After taking this class and traveling to Guatemala to work with community health workers, I realize how important and influential community mobilization is toward a necessary change.  I found a really great guide published by USAID that details how communities can be mobilized specifically toward improved maternal and newborn health.  It details the problems that mothers and unborn children face at birth, all of which we’ve outlined throughout the semester (i.e.-the three delays).  It talks about common complications, potential illnesses, and their appropriate interventions.  Yet it also highlights the importance of including the community as drivers for change and the ways in which this can be accomplished.  The document explains this necessity:

“Any approach to improve essential maternal and newborn care services must address the issues of the community and the health system together, systematically, and in close collaboration among all stakeholders if it is to be successful.”

It includes the use of the “Community Action Cycle” as pictured above.  This involves different phases such as organization of community stake-holders, planning outcomes and interventions, and preparing to mobilize.  However, the cycle doesn’t start or end at a designated point because all communities operate differently.  The important part of community mobilization is identifying appropriate stakeholders (mothers, health workers, community leaders, government leaders, etc) and having them establish strategies for issues that the entire community is affected by.  Finally, in order for change to be sustainable, mobilization has to continue and consistently be reinforced within the community.  I think this is a great tool to use for individuals or groups who are considering using this method whether it be for infant and maternal health or for any other public health issue.

USAID & ACCESS.  (2009).  How to Mobilize Communities for Improved Maternal and Newborn Health. Retrieved from http://www.accesstohealth.org/toolres/pdfs/access_cmmnh.pdf

After searching through topics that we’ve reviewed in this class this semester, I found a couple of articles about infant mental health, which piqued my interest because it hadn’t been covered so much in class.  Human health does not only comprise of physical health but consists of elements that lend to mental and spiritual health as well.  Unfortunately, there are many circumstances where infant mental health is at jeopardy, such as in the presence of child abuse, violence, attachment problems, depression, and anxiety. So what is currently being done for these infants?  What are the current interventions and health promotions being enacted for infant mental health?

What is infant mental health?  According to The Center on the Social and Emotional Foundations for Early Learning at Vanderbuilt University, infant mental health is the social and emotional development of a child from birth to 3 years of age.

How do we measure infant mental health?  In addition to developmental milestones related to speech, recognition, and social cues, infant mental health is also measured by the infant’s ability to experience, regulate, and express emotions.

What influences infant mental health?  These include the availability of close, secure, and interpersonal relationships with caregivers and family members.  Culture is a huge factor as well, contributing to parenting style and childrearing practices.  What is also considered is the infant’s “inborn” capacity to explore his or her own environment and participate in sensory-filled activities?

What interventions are available to help ensure positive infant mental health?  Prevention via early childhood care, focused intervention for families experiencing domestic issues, crises, etc., and intensive intervention which includes family support, therapy groups, and coping and stress management workshops.

I feel infant mental health is often not given the attention it deserves.  The social relationships and coping behaviors that shape an individual begin at a very early age. What are your thoughts on the importance of mental health in infants?  Should it be given more attention?  How do you think parenting affects attachment styles and how does that affect current and future mental health in children?

http://csefel.vanderbilt.edu/documents/rs_infant_mental_health.pdf

During my presentation about infant morbidity and mortality, I just barely touched on infants and children that suffer from diarrhea and malnutrition.  These are two of the most serious afflictions faced by young children, especially in low-resource settings.  This particular article looks at the feeding practices of children with diarrhea in a semi-urban setting in Lima, Peru (I chose to look at Peru because my family is Peruvian).  In 2010, 4% of deaths among children younger than 5 years occurred because of diarrhea.  In addition, chronic malnutrition is prevalent (roughly about 32% in rural areas and 11% in urban areas).  Although such illnesses, when recognized, are easily resolved with home interventions such as increased breastfeeding, oral rehydration, and increasing the intake of foods (especially with high water content), the feeding practices in Lima are not coherent with these practices.  In fact, in this article, a survey revealed that of 390 caregivers, 71.9% discontinued or lessened normal feeding (40% of those withheld vegetables and fruits), and 22.1% believed feeding to children during episodes of diarrhea was harmful.  Yet, after an educational intervention (which included pamphlets with advice for breastfeeding throughout diarrheal episodes, signs and symptoms of dehydration, and improved feeding measures), only 23% of caregivers would recommend withholding feeding during diarrhea.  The second follow-up survey was taken 3 months after the intervention.

It would be beneficial to continue follow up of these caregivers to see if they continue to follow these guidelines.  Also, there could be implementation of community awareness, with some sort of community educator program to further educate all caregivers in Lima.  No child should die from something as treatable as diarrhea.

Pantenburg, B., Ochoa, T.J., Ecker, L., & Ruiz, J.  (2014).  Feeding of Young Children during Diarrhea: Caregivers’ Intended Practices and Perceptions.  Am. J. Trop. Med. Hyg, 91(3): 555-562.  doi: 10.4269/atjmh.13-0235

I came across an article in The New York Times yesterday about Britain’s national health service encouraging women with low-risk pregnancies to have their birth experiences at home-that it was actually safer to do so than in a hospital or birthing center!  This echoes our discussion earlier this semester about the politics around birth location and the small, but active movement of home births in nations that are so accustomed to traditional hospital births.  This article claims that “giving birth in a traditional maternity ward increase(s) the chances of surgical intervention and therefore infection.”  Although we have already discussed the benefits and risks of having a home birth, the article is notable because it is comes from a national source and not a minority voice.  This could have tremendous impact on the way women in Britain think about their deliveries, where normally 9/10 women give births in hospitals.  Still, there are opponents to the recommendations, citing a trend that could be misinterpreted by women who are not low-risk.

What are your thoughts about this?  Do you think it’s ethical of an announcement as influential as the national health service (albeit of Britain, not the U.S.) to be broadcasted?  How do we establish a balance between preventing unnecessary hospital interventions and having as safe a birth as possible at home?

Hey class, I wanted to add on to my presentation by giving you a little insight about what countries like Nepal, Nigeria, and Madagascar feel about the chlorhexidine program to combat neonatal infections.  This intervention is simple, cheap, and growing in accessibility in developing countries with high neonatal death rates.  Below are a couple of links to videos that help illustrate this.  The first link is a video about Nigerian health workers who travel to Nepal to learn about the chlorhexidine program, its utilization, and ways in which to implement community health workers to spearhead the program.  The second link is a panel of government and community health workers from Nepal, Nigeria, and the United States who talk about product feasibility and effectiveness, ways to promote political support (which we know from our class is highly beneficial for greater recognition of a health issue), and new methods to facilitate cultural compliance to the product.

https://www.youtube.com/watch?v=iIsDqXhDvpo

https://www.youtube.com/watch?v=I-tuRmSKj0M