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Evidence suggests that community-based nutrition programs can have a positive impact on health outcomes allergy treatment hospital generic claritin 10 mg. In the program allergy medicine for kids under 6 buy claritin 10mg, monthly community sessions are held to monitor and promote the growth of children ages two years and younger (Getachew 2011; World Bank 2012) allergy testing environmental cheap claritin 10 mg. The program empowers communities to assess the nutritional status of their children and take action allergy forecast el paso tx best claritin 10 mg, using their own resources, to prevent malnutrition. Monthly tracking of all children in the community enables the timely identification of severely underweight children and their referral for further examination and treatment. The government of Ethiopia introduced this initiative in 2008 in drought-prone and foodinsecure districts. The study also finds that the program positively influenced infant and young child feeding, including greater adherence to exclusive breastfeeding for babies younger than age six months, complementary feeding between ages 6 and 23 months, and dietary diversity for older children, thereby reducing morbidity and mortality related to malnutrition (Getachew 2011; World Bank 2012). A systemic review of community-based interventions to improve child nutrition status suggests that nutrition education in both food-secure and foodinsecure populations is associated with an increase in height-for-age Z scores of 0. The review also suggests that simple interventions, such as individual counseling and group counseling, increase the odds of exclusive breastfeeding practices (Bhutta and others 2013; Lassi and others 2013). A decrease in neonatal morbidity through benefits of domiciliary practices, such as early initiation of breastfeeding and health-seeking behaviors, was also observed (risk ratio 1. A total of 35 centers were developed; only 20 were functioning as nutrition centers. Entry and exit criteria for rehabilitation were ill defined, resulting in some nonmalnourished children being enrolled. Few staff were adequately trained; knowledge was weak, especially about case management; and mothers were not effectively instructed. The program improved knowledge by about 10­20 percentage points beyond that seen in nonproject areas regarding exclusive breastfeeding. The program began in 168 villages in the Iringa Region of Tanzania, covering an estimated population of 46,000 children under age five years. Also aims to enhance the capability of the mother to look after the normal health, nutritional, and developmental needs of the child through proper community education. A World Bank evaluation in 1999 suggested that the program had no significant impact on nutritional outcomes. Sources: Balachander 1993; do Monte and others 1998; Gupta, Gupta, and Baridalyne 2013; World Bank 2005; Yambi and Mlolwa 1992. Six randomized controlled trials that built community support and advocacy groups for mobilization on issues related to maternal, neonatal, and child health were analyzed. A study from Ethiopia showed promising results when a group of women from the community were empowered and mobilized to recognize and treat malaria (Rosato and others 2008). This process led to an overall 40 percent reduction in mortality in children under age five years (Kidane and Morrow 2000). Neonatal mortality rates were reduced by 45 percent in the intervention arm (Tripathy and others 2010). The Makwanpur trial was conducted in a rural mountainous community in Nepal, where 94 percent of babies are born at home (Pradhan and New 1997) and only 13 percent of births are attended by trained health workers (Central Bureau of Statistics 2001). With the implementation of facilitated monthly group meetings among pregnant women, a decrease in neonatal mortality was seen in the intervention arm, compared with the control arm, with an odds ratio of 0. Results show that of the 1,421 women in the intervention group who took misoprostol, 100 percent correctly took it after birth. In the intervention area where communitybased distribution of misoprostol was introduced, near-universal uterotonic coverage (92 percent) was achieved, compared with 25 percent coverage in the control areas (Sanghvi and others 2010). Usage is particularly seen more in the South Asia region, with uterotonic usage rates of up to 69 percent (Flandermeyer, Stanton, and Armbruster 2010). In this trial, women receiving oxytocin had a reduced risk of postpartum hemorrhage (risk ratio 0. Investigators should focus on this area of research as a promising approach in low-resource settings. Improving the Quality of Community-Based Care Ensuring that care provided in communities meets quality standards is a key concern, and training and supervision are crucial mechanisms for ensuring quality care.


