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Changing Practice with Operational Research

This article discusses how simple operational research and well-chosen publications can drive change in community-based therapeutic care (CTC) for acute malnutrition. It explores the importance of understanding your audience, demonstrating the need for change, choosing the right research tools, using a range of data collection instruments, and disseminating results effectively. The article also highlights the key components of CTC, such as providing easy access for populations, decentralized outpatient therapeutic care, and community mobilization.

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Changing Practice with Operational Research

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  1. Changing Practice with Operational Research Kate Sadler Valid International

  2. 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

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

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

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

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

  7. ETHIOPIA 2000 BOLLOSSO SORIE

  8. 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)

  9. 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

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

  11. Quantitative: programme monitoring

  12. Qualitative: programme monitoring

  13. 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

  14. Observation & case studies: programme monitoring

  15. 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

  16. Results of CTC programmes: Sep 00-Jun 05

  17. 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

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

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

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

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

  22. 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

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

  24. >70% coverage Positive feedback Information and mobilisation

  25. 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

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