ChildCount.org

Now that we have the ability to record the key health interventions in a child’s health history, we’ve begun to think how we can convey this visually. Ideally, we want a method that will allow us to quickly evaluate the status of a child’s health taking in consideration health events in the past. We hope that this will also serve as a useful tool in discussing with with CHWs cases that go wrong or right.

Here is our first attempt. The line plot on the graph is based on the child’s mid-upper arm circumference (MUAC) which provides an indicator of the child’s nutritional status and is a good proxy for a child’s overall well being. The MUAC is plotted over periods of time (P) which is intersected by health events in the child’s life. We represent each intervention: nutrition screen, CMAM treatment or malaria/diarrhea diagnosis and treatment with a line. If the intervention is performed properly ie) a malaria diagnosis and treatment with 48 hour followup – the intervention line is solid. When a followup or screening is missed a dotted line is used.

For this example, we assume that for each period P a child should receive a routine nutrition screening where a MUAC is taken. In this example the child misses his screening at P2 but receives one at P3. Between P3 and P4 the child is diagnosed with diarrhea but for some reason does not receive the proper treatment (Zinc + ORS) or perhaps misses the required 48 hour checkup. At P5, the child has a MUAC of 108 which means he has secure acute malnutrition and needs to go on plumpynut therapy. In this case, the child receives treatment through period P8 until his health rebounds. He gets malaria somewhere between P8-P9 but is properly treated and child’s nutrition status returns to a normal level.

In this chart, the history is exactly the same for the child through P7. In this case, the child misses a key nutrition screening at P8 and is not properly treated for malnutrition at P9 when is MUAC is updated. Weakened after just having recovered from malaria, the child dies, unfortunately, before P10.

[...]

Continue Reading

Child Mortality

The World Bank just made open their database of 2,000+ development indicators at data.worldbank.org.  The site, done by our talented friends at DevelopmentSeed, does a powerful job of exposing with data how important the work to improve child and maternal health is.

Continue Reading

The Lancet estimates that 200 million children under-five in developing countries do not reach their cognitive, physical and social potential due to a number of biological, environmental and social risk factors that they are exposed to during the critical early stages of their development. For example, stunting, a direct result of chronic malnutrition and infection, is directly linked to poor cognitive and educational performance. It has been shown that for every 10% increase in stunting, the proportion of children reaching the final year of primary school drops by 7.9%. Correspondingly, with every 10% increase in the prevalence of poverty there is a 6.4% decrease of children entering their final year in school.

Children are also exposed to a number of psychosocial risks including under-stimulation, maternal depression, exposure to violence and environmental contamination (unsafe drinking water, smoke inhalation and heavy metal exposure), and lack of access to education. Such risks are often linked to extreme poverty and are exacerbated by high fertility rates.

On Tuesday, we had the pleasure to present ChildCount+ to a group of the world’s leading researchers on early childhood development (ECD) research conference hosted at by UNICEF. It was terrific to learn about the current research in this emerging field. While great strides have been made in recent years, the participants also identified critical knowledge gaps where there is still so little known.

ChildCount+ focuses primarily on child and maternal survival and addresses some of the core health risks like malnutrition, malaria and preventable diseases that affect early childhood development. We were, however, able to use our time at the retreat to identify some potential ways ChildCount+ could be adapted to more directly support ECD.

Health and ECD Messaging

One of the most important techniques available to promote ECD is simply raising awareness to parents, health workers and teachers on best practices for basic sanitation, nutrition, health and cognitive stimulation. In addition, it is helpful to provide parents and primary caregivers with pragmatic advice on how to look for the key physical and cognitive stages of development in their children.

One phenomenal resource for this is the Facts for Life program by UNICEF.   Besides providing key lessons on breastfeeding, nutrition and growth, immunization, malaria, HIV/Aids, injury and prevention, disasters and emergencies, it also has an important section on child development and early learning. Included in this section are child development milestones that provide a parent with clear guidance on what a child should be able to do by specified ages (1 month, 6 months, 12 months, etc); it also provides concrete examples on how to stimulate the child and provides warning signs for the parents to watch for.

Source: Facts for Life

Since the hard work of developing proven content is complete, ChildCount+ could be used to send Facts for Life messages by SMS directly to CHWs and the parents of children registered in the system. This could be a means of providing effective, and potentially fun, supplementary and continuous education on ECD best practices (to foster better parenting).

