Therapeutic Care
Hearth - Malnutrition Rehabilitation Program
The Hearth Program is a low-cost nutritional model used in many resource-poor countries designed to rehabilitate the moderately-to-severely malnourished child. The Children' Nutrition Program began its Hearth Program in 2000, and is continually expanding it to new villages. The CNP uses a "Positive Deviance" approach, whereby we learn from poor mothers who manage to keep their children healthy. Specific recipes and behaviors of these "Positive Deviant" mothers are practiced at hearths.
The Children's Nutrition Program has hired and trained community nutrition workers to supervise the program in their own villages and collect information on every household, including weighing each child less than five years of age. Caregivers of children who are found to be moderately malnourished are invited to participate with their children for two weeks in a Hearth. The community nutrition workers work with volunteer mothers who offer their homes for the Hearth, and teach through songs and poems while participants prepare and feed the children nourishing meals using locally available and affordable foods.
Each day mothers spend time together preparing a meal and discussing local foods and their nutritional value, the importance of vaccinations, breastfeeding, hygiene, child spacing and care-giving practices to bring their children back to good health. After the two weeks, mothers notice visible improvement in the child's weight and demeanor, which encourages them to continue what they have learned in their own homes. After the Hearth has concluded, the community nutrition workers regularly visit the mothers and children to offer encouragement and support.
CNP has expanded the original curriculum of the Hearth Program going beyond the treatment of moderate acute malnutrition and post severe acute malnutrition to cover pregnant women and growth faltering children, mothers with infants, especially low birth weight infants and all women of childbearing age, with a focus on adolescent and young adults.
Outpatient Therapeutic Food Program
As CNP community nutrition workers find children who are too ill to be rehabilitated through the Hearth Program, they refer them to the CNP Outpatient Therapeutic Care Program. Here the children are further evaluated. If they are severely malnourished but without other complications, they may be sent home with packets of PlumpyNut, a ready-to-use food that is high in calories, oils and nutrients. These children will return to outpatient care weekly for evaluation.
Some children will come into the program without complications but may fail to improve with care. These children and their caregivers are referred to pediatrician Dr. Kern Mathieu at the Holy Cross Hospital who will evaluate them for further care.
If children come into the program with complications, they will be referred to the Terre des Hommes Stabilization Center in Petit Goave, where they can be stabilized. The CNP provides transportation to the Stabilization Center for these very sick children and their caregivers. The children are first treated for any medical complications and then rehabilitated nutritionally. Children usually stay in the stabilization center for five to seven days. Once they meet criteria for discharge, they can be referred to the Outpatient Therapeutic Program or to the Supplemental Food Program.
Supplemental Food Program
As children complete the Outpatient Therapeutic Care program or are discharged from the Nutritional Stabilization Unit, they need a different level of nutritional support than can be provided through PlumpyNut. These children receive PlumpySup, a ready to use supplemental food that treats moderate acute malnutrition and helps to establish stable rehabilitation. Children in this program are seen biweekly and remain in treatment until they are nutritionally sound. Either during treatment or at discharge these children are referred to a local Hearth program.
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