What are the barriers to attendance to the MNCHW and how can these be reduced?

Maternal Newborn and Child Health Week (MNCHW) was launched in Nigeria in 2009 as a bi-annual campaign-style programme designed to deliver key child and maternal health interventions and to revitalise health care systems. Support to strengthen this programme, in the five northern Nigerian States of Katsina, Jigawa, Kebbi, Zamfara and Yobe, is being provided by the UK Department for International Development (DFID) through its 6-year programme - Working for Improving Nutrition in Northern Nigeria (WINNN). This programme is being implemented by Save the Children International (SCI) and Action Against Hunger (Action Contre la Faim, ACF) in partnership with the five state governments. WINNN focuses on strengthening three key interventions within MNCHW, which are supplementation of Vitamin A and deworming (Albendazole), for children 6-59 months of ages, and supplementation of iron-folate for pregnant women. However, a key challenge, identified by WINNN for MNCHW programme success, has been low rates of MNCHW attendance. This document reports on the operations research undertaken to understand the barriers to MNCHW attendance and how to strengthen social mobilisation to improve it.UKAi

Development of a patient-reported palliative care-specific health classification system: the POS-E

BackgroundGeneric preference-based measures are commonly used to estimate quality-adjusted life-years (QALYs) to inform resource-allocation decisions. However, concerns have been raised that generic measures may be inappropriate in palliative care.ObjectiveOur objective was to derive a health-state classification system that is amenable to valuation from the ten-item Palliative Care Outcome Scale (POS), a widely used patient-reported outcome measure in palliative care.MethodsThe dimensional structure of the original POS was assessed using factor analysis. Item performance was assessed, using Rasch analysis and psychometric criteria, to enable the selection of items that represent the dimensions covered by the POS. Data from six studies of patients receiving palliative care were combined (N = 1011) and randomly split into two halves for development and validation. Analysis was undertaken on the development data, and results were validated by repeating the analysis with the validation dataset.ResultsFollowing Rasch and factor analyses, a classification system of seven items was derived. Each item had two to three levels. Rasch threshold map helped identify a set of 14 plausible health states that can be used for the valuation of the instrument to derive a preference-based index.ConclusionCombining factor analysis and Rasch analysis with psychometric criteria provides a valid method of constructing a classification system for a palliative care-specific preference-based measure. The next stage is to obtain preference weights so the measure can be used in economic evaluations in palliative care

Symptom prevalence of patients with fibrotic interstitial lung disease: A systematic literature review

© 2018 The Author(s). Background: Those affected by advanced fibrotic interstitial lung diseases have limited treatment options and in the terminal stages, the focus of care is on symptom management. However, quantitatively, little is known about symptom prevalence. We aimed to determine the prevalence of symptoms in Progressive Idiopathic Fibrotic Interstitial Lung Disease (PIF-ILD). Methods: Searches on eight electronic databases including MEDLINE for clinical studies between 1966 and 2015 where the target population was adults with PIF-ILD and for whom the prevalence of symptoms had been calculated. Results: A total of 4086 titles were screened for eligibility criteria; 23 studies were included for analysis. The highest prevalence was that for breathlessness (54-98%) and cough (59-100%) followed by heartburn (25-65%) and depression (10-49%). The heterogeneity of studies limited their comparability, but many of the symptoms present in patients with other end-stage disease were also seen in PIF-ILD. Conclusions: This is the first quantitative review of symptoms in people with Progressive Idiopathic Fibrotic Interstitial Lung Diseases. Symptoms are common, often multiple and have a comparable prevalence to those experienced in other advanced diseases. Quantification of these data provides valuable information to inform the allocation of resources

How to strengthen the Infant and Young Child Feeding (IYCF) programme in Northern Nigeria

This report presents findings from the operations research (OR) study which was conducted to strengthen the Infant and Young Child Feeding (ITCF) programme, in northern Nigeria .The work was a collaborative project between the London School of Hygiene & Tropical Medicine, Food Basket Foundation International and Oxford Policy Management. The prevention of under-nutrition via the IYCF programme is one of four outputs of the DFID-funded programme “Working to Improve Nutrition in Northern Nigeria” (WINNN). This output aims to prevent under-nutrition by promoting evidence-based IYCF feeding recommendations, including exclusive breastfeeding until an infant is 6 months of age, feeding a diverse diet of nutritious foods and breastmilk from 6-23 months of age, feeding a sick child and good hand-washing practices. WINNN is implemented by UNICEF, Action Against Hunger (ACF) and Save the Children International (SCI), in partnership with five state governments. SCI is responsible for its implementation in Zamfara, Kebbi and Katsina states, and ACF is responsible for its implementation in Jigawa and Yobe states. Each of the five WINNN states implements the IYCF programme in three Local Government Areas (LGAs). The IYCF programme includes: (1) Facility-based IYCF counselling for pregnant women and mothers with an infant less than 2 years of age, facilitated by health workers (HWs); (2) Community-based IYCF counselling for pregnant women and mothers with an infant less than 2 years of age, facilitated by community volunteers (CVs); (3) Community-based meetings with fathers of infants less than 2 years of age and grandmothers, facilitated by CVs

