1. 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

2. 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

3. 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

4. ‘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

5. 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

6. 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 -

7. 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

8. 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

9. 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

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

11. 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

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

13. 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