Supplementation Campaign Research Articles

Nutrition policy or price stabilisation policy: which policy is more effective for nutrition outcomes?

BackgroundMalnutrition remains a global problem and is increasing with the emergence of the COVID-19 pandemic. In Madagascar, half of the children under five years of age suffer from stunting. However, since 2006, vitamin A supplementation campaigns, deworming and free vaccinations have been implemented within the framework of the Mother and Child Health Week (MCHW) to strengthen the fight against micronutrient deficiencies and reduce mortality. On the other hand, rice, the staple food of the Malagasy population, can provide some of the micronutrients necessary for good nutrition. However, the country’s rice production is still insufficient, and the price has been rising steadily in recent years. This has led the government to resort to the policy of stabilizing rice prices through imported rice in 2017 and 2018. The aim of this paper is therefore to analyse the effects of these policies on the prevalence of malnutrition among children under five years of age in Madagascar. Which policy would be more effective: the nutrition policy or the price stabilisation policy?MethodsData from the Multiple Indicator Cluster Survey conducted by the National Institute of Statistics in 2018 are used, and logistic regressions for the analysis of the effects of nutrition policies on nutrition outcomes are performed. For the effect of price stabilisation policy, panel data on 22 regions of Madagascar from 2016 to 2019 are considered, and a fixed effect model is used.ResultsWe found that the effects of the nutrition policy are not immediately visible. Only participation in the 2016 MCHW contributes to a lower probability of malnutrition occurrence. The odds ratios of the effects of this participation on stunting are 0.69 (p-value: 0.05); on underweight: 0.70 (p-value < 0.01); and on wasting: 0.57 (p-value < 0.01). However, the participation rate remains very low. Then, there is no effect of the rice price stabilization policy on nutrition outcomes (0.00; p-value = 0.11).ConclusionsPrice stabilisation policy is not sufficient to fight against malnutrition, due to a lack of food diversification. These results suggest the need for a policy to ensure nutritional intake and to sensitize the population to participate in the MCHW.Trial registrationNot applicable.

Mise à jour de la situation nutritionnelle en République du Soudan

Background: Sudan is situated in the northeastern part of Africa. The population of the country is approximately 43 million, spread over 1.88 million square kilometers. Although Sudan has great resources, most of the population suffers from poverty and food deficiency because of the conflicts in the different parts of the country .The suffering was augmented by climatic drought and floods which resulted in food insecurity. The population’s internal displacement is disadvantageous regarding access to health services and is consequently more vulnerable to diseases and malnutrition. In Sudan, thirty-three percent of the population suffered from food deprivation according to the national survey of 2010. The prevalence of undernourishment was 31% and 34 % percent for urban and rural populations respectively. Furthermore, based on WHO epidemiologic criteria, the prevalence of stunting and wasting are classified as profound, 38.2%, for stunting which is more than the average of the developing countries( 25%), wasting defined as low weight for height also has a higher prevalence in under-five in Sudan comparing it to the developing countries' average which is 16.8% and 8.9% respectively. Although recent national survey data are lacking, it is evident that micronutrient deficiencies are a major public health concern from the sporadic studies’ findings. Notwithstanding these challenges, the government and the Federal Ministry of Health, move along to make progress towards nutrition and food security, some supplementation campaigns have been conducted but coverage of the population is still low. Sudan is one of the 61 countries that leading a global movement to end up malnutrition in all its forms. Keywords: Sudan, deficiencies, food, micronutrient, mortality, insecurity.

