An Iterative Process for Training Design and Implementation Increased Health Workers\u27 Knowledge for Taking Nutrition Behavior Change to Scale

The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. Objective: The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. Methods: The design and implementation of training followed a 5-phase process: situation analysis, formative research, large-scale feasibility study, redesign and scale up, and evaluation. We conducted document reviews, surveys, and focus groups during the first phases to inform and refine the training, as well as a pre- and posttraining telephone survey to evaluate change in knowledge. Results: The initial phases of the design provided a clear understanding of the opportunities and challenges for promoting infant and young child feeding, as well as health workers\u27 routines and practices, which informed training design. The feasibility study allowed tailoring and refinement of training. The vertical coherence and coordination between the federal and state levels during redesign and scale up facilitated compliance with training timeline and process. Evaluation results showed significant improvement in knowledge posttraining of up to 19 percentage points. Conclusions: The EsIAN training component for health providers was developed using a systematic approach to consolidate and generate relevant evidence, following an iterative process to test, learn, and improve both design and implementation. This process allowed for flexibility to take advantage of new opportunities and respond to findings from iterations. Garnering and ensuring political support allowed for continuity and sustainability of actions

Morbilidad derivada del olvido de gasas en actos quirúrgicos

Introduction. Textiloma is a surgical iatrogenia whose real incidence is not known, because it is not reported habitually. Their complications can take serious injuries to the patients, even the death. Material and methods. We reviewed the complaints attended in CONAMED of January of 2001 June of 2007 which were related to textilomas, sociodemographic variables, diagnoses and complications displayed in the cases are described. Results. Fifteen cases were identified; the age average of the patients was 36,6 years; 53,3% women; 66.7% occurs in the Distrito Federal, 46,7% in private institutions; 80% in abdominal or gynecological surgery. The most serious damages were irreversible injury to intraabdominal organs 33,3% and death 13.3%. Conclusions. Textilomas are prevenibles adverse events, joint responsibility of surgeons, instrumentalist and circulating like part the surgical team.Introducción. Los textilomas son iatrogenias quirúrgicas cuya incidencia real se desconoce, pues no se reporta habitualmente. Sus complicaciones pueden llevar a lesiones graves a los pacientes, incluso la muerte. Material y métodos. Se revisaron las quejas relacionadas a textilomas que fueron atendidas en CONAMED de enero de 2001 a junio de 2007. Se describen variables sociodemográficas, diagnósticos y complicaciones presentadas en los casos. Resultados. Se identificaron 15 casos; la edad promedio de los pacientes fue 36.6 años; 53.3% mujeres; 66.7% atendidos en el Distrito Federal, 46.7% en instituciones privadas; 80% en cirugía abdominal o ginecológica. Los daños más graves fueron lesión irreversible a órganos intraabdominales 33.3% y muerte 13.3%. Conclusiones. Los textilomas son eventos adversos prevenibles, responsabilidad conjunta de cirujanos, instrumentistas y circulantes como parte el equipo quirúrgico

An Iterative Process for Training Design and Implementation Increased Health Workers’ Knowledge for Taking Nutrition Behavior Change to Scale

The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. Objective: The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. Methods: The design and implementation of training followed a 5-phase process: situation analysis, formative research, large-scale feasibility study, redesign and scale up, and evaluation. We conducted document reviews, surveys, and focus groups during the first phases to inform and refine the training, as well as a pre- and posttraining telephone survey to evaluate change in knowledge. Results: The initial phases of the design provided a clear understanding of the opportunities and challenges for promoting infant and young child feeding, as well as health workers\u27 routines and practices, which informed training design. The feasibility study allowed tailoring and refinement of training. The vertical coherence and coordination between the federal and state levels during redesign and scale up facilitated compliance with training timeline and process. Evaluation results showed significant improvement in knowledge posttraining of up to 19 percentage points. Conclusions: The EsIAN training component for health providers was developed using a systematic approach to consolidate and generate relevant evidence, following an iterative process to test, learn, and improve both design and implementation. This process allowed for flexibility to take advantage of new opportunities and respond to findings from iterations. Garnering and ensuring political support allowed for continuity and sustainability of actions