School Safety Net

Working with our education team, we have also looked at how ChildCount+ could be used to create a School Health Safety Net program. Since ChildCount+ creates a living registry of all the children in a community (complete with their ages) it should be possible to provide schools with a list of all the community’s school age children at the beginning of each school year. The schools could then use ChildCount+ to ensure that all children (especially girls) are enrolled for at least their first two years of school – the critical period where most drop-outs occur.

In addition, the School Health Safety net would strengthen the link between community health care workers and teachers — important secondary caregivers to all children. Through a simple report, a teacher would be able to notify a CHW when a child has been absent from school for an extended period of time, if they become sick or injured or if the teachers suspects maltreatment (abuse, malnutrition, sanitation) problems at the home. Similarly, a teacher could be notified by the CHW when a child is found sick at home.

Cash Transfers or Mobile Based Incentives

While the value of cash transfers in ECD is still hotly debated, mobile platforms like ChildCount+ could be used to facilitate the transfer of money or vouchers to primary caregivers of children. SMS based news feeds of crop pricing, soccer scores, etc. could be used as a non-monetary incentive to reward caregivers (especially fathers) for good parenting.

Notes

• The full version of the Facts for Life book (4th Edition) can be downloaded here.
• Download  the ChildCount+ presentation at the UNICEF ECD Conference
• Congrats to William Salîm Gaudin (son of Renaud — one of the lead ChildCount+ developers) who turns one today!

Continue Reading

We are seeking an experienced software engineer to join our New York based team to play a key role in the development of mHealth systems including our ChildCount+ platform.   In particular, we are looking for someone with an excellent design sense and demonstrated expertise developing web-based user interfaces.   Strong Python skills are also highly preferred.

• This is initially a six-month, full-time consulting position.
• The position is based at Columbia University in New York City with the potential (not guaranteed) of travel to help with the implementation of programs in the field.
• While you are NYC based you will be expected to work closely with our programming team spread out across East and West Africa.
• Software development will be done primarily in Python using RapidSMS which is based on Django.  The position may also require developing integration components for OpenMRS.
• We are looking for someone who is passionate about making a difference with code and we are proud to be an FOSS shop.
• We are looking to hire immediately.

A full job description follows.  If you are interested in applying for this position, please send your CV and cover letter to mberg at ei.columbia.edu.

[...]

Continue Reading

In a recent article in the Scientific American entitled, “Expert Systems Fight Poverty“, Jeffrey Sachs, Director of the Earth Institute, wrote about how appropriate information communication technology paired with community involvement can save lives.  In the article, Sachs mentions how mobile phones are being used in Ghana to coordinate teams of ambulance drivers, midwifes and CHWs to refer emergency pregnancies and save lives.   He then goes on to talk about how ChildCount+ along with rapid diagnostic tests (RDTs) are being used in Kenya to improve home based treatment of Malaria by CHWs.

In the Kenyan village of Sauri, also part of the Millennium Village Project, CHWs are pioneering the application of expert systems for malaria control. In the past, suspected malaria patients had to walk or be carried to a clinic, often miles away, have a blood smear read under a microscope by a trained technician and, if positive, receive a prescription. With clinics few and far between and with trained technicians and microscopes even scarcer, untreated, lethal malaria ran rampant.

In the new approach, CHWs visit households on the lookout for fevers that may signify malaria. They carry rapid diagnostic tests that examine a drop of blood for the presence of the malaria pathogen. Then they send an SMS (short service message) text with the patient’s ID and the test results. Seconds later an automated text response informs the health worker of the proper course of treatment, if any. The system can also send reminders about any follow-up treatments or scheduled clinic visits for the patient. The new system of malaria control includes insecticide-treated bed nets made to last for five years and a new generation of combination drugs based on a traditional Chinese herbal treatment, artemisinin.

This full set of tools constitutes a remarkably effective malaria-control system. Already a partial deployment of the system is reducing the malaria burden dramatically in several parts of Africa. Modest international financial support could greatly accelerate the deployment of the full system, and if it were scaled up throughout Africa, hundreds of thousands of lives could be saved annually at around $7 per person a year in the malaria-transmission zones.

Continue Reading

By Jessica Fanzo
Nutrition Director, Earth Institute

Severe acute malnutrition (SAM) affects 20 million children under five years of age each year and contributes to 1 million child deaths per year. Moderate acute malnutrition contributes more to the overall burden of disease, as it affects many more children. As a nutritionist, these statistics are devastating, and largely go unrecognized by many working in global health. Why is this? Often, children who are malnourished suffer from complications of other diseases and nutrition is often an orphan – misunderstood in diagnosis and treatment. Nutrition is often seen as “complicated.” It is not totally untrue – in the past, treating malnutrition has been cumbersome, requiring hospital services and complex medical treatment. However, in the last few years the game has changed.

