthy brain growth and development during early childhood • Challenges to early childhood development
• 44% of children in Rwanda are stunted (DHS 2010) • Few have access to ECD opportunities
• Minimal opportunities for parental education and support
• Infants with perinatal complications have even higher biologic and social risk
Alignment with National
Strategic Plans
• Rwanda Health Sector Strategic Plan
•
Scale-up of post-natal services
•
Post-natal service capacity development
•
Community-centered ECD services
• Ministry of Education Integrated Early
Childhood Development Strategic Plan
•
Need for caregiver training
Implementation Setting
• Southern Kayonza: 1
District Hospital, 8
health centers, 926
CHWs
• Population: 188,363
people (2012 Census)
• 3 health centers that
provide
non-communicable disease
(NCD) services with
Pediatric Development Clinic
Goal 1
• Create follow-up clinic for early
intervention for the nutritional,
medical and developmental needs of
at-risk infants
•
Provide high-quality care through
screening, simple interventions, and
caregiver counseling to support ECD
Goal 2
• Prospectively track and evaluate
medical and developmental
Goal 3
• Demonstrate feasibility of model
implementation with potential for
national scale-up
•
District Hospital and Health
Center levels
Program Overview
• Weekly nurse-led clinic housed within outpatient
non-communicable disease services
• Training in basic nutritional, medical and
developmental protocols
• Setting: 3 health centers in year 1, 2 additional
health centers in year 2
• Timeframe: 24 months
• Initiative led by MCH with NCD support
• Protocols approved by Rwanda Pediatric
Populations Served
• Primary:
•
Infants with prematurity/low birth weight
•
Birth asphyxia
• Secondary:
•
Trisomy 21
•
Cleft lip/palate
•
Hydrocephalus
•
Other developmental delay, neuromuscular
disorder, suspected genetic syndrome
Program Services
• Nurses and social workers provide:
• 1. Condition-specific medical screening • 2. Monitoring of growth and nutrition • 3. Developmental screening and care
• Screening using Ages and Stages questionnaire adapted to Rwanda (developed by CARE)
• UNICEF package for developmental intervention
• Social supports for vulnerable families meeting criteria:
• Transport fees • Food packages
• Home visits by CHW as needed
Trainings
• Training of NCD nurses in:
• PDC Clinical Protocol (developed by PIH)
• General ECD support (Care for Child Development -UNICEF)
• Specific ECD support based on developmental screening results (UNICEF)
• Training of Social Workers in:
• ECD kit for child-friendly space use (UNICEF)
Clinic Flow
• Referral from hospital upon discharge and rendezvous
given in Pediatric Development Clinic
•
Arrival at clinic:
• 1) General ECD counseling provided by NCD nurse during morning group teaching session
• 2) Wait for consultation in ‘child-friendly space’ with SW
trained in ECD facilitating interactive play with children and caregivers
• 3) Individual consultation with NCD nurse providing medical, nutritional, developmental screening and
Monitoring and Evaluation
• EMR monitoring indicators in process and
outcomes for:
•
Program monitoring
•
Growth and feeding
•
Medical danger signs
•
Developmental screening and counseling
• Alerts, reminders and automated patient-level
and aggregate reports generated from the EMR
system
Monitoring and Evaluation
• Early qualitative assessment after 3 months of
implementation to assess:
•
Caregiver perceptions, value, and feedback to the
clinic
•
Nurse feedback on training effectiveness and
protocol use
• Outcomes of at-risk neonates after 1 year of
implementation will be compared to those at baseline
• Results will be used to inform potential national
Thank you
Pediatric Development Clinic
An Integrated Model to Support Nutrition and
Early Childhood Development of Vulnerable
Co-Authors
• Hema Magge, MD, MS, Partners In Health
• Jean Claude Uwamungu, MD, Partners In Health • Leonce Mwizerwa, MD, Rwanda Ministry of Health
• Thacien Twagirumukiza, MD, Rwanda Ministry of Health • Evrard Nahimana, MD, Partners In Health
• Gedeon Ngoga, Partners In Health
• Francis Mutabazi, Rwanda Ministry of Health • Cheryl Amoroso, MPH, Partners In Health
Improving Neonatal Survival in
Rwanda
• Significant neonatal mortality with 40% of childhood deaths occurring in neonatal period (RDHS 2010) • Since 2010, national strategies focus on improving
immediate neonatal survival with neonatal special care units
• Emerging group of vulnerable infants at higher
nutritional, medical and developmental risk (ex. LBW, preterm)
• No systematic way of providing long term nutritional support, medical care, or ECD opportunities for these at-risk infants
Early Childhood
Development in Rwanda
• Early childhood (0-5 years) is critical period of brain growth and affects long-term outcomes
• Adequate nutrition is essential to ensuring healthy brain growth and development during early childhood • Challenges to early childhood development
• 44% of children in Rwanda are stunted (DHS 2010) • Few have access to ECD opportunities
• Minimal opportunities for parental education and support
• Infants with perinatal complications have even higher biologic and social risk
Alignment with National
Strategic Plans
• Rwanda Health Sector Strategic Plan
•
Scale-up of post-natal services
•
Post-natal service capacity development
•
Community-centered ECD services
• Ministry of Education Integrated Early
Childhood Development Strategic Plan
•
Need for caregiver training
Implementation Setting
• Southern Kayonza: 1
District Hospital, 8
health centers, 926
CHWs
• Population: 188,363
people (2012 Census)
• 3 health centers that
provide
Pediatric Development Clinic
Goal 1
• Create follow-up clinic for early
intervention for the nutritional,
medical and developmental needs of
at-risk infants
•
Provide high-quality care through
screening, simple interventions, and
caregiver counseling to support ECD
Goal 2
• Prospectively track and evaluate
medical and developmental
Goal 3
• Demonstrate feasibility of model
implementation with potential for
national scale-up
•
District Hospital and Health
Center levels
Program Overview
• Weekly nurse-led clinic housed within outpatient
non-communicable disease services
• Training in basic nutritional, medical and
developmental protocols
• Setting: 3 health centers in year 1, 2 additional
health centers in year 2
• Timeframe: 24 months
• Initiative led by MCH with NCD support
• Protocols approved by Rwanda Pediatric
Populations Served
• Primary:
•
Infants with prematurity/low birth weight
•
Birth asphyxia
• Secondary:
•
Trisomy 21
•
Cleft lip/palate
•
Hydrocephalus
•
Other developmental delay, neuromuscular
disorder, suspected genetic syndrome
Program Services
• Nurses and social workers provide:
• 1. Condition-specific medical screening • 2. Monitoring of growth and nutrition • 3. Developmental screening and care
• Screening using Ages and Stages questionnaire adapted to Rwanda (developed by CARE)
• UNICEF package for developmental intervention
• Social supports for vulnerable families meeting criteria:
• Transport fees • Food packages
• Home visits by CHW as needed
Trainings
• Training of NCD nurses in:
• PDC Clinical Protocol (developed by PIH)
• General ECD support (Care for Child Development -UNICEF)
• Specific ECD support based on developmental screening results (UNICEF)
• Training of Social Workers in:
• ECD kit for child-friendly space use (UNICEF)
• Training planned for March 2014 followed by immediate
implementation and supervision
Clinic Flow
• Referral from hospital upon discharge and rendezvous
given in Pediatric Development Clinic
•
Arrival at clinic:
• 1) General ECD counseling provided by NCD nurse during morning group teaching session
• 2) Wait for consultation in ‘child-friendly space’ with SW
trained in ECD facilitating interactive play with children and caregivers
• 3) Individual consultation with NCD nurse providing medical, nutritional, developmental screening and