Mise à jour de la situation nutritionnelle en République du Soudan

Background: Sudan is situated in the northeastern part of Africa. The population of the country is approximately 43 million, spread over 1.88 million square kilometers. Although Sudan has great resources, most of the population suffers from poverty and food deficiency because of the conflicts in the different parts of the country .The suffering was augmented by climatic drought and floods which resulted in food insecurity. The population’s internal displacement is disadvantageous regarding access to health services and is consequently more vulnerable to diseases and malnutrition. In Sudan, thirty-three percent of the population suffered from food deprivation according to the national survey of 2010. The prevalence of undernourishment was 31% and 34 % percent for urban and rural populations respectively. Furthermore, based on WHO epidemiologic criteria, the prevalence of stunting and wasting are classified as profound, 38.2%, for stunting which is more than the average of the developing countries( 25%), wasting defined as low weight for height also has a higher prevalence in under-five in Sudan comparing it to the developing countries' average which is 16.8% and 8.9% respectively. Although recent national survey data are lacking, it is evident that micronutrient deficiencies are a major public health concern from the sporadic studies’ findings. Notwithstanding these challenges, the government and the Federal Ministry of Health, move along to make progress towards nutrition and food security, some supplementation campaigns have been conducted but coverage of the population is still low. Sudan is one of the 61 countries that leading a global movement to end up malnutrition in all its forms. Keywords: Sudan, deficiencies, food, micronutrient, mortality, insecurity.

The Power of Intelligence Element: The Long-term Impact of the Prevention of Iodine Deficiency Disorders on Economic Development in China

Disease is an important factor affecting economic development. Researches show the diseases like malaria, hookworm and HIV can significantly impede the human capital accumulation and economic development in the endemic regions around the world. Compared with diseases caused by parasite or virus, the diseases caused by micronutrients deficiency are less noticed. However, the impact of micronutrients deficiency could be severe, especially the deficiency of iodine. Iodine deficiency during pregnancy can hamper the brain development of fetus, leading to permanent intelligence damage. Because intelligence is an important factor for human capital accumulation, the widespread popularity of iodine deficiency is likely to have a negative impact on economic development. China’s large-scale campaign to prevent and control iodine deficiency since 1970s could have significant impacts on economic development. Before the campaign, endemic iodine deficiency was found among all the provincial administration regions except Shanghai; the number of iodine deficiency patients was estimated to be 35 million; about 200 thousand people were diagnosed as cretinism; and the population whose intelligence was slightly affected by iodine deficiency（subclinical cretinism）could be much larger than cretinism. Considering the severe threat of iodine deficiency, the Chinese government launched a large-scale campaign of iodine supplementation across the country since 1975. By 1985, 83.23% of the endemic countries and 87.3% of the population in endemic regions had been covered by salt iodization program. More than 22 million iodine deficiency patients had been treated in this period, and the birthrate of cretinism had been decreased by a great magnitude. Since the iodine supplementation campaign improved the iodine nutrition for a large population of China, it’s likely to increase people’s intelligence and affect human capital accumulation and economic development in China deeply. This paper studies the long-term impact of iodine supplementation on individual height, education and income by using the micro data provided by China Labor-force Dynamic Survey（CLDS）in 2012. Difference-in-difference model is used as our empirical strategy. The results show that: iodine supplementation during the early childhood has no significant impact on individual height, but iodine supplementation significantly improves individual education and income. If the incidence of cretinism increased by 1‰ before the iodine supplementation, the years of education for individuals born in that region after the iodine supplementation would increase by 0.562 year while the annual income would increase by 7.83%. Besides, we find the fetal stage is the most important period for iodine supplementation, and the effect of iodine supplementation after fetal stage is much smaller. Therefore, iodine supplementation is an effective measure to boost economic growth by improving people’s intelligence and promoting human capital accumulation. This paper contributes to the current researches in the following aspects. Firstly, for the remarkable economic growth of China since the reform and opening-up policy, although many scholars have provided the explanation from the channels like political institution, economic institution and infrastructure, little attention has been paid to the important role of large-scale campaign of disease prevention and treatment. Thus, this paper deepens our understanding of China’s economic miracle from a new perspective. Secondly, by studying the long-term impact of iodine deficiency prevention campaign, this paper also enriches the field of the long-term impact of historical events. Finally, our empirical findings provide guidance for the further insurance of people’s iodine nutrition and prevention of intelligence damage in poor regions.

