SPOON’s Count Me In is a web-based app used to improve nutrition and feeding practices for children living outside permanent family care and those with disabilities – two populations often not included in mainstream health programs, yet who have high rates of malnutrition. The app generates holistic care plans customized to meet each child’s needs, empowers caregivers through educational content, and provides healthcare administrators with early warning systems for nutrition-related problems.
Count Me In guides the user through the assessment of a child broken down into three sections: Mealtime, Growth, and Anemia. It then takes these assessment inputs–alongside the child’s demographics, special needs, disability status, and longitudinal history of growth, anemia, and feeding–and generates recommendations using WHO standards and decision-tree logic designed to replicate clinical care.
The Mealtime section is a series of questions examining the technique by which the child is fed (or feeds himself). It screens for undiagnosed feeding difficulties, and if detected, probes with a comprehensive set of questions. The Growth section solicits the child’s weight, height, and head circumference. It then plots those data points, alongside past values, in World Health Organization’s (WHO) growth charts, for which it then provides interpretation. The Anemia section requires the results of a hemoglobin test; it interprets that result and conditionally recommends iron and other nutrient supplementation.
An intuitive interface helps users keep track of when children are due for assessment. Although the use of Count Me In requires training, supplementary educational content is woven into the app to remind users about the technical details of testing hemoglobin, weighing and measuring children, and assessing the feeding practices of children with disabilities and infants.
Any device connected to the Internet and with a modern web browser can use Count Me In. This includes all smartphones and tablets, or any laptop or desktop running the freely available browsers Chrome or FireFox.
Do you have current users or testers?
We have four users in two sites in Mauritius who are actively using Count Me In. There, 38 children have been assessed a total of 73 times as of November, 2016. In addition, experts in the fields of pediatrics, nutrition, disability, and feeding therapy are currently conducting a peer-review and testing the app for quality of recommendations.
What is your innovation's value proposition?
Bolsters the health of children.Count Me In looks at each child individually and generates nuanced, child-specific nutrition and feeding care plans which are the product of our innovative integration of feeding practices and the child’s historical growth data. It also includes two populations that are often overlooked in health programs across the world - children living outside of permanent family care and children with disabilities, despite their increased risk for malnutrition and feeding difficulties.
Builds staff capacity. Multimedia content is integrated into the tool demonstrating best practices for feeding technique, growth measurements, and anemia testing. By providing interpretations alongside of the recommendations, caregivers gain a better understanding of the underlying feeding and nutrition issues and interventions to address them.
Supports monitoring and evaluation. Real-time data collection supports monitoring for stakeholders across the spectrum with comprehensive child-, institution-, and multi-site-level reports. These real-time data not only guide the individualized care for a child, but also provide compelling statistics for use in advocacy agendas.
Ease of use and access. Any device connected to the Internet can use Count Me In. SPOON is constantly refining the content of Count Me In and adding new features. Being web-based, all users receive those benefits as soon as they are available.
Target results and impact
Count Me In allows us to capture clean, real-time data to monitor caregiver behavior change and measure child-level impact including growth monitoring, anemia screening, and improved caregiver feeding techniques. Based on pre-digital results (when SPOON used primarily paper-based tools), we anticipate we will reduce the prevalence of anemia by 60% and wasting by 25% within a year.
What Evidence do you have that your Innovation works?
All of our recommendation content is based on WHO standards, and feeding therapists’ clinical best practices determined by evidence-based practice. The paper-based precursor to Count Me In yielded improvements in India, China, and Vietnam: an over 25% reduction in wasting, and a nearly 65% reduction in anemia. Early data from our pilot deployment are showing a strong impact on anemia in line with our goals.
Provide a status update for your Innovation.
Count Me In was launched as a pilot project in orphanages in Mauritius in November 2016. Since the launch, we have iterated on the app and consistently roll out new features and improvements to the content based on feedback from users, and from our own monitoring and evaluation. We are designing new features to broaden the scope of the app and improve the quality and nuances of its clinical care. We are currently working with local partners in Vietnam and Zambia to deploy Count Me In for children in institutional care. In 2017, we will translate the app to Vietnamese, Russian, and possibly Chinese.
What is your strategy for expanding use of your innovation?
We work with implementing partners to deploy Count Me In. Our scaling strategy relies on a train-the-trainer model, and an increased usage of training content built into the app.
Our next steps are to expand the regions where Count Me In is deployed–initially to Zambia and Vietnam–and to experiment with models for scaling, including the use of a train-the-trainer model, incentive features built into the app, and the expanded use of e-learning.
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