A Three-Day training guide for a medical community in Paktika Afghanistan

1. A Three-Day training guide for a medical community in Paktika Afghanistan Management and Treatment of Childhood Malnutrition Kristy Boan MPH Capstone Project May 2012

2. Outline • Background • Description of Trainees • Diagnosis of Training Needs • Training Objectives • Evaluation Plan • Summary/Conclusion

3. Afghanistan provincial map

4. Background Setting • High under-five mortality rates • Worse in southern region of country • Ministry oversees health delivery • Provincial Health Directors • Essential Package of Hospital Services • Basic Package of Health Service • Financial donors (World Bank, EC, USAID)

5. Description of Trainees • Physicians at Sharana Hospital • Nursing Staff • Provincial Health Director

6. Diagnosis of Training Needs • Training Committee • Assess medical knowledge about malnutrition and treatment • Review and observe protocol followed for malnutrition cases • Pose questions and interview staff to assess commitment level • Document malnutrition cases reported by district • Summary • Physicians informed about malnutrition • Nurses lack basic fundamentals • Zinc supplementation knowledge lacking • No records system • No continuing education • Staff committed

7. Training objectivesday one • Objective 1: By the end of training, healthcare workers will recognize signs and symptoms of childhood malnutrition • Objective 2: By the end of training, healthcare workers will identify treatment of diarrhea in the malnourished child. • Objective 3: By the end of training the Healthcare worker will describe the conditions in which a child should return for a well child examination • Objective 4: By the end of training the healthcare worker will conduct a physical examination on a malnourished child using WHO guidelines.

8. Training objectivesday two • Objective 5: By the end of training the healthcare worker will discuss the child mortality results from the Afghan Mortality Survey 2010 as it relates their region. • Objective 6: By the end of training the healthcare worker will identify major components of the MOPHs Basic Package of Health Services, and Essential Package of Hospital Services. • Objective 7. By the end of training the healthcare workers will identify the major components of MOPH balanced scorecard related to maternal/child health. • Objective 8: By the end of training, healthcare workers will demonstrate how to make Strong Foods nutritional supplement

9. Training objectivesday three • Objective 9: By the end of training the healthcare workers will discuss healthcare data collection methods. • Objective 10: By the end of training the healthcare worker will identify a need for integrating programs to improve child health. • Objective 11: By the end of training the healthcare worker will discuss the importance of community empowerment • Objective 12: One month from the conclusion of training, the Provincial Health Director will report key findings of malnutrition program to Ministry of Health.

10. Evaluation plan • DAY One • Pre-test (pen/paper) • Lectures, demonstration (ORS), hands on physical examination, lecture

11. Evaluation plan • DAY Two • Two parts • MOPH vision, strategy • Making food supplement • DAY Three • Lecture, practical exercise, post-test

12. Summary/conclusion

13. Questions?

14. References • http://www.cdc.gov/nchs/surveys.htm • Poureslami IM, MacLean DR, Spiegel J, Yassi A., Sociocultural, environmental, and health challenges facing women and children living near the borders between Afghanistan, Iran and Pakistan (AIP region). MedGenMed.2004 Sep 20;6(3):51. • Mashal T, Takano T, Nakamura K, Kizuki M, Hemat S, Watanabe M, Senio K, Factors associated with the health and nutritional status of children under 5 years in Afghanistan: family behavior related to women and past experience of war-related hardships. BMC Public Health 2008 Aug 29; 8:301. • Ahmad, K. Warlords and bandits slow Afghanistan's efforts to rebuild. Attacks drive relief workers from some areas. • Lancet. 2003 Aug 30; 362(9385): 710-1. • Johnson, T, Mason, C. Understanding the Taliban and Insurgency in Afghanistan. Orbis. 2007 Nov. vol 51:1: 71-89. • http://www.who.int/childgrowth/standards/en/, WHO Child growth standards • Afghan Public Health Institute, MOPH (APHI/MoPH) {Afghanistan], Central Statistics Organization (CSO) [Afghanistan], ICF Macro, Indian Institute of Health Management Research, and World Health Organization Regional Office for the Eastern Mediterranean (WHO/EMRO) [Eygpt]. 2011 Afghanistan Mortality Survey 2010. Calverton, Maryland, USA: APHI/MoPH, CSO, ICF Macro, IIHMR and WHO/EMRO. • Islamic Republic of Afghanistan Ministry of Public Health, A Basic Package of Health Service for Afghanistan, 2005/1384. • Islamic Republic of Afghanistan Ministry of Public Health, A Essential Package of Hospital Services for Afghanistan, 2005/1384 • Department of Child and Adolescent Helath and Development, World Health Organization, “Reduced osmolarity oral rehydration salts (ORS) formulation- Report from a meeting of experts jointly organized by UNICEF and WHO (WHO/FCH/CAH/01.22), New York, 18 July 2001. • The Treatment of Diarrhoea- A Manual for physicians and other senior health workers, WHO/CAH/03.7, World Health Organization, Geneva.