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In 2011 allergy symptoms 2012 safe claritin 10mg, 18 million (uncertainty interval 14 million to 22 million) stunted children lived in urban South Asia and 15 million (14 million to 16 million) in urban Sub-Saharan Africa allergy testing no insurance quality 10 mg claritin. Other anthropometric indicators allergy index chicago purchase 10mg claritin, such as wasting and severe wasting allergy medicine for toddlers under 2 best 10mg claritin, provide complementary information on acute nutritional situations (box 5. However, interventions such as nutrition education and diarrhea case management can mitigate low height-for-age (Bhutta and others 2008; Bhutta and others 2013). This finding implies that, for the past two and a half decades, the primary Map 5. These population improvements include enhanced health promotion, such as breastfeeding and complementary feeding; improved environmental and sanitary conditions; increased availability and affordability of nutritious foods; and improved income and education levels. Although the relative importance of various population forces is uncertain, several lessons have emerged from the research: · Growth in national income seems to have a positive effect on child nutrition but may be insufficient, perhaps because improving nutritional status requires more equitable income distribution and increased investments in health care and nutrition programs (Anand and Ravallion 1993; Haddad and 90 Reproductive, Maternal, Newborn, and Child Health Figure 5. Number of stunted children in rural areas 200 180 160 140 Millions Millions 120 100 80 60 40 20 0 200 180 160 140 120 100 80 60 40 20 0 b. Number of stunted children in urban areas 03 05 07 97 99 01 09 11 97 99 91 93 95 91 93 95 01 05 85 87 89 85 87 89 03 07 20 20 20 19 19 20 20 20 19 19 19 19 19 19 19 19 20 20 09 20 19 19 19 19 19 19 20 Sub-Saharan Africa South Asia Source: Paciorek and others 2013. Middle East and North Africa Latin America and the Caribbean Europe and Central Asia East Asia and Pacific Box 5. The World Health Assembly endorsed a target goal of reducing and maintaining childhood wasting to less than 5 percent by 2025 (World Health Assembly 2012). According to these estimates, the prevalence of wasting and severe wasting were highest in the World Bank regions (in decreasing order) of South Asia, Sub-Saharan Africa, and the Middle East and North Africa, with estimated regional prevalence of wasting ranging between 15 percent and 7 percent. Of the 102 countries for which data on severe wasting from 2006 to 2012 were available, 51 had at least one survey with a severe wasting prevalence of 2 percent or higher. Of the 110 countries reporting data on wasting in the same period, 64 reported prevalence of wasting greater than 5 percent in at least one survey. The adverse effects on nutrition were greatest in poorer households, especially in rural areas, transmitted through lower household earnings and assets, reduced food subsidies, and reduced health care use (Cooper Weil and others 1990; Pongou, Salomon, and Ezzati 2006). Levels and Trends in Low Height-for-Age 20 20 91 11 In contrast, programs that improve income, nutrition, and health care among the poor generally also improve growth outcomes, especially in children of lower socioeconomic status (Bhutta and others 2013; Fernald, Gertler, and Neufeld 2008; Lagarde, Haines, and Palmer 2007; Rivera and others 2004). These findings indicate that child nutrition is best improved through equitable economic growth, propoor primary care, and nutrition programs that support breastfeeding and appropriate complementary feeding. Conditional cash transfer programs, especially those linked to nutrition education and primary health care, offer the potential to help target and deliver these interventions (Bassett 2008). A second essential component of improvement initiatives is the development and implementation of complementary policies and programs for children in urban settings. An increasing share of undernourished children live in cities; these children are susceptible to economic shocks that affect food prices and may face different barriers to accessing adequate nutrition than rural children. These actions differ from many other health interventions in that the motivation for their use is not necessarily limited to better health and involves cultural and societal norms. Irrespective of these additional considerations, these interventions have important health implications. This chapter describes four areas of intervention: · · · · Family planning Adolescent sexual and reproductive health Unsafe abortion Violence against women. Support for voluntary family planning has been based on several rationales, including the following (Habumuremyi and Zenawi 2012): · Population and development, the so-called demographic rationale · Maternal and child health · Human rights and equity · Environment and sustainable development. Recent evidence Each of these areas involves the delivery of specific health services to prevent or alleviate health risks; each also involves the complex social and cultural issues that affect the widespread implementation and use of the services. The demographic dividend allows countries to take advantage of a beneficial dependency ratio between the working-age population and the groups who need support, that is, children and the elderly (Bloom, Canning, and Sevilla 2003). It is important to have supportive economic policies and labor regulations in place to reap the potential benefits of the demographic dividend; many countries in Sub-Saharan Africa need to coordinate development of their economic and reproductive health policies to fully realize this effect. Maternal and Child Health Rationale the improved health of mothers and children has long been a rationale for the provision of family planning (Seltzer 2002). These reasons ranked higher than fertility reduction, economic development, and reduction of childbearing among unmarried youth. By one estimate, increases in contraceptive use from 1990 to 2008 contributed to 1. Reductions in fertility rates accounted for 53 percent of the decline in maternal deaths; lower maternal mortality rates per birth accounted for 47 percent of the decline (Ross and Blanc 2012). These analyses have confirmed the usefulness of program initiatives to promote healthy timing and spacing of births.

