Changing Practice with Operational Research Kate Sadler Valid International

Aims Changing international practice with simple operational research and well chosen publications: –Community-based therapeutic care (CTC) –Know your audience –Demonstrate need for change –Choose the right research tools –Use a range of data collection instruments –Disseminate results widely and effectively

Community based Therapeutic Care (CTC) 1. Treats acute malnutrition –Marasmus & Kwashiorkor 2. Provide easy access for populations –Decentralised outpatient therapeutic care (OTP) 3. Care in homes not feeding centres or hospitals –Using existing health infrastructure 4. Community mobilisation –Formal and informal networks –Traditional practitioners 5. Uses Ready to Use Therapeutic Foods

–Medical profession, docs High science –Donors Cost! –NGOs and implementers ‘Doable’ Impact Your Audience

Demonstrate need for change Impact of existing centre-based programmes poor in nutritional emergencies: –Not ‘doable’ –High risks

Demonstrate need for change Impact of existing centre-based programmes poor in nutritional emergencies: –Not ‘doable’ –High risks –Imbalance coverage : intensity

ETHIOPIA 2000 BOLLOSSO SORIE

One of many highland districts 400,000 people - 40 km radius 20% < 5 years = 80,000 children < 5 years 10% severe malnutrition = 8,000 requiring TFC TFC programme duration 4 months 20 TFCs REQUIRED (8000 / 400 = 20)

Choose the right research tools RCTs –Emergencies - too many external constraints –Humanitarianism? Timely interventions, ethical –Directed a lot of our high quality research to outside emergencies and the REAL suffering –Our experience disaster! Observational studies, retrospective and prospective cohorts –Easily integrated into ongoing programmes

Use a range of data collection instruments (1) Quantitative, qualitative, observation and case studies –Triangulation

Quantitative: programme monitoring

Qualitative: programme monitoring

Anthropological studies looking at the acceptability of non-centre based treatment compared to traditional TFC models: –Less disruption to home life –Carers able to fulfil social responsibilities –Improved access –Carers felt sense of empowerment being trusted to care for their kids –Tap into community ethos of looking after each other

Observation & case studies: programme monitoring

Use a range of data collection instruments (2) Meta-data with range of partners –one observational and replicated 20 times. All data comparable and all showed the same thing

Results of CTC programmes: Sep 00-Jun 05

Disseminate results widely and effectively (1) Use a combination of the right channels of dissemination –High-science journals – difficult? –Low-science journals –Practitioner publications –Meetings and teaching

Disseminate results widely and effectively (2) Design message with audience in mind: –Impact: outcomes, coverage

Comparison of coverage of severely malnourished in Dowa and Mchinji districts - Malawi (March 2003)

Disseminate results widely and effectively (2) Design message with audience in mind: –Impact: outcomes, coverage –‘Doability’: simple protocols integrated into national PHC delivery

OTP: Appetite assessment (RUTF) One week ration « Appetite test »

Disseminate results widely and effectively (2) Design message with audience in mind: –Impact: outcomes, coverage –‘Doability’: simple protocols integrated into national PHC delivery For effective communication –Tell a story

Disseminate results widely and effectively (3) Don’t be afraid to present problems and failings > credibility

>70% coverage Information and mobilisation Positive feedback

Conclusions Making a good case for change supports a positive research environment Choosing the right research tools is key to obtaining rigorous data in emergency settings Use the right channels of dissemination to reach the target audience Presentation of research outcomes must focus on information needs of audience