Preventing vitamin D deficiency (VDD): a systematic review of economic evaluations.

Vitamin D deficiency (VDD) is a public health concern worldwide. If untreated, it can lead to reduced quality of life and escalated costs brought about by ill-health. Preventive programmes to improve population vitamin D status exist but little is known about their cost-effectiveness. This information is vital so that decision-makers adopt efficient strategies and optimise use of public resources. Systematically review and critically appraise economic evaluations of population strategies to prevent VDD. The databases reviewed were MEDLINE, EMBASE, Econlit, NHS EED, CEA, and RepEc. All full economic evaluations of VDD prevention strategies were included. Interventions considered were food fortification, supplementation and public health campaigns. Data extracted included type of evaluation, population, setting, measure of benefit and main results. Of the 2492 records screened, 14 studies were included. The majority of studies focused on supplementation within at-risk groups with the primary objective of either preventing fractures or falls in older adults. There was insufficient economic evidence to draw conclusions about the cost-effectiveness of population strategies. No study was identified that offered a direct comparison of the two main alternative population strategies: food fortification vs. supplementation. Whilst there is a growing body of evidence on the cost-effectiveness of micro nutrient programmes, there is a paucity of data on vitamin D fortification and how fortification programmes compare to population supplementation programmes. We highlight research gaps, and offer suggestions of what is required to undertake population-based cost-effectiveness analysis.

Vitamin Status among Breastfed Infants in Bhaktapur, Nepal.

Vitamin deficiencies are known to be common among infants residing in low- and middle-income countries but relatively few studies have assessed several biochemical parameters simultaneously. The objective of the study was to describe the status of vitamins (A, D, E, B6, B12 and folate) in breastfed infants. We measured the plasma concentrations of trans retinol, 25 hydroxy vitamin D, α-tocopherol, pyridoxal 5′-phosphate, cobalamin, folate, methylmalonic acid, homocysteine, hemoglobin and C-reactive protein from 467 randomly selected infants. One in five (22%) was deficient in at least one vitamin. Mean (SD) plasma folate concentration was 73 (35) nmol/L, and no infant in the sample was folate deficient. Vitamin B6 deficiency and vitamin B12 deficiency was found in 22% and 17% of the infants, respectively. Elevated plasma methylmalonic acid or total homocysteine concentration was found in 82% and 62% of infants, respectively. Fifteen percent of infants were vitamin A deficient and 65% were marginally deficient in vitamin A. Fewer than 5% of infants had low plasma vitamin D concentration or vitamin E concentration (α-tocopherol <9.3 µmol/L). Our results illustrate the importance of continued supplementation campaigns and support the expansion of food fortification and dietary diversification programs that target children and women in Nepal.

Medicalizing Gutom: Hunger, Diet, and Beriberi during the American Period

This article looks at American responses to food scarcity in the colonial Philippines. Dismissive of hunger and starvation in the early occupation, Americans initially ascribed ill health to poorly chosen foods like rice. Labor unrest, crop failures following Taal Volcano’s 1911 eruption, and Jose Albert’s identification of infantile beriberi, however, forced American administrators, doctors, and agriculturalists to confront scarcity in several ways. First, “corn campaigns” sought to enhance rice-based diets with corn. Second, research linking beriberi to mechanically milled rice led to vitamin B supplementation campaigns. However, the medicalization of hunger obscured the root causes of scarcity, which American rule exacerbated. KEYWORDS: BERIBERI • FAMINE • UNITED STATES • HEALTH • PHILIPPINE–AMERICAN WAR

