Presented By: Piyasree Mukherjee Efficacy Evaluation of First 1000 Days Program implemented by Foundation for Mother & Child Health, India Piyasree Mukherjee Rupal Dalal, MD Mathew Nudelman MD Sonya Misra MD MPH Presented By: Piyasree Mukherjee

CASE STUDY A ABOUT FMCH Established in India in 2006, working with economically vulnerable communities in Mumbai a large metropolitan city Has reached over 6000 women and children through the First 1000 Days’ Initiative in the last 4 years The FMCH team is built with women from the community we work in. These women are trained by FMCH, and work alongside the social workers, medical professionals, nutritionists and volunteers FMCH locations at Mumbai City February 2014

Over 60% of the population are migrants from various parts of India. CASE STUDY A WHO WE WORK WITH Over 60% of the population are migrants from various parts of India. Average monthly household income USD $75-120, similar to the Indian average Average family size is 5 plus members, including children 22% of our mothers are 21 or younger, the youngest being 15 100% of these women report their husband, mother-in-law or another male relative to be the primary decision maker of the household Living in semi-permanent shanties which are usually rented or illegally built February 2014

‘our mothers face in trying to establish exclusive breastfeeding’ CASE STUDY A CHALLENGES ‘our mothers face in trying to establish exclusive breastfeeding’ No information on breastfeeding: right from positioning to latching to frequency Too many people at home, so there is very limited privacy No control over own nutritional requirements, since family takes the decision of what, when and how much a lactating mother should eat ‘Not enough milk’ as a pressure point since medical practitioners prescribe formula very easily Myths such as inverted nipples means a mother cannot breastfeed, or children need water when it is ‘too hot’ in summer February 2014

FMCH INPUTS Regular anthropometric monitoring Maternal nutrition supplements such as multi-vitamins, calcium, iron, vitamin D-3 and food supplements Breastfeeding assessment tool used for every visit to assess technique and reinforce exclusive breastfeeding practice Intensive education of extended family members (husband, mother, mother-in-law) to ensure support for the mother and her child

SALESFORCE FMCH uses a robust, web-based, electronic monitoring system since 2014 which helps capture accurate data and track progress vis-à-vis the pre-designed program indicators. Need to mention date of implementation and needs assessment prior to buying -

To customize this system to ensure it captures all the data points as required, FMCH partnered with Vera Solutions. Vera also helped integrate WHO recommended indicators and tools (example the growth chart) to ensure translatability and easy dissemination

The data is recorded in ‘Real Time’ (instantly, through tablets) during every interaction with the mother and child. The interface has been kept simple to ensure the community health workers are able to use the same. These tablets were procured through the funding support of several individual donors and grants

Length – Recumbent length board DATA: 6608 visits which included all available electronic record visits on term and preterm children that had joined the program at under 6 months of age and left the program within the last 2 years ( 2011 – 2016) that were exclusively breastfed 738 children < 6 months Weight – Digital scale Length – Recumbent length board Plotted on WHO chart 117 single visit 621 > 1 visit (2 – 107 visits) 48% Female 56% < 2.5 kg Avg Age 2.16 months X

UNDERWEIGHT p=0.02 Healthy Moderate Severe Baseline n 462 103 47 Final n 491 95 27 50% reduction in Severe Underweight status

WASTING p=0.007 Healthy Moderate Severe Overweight Baseline n 493 54 21 11 Final n 523 46 6 5 50% reduction in overweight 75% reduction in severe wasting

STUNTING p=0.001 Healthy Moderate Severe Baseline n 444 77 56 Final n 432 106 40

We plan to continue to maintain the metrics of our program FUTURE DIRECTIONS We plan to continue to maintain the metrics of our program Give feedback to providers to encourage detailed charting Look at maternal variables to help us understand the reasons behind success and failure of the program for individuals Share our findings and learnings with a larger audience