An innovative community-led public health model to address acute malnutrition in developing countries has been established called Community-Based Management of Acute Malnutrition (CMAM). The community-based approach engages the community to detect signs of SAM early by sensitizing communities and subsequent active case finding, and provides treatment for those without medical complications with ready-to-use therapeutic foods (RUTF) or other nutrient-dense foods at home. If properly combined with clinical care for those malnourished children with medical complications and implemented on a large scale, community-based management of severe acute malnutrition could prevent the deaths of hundreds of thousands of children. The CMAM combines three treatment modalities, inpatient therapeutic (IP), outpatient therapeutic (OTP) and supplementary feeding (SFP) according to the clinical and anthropometric characteristics at presentation. CMAM can maximize treatment by improving coverage, access, and cost-effectiveness of treatment.

[...]

Continue Reading

The following is from a posting by Dr. Prabhjot Singh Dhadialla, our CHW team leader, on the ICT4CHW mailing list, an excellent discussion, started by Neal Lesh and others, on using technology to enable CHW programs.

CHW Programs within MVP

I’m currently the Community Health Worker and Health System advisor to the MVP. In this post I’ll give some background about the Millennium Villages Project, the Health component/CHW program and then a bit about our approach to technology usage. It may seem like a long preamble to getting to the ICT, but I’ll say something about why I’ve done this at the end. In addition, I’ll speak about ongoing scale-up work:

The Millennium Villages Project

The MVP was designed to consolidate the world’s current implementation knowledge about achieving the Millennium Development Goals and put them into action throughout challenging terrains in Sub-Saharan Africa. Located in 10 countries at 14 sites, the first wave of Millennium Villages are clusters of about 40 to 80 thousand people — ~450,000 in total. The clusters were identified through a process that requires a national government to request MV presence in the country [1]. This triggers a process of identifying areas of high need and then working with the districts to find candidate communities where there was enthusiasm for the process.

[...]

Continue Reading

We’re thrilled to announce our new ChildCount+ logo which reflects the addition of maternal health (hence the plus) to the ChildCount+ system.

The logo was generously designed for us by Arthur Dagard of MonAmour* Studio, an independently owned, cross-design agency in Paris.

Arthur has long been supportive of the work of members of our team including the design of the Kunnafoni Foundation logo in Mali and MoulinWiki, an off-line Wikipedia project, we launched at Geekcorps Mali over 4 years ago.

Arthur a sincere thanks from the entire ChildCount+ team.  Thank you very much for the continued support of our work. Once we get t-shirts made, we’ll be sure to send some your way!

Continue Reading

ChildCount+ Dev Team at work in Uganda

We are looking to hire a skilled programmer (ICT Solutions Expert) to help lead the development and implementation of our ChildCount+ program in Ghana.  While Python experience is preferred, we are looking most for someone with a demonstrated passion for making things with code and who is willing and eager to learn.  The programmer will join a growing team of developers spread across East and West Africa.

While primarily a programming position, the ICT Specialist will be expected to help support the design, development and deployment of other ICT interventions at the Millennium Villages Site in Ghana.

If interested please email me directly at mberg at ei.columbia.edu

Please click continue reading to view full job posting.

[...]

Continue Reading

Credit: James Hill for the New York Times

From March 9th, 2010 New York Times article by Jeffrey Gettleman: “Shower of Aid Brings Flood of Progress“.

His (Jeffrey Sachs) intent was to show that tightly focused, technology-based and relatively straightforward programs on a number of fronts simultaneously — health care, education, job training — could rapidly lift people out of poverty.

In Sauri, at least, it seems to be working. Some of the goals were literally low-hanging fruit, like teaching banana farmers to rotate their crops. Other programs were more sophisticated, like the battle against malaria, which employs cutting-edge mobile technology against a disease that kills more than one million children each year.

The other day, a community health team in Sauri stooped through the doorway of a home of several sick children, said hello to Grandma and got to work. Within minutes, a health worker had pricked a child, sent a text message with the blood results by cellphone to a computer server overseen by a man named Dixon in a town about an hour away and gotten back these instructions: “Child 81665 OKOTH Patrick m/16m has MALARIA. Please provide 1 tab of Coartem (Act) twice a day for three days.”

These small miracles are happening every day now in Sauri, population 65,000.

Continue Reading