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Ronald Gutierrez, Country Health Advisor, Plan International - Bolivia, Calle Capitan Ravelo No. 2189, Pasaje detras del Hotel Radisson, La Paz, Bolivia and Pierre-Marie Metangmo, MD,, MBA,, MPH, Headquarters, PLAN International, 3260 Wilson Bouldvard, Suite 21, Arlington, VA 22201, 703-807-0190, metangmp@plan.geis.com.
This presentation will summarize the findings of a quasi-experimental, population-based, controlled study of Community IMCI (C-IMCI) in Bolivia. The study hypothesized that application of C-IMCI by Community Health Agents (CHAs), as a complement to the application of Clinic-based IMCI, would produce results demonstrating higher levels of knowledge and practice for care of children under five (CU5), compared to implementation of Clinic-based IMCI alone.
The study was implemented in 105 communities (51 intervention / 54 control) in 4 regions of Bolivia. Phase one (5-9 months) of the three phase study began in late 1999 with the adaptation of BASICS II C-IMCI materials, phase two (12-15 months) encompassed the intervention itself and phase three (1 month) was dedicated to evaluation. CHAs were selected and trained utilizing the aforementioned materials and CHA activities were monitored.
Results indicate that application of C-IMCI significantly increases knowledge of caregivers of CU5 on relevant care giving practices, compared to the sole application of Clinic-based IMCI. C –IMCI facilitates health knowledge transfer in areas without access to health facilities and can contribute to improved health of children and their mothers. The Bolivian Ministry of Health now encourages public health staff to combine Community and Clinic-based IMCI strategies, and local municipalities are investing their own funds to replicate the program.
Recommendations include addition of behavior change activities into C-IMCI strategy, and strengthening the nutritional focus of C-IMCI training materials for CHAs. A “Preventable Mortality” indicator should be developed to determine the percentage of preventable deaths of CU5.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.