Severe vitamin D deficiency among pregnant women and their newborns in Turkey

Objectives: Vitamin D deficiency is an important health problem in pregnant women and their infants in sunny countries. Low socio-economic status (LSES), covered dressing style, pregnancies in winter season and having dark skin are the major risk factors for vitamin D deficiency. The present study evaluated serum 25-hydroxyvitamin D3 [25(OH)D3] concentrations in pregnant women and in their newborns and determined the risk factors in LSES cities in Turkey.Methods: Ninety-seven pregnant women and their newborns were included in the study between December 2012 and February 2013. All of the pregnant women had irregular follow-up or had received no antenatal care, were pregnant during summer, had presented to the hospital after 37 weeks of gestation (WG) and had received no vitamin D supplementation. A detailed history was obtained, which included mothers’ age, number of births and dressing sytle. Maternal and cord blood samples were taken to measure 25(OH)D3 levels.Results: All of the pregnant women were predominantly LSES, had covered dressing style and none of them had received vit D3 supplementation during pregnancy. The mean serum 25(OH)D3 level and mean cord blood level of of 97 mothers were 4.97 ± 3.27 ng/ml and 4.29 ± 2.44 ng/ml, respectively. There was a strong positive correlation between maternal serum and umbilical cord 25(OH)D3 levels (r: 0.735, p < 0.05). Ninety-five mothers had serum 25(OH)D3 below 20 ng/ml and all cord blood serum 25(OH)D3 levels were below 20 ng/ml. Level of 25(OH)D3 was not correlated with mother age, WG or newborn weight. Serum 25(OH)D3 concentrations in primigravida and multigravida were 3.71 ± 1.88 and 5.2 ± 3.4 ng/ml, respectively, with a significant difference between them (p < 0.05).Conclusion: Severe vitamin D deficiency is common in reproductive women and their newborns in LSES cities of Turkey. Covered dressing style, not receiving any vitamin D supplementation and primigravida women are at greatest risk. Vitamin D supplementation campaigns which should cover pregnant women and the newborn to prevent maternal and perinatal vitamin D deficiency should be implemented especially in risk areas.

Microsatellites and multiplex PCRs for assessing aquaculture practices of the grooved carpet shell Ruditapes decussatus in Spain

Abstract Supplementation aquaculture is intended to reinforce harvestable abundances of viable, naturally reproducing populations. The grooved carpet shell Ruditapes decussatus is one of the most important shellfish species in northern Spain (Asturias and Galicia), and their wild populations are annually supplemented using seeds produced in hatcheries. The current genetic status of these populations and a genetic evaluation of the consequences of the supplementation campaigns are lacking due to the absence of useful genetic markers that allow these kinds of studies. In this work, twelve variable microsatellite markers (mean HE = 0.663) and two useful multiplex PCRs are reported for R. decussatus. Different genetic characteristics were found between wild clams from Asturias and Galicia. Moreover, the seeds obtained in hatcheries for supplementation campaigns did not represent the wild gene pools well. Reductions of effective breeding numbers relative to the actual number of breeders were as large as 65%, due to unequal parental contributions and family variances. Finally, in an experimental supplementation programme conducted in a Galician population (Cambados), we report that the genetic status of the studied population changed significantly from one year to the next (FST = 0.011 P

Knowledge on Vitamin A Rich Foods among Mothers of Preschool Children in Nepal: Impacts on Public Health and Policy Concerns

