Health Education Program on prevention of Tuberculosis

Using PRECEED PROCEED Framework

439. Dip Narayan Thakur440. Gauri Shankar Mandal

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Objectives of the presentation

To share planning of a health education program on prevention of Tuberculosis so as to develop presentation skills

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Presentation’s Map

• Introduction: Tuberculosis• Baseline Information• Introduction to PRECEDE PROCEED Framework• PRECEDE

• Social Assessment• Epidemiological Assessment• Behavioural and Environmental Assessment• Educational Assessment• Administrative and policy assessment

• PROCEED• Program Design• Objectives (Different levels)• Detail plan of Action• Monitoring and supervision planning• Plan for Evaluation

• References

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Tuberculosis: Introduction• An infectious disease caused by Mycobacterium tuberculosis.• It primarily affects lungs (Pulmonary TB) but can affect other tissues

(Extra-pulmonary TB).• It can also affects other animals like cattle (Bovine TB) which may

sometime be communicated to human.• MOT: Air-borne (Droplet infection through cough, sneeze, etc.)• IP: Weeks to years but Tuberculin test is positive within 3 to 6 weeks

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Tuberculosis: IntroductionSigns and Symptoms• A bad cough that lasts 3 weeks or

longer• pain in the chest• coughing up blood or sputum

(phlegm from deep inside the lungs)• weakness or fatigue• weight loss• no appetite• chills• fever• sweating at night

Diagnosis• Tuberculin test• Sputum Microscopy• Chest X-Ray

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Baseline Information: From VDC profile Madhopur, Rautahat

• Total households: 1035• Total Population: 7609 (M:03932; F:3677)• Literacy Rate: 37.43% (Male-49.45%; Female-24.53%)• Ethnicity distribution:

• Yadav (27.80%)• Koiri (10.53%)• Teli (9.29%)• Kanu (7.93%)• Dalit (15.40%)• Others (29.05%)

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PRECEDE PROCEED Framework

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Social Assessment• Lower quality of life (1) (Women feel the intense social impacts)• Cuts down in economic production (↓GDP 4-7% (3); ↓Average

monthly income; etc.)• Cost related to treatment (Medicine, travel, etc.)• Reduced interpersonal communication• School and job absenteeism (54% among diseased people)• ↑ Unemployment (3.6%) and underemployment

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Epidemiological Assessment• About 45% of population is infected with TB bacteria. (National data)• Every year 45000 people develop active tuberculosis, • Out of which, 51% has infectious pulmonary tuberculosis. (National

data)• Case finding rate- 59% • Prevalence of TB among HIV patient- 17% (5)• Annual 1-2 deaths due to tuberculosis• Childhood tuberculosis case- 2.2%• Treatment success rate: 91%• Malnutrition: 0.1%

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Behavioural and Environmental Assessment• List of significant behavior to be addressed which are related to tuberculosis

• Practice of using safety masks (About 1%*)

• Health Care utilization (poor, particularly government health services)

• Tobacco use (30% : >12 yrs. age)• Substance abuse (HIV-TB co-infection)

• Dietary and life style: poor (Malnutrition) • BCG coverage: 97%

• Environmental factors• Overcrowding (public places/ FS:6.44)• Poor housing and Indoor air pollution (use of firewood as main cooking fuel)• Occupational settings

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Behavioural prioritizationBehaviour Importance Changeability Total Score

Practice of using safety mask 3 4 7Tobacco and substance abuse 4 1 5Health care utilization (Vaccines and DOTS)

4 3 7

Dietary and lifestyle 5 3 8

Prioritized Behavior for health education intervention: Dietary and lifestyle

Score : Very high-5, High-4, Neither high nor low-3, low-2, Very low-1

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Educational Assessment• Predisposing factors: Knowledge on TB, its causes, signs & symptoms, mode

of transmission, preventive measures.• Tuberculosis: Communicable (80%); Non-Communicable(14%); Didn’t know (6%)

• Transmission of TB: Coughing(82%); Blood(9%); Direct contact(2%); Eating leftover foods(25%)

• Treatment: Possible(90%); Not possible(3%) and Didn’t know (7%)

• Availability of treatment: Government health institution(84%); private hospital and clinic (28%) and Didn’t know (2%)

• Malnutrition makes prone to TB: 25%

• Treatment cost: Totally free (70%); Should pay money (22%); Others didn’t know

• Only about ten percent people have heard technical term ‘DOTS’.

