Carolyn Kruger, Ph.D.Sr. Advisor MNCH, PCI

Community Approaches to Underutilized and

Evidence-based Interventions

Prevention of Pre-term Birth

CORE GROUP FALL MEETING 2013

Evidence-based PTB/LBW Interventions

Use of antenatal corticosteroids (ACS) for pre-term birth

Use of appropriate drug regimens for premature rupture of membranes and infectious diseases (STIs, malaria, newborn infections)

Resuscitation methods to help babies breatheKangaroo Mother Care for LBW babiesChorhexidine – cord care

Additional InterventionsEvidence-based –applied at community

level

Comprehensive Antenatal Care – early and regular visits

Maternal nutrition and weight gain

Birth preparation and early recognition of complications

Clean/Skilled care deliveryEssential newborn careHome-based Life Saving

Skills and HBB© 2011 Save the Children. All Rights Reserved

Interventions Applied at Community Level

Prevention of infection – especially for PTBDomestic violence- global violence- stressMental Health- assessment of depressionPregnancy spacing and family planning

Community Strategies: Newborn

Utilize existing platforms ( vulnerable groups, HIV, MCH maternal and newborn, child health) and integrate PTB evidenced-based interventions

Strengthen access, quality and equity

of health services through communityadvocacy- tracking vulnerable groups

Build capacity of health servicesin emergency care, Helping Babies to Breathe and PTB

Community Strategies: Newborn/PPTB

Ensure Essential Commodities- advocacy by community health committees

Build community leadership (tribal, religious, community/civil committees) and capacity to prevent PTBs

Overcome bottlenecks ( distance, referral systems, poverty)

Mother/Father Care Groups and home visits to promote early ANC, birth preparation, recognition of complications and skilled care delivery

Bangladesh “Trio” Care Groups- -Mother, Father and Grandmother influence behavior change-Fathers commit to providing food for malnourished mothers and children-Grandmothers commit to caretaking children so that mother can “rest”

Promising Practices

© UNICEF/NYHQ20102330/ Olivier Asselin, Mali, 2010

Trio Care Groups

Each Care Group Trio consists of 12 leaders each. Mother CGs meet monthly. Grandmothers & Father CGs will meet every three months with the

mother CGs.

(162 Care Group Trios total)

Each paid promoter oversees

approximately 10 Care Group Trios

(12 promoters total)

Each supervisor oversees

approximately three paid promoters

(4 supervisors total)

Supervisor

PromoterGrandmothers

Mothers Fathers

Promoter

Promoter

PROSHAR TRIO CARE GROUP APPROACH

Each leader will meet with approximately 14 peers regularly (monthly/mothers & quarterly/ fathers & grandmothers) reaching

81,648 HH decision-makers

Trios Care Groups

31.438.2

32.3 34.629.2

56

88.7

53

73

40.9

0

10

20

30

40

50

60

70

80

90

100

Exclusive BreastFeeding

Early Initiationof BF

3+ ANC Visits Post Partum Vit-A

3 Correct IYCFBehaviors

Baseline Sept 2012 Results

BEHAVIOR CHANGE TRENDS

Promising Practices

Adolescent and mother-friendly reproductive health services- youth corners and teaching centers

School and community advocacy for prevention of early marriage and pregnancy- PTAs, teacher training, youth groups

Community referral/ transportation systems- community planned and owned

Respectful maternity care- cultural sensitivity, equity supportEconomic and social empowerment groups- mothers group

that include a micro-credit component that increased their sense of decision-making and household resources; WE groups – Women’s Empowerment groups

Feeding support- extra support for PTB

Promising Practices

Kangaroo Mother Care – health facility and community outreach

Maternal Waiting Homes for high-risk pregnant women

Social shifting to prevent early marriagePromotion of girls’ and women’s

educationCommunity Health Committees that advocate for essential commodities at primary health clinics

Overcome Bottlenecks

Formative research- Barrier Analysis/doer-non-doer

Promote culture of respectful and equitable careKnowledge sharing among community leaders –

championsInter-family dialoguesUtilize community leaders to advocate for improved careCommunity ownership of the problem and solution

Photo property of CARE, Nov 2011

DISCUSSION

Are you integrating prevention of PTBs? If so, HOW?

What is working? And if so WHY?What are the barriers to integration?What are the facilitating factors to integration?Community ownership- ideas?Are you aware of Newborn/PTB opportunities

and resources to share?Have you visited your representative lately?