This study investigated the association of some socio-demographic, attitude, service availability and info-communication factors with the knowledge on vitamin A rich foods among mothers of preschool children in Nepal with its impacts on public health and policy concerns. The analyses demonstrated that about 71% of mothers were the Hindus ethnic group and 67% lived in nuclear family. A half of the child bearing aged mothers (51%) had higher secondary education with nearly 91% of the mothers were aware of vitamin A rich foods. A majority of mothers (53%) were in workforce and 65% of them had monthly family income above 10,000 Rupees with a good economic status. Almost 91% of the respondents’ mothers grew vitamin A rich foods in their kitchen gardens and took it in their daily meal as diet. An estimate of 93% mothers attendeda health centre with their children during the vitamin A supplementation campaign. About79% mothers reported that they knew about the first visible symptoms of vitamin A deficiency disorder (VADD) and 95% mothers knew about the night blindness. The findings revealed that in Nepal knowledge on vitamin A rich foods among mother’s of pre-school children is widely increasing, and in a particular community VADD has estimated as 9% while at the national level its real magnitude is still high at 24%. When the prevalence of VADD has been in a decreasing trend at local level communities then the overall rate also drops at the national level. Bivariate analysis showed that the three selected factors such as mother’s education levels, mother’s occupations, and monthly family income were significantly and positively associated with the mother’s knowledge on vitamin A rich foods in diet, VADD curable and include green leafy vegetable and yellow fruits in diet.As these significant factors are directly influencing the level of awareness and practice of consuming vitamin A rich foods, efforts from the government and non-government organisations are needed to improve the overall conditions of mothers and allied public policy concerns in Nepal.

Perceptions of Health, Health Care and Community-Oriented Health Interventions in Poor Urban Communities of Kinshasa, Democratic Republic of Congo

In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city’s major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and interventions. Novel ways of reducing the high out-of-pocket expenditure should also be explored.

Overestimation of Vitamin A Supplementation Coverage from District Tally Sheets Demonstrates Importance of Population-Based Surveys for Program Improvement: Lessons from Tanzania

BackgroundTanzania has conducted a national twice-yearly Vitamin A supplementation (VAS) campaign since 2001. Administrative coverage rates based on tally sheets consistently report >90% coverage; however the accuracy of these rates are uncertain due to potential errors in tally sheets and their aggregation, incomplete or inaccurate reporting from distribution sites, and underestimating the target population.ObjectivesThe post event coverage survey in Mainland Tanzania sought to validate tally-sheet based national coverage estimates of VAS and deworming for the June 2010 mass distribution round, and to characterize children missed by the national campaign.MethodsWHO/EPI randomized cross-sectional cluster sampling methodology was adapted for this study, using 30 clusters by 40 individuals (n = 1200), in addition to key informant interviews. Households with children 6–59 months of age were included in the study (12–59 months for deworming analysis). Chi-squared tests and logistic regression analysis were used to test differences between children reached and not reached by VAS. Data was collected within six weeks of the June 2010 round.ResultsA total of 1203 children, 58 health workers, 30 village leaders and 45 community health workers were sampled. Preschool VAS coverage was 65% (95% CI: 62.7–68.1), approximately 30% lower than tally-sheet coverage estimates. Factors associated with not receiving VAS were urban residence [OR = 3.31; p = 0.01], caretakers who did not hear about the campaign [OR = 48.7; p<0.001], and Muslim households [OR<3.25; p<0.01]. There were no significant differences in VAS coverage by child sex or age, or maternal age or education.ConclusionCoverage estimation for vitamin A supplementation programs is one of most powerful indicators of program success. National VAS coverage based on a tally-sheet system overestimated VAS coverage by ∼30%. There is a need for representative population-based coverage surveys to complement and validate tally-sheet estimates.

Integration of deworming into an existing immunisation and vitamin A supplementation campaign is a highly effective approach to maximise health benefits with minimal cost in Lao PDR

Infection with soil-transmitted helminths (STH) is a major public health problem in many developing countries, with pregnant women and children particularly at risk. Preventive chemotherapy, which is the intervention currently recommended by the WHO against the main helminth infections including those caused by STHs, aims at reducing morbidity through periodical administration of anthelminthic drugs either alone or in combination. The Expanded Programme on Immunization is one of the most widely implemented health programmes in the world and has well established access to children and women. The present study investigated the cost of the provision of anthelminthic drugs during existing immunisation campaigns. In Lao PDR, use of this integrated approach compared with implementation of the vertical deworming campaign alone allowed a reduction of the individual cost of deworming by 10 times (from US$0.23 in the vertical deworming campaign to US$0.03 in the integrated campaign). When drug cost was excluded, the cost of deworming an individual was US$0.007, implying that deworming 100 children would cost less than US$1 if drug donation was in place. The burden posed on health workers by the integration process was perceived as minimal and manageable. Moreover, delivery of anthelminthic drugs during immunisation campaigns enabled campaign teams to observe drug intake directly, which assured safety. These findings prove that integration is an opportunity to maximise health benefits through the delivery of multiple health products and the attainment of high coverage.

