Impact of fathers' clubs on child health and survival in rural Haiti

Introduction: Fathers clubs have existed for over ten years in rural villages in southwest Haiti as part of the primary care program of the Haitian Health Foundation. Fathers meet regularly to learn about how to best care for their families. This research explores the activities of the fathers clubs to determine whether the participation of fathers in the club has a positive impact on family and child health in the villages. Methods: The service-oriented computerized data base of the organization provides census and health data for all the individuals and families in participating villages. The data is nested: families, households, and villages. Random sampling resulted in 559 children for the analysis. Logistic and linear regression modeling was employed with child health outcomes: immunization status, Vitamin A status, growth monitoring frequency, child weights, and child mortality. Results: Positive effects were seen with growth monitoring and vitamin A supplementation, for children at one and two years of age in villages with fathers' clubs, after controlling for socioeconomic status, year of child's birth, and the quality of the village health agent. Children were more likely to be fully vaccinated at one and two years of age when born in a village with a fathers club, but this difference disappeared when controlled for time, indicating that the HHF program vaccination efforts improved for all children over time. Weights, recorded as weight-for-age Z scores, and mortality rates at one year were not affected by the fathers clubs. This was true before any model adjustment, an indication of the poverty and civil strife in the country and region. Conclusions: The study highlights the success of one primary health care program with a community-based participatory approach. It shows the importance of fathers in children's lives in Haiti. The results from the study are not conclusive about the impact that the fathers' clubs have had on five discrete child health outcomes. Evaluating one program component, when the whole program is operating synergistically with multiple components, is a study limitation. A full program evaluation of HHF and all its components is recommended, utilizing the rich data base, and extending the qualitative methodology to include participant observation.