"programme_id","programme_title","programme_language","programme_type","other_program","iso3code","country_name","program_location","area","status","start_date","end_date","brief_description","references","related_policy","new_policy","partner_gov","partner_government_details","partner_un","partner_un_details","partner_ngo","partner_ngo_details","partner_donors","partner_donors_details","partner_intergov","partner_intgov_details","partner_national_ngo","partner_nat_ngo_details","partner_research","partner_research_details","partner_private","partner_private_details","partner_other","partner_other_details","cost","fsector_0","fpartner_0","fdetails_0","fsector_1","fpartner_1","fdetails_1","fsector_2","fpartner_2","fdetails_2","fsector_3","fpartner_3","fdetails_3","fsector_4","fpartner_4","fdetails_4","fsector_5","fpartner_5","fdetails_5","fsector_6","fpartner_6","fdetails_6","fsector_7","fpartner_7","fdetails_7","fsector_8","fpartner_8","fdetails_8","fsector_9","fpartner_9","fdetails_9","fsector_10","fpartner_10","fdetails_10","fsector_11","fpartner_11","fdetails_11","fsector_12","fpartner_12","fdetails_12","fsector_13","fpartner_13","fdetails_13","fsector_14","fpartner_14","fdetails_14","fsector_15","fpartner_15","fdetails_15","fsector_16","fpartner_16","fdetails_16","fsector_17","fpartner_17","fdetails_17","fsector_18","fpartner_18","fdetails_18","fsector_19","fpartner_19","fdetails_19","fsector_20","fpartner_20","fdetails_20","fsector_21","fpartner_21","fdetails_21","fsector_22","fpartner_22","fdetails_22","fsector_23","fpartner_23","fdetails_23","fsector_24","fpartner_24","fdetails_24","fsector_25","fpartner_25","fdetails_25","fsector_26","fpartner_26","fdetails_26","fsector_27","fpartner_27","fdetails_27","fsector_28","fpartner_28","fdetails_28","fsector_29","fpartner_29","fdetails_29","fsector_30","fpartner_30","fdetails_30","fsector_31","fpartner_31","fdetails_31","fsector_32","fpartner_32","fdetails_32","fsector_33","fpartner_33","fdetails_33","fsector_34","fpartner_34","fdetails_34","fsector_35","fpartner_35","fdetails_35","fsector_36","fpartner_36","fdetails_36","fsector_37","fpartner_37","fdetails_37","fsector_38","fpartner_38","fdetails_38","fsector_39","fpartner_39","fdetails_39","fsector_40","fpartner_40","fdetails_40","fsector_41","fpartner_41","fdetails_41","fsector_42","fpartner_42","fdetails_42","fsector_43","