摘要：In recognition of the important role that fathers play in the lives of young children in Haiti, a public health organization instituted fathers’ clubs in 1994 as a strategy to improve the health outcomes of children. Fathers’ clubs focus on child and family health education. To evaluate the effectiveness of fathers’ clubs, we examined the health of children born in Haitian villages with and without active fathers’ clubs and compared results for the two groups. The presence of a fathers’ club in a child's birth village had a positive effect on vaccination status, growth monitoring, and vitamin A supplementation after we controlled for socioeconomic status, time, and the quality of the village health agent. Child weights and mortality were not affected by the fathers’ clubs. IN MANY LOW-RESOURCE countries, child health is unacceptably poor. Children in such countries suffer from high morbidity and mortality that are often caused by preventable diseases. 1 Fortunately, affordable, locally designed programs with a broad, integrated approach can improve child health and survival in these circumstances. 2 – 4 One such program is run by the Haitian Health Foundation (HHF), a nongovernmental organization in rural southwestern Haiti. HHF was founded in 1985 as a single clinic in the town of Jérémie, and the organization has since grown to provide outreach in 104 villages. HHF instituted village-level fathers’ clubs as part of its Primary Care Program in 1994, in response to the discovery that in southwestern Haiti, fathers provided a much larger share of child care than was expected. 5 The clubs, unique in Haiti, were founded to enhance child health and welfare. KEY FINDINGS ▪ Enlisting the strengths and abilities of fathers in the improvement of their children's lives is a worthy goal of public health programs worldwide. ▪ The rural fathers’ clubs of the Haitian Health Foundation are a unique public health intervention that shows promise for improving the health of young children and families. ▪ Adapting this program of father involvement for different communities may augment public health efforts in other parts of Haiti and the world. ▪ Public health improvements rely on continued political and economic change that supports local health efforts. Fathers’ club participants meet regularly to learn about child and family health. They discuss how to best support their wives and mutually care for their children. Fathers’ clubs are run by the men themselves and are open to all men in the village. Health education sessions occur with input from the nurse or village health agent. Education formats include discussion, songs, and skits. The ultimate goal of the fathers’ clubs is to improve child health through education. The health education provided in the fathers’ clubs is based on the Twelve Key Family Practices identified by the World Health Organization and UNICEF. 6 These practices are taught and reinforced in the hope that fathers will institute these practices in their families. The practices include exclusive breastfeeding for 6 months, immunizing children, and providing adequate fluids and seeking appropriate health care when the child is sick. Fathers’ improved knowledge, skills, and performance are expected to improve child health along 3 pathways, as depicted in the intervention impact model shown in Figure 1 . HHF developed this model to measure how child health improves over time. Open in a separate window FIGURE 1 Intervention impact model of how fathers’ clubs lead to improved health for children born in Haiti, 1994–2005. The specific aims of our study were to document how selected child health indicators have changed for children in particular villages served by HHF since 1988 and to test the hypothesis that child health indicators in a village improve after a fathers’ club is established in that village.
