Community-Based Primary Health Care in Action in Rural Nicaragua Scott L B erg er MD/MPH Class of 2017, Department of Public Health Sciences, University of Miami Miller School of Medicine Dr. L aura Paraj on, A lex is Sieg el, and Desiree Sanabria, A MO S Health & Hope, Manag ua, N icarag ua
Introduction AMOS Health &
Hope
Non-government organization (NGO) that partners with 27 rural communities— as of J une 2014— to improve health outcomes through the model of community-based primary health care (CBPHC).
Results
Obj ectives (continued) Naw aw acito Water Supervision
Naw aw acito 1. Assess overall health outcomes (diarrhea, disease, q uality of life) in families with SAM-III Water Filter 2. Identify areas for q uality improvement in filter maintenance
L imited use of their own vegetables and cheeses; not eating at tables; many children drink coffee Two pregnant mothers were encouraged by other mothers using evidence-based information to plan for a delivery at MINSA
Where?
Methods AMOS is located in Managua, Nicaragua
Banco de Siq uia and Nawawacito are both located in the southeastern autonomous state of Regió n Autonó mica Atlá ntica Sur (RAAS)
Health Promoters
Height, weight, and hemoglobin levels
Shares current practices and evidence with AMOS so that they can do ongoing evaluations and research so that appropriate evidence-based practices can be shared with and benefit their community and others
Banco de Siq uia Malnutrition & Anemia
Knowledge, Assessment, and Practice (KAP) interviews with mothers Women’ s Focus groups Water Filter Interview & Surveys
Recipient maintenance, spout maintenance, filter covers, and hand washing are areas for q uality improvement
Evaluation of filter water q uality, recipient water q uality, filter maintenance techniq ue, and rate of water filtration
Insights Gained
Activities Health Fair
Community Doulas
SAM-III Filters
Community Empow erment— focus groups, photovoice, and community health worker programs— helped get men, women, and children involved in improving community health. Three-Way Partnership— NGOs, community members, and MINSA worked together to implement a strategy for maternal and child health
Obj ectives Banco de Siq uia: 1. Evaluate current prevalence of anemia and malnutrition in children under 5 2. Identify observations of factors that may contribute to anemia and malnutrition in children 3. Identify observations made by the community as future intervention targets
Water sanitation; trash disposal; and eating habits identified by Photovoice as areas community members want to address L ower rates of diarrhea, improved taste, and improved q uality of life unanimously reported with the SAM-III water filter
Photovoice with men, women, and children
Trained by AMOS as a first responder, liaison for the Ministry of Health (MINSA), and leader for implementing evidence-based practices introduced by AMOS
24% iron deficiency anemia. 23.5% malnutrition by weight, 18% malnutrition by height
SAM-III Water— lower rates of contamination, lower rates of diarrhea, and improved self-reported q uality of life Focus Group & Crafts
Photovoice
Water Filter Surveys
Ack now ledgements Thank you to my field team— L orente L ester, Guillermo, Carlos, Sarah Williams, J ared Stoneman, Summer Preg, Madeline Plaster, and Harris Short— and to my fellow Global Health Interns. This field experience was supported with funds from the Global Health Scholar Award