How to Strengthen the CMAM programme in Northern Nigeria and reduce rates of programme defaulting

This report presents findings from the operations research (OR) study which was conducted to identify barriers to attendance of the Maternal Neonatal and Child Health Weeks programme (MNCHW), in two states of northern Nigeria – Jigawa and Zamfara States. The work was a collaborative project between the London School of Hygiene & Tropical Medicine, Food Basket Foundation International and Oxford Policy Management. The treatment and prevention of severe acute malnutrition via the Community Management of Acute Malnutrition programme (CMAM) is one of four outputs of the DFID-funded development project “Working to Improve Nutrition in Northern Nigeria” (WINNN). This output aims to deliver, in the five WINNN supported northern states, effective treatment for severe acute malnutrition through local health systems. WINNN is implemented by UNICEF, Action Against Hunger (ACF) and Save the Children International (SCI), in partnership with the five state governments. SCI is responsible for its implementation in Zamfara, Kebbi and Katsina states, and ACF is responsible for its implementation in Jigawa and Yobe states. The CMAM services include: (1) Community outreach, for the early identification and referral of severe acute malnutrition (SAM) and later follow-up; (2) Outpatient care for children with SAM without medical complications at health facilities and at home (Outpatient Therapeutic Programme, OTP); (3) Inpatient care for children with SAM, and medical complications or no appetite (Inpatient Therapeutic Programme, ITP)

Variations in the cost of formal and informal health care for patients with advanced chronic disease and refractory breathlessness: A cross-sectional secondary analysis

Background: Refractory breathlessness in advanced chronic disease leads to high levels of disability, anxiety and social isolation. These result in high health-resource use, although this is not quantified. Aims: To measure the cost of care for patients with advanced disease and refractory breathlessness and to identify factors associated with high costs. Design: A cross-sectional secondary analysis of data from a randomised controlled trial. Setting/participants: Patients with advanced chronic disease and refractory breathlessness recruited from three National Health Service hospitals and via general practitioners in South London. Results: Of 105 patients recruited, the mean cost of formal care was 3253 pound (standard deviation 3652) pound for 3 months. The largest contributions to formal-care cost were hospital admissions (>60%), and palliative care contributed 250% to 1,507 pound (standard deviation 9911) pound. Increased patient disability resulting from breathlessness was associated with high cost (629 pound per unit increase in disability score;p = 0.006). Increased breathlessness on exertion and the presence of an informal carer were also significantly associated with high cost. Patients with chronic obstructive pulmonary disease tended to have higher healthcare costs than other patients. Conclusion: Informal carers contribute significantly to the care of patients with advanced disease and refractory breathlessness. Disability resulting from breathlessness is an important clinical cost driver. It is important for policy makers to support and acknowledge the contributions of informal carers. Further research is required to assess the clinical- and cost-effectiveness of palliative care interventions in reducing disability resulting from breathlessness in this patient group

How to strengthen an Infant and Young Child Feeding programme in Northern Nigeria

This four-page research summary brief highlights findings and recommendations from operations research into how to strengthen the implementation of an Infant and Young Child Feeding (IYCF) programme and to motivate behaviour change to improve IYCF practices in northern Nigeria. The research found that the IYCF programme was viewed positively by a range of beneficiaries and stakeholders, including family members, traditional birth attendants, IYCF programme community volunteers, health workers and state government officials, because of the perceived visibility of the health benefits, including less episodes of diarrhoea, and consequent savings on health care. Recommendations for the IYCF programme include review strategies for CV training and strengthen supportive supervision, especially in relation to counselling techniques and facilitation of support groups; reinforce and strengthen the use of examples of real healthy children who have been exclusively breastfed to enhance the acceptability of the messages and adoption of the behaviour change; and adopt multiple behaviour change techniques, including food demonstrations and professionally developed mass media

How to strengthen a Community-Based Management of Acute Malnutrition programme in northern Nigeria

This summary highlights findings and recommendations from operation research on a Community-Based Management of Acute Malnutrition (CMAM) programme in northern Nigeria. The study analysed the perceived benefits of CMAM; reasons for beneficiaries not defaulting from the programme; challenges of accessing CMAM services; the workloads and motivation of health workers and community volunteers; and what is required to integrate CMAM into the primary health system.UK Ai