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Educational Assessment• Reinforcing factors:

Health Education on nutrition, dietary habits and tuberculosis: -Not integrated-Components in school level curriculum not

taught effectively-Mothers group session conducted by FCHV

Social support:-Good for people who is in touch with family and

community whereas bad for displaced, abandoned

Peer support: Not good (Molysmophobia)*

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Educational Assessment• Enabling factors:

Resources (nutritious food) availability and accessibility: poor due to poverty (though the area fall in granary of

Nepal)Skills of having balanced diet- not good

Programs on nutrition by different NGOs and INGOs: focused mainly on children (good) but post disease requirement of nutrition is not addressed

Community interest: people thinks that TB is individual problem. Dietary habit and lifestyle are individual

issue

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Administrative and policy assessment• HE program supported by National health policy 2071.

• No health education corner in SHP.

• Training on Tuberculosis and DOTS received by 80% Health Workers.

• Free distribution of drugs to the infected population as DOTS therapy.

• Supportive program from local clubs and NGO working in nutrition.

*Data mentioned in the assessment section are not all real for the given VDC. Most of the data are based on our assumption.

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Health Education program design• GoalImprove health related QoL of people attributed by tuberculosis in Madhopur VDC of Rautahat district

• Program ObjectiveReduce incidence of tuberculosis by one fourth after three years of health education program.

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Behavioural Objectives:• To modify eating habits of 80% people of Madhopur after three year

of health education program on dietary habits and lifestyle.• To improve cooking habits of 55% of households of Madhopur after

three year of health education program on dietary habits and lifestyle.• To promote the use kitchen garden for growth of different crops,

vegetables and fruits in Madhopur after three year of health education program on dietary habits and lifestyle.

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Objectives cont.…Educational Objectives:• To aware local people and health workers on relationship between

malnutrition and tuberculosis• Develop knowledge and skills of mothers on cooking food without

deteriorating nutritious component.• Develop knowledge and skills of health workers and local

communities on balanced diet and dietary habits.

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Objectives cont…Organizational and Policy objectives:• To establish health education corner at local health facility for

integrated health education.• To coordinate with agriculture related organization for assistance in

the kitchen garden.

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Resource Assessment Resource Source IEC materials District health officeHuman resource Local health facility, local clubs, FCHVFunding USAID (Kathmandu), VDC office-

MadhopurInfrastructure Local community

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Program design

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Objectives Activities Indicators/ Targets Means of verification

Overall Goal

Improve health related QoL of people attributed to tuberculosis

HE program on nutrition, dietary and lifestyle.

HDI, HPI PCI, Literacy rate, Life expectancy

Program Objective

Reduce incidence of tuberculosis by one fourth

HE program on nutrition, dietary and lifestyle.

Tuberculosis IncidenceCase Finding Rate

HMIS, Annual Report of the district

Planning MatrixTitle: Health Promotion and Education program on nutrition, dietary habits and life style to prevent tuberculosis.Duration: 2016-2018 AD Location: Madhopur, Rautahat, Nepal

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Objectives Activities Indicators/ Targets Means of verification

Educational Objectives

To aware local people and health workers on relationship between malnutrition and tuberculosis

Meeting and discussion on malnutrition and tuberculosis with health workers and FCHVs

100% of the participants could reply the link between tuberculosis and malnutrition.

Post meeting questions.

Integrated health education at Health facility by health worker and in community by FCHVs.

70% of local people will know the relationship between malnutrition and tuberculosis.

Questionnaire survey at the end of project.

To Develop knowledge and skills of mothers on cooking food without deteriorating nutritious component.

Mothers group discussion on importance and ways of saving nutrients while cooking.

80% of participants would be able to recall the ways of saving nutrients while cooking.

Post meeting questions

Demonstration on healthy cooking techniques.

76% of participants will be able to demonstrate the healthy cooking techniques.

Randomly some participants will be asked to demonstrate.

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Objectives Activities Indicators/ Targets Means of verification

Educational Objectives

Develop knowledge and skills of FCHVs and local communities on balanced diet and dietary habits

Training to the FCHVs on balanced diet and dietary habits.

100% of FCHVs should understand about balanced diet and dietary habits.

Post training evaluation

Discussion on balanced diet and dietary habits in mothers group meeting by FCHVs.

80% of participants will be able to recall content of discussion.

Post discussion questions.

Wall painting through out the VDC in public places with different related information (pictorial)

40% people of the VDC will be able to understand the message

Post painting survey

Integrated School health program on tuberculosis and malnutrition and balanced diet.

68% of the students will be able to recall the information given.

Post program questionnaire survey.

Radio program on tuberculosis, malnutrition and balanced diet.(with early information)

40% of the listener will be able to understand the message on the radio

Post program evaluation.

