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Propose Project Activity description and output for 2012-2013

1. Reduced morbidity and mortality among young children.

a. No. of children under 5  who received clinic consultations.

Children under 5 are most vulnerable for infectious diseases (respiratory tract infections, diarrhea, skin diseases, dengue, cholera, measles) as their immunity is still low and they have a high mortality. In particularly in rural slums were infectious diseases are rampant. All children who are sick are seen by a doctor for a medical consultation.

Expected result;10,000 consultations for children

b. No. of children treated for acute malnutrition .

Children with acute severe malnutrition are extremely vulnerable and have a mortality of 50% if untreated. A large proportion of them are malnourished due to tuberculosis. Children under 5 years of age are weighed and measured in the clinic. Acute severe malnourished children (<70% of normal weight for height) have an estimated mortality of 50-70% without treatment). All children with malnutrition (<75% of normal weight for height) are admitted in the MAM feeding centre for medical treatment and therapeutic feeding (6 meals a day). After discharge they are followed up for 6 months. With therapeutic feeding and/or tuberculosis treatment their survival is around 90%. After one treatment episode children usually progress well and the treatment doesn’t need to be repeated.

Expected result ;100 severe malnourished children treated

c. No. of children treated for HIV.

All children who are at high risk for HIV (malnourished children, children with Tuberculosis and children from HIV (+) parents) are screened for HIV. ART will be provided according to specific criteria and after counseling and consultation with the care takers.

Expected result ; 50 children treated for HIV and 30 children received ART.

2. Improved access to maternal and reproductive health

a. ANC services

ANC is provided to prevent diseases and complicated deliveries without expert supervision. To prevent transmission of syphilis and HIV from mothers to children, all pregnant women will be offered screening with laboratory tests. If positive they will be offered antibiotics or ART to protect themselves and their baby.

Expected result ;1000 women received ANC services

b.Family Planning

Many women have more children than they want and more children they can care for adequately. This leads to poor health of both mothers and children. Family planning methods will be offered to all women and men who visit the clinics. Various methods of family planning are offered to all women who visit the health centre, including oral tablets, a depot, an IUD and male and female condoms

Expected result ; 10,000 consultations for women who want family planning.

c. Reproductive tract infections

All women who come for ANC or birth control services are screened for STD and offered treatment, together with their partner, if necessary.

Some people with high risk sexual behaviour are at a very high risk of becoming infected with reproductive tract infections (RTIs) including STDs and HIV. RTIs facilitate the transmission of HIV and it is therefore even more essential to prevent them through the use of condoms or treat them early. As many women and to a lesser extent men with STI have no symptoms, sex workers and others with high risk behavior are actively invited to visit the clinic to be screened for STD’s and HIV. This is a proven strategy to reduce transmission in the community. To convince people who are at high risk, but who have no complaints, to come to the clinic, a good relationship between the health provider and high-risk persons, including brothel owners, will be essential.

Expected result ; 1000 women and 300 men tested +/- treated for RTI.

Next to treatment, condoms will be provided to prevent further transmission.

Expected result ; 200,000 condoms distributed for people at high risk.

3. Reduced morbidity and mortality due to Tuberculosis, HIV and other prominent infectious diseases.

Patients diagnosed in the clinic with uncomplicated Tuberculosis (but not HIV) will usually be sent to the Department of Health. Treatment should be free of cost. However complicated TB, TB as coinfection with HIV and severely sick and poor, will be treated by the MAM clinic to improve the chance of access to adequate treatment.

Expected result; 200 TB patients diagnosed and referred,200 patients diagnosed and treated by MAM

Patients with HIV/AIDS (PHA) will be offered prophylaxis and/or treatment for opportunistic infections, and antiretroviral treatment and food. An increasing number of women with children are HIV positive and need treatment. All children of HIV positive women will be tested and treated if necessary. Single parents with children will get preferential treatment.

Expected result ;100 PHA managed without ART (only prophylaxis or OI treatment),  300 PHA managed with ART

4. Low morbidity and mortality due to cholera and other water born diseases

The cholera outbreak is around April-May each year. Water pumps, which do not have an apron, are usually contaminated. These wells will be chlorinated in the first 3 months of the year.

A permanent solution for the poor quality of the water from the water pumps is the construction of simple aprons around the water pumps, which leads to a more permanent improvement of the quality of the water.

Expected result ; 2,000 wells chlorinated. And 2,000 aprons contructed around water pumps

5. Improved socio-economic response of the poorest patients/families.

Income generation activities for families who are in the most desperate socio-economic situation, often caused by long term disease. In cooperation with AFXB, an organization long time involved with vocational training, MAM will promote income generation activities for the most vulnerable, after the health situation has stabilized, in order to sustain improved health and prevent to drop back in the vicious circle of poverty and disease. A number of persons will offered vocational training. Others will get access to a micro-credit scheme, to start up their own business.

Expected result ; 100 adults (mostly women) will have learned a skill. 300 families will have access to a micro-credit scheme.

6. Additional and supportive activities

a. The clinic will focus on children and pregnant women but any patient with a serious life threatening disease will be examined and treated in the clinic if feasible and within the limits of the organization.

Expected results :2,000 older children and adults will receive medical examination and treatment for general pathology.

b. Health education is provided through Burmese health education videos with Burmese movie stars, posters, pamphlets and flip charts made with local painters and cartoonists. Health education will focus on HIV and reproductive tract infections and –potentially – in case of outbreaks of diseases.

Expected result ; 20,000 people, many at high risk of HIV, will have a discussion about HIV.

c. Outreach activities will include treatment adherence support for chronic ill and home based care for critically ill who cannot come to the clinic.

Expected results : All HIV and TB patients will be visited at home, and all immobile patients will be regularly visited at home or referred to a hospital.