Objectives Review of BASS activities phase 1.0 Challenges in implementing different activities of phase 1.0 Finalise the activities for phase 1.5

Components of BASS Phase 1.0 Anchal V3.0 SwimSafe V3.0 Injury surveillance Community awareness

Component of Anchal V3.0 –Supervision of U5 children & provision of ECD stimulations through different activities –Anthropometric measurements for physical development –Measurement of mental and social development –Screening for disabilities –Playpen use for safety and supervision –Health issues – immunization status

Supervision and ECD in Anchal 40 Anchals functioning

Anchal children by age and sex in July 2015 Age in monthBoysGirlsBoth 9-11 months1 (0.2)2 (0.4)3 (0.3) months45 (9.5)56 (10.9)101 (10.3) months140 (29.6)114 (22.3)254 (25.8) months161 (34.0)182 (35.5)343 (34.8) months126 (26.6)158 (30.9)284 (28.8) Current children Graduate17(1.6) 34 (3.2) Drop out25(2.3)32 (3.0)57 (3.2) Total enrolled515 (47.9)561 (52.1)1076 (100.0) FORM 1

Anthropometric measurements Weight and height of Anchal children Anchal Ma trained Instruments used –Bathroom scale-2-5 years –Salter scale-< 2 years –Wooden height scale Measurement done-every month –8 rounds (Nov’14-June’15) FORM 3

Anthropometric measurements-June ‘15 Nutritional status -Severe stunt (below-3SD) : Height for age Age in months BDHS % % (Number) % (Total) (0) (3) (5) (16) (19) (85) (37) (254) (34) (343) (21) (284) All ages 11.8 (116) (985) Nutritional status - Severe wasting (below -3SD): Weight for age Age in months BDHS % % (Number) % (Total) (0) (3) (0) (16) (3) (85) (16) (254) (20) (343) (12) (284) All ages 5.2 (51) (985)

Challenges in Anthropometric measurement ChallengesSolutions Bathroom scales - measurement errors o Used a fixed known weight o Changed batteries o Compared with other scale Alternate: Use of Standard weighing machine, but expensive Measuring weight and height by AMs (5%) o Increased supervision o Assistance during measurements o Refreshers training (twice) Plotting growth charts (25%) o Increased supervision o Assistance during ploting o Refreshers training (twice)

Measurement of mental and social development Two sets of checklists used for child development screening –CDC checklist 9, 12, 18, 24, 36, 48, 60 months –WHO 10 Questions for disability screening 2-5 years old children

Development of Anchal children CDC checklist

Screening of child disability by 10Qs Age in months BoysGirlsBoth n%n%n% 24 months (N=320, Boys=166, Girls=154) months (N=321, Boys=138, Girls=183) months (N=140, Boys=69, Girls=71) Total (N=781, Boys=373, Girls=408)

Challenges in using development checklists Challenges of using CDC checklistSolutions Extensive and complicated o Increased supervision o Assistance during measurements to >50% AMs o Refreshers training during cluster meetings Time consuming Do more mistakes Can we consider to exclude in Phase 1.5 and Phase 2 ?

Screening for physical disabilities Congenital and acquired disabilities Anchal childrenSiblings Status BoysGirlsBothBoysGirlsBoth Disabled 10 (2.0)7 (1.3)17 (1.6)16 (3.9)14(2.9)30(3.3) Normal 482 (98.0)534 (98.7)1016(98.4)395 (96.1)472(97.1)867(96.7) Total 492 (100.0)541 (100.0)1033 (100.0)411(100.0)486(100.0)897(100.0) Distribution of Anchal children and their siblings by physical disability and sex Anchal children & their siblings Sex Both% Boys%Girls% Disabled Normal Total

Immunization status of children Vaccine’s Name Immunization Status SexTotal Boys N= 475Girls N=524Both N= 999 N%N%N% B.C.G DPT OPV MR Measles