Vitamine A chez les enfants gabonais non supplémentés: relation avec les pathologies oculaires et nutritionnelles

To define vitamin A status in Gabonese children before the supplementation campaigns by UNICEF and the Gabonese Ministry of Health. We conducted an epidemiological, clinical and laboratory study at two of the main child health centers of Libreville and included 150 children aged from 0 to 156 months. We assessed their nutritional and ophthalmological status, their consumption of food rich in vitamin A and their blood levels of vitamin A (retinol). The latter was below the normal level (0.76 mmol/l) for 70% of the children. We observed the following eye diseases correlated with retinol levels: nyctalopia (16%), conjunctiva xerosis (6.7%), Bitot's spots (1.3%), corneal xerosis (3.3%), leukoma (0.7%) and blindness (1.3%). Moreover, 48.7% of the children had delayed growth, positively correlated with low retinol concentrations (0.643 mmol/l), 10% kwashiorkor and 19.9% marasmus. Among the mothers interviewed, 56% were unemployed and 69.3% knew little about vitamin A-rich food, which indeed is a rare part of the population's diet. This prospective study showed that the vitamin A deficiency is a major public health problem in Libreville. Supplementation campaigns are certainly necessary to fight it, but also and especially improved nutrition, including regular consumption of the vitamin A-rich food available in Gabonese market places.

Prevalence of vitamin D deficiency rickets in the eastern part of Turkey

Turkey, especially its eastern part, has been accepted as endemic for vitamin D deficiency rickets (VDDR). In a study performed by our team in the region in 1998, the incidence of VDDR was 6.09% in children aged between 0-3 years. In 2005, the Ministry of Health initiated a free vitamin D supplementation campaign nationwide for every infant to eradicate VDDR. In this study, we aimed to investigate the prevalence of VDDR in children aged between 0-3 years in order to evaluate the effectiveness of this campaign. Between March 2007 and February 2008, 39,133 children aged between 0-3 years who were brought to different pediatric outpatient clinics in Erzurum, Turkey, were examined for VDDR. VDDR diagnosis was made by radiological and biochemical findings in the cases who were initially suspected of having clinical VDDR. During a one-year period, 39 (0.099%) of the 39,133 patients were diagnosed with VDDR. None of the cases with rickets was taking vitamin D supplementation. The most frequent physical findings were rachitic rosary, enlargement of the wrists, and craniotabes. The laboratory findings of the cases were compatible with VDDR; serum calcium (Ca) 7.5 +/- 1.9 mg/dL, PO4 4.4 +/- 1.3 mg/dL, alkaline phosphatase (ALP) 1,341 +/- 823, 25-hydroxyvitamin D (25 (OH) D) 5.8 +/- 2.9 ng/mL, intact parathyroid hormone (iPTH) 240 +/- 106 pg/mL. It was concluded that, although VDDR has been a continuing childhood health problem, a nationwide free vitamin D supplementation campaign initiated by the government appeared to be effective in eliminating VDDR.

