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Healthy Children, Healthy Futures:
INMED’s Public-Private Partnership Initiative
Improves the Health and Lives of Brazil’s Children
(Joyce Capelli or Linda Pfeiffer of INMED, will be available for interviews in São Paulo on April16, 17 and 18. Please call Nils Hoffman or Liliana Hisas to schedule time. Thad Jackson orSuzanne Wilcox of INMED will be available for interviews in Washington, DC, April 16, 17 and18. Call Marshall Hoffman to schedule time.)__________________________________________________________________More than 350,000 children across Brazil have been freed from debilitating and sometimes life-threatening intestinal parasites by an innovative public-private program led by INMED and itspartners, stressing treatment and critical health education. In the next five years INMED plansto reach at least 2 million of the most at-risk children in communities identified by Brazilianhealth authorities throughout Brazil. Intestinal parasites infect 2 billion people worldwide – and children suffer the most. Intestinalparasites have long constituted the single largest health problem among school-age children inBrazil, infecting up to 90 percent of children in rural areas, and between 40 and 45 percent incities, according to the World Health Organization. Parasites can stunt children's physical andmental development by robbing their bodies of micronutrients, especially vitamin A and iron.
Children with parasites are also more vulnerable to disease, anemia, malnutrition, blindness andeven death. In 1988, INMED, a U.S.-based international health and development organization,headquartered in Sterling, Virginia, developed the Healthy Children, Healthy Futures program,based on a combined strategy using children as positive agents of change. The program isaimed at not only ridding the children of parasites with medicine but also educating children,their families and entire communities on how to prevent re-infections of parasites by improvinghygiene, sanitation, and nutrition behaviors. INMED and its partners accomplish all this for acost of less than US$5 per year per child – an essential investment for the future.
After biomedical screening, children between the ages of 5 and 14 are given the drugmebendazole in a school setting. Mebendazole, produced and marketed under the brand namePantelmin by Janssen-Cilag in Brazil, kills the parasites in two or three days. The results of thetreatment are dramatic: children who were once listless, bloated and malnourished quicklybecome vibrant, energetic and eager to learn. The immediate improvements in the childrens’energy level, vitality, and well being win support for the program from parents and teachers.
Since parasites are transmitted in soil and water contaminated with fecal matter, re-infectioncan occur easily in communities with poor sanitation infrastructure. Thus, INMED found that it isonly possible to interrupt the cycle of parasite transmission if the entire community becomesinvolved in healthy hygiene and sanitation.
Children are taught basic lessons, like washing their hands, wearing shoes, avoiding contactwith fecal matter, washing fruits and vegetables, purifying water, and building corrals foranimals. They also learn about good nutrition and safe food preparation.
"The teaching methods are unusual, but they need to be in order to prevent re-infection," saysLinda Pfeiffer, Ph.D., president of INMED. "We use songs, theatre, skits and even parades toteach our lessons. The entire community becomes involved through outreach activities such as science fairs, cooking contests and parent days." A recent addition to INMED’s teachingmethods is Dr. Med, a puppet that thoroughly engages the children in dialogue about theirhealth behaviors. Dr. Med attends classroom education activities and special events, bringingalong a delightful sense of humor and a wealth of information tailored for children.
"Children are great teachers for the rest of the family and the whole community,” says Dr.