Playpen use in Anchal Age: 9-24 months (90% AM) Time: During anchal activities (92% AM) Sleeping, not interested to participate Duration: About 30 mins (92% AM) children were kept in anchal Not suitable: 30 months and over Wooden playpen

SwimSafe

SwimSafe: First response A total of 659 children have been graduated Children age group was 7-9 years old Target was to train 600 children

CPR graduates (Mid July – Sep ‘14) Distribution of CPR graduates by age and sex with the percentage Status 7 year (%) 8 year (%) 9 year (%) All ages (%) Pass 201 (85.5) 226 (85.9) 232 (85.9) 659 (85.8) Fail 14 (6.0) 9 (3.4) 7 (2.6) 30 (3.9) Drop out 20 (8.5) 28 (10.6) 31 (11.5) 79 (10.3) Total 235 (100.0) 263 (100.0) 270 (100.0) 768 (100.0)

Swimming teaching for disabled children in a portable pool Disabled children Target was to teach 40 disabled children –18 were attended but not graduated –Next swimming session will be started soon

Injury surveillance At the three unions including Dhangara injury surveillance has been conducted. Each surveillance round is a 6 months cycle Two rounds of surveillance has been conducted during BASS phase 1.0. Data entry is in progress

Population in Dhangara union Total household – 9,687 Total population – 50,240 Male: 25,195 Female: 25,225 U5 children – 11, 618 Male: 5,875 Female: 5,743

Plan for BASS 1.5 Bridging period July – Dec 2015 /Mar 2016

Anchal activities Bass 1.0Proposed BASS 1.5 1Child supervision and ECD possible (Form 1) The same activities continue 2Anthropometric measurement possible by Anchal Mas (Form 3) Moderate and severe malnourished children will be referred to IMCI of UHC 3Identification of disabilities in children is possible (Checklists- CDC and 10Q; Form-7 and Form 8) Disabled children will be referred to 1.JPUF (disability centre) – Sirajganj 2.Surgical cases – Bogra Medical College Hospital 4Measurement of immunization status possible Those who missed immunization will be referred to vaccination centres 5Vitamin A capsule ingestion not checked Vitamin A capsule –check and referral (Form 9) 6Deworming not checkedDeworming – check and referral 7Common illness – not doneCommon illness information (Form 13) 8Play-pen observation (Form 10) ??

SwimSafe AgeBASS 1.0BASS yrs 1.25 meters swimming 2.30 seconds treading/floating 3.Reach or throw rescue 1.25 meters swimming 2.30 seconds treading/floating 3.Reach or throw rescue 4.Risk management 5 – 6 yrs 1.25 meters swimming 2.30 seconds treading/floating 3.Reach or throw rescue 4.Height measurement 1.25 meters swimming 2.30 seconds treading/floating 3.Reach or throw rescue 4.Height measurement 5.Weight measurement 6.Risk management 7.In water rescue* (*Draft instructions for CSIs)

SwimSafe AgeBASS 1.0BASS – 9 yrs 1.25 meters swimming 2.30 seconds treading/floating 3.Reach or throw rescue 4.In water rescue 5.First aid including CPR 6.Height measurement 1.25 meters swimming 2.30 seconds treading/floating 3.Reach or throw rescue 4.Height measurement 5.In water rescue 6.Weight measurement 7.Risk management 8.First aid including CPR 9.First response to the community - Reporting form available from IDRC-B project Disabled children 1.25 meters swimming 2.30 seconds treading/floating

SwimSafe: in water rescue Children below 7 years old will not be trained to conduct in-water rescue During conduction of rescue; rescuer should not enter more than chest level of water. Rescuer will call adults for help during rescuing.

Type of in water rescue In water throw rescue –Rescuer could rescue a person by throwing a floating object into the water

Type of in water rescue In water reach rescue –The rescuer will conduct reach rescue with a bamboo pole or stick, rope or cloth

Type of in water rescue In water reach rescue –Maintaining a certain distance or not entering into the water, rescuer will pull the drowned person to the bank holding his/her hand, leg, hair, part of clothing

Type of in water rescue In water reach rescue –By forming human chain