Vitamin A supplementation in Tanzania: the impact of a change in programmatic delivery strategy on coverage

BackgroundEfficient delivery strategies for health interventions are essential for high and sustainable coverage. We report impact of a change in programmatic delivery strategy from routine delivery through the Expanded Programme on Immunization (EPI+) approach to twice-yearly mass distribution campaigns on coverage of vitamin A supplementation in TanzaniaMethodsWe investigated disparities in age, sex, socio-economic status, nutritional status and maternal education within vitamin A coverage in children between 1 and 2 years of age from two independent household level child health surveys conducted (1) during a continuous universal targeting scheme based on routine EPI contacts for children aged 9, 15 and 21 months (1999); and (2) three years later after the introduction of twice-yearly vitamin A supplementation campaigns for children aged 6 months to 5 years, a 6-monthly universal targeting scheme (2002). A representative cluster sample of approximately 2,400 rural households was obtained from Rufiji, Morogoro Rural, Kilombero and Ulanga districts. A modular questionnaire about the health of all children under the age of five was administered to consenting heads of households and caretakers of children. Information on the use of child health interventions including vitamin A was asked.ResultsCoverage of vitamin A supplementation among 1–2 year old children increased from 13% [95% CI 10–18%] in 1999 to 76% [95%CI 72–81%] in 2002. In 2002 knowledge of two or more child health danger signs was negatively associated with vitamin A supplementation coverage (80% versus 70%) (p = 0.04). Nevertheless, we did not find any disparities in coverage of vitamin A by district, gender, socio-economic status and DPT vaccinations.ConclusionChange in programmatic delivery of vitamin A supplementation was associated with a major improvement in coverage in Tanzania that was been sustained by repeated campaigns for at least three years. There is a need to monitor the effect of such campaigns on the routine health system and on equity of coverage. Documentation of vitamin A supplementation campaign contacts on routine maternal and child health cards would be a simple step to facilitate this monitoring.

Effectiveness of Distribution of Multimicronutrient Supplements in Children and in Women and Adolescent Girls of Childbearing Age in Chiclayo, Peru

There is a need to better understand the coverage of scaled-up multimicronutrient supplementation programs. The coverage of the distribution of multimicronutrient supplements in 26 urban communities among women and adolescent girls 12 through 44 years of age and children under 5 years of age was evaluated for purposes of scaling-up. Formative research and descriptive statistics were used to analyze the distribution of supplements. Despite a delayed memorandum of understanding with the health sector and delayed delivery by the producer of the supplement, a high coverage rate of supplement distribution to the children (88% on average during the 3 months of supplementation) was still achieved as a result of the strong commitment of the community and the Integrated Food Security Program. The lower coverage rate among women and adolescent girls (47% on average) was the result of too short a period of enrollment in the program. There was no decrease of coverage during the 3 months of supplementation in both groups. Effective, sustainable, large-scale micronutrient supplementation programs require broad partnerships with commitments of governmental and nongovernmental organizations, communities, and the private sector. Availability of the supplements and communication materials must be secured well ahead of the supplementation campaign and distribution of the supplement.

We Know Much about What to Do but Little about How to Do it: Experiences with a Weekly Multimicronutrient Supplementation Campaign

Global population growth is concentrated in urban areas, but there is little understanding of how to implement the necessary interventions to control food and nutrition insecurity. In the urban area of Peru, food insecurity is characterized mainly by micronutrient deficiencies and not by energy deficiency. To increase the effectiveness and cost-effectiveness of weekly multimicronutrient supplementation programs in poor urban communities. A series of operational studies were conducted of preventive weekly multimicronutrient supplementation to reduce micronutrient-deficiency anemia in a population consisting of 8,081 children under 5 years of age and 20,082 women and adolescent girls of reproductive age (12 through 44 years). This is one of a series of papers that describe in as much detail as possible the experiences of a multimicronutrient intervention program for poor urban mothers and their young children and summarizes the lessons learned for consideration of future programming. This paper shows that such programs can achieve a high compliance with good training of program staff involvement of the community, education and motivation of beneficiaries, adequate supplies, and careful monitoring.

Randomised study of effect of different doses of vitamin A on childhood morbidity and mortality

Objectives To determine whether the dose of vitamin A currently recommended by the World Health Organization or half this dose gives better protection against childhood morbidity and mortality.Design Randomised study.Setting...