Combined Preventive Strategies in Public Health Interventions
MSF's experience in implementing combined preventive strategies focusing on SMC, Vaccination, and Nutrition Screening in various countries like Mali, Niger, Chad, and Nigeria. The interventions aim to address malnutrition, improve vaccination coverage, and reinforce EPI programs. Advantages include avoiding missed opportunities on comorbidities, while challenges involve the need for specific training and increased paperwork. Financing for these interventions comes from various actors, and continued screening can help reduce levels of malnutrition.
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SMC AND COMBINED PREVENTIVE STRATEGIES The MSF Experience Joint Consultation on SMC, Ouagadougou, Feb 15 2017 Estrella Lasry, MSF Estrella.Lasry@barcelona.msf.org
SMC & OTHER INTERVENTIONS IN MSF MALI CHAD (Moissala) NIGER GUINEA BISSAU NIGERIA 2012 SMC SMC SYSTEMATIC NUTRITIONAL SCREENING (MUAC) SYSTEMATIC NUTRITIONAL SCREENING (MUAC) 2013 SYSTEMATIC NUTRITIONAL SCREENING (MUAC) VACCINATION: EPI reinforcement Pentavalent - NUTRITIONAL SCREENING (MUAC) 2014 -SMC IN PREVENTIVE PACKAGE -PPDoz DISTRIBUTION -ALBENDAZOL DISTRIBUTION Koutiala: MUAC Ansongo: NUT SCREENING+ VACCINATION VACCINATION: EPI reinforcement Pentavalent, OPV, measles -NUTRITIONAL SCREENING 2015 -VACCINATION Ansongo: SMC+vacci Kidal: SMC remote VACCINATION NUT SCREENING NUTRITIONAL SCREENING NUTRITIONAL SCREENING Borno (IDP camps): 2016 NFI distribution, Nut screening Yobe (IDP camps): NFI distribution
COMBINED INTERVENTIONS-NUTRITION NUT SCREENING KOUTIALA, MALI 2013-2014 Mali: >160,000 children screened in 2013 >172,000 children screened in 2014 >187,000 children screened in 2015 Cases of SAM detected during SMC distributions, all sites Niger 2014 1.60% 1.40% Magaria 1.20% Niger : ->415,000 children screened in 2014 in 5 districts -Distribution of PlumpyDoz in 6 health areas Madarounfa 1.00% Guidam Roumji 0.80% Madaoua 0.60% Bouza 0.40% 0.20% 0.00% SMC 1 SMC 2 SMC 3 SMC 4
COMBINED INTERVENTIONS-NUTRITION ADVANTAGES DISADVANTAGES -Avoid missed opportunities on comorbidities -Need to train staff and supervise activity -Need specific tally (increase of paperwork) -Same age group -Relatively simple: MUAC screening (can be done in Fixed site and Door-to-door) -Need to ensure staff and supplies at Health center level in order to ensure compliance -Continued screening can reduce levels of malnutrition (by increasing children in programs) -Financing for nutrition comes from different actors
COMBINED INTERVENTIONS-VACCINATION EPI REINFORCEMENT, MOISSALA, CHAD 2014, 2015
COMBINED INTERVENTIONS-VACCINATION ADVANTAGES DISADVANTAGES -Avoid missed opportunities on comorbidities -Intense specific training and supervision needed: need of medical staff for injectable vaccines -Increased vaccination coverage in areas of poor EPI coverage (13-80% increase) -Different age groups for different vaccines -Substantial increase in HR needs (difficulty in D2D approach) -SMC can increase adherence to vaccination -Need specific tally (increase of paperwork) -Logistics: Cold chain and waste disposal issues -Duration of SMC cycles increases (distribution days) -Significant increase in cost: Financing for vaccination comes from different actors -Little communication at capital level between different programs
CONCLUSIONS -COMBINED STRATEGIES CAN INCREASE COVERAGE OF INTEGRATED CHILD PREVENTIVE PACKAGES -NUTRITIONAL SCREENING IS A QUICK WIN AND EASY TO INTEGRATE BUT REQUIRES ENSURING A CAPACITY AT REFERRAL FACILITY (OUTPATIENT AND INPATIENT) -SOME VERY CONTEXT-SPECIFIC: NFI distribution -OTHER POSSIBLE INTERVENTIONS: LLIN distribution, Pneumococal vaccine, Ivermectine distribution, intervention on adults/caretakers -COST-ANALYSIS SHOULD BE DONE INCLUDING COSTS OF DIFFERENT PROGRAMS -NEED FOR CENTRALIZED COORDINATION: UNICEF?
