Maternal & Child Health:

Healthy Families Initiative

Eprise Armstrong, Dessa Shuckerow & Audra Tafoya

July 21, 2011

Overview

The Healthy Family Initiative (HFI) is designed

to lower the prevalence of maternal nutrition-

related anaemia through social marketing

and the early introduction of a maternal

micronutrient supplement (MMS).

Overview

Background

Intervention

Implementation

Evaluation

Background

Tamil Nadu Statewide

- 53% maternal anaemia1

ICTPH Catchment Area

- 59.3% of pregnant women were anaemic2

- 50.3% of non-pregnant women were

anaemic3

Maternal Anaemia

Sources: NHFS-3, NHFS-2, ICTPH Epidemiological Baseline Survey

Burden of Disease

Anaemia costs an estimated 6% of

India’s GDP4

$320 in GDP/capita5

153 million deaths world-wide6

16.152 million Daily Adjusted Life Years

(DALYs) worldwide7

Main Determinants

Health System

- Diagnostics

- Education

Population

- Lack of access to Vitamin B/Iron rich foods

Household

- Worm infestations

- Diet

Intervention

Intervention Strategies

Preparation

Education & Training

Procurement & Distribution

Diagnostics

Strategy 1: Preparation

Formative Research

- Knowledge, Attitudes, and Practices (KAPS)

- Acceptability of UN Multiple Micronutrient

International Preparation (UNIMAP)

- Development of education & marketing

materials

Strategy 2: Education & Training

Educate SVGs/CHWs

- Anaemia

- Early Pregnancy Detection

- UNIMAP/MMS

- Incentives Program

- Diagnostics

Educate women & families in their homes

Strategy 3: Procurement &

Distribution

RMHC (by nurses/staff)

- Diagnostics

- Photo calendar making equipment

- UNIMAP/MMS

- Container/Scoop

Household (by SVGs/CHWs)

- Pregnancy tests

- Educational materials

- Photo calendar

Strategy 4: Diagnostics

Early detection of pregnancy with in-home

pregnancy tests

Peripheral Blood Smears to identify specific

micronutrient deficiency

Antenatal diagnostics in 1st trimester

Woman is educated and given a copy of her

diagnostics to take to PHC

Prospective Cohort Evaluation

Phase I: includes intervention strategies occurring prior to

a woman giving birth

Phase II: includes follow up for the purposes of continued

education, training, and evaluation.

Primary Impact Objective

Lower prevalence of maternal nutrition

related anaemia by end of 2nd trimester

of pregnancy

- Measure: HGL and Peripheral Blood Smear

Test

Secondary Client Outcomes and

Indicators

Outcomes Indicators

Infant birthweight Weight at birth (self-

report)

Maternal weight gain Weight at monthly check-

ups

Infant malnutrition Height, weight, arm-

circumference

Preterm delivery Earlier than-expected

delivery

Infant anaemia HGL Levels

Process Objectives

Improved KAPs regarding early

pregnancy detection and MMS

More complete antenatal diagnostics

More complete picture of anaemia

prevalence and causes

Acknowledgements

ICTPH Staff

Vani Priya, Sangeetha Lakshmanan,

Subhalakshmi Ganguly, Deepak Rajanna,

Sabyasachi Das, Selva Swetha, and Dr. Zeena

Johar

SVGs and RMHC Staff

Residents of Karambayam

Contact Information

Eprise Armstrong, MSW

earmstrong@wustl.edu

Dessa Shuckerow, MPH/MSW

shucked@wustl.edu

Audra Tafoya, MPH

audratafoya@wustl.edu

Washington University in Saint Louis

George Warren Brown School of Social Work

One Brookings Drive - Saint Louis, MO 63130

References

1. National Family Health Survey 2005-2006 (NHFS-3: Tamil Nadu State Report). (2008). Mumbai:

International Institute for Population Sciences (IIPS) and Macro International.

2. ICTPH Epidemiological and Needs Assessment Census Survey in three villages of Rural Tamil Nadu.

(2010-2011).

3. Ibid.

4. Horton, S. (2003). The Economics of Iron Deficiency. Food Policy, 28(1), 51-75. doi: 10.1016/s0306-

9192(02)00070-2

5. Ibid.

6. The World Health Organization. (2004). WHO Annex A: Death and DALYs 2004. Annex Tables. Accessed

on 6/15/2011:

http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_AnnexA.pdf

7. Ibid.

Thank you