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Eradication through immunization-although costly in the short and medium terms-may be cost saving in the long term by eliminating the need for vaccination; smallpox is the best example allergy testing child generic 10 mg claritin. This delivery schedule also affects rubella because measles and rubella vaccines are typically delivered together allergy labels trusted claritin 10 mg. A systematic review of studies of interventions to affect the demand side of vaccine uptake (Shea allergy symptoms of peanut butter purchase claritin 10 mg, Andersson quinolone allergy symptoms generic claritin 10 mg, and Henry 2009) finds that the literature was of variable quality, with only two randomized controlled trials. Some of the interventions, such as mass media campaigns, do not lend themselves to randomized controlled trials. The review concludes that mass media campaigns might be effective, but their effectiveness depends on the context. Cost-Effectiveness of Interventions for Reproductive, Maternal, Neonatal, and Child Health 325 Incentives to households might help. Other interventions have been tried, such as conditional cash transfers and use of text message reminders, but no results on cost-effectiveness of these methods were found. This finding is driven in part by the high probability, as high as 20 percent, that children will die if not treated. Experience suggests that substituting cheaper ready-to-use therapeutic food for proprietary ones does not lead to outcomes that are quite as good, although it may lower costs. Interventions for Infant and Young Child Growth the majority (14) of the studies of nutrition for the general population focus on micronutrient interventions, 1 on nutrition education, 1 on the effects of scaling up a comprehensive package of nutrition intervention, and 1 on outcomes other than nutrition. Nutrition interventions are associated with impacts on multiple outcomes of importance. Some nutrition interventions reduce morbidity and save lives in the more malnourished populations. In other cases, nutrition is associated with impacts on cognitive improvements, and these benefits are better measured using benefit-cost ratios because benefits can be measured in financial units (higher wages). From the literature search, five studies for folic acid, iron, and iodine interventions all had very favorable benefit-cost ratios (Horton, Alderman, and Rivera 2008; Horton and Ross 2003, 2006; Sayed and others 2008; Sharieff, Horton, and Zlotkin 2006; Sharieff and others 2008). Hoddinott and others (2013) undertake a benefit-cost analysis for a comprehensive set of nutrition interventions. Fortification is more cost-effective than supplementation for micronutrients where deficiencies are widely spread throughout the population and the micronutrient is relatively cheap, for example, iron; the opposite is true for micronutrients that are relatively more expensive, and where the benefits are concentrated particularly in vulnerable groups, for example, vitamin A. However, the biofortification estimates for staple food crops, such as rice, were early stage projections, and it remains to be proven whether these optimistic projections can be realized. There has been more success to date for more minor crops (orange-flesh sweet potato, beans, and vitamin A­rich cassava), although iron-rich rice and wheat seeds are now beginning to be disseminated to farmers (Harvest Plus 2013). Another innovation since 2000 has been the evaluation of packages of nutritional interventions. When interventions are combined, the cost-effectiveness of each individual component tends to become less attractive. Either vitamin A supplements or measles immunization can save lives, but the combined effect of both vitamin A supplements and measles immunization saves fewer lives than the sum of the two individually. Service delivery can be combined on any of the platforms if doing so increases cost-effectiveness. In part, the type of health activity determines the appropriate platform: surgical interventions related to delivery need to be provided at the facility level, whereas immunizations have achieved better coverage in some countries through mobile outreach or community-level delivery. They are also critical for linking beneficiaries to health facilities for preventive care and treatment, when essential. For example, outreach workers, by going to households to provide family planning and maternal and child health services in Bangladesh, played an important role in reducing birth rates; but Routh and Khuda (2000) show that in urban Dhaka, the delivery of family planning and maternal and child health services at clinics now become more cost-effective. However, the delivery of vaccinations by community-based workers cost less and achieved greater coverage than outreach by health workers in communities reached by river in the Amazon (San Sebastian and others 2001). Task-shifting through the use of lay workers sheds some light on the potential cost reductions and improved cost-effectiveness. Sabin and others (2012) find that training traditional birth attendants in treating birth asphyxia, hypothermia, and sepsis was very costeffective in situations in which access to facility care was not readily available; but this intervention would not be effective in addressing obstructed labor and deliveries requiring cesarean section. An emerging area of interest is the integration of services to improve impact and reduce costs. The costeffectiveness of integrating services while maintaining the effectiveness of individual interventions is a high priority research area, given the investments in individual interventions. For some preventive services, there may be trade-offs between cost-effectiveness and coverage.


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