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Detail Plan of Action

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Activities Contents Target group

Methods and medias

Responsible persons

Venue Date/ Time

Meeting and discussion on malnutrition and tuberculosis with health workers and FCHVs

TuberculosisMalnutritionRelationshipBurdenFuture actions

FCHVsHealth workers

Group discussion/Flip chartElectronic medias

Program coordinator (BPH graduate)

Madhopur Sub-Health Post

2016 Jan 6 and 7 10 am- 2 pm

Integrated health education at Health facility by health worker and in community by FCHVs.

TuberculosisMalnutritionRelationshipDietary habits

Community peoplePatients and their family

CounsellingGroup discussion/Flip chartPoster

SHP Incharge

FCHVs of respective wards.

Madhopur Sub-Health PostEach wards

2016 Jan 10 onwards

Training to the FCHVs on balanced diet and dietary habits.

TuberculosisMalnutritionRelationshipDietary habitsKitchen gardenHealthy cooking habits

FCHVs Workshop Program coordinator (BPH graduate)

Madhopur Sub-Health Post

2016 Jan 14 To Jan 20

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Activities Contents Target group Methods and medias

Responsible persons

Venue Date/ Time

Discussion on balanced diet and dietary habits in mothers group meeting by FCHVs.

Dietary habitsKitchen gardenHealthy cooking habitsBalanced diet

Mothers group Group discussion/Flip chart

FCHVs of respective wards

Each ward Jan 22- Feb 13

Wall painting through out the VDC with different related information (pictorial)

TuberculosisMalnutritionHealthy cooking habitsKitchen garden

Community people Wall painting Hired painter Each ward Feb 1- Mar 29

Integrated School health program on tuberculosis and malnutrition and balanced diet.

TuberculosisMalnutritionHealthy cooking habitsKitchen gardenBalanced diet

School children Mini-lecture Postures

Executive team All schools of the VDC

Feb 15- Mar 30

Radio program on tuberculosis, malnutrition and balanced diet.(with early information)

TuberculosisMalnutritionHealthy cooking habitsKitchen gardenBalanced diet

Community people InterviewAudio tapeAd type short message

Communication team

Madhopur FM Mar 31 onwardsWeekly (Interview)Ad- Daily

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Activities Content Target group Methods and medias

Responsible persons

Venue Date/ Time

Mothers group discussion on importance and ways of saving nutrients while cooking.

Balanced dietWays of healthy cooking

Mothers group Group discussionDemonstration

FCHVs Each wards in mothers group meeting

Mar 31 – Apr 16

Demonstration on healthy cooking techniques.

Cooking techniques

Mothers group Demonstration FCHVs Each wards in mothers group meeting

Mar 31 – Apr 16

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Risk ManagementRisks Risk ManagementThe willingness of the community may decrease during the program

Community will be involved in all stages of the program: planning, implementation and evaluation

Seasonal busyness of local people Program will be conducted in off time.

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Plan for Supervision and monitoring of the program

• There will be one monitoring and evaluation sub-committee for the programme. • The members will be one VDC Secretary, one BPH graduate, one target

group representative and one SHP representative. • The focal person for the program monitors and advise where required,

and will ensure that there is good accountability and also act as process facilitator. • The Monitoring committee will monitor in line with log framework of the

programme. The committee will monitor the programme one time a month. • Each monitoring will produce a report and the monitoring findings will be

utilised to modify and strengthen the health education programme

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Plan for Evaluation of the program Will be done at all level of program phases• Process evaluation – Evaluation of implementation of detail plan of

action and educational objectives and indicators• Impact evaluation – Evaluation of behavioral objectives and indicators• Outcome evaluation – Evaluation of epidemiological and social

indicators and objectives.

Why tuberculosis is important?

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Limitation of the plan• The situation analysis for the planning is based on secondary data

from various sources so it may not reflect the real situation of the VDC.• The plan has been developed for learning process only and may not

be practical.

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References:1. Impact of Tuberculosis on the Quality of Life Dhuria M, Sharma N, Ingle G K -

Indian J Community Med." Impact of Tuberculosis on the Quality of Life Dhuria M, Sharma N, Ingle G K - Indian J Community Med. N.p., n.d. Web. 14 Mar. 2013.

2. National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 14 Mar. 2013. <http://www.ncbi.nlm.nih.gov/pubmed/20565494>."TB Alliance: Putting Science to Work for a Faster TB Cure."

3. Economic Impact of TB. N.p., n.d. Web. 14 Mar. 2013. <http://www.tballiance.org/why/economic-impact.php>.

4. Patient Medical Costs for Tuberculosis Treatment and Impact on Adherence in China: A Systematic Review." BMC Public Health. N.p., n.d. Web. 14 Mar. 2013.

5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731868/

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