Joyce Capelli, Executive Director of INMED Brazil. “Once they go through our program, they willbegin to ask their mothers why they aren't washing their hands before preparing supper. They’llrecite program poems and songs containing health messages at home. They teach their youngersiblings through example. Through the influence of the children, we estimate that about onemillion family members and neighbors are also adopting healthier behaviors and changing theirlives.” “This community trust and support allow INMED to introduce targeted hygiene, sanitation, andnutrition messages as part of the school curriculum,” Dr. Pfeiffer says. “Drawing on their new-found energy and enthusiasm, the children are able to learn and apply the health messages intheir lives and enthusiastically take these messages to their families and communities.” The program boasts a wide range of public- and private-sector partners including localuniversities that provide personnel and lab support for biomedical exams; federal, state, andlocal government offices in both the health and education sectors; and national andinternational corporations that provide both monetary support and donations of medicines,vitamin A and iron. Corporate support comes from sectors as diverse as telecommunications,pharmaceuticals, energy, and food technology. Janssen-Cilag and its parent company, Johnson& Johnson, are core partners with INMED in Brazil, providing deworming medicines and coresupport and joining with INMED in welcoming a broad range of other corporate, government,foundation, community and individual partners in this effort for the children of Brazil. The project has brought far-reaching benefits to the participating children and their families: • Biomedical examinations confirm that parasitic infection rates fell by more than half in SãoPaulo, Brazil’s most populous city, from 44 percent to 20 percent. In Rio de Janeiro, infectionrates were reduced from 41 percent to 28 percent in the participating communities. In ruralareas where infection rates for children reach 80 to 90 percent, infections have been reduced to25 percent. • Significant reductions in anemia have been achieved through the program’s treatmentactivities. Sixty-three percent of children identified as anemic have at least a one-pointimprovement in blood hemoglobin levels after receiving iron supplements.
• Communities have joined forces to improve their health. More than 70 percent of families inprogram communities are active in outreach activities such as science fairs, theaterperformances, and workshops. This participation translates into community action projectswhere children, families and neighbors work together to make significant improvements in localsanitation infrastructure, such as building latrines, handwashing stations and animal corrals.
• Students are engaging in proactive efforts to make positive changes in their communities suchas petitioning for increased garbage pickup, making environmental surveys of theirneighborhoods, and distributing fresh vegetables grown in school gardens. Through theseactivities, students are learning important lessons in citizenship.
• After witnessing and participating in successful treatment and education activities, localgovernments, school systems and health departments have pledged their active and continuedsupport to the project. For example, schools in São Paulo agreed to formally incorporate theproject’s education component into their official school curriculum. In addition, the Rio healthdepartment dedicated a day to the treatment component of the project. • The local capacity of teachers and health clinics to identify and treat health problems has beenenhanced greatly through program activities, including training. More than 10,000 teachers,cafeteria workers, and health department staff have been trained through the program andcooperation between education and health personnel has been stimulated.
• Many of Brazil’s premier academic, civic and nonprofit institutions have committed theirsupport to the Healthy Children, Healthy Futures project, including the São Paulo and Rio statedepartments of Health and Education, São Paulo State University Institute of the Child, Rio deJaneiro State University Biochemistry and Pharmacy College and Nursing College, FaculdadeCarioca, Centro de Defesa da Cidadania de Jacaré e Manguínhos, Centro Comunitário BrazilCabo Verde, Fundação Leão XII, and Fundação Oswaldo Cruz. The first Lady of Brazil has alsobeen very supportive. Although Healthy Children, Healthy Futures was developed internationally, each of thecommunity-based projects is designed and adapted within the local context. All of the programstaff members are Brazilian, and other contributing partners and supporters are deeply rooteddomestically. INMED operates similar programs in Mexico and the Dominican Republic. They have taught theHealthy Children, Healthy Futures strategy (sometimes called Children as Agents of Change) inBurkina Faso, Chile, Ecuador, Bolivia, Guatemala, Honduras, The Philippines and India. Inaddition to Healthy Children, Healthy Futures, INMED also is the parent organization for theMotherNet program and The Millennium Alliance for Social Investment.
Contact: Hoffman & Hoffman Worldwidewww.inmed.org (U.S.)<br>www.inmed.org.br (Brazil)
DATA EDITING AND QUALITY OF DAILY DIARIES IN THE ITALIAN TIME USE SURVEY* Istat (Italian National Statistical Institute) 1. Introduction The multipurpose survey on households called “Time use survey” has been carried out by Istat (Italian National Statistical Institute). A sample of 21,075 families was interviewed, summing up to about 55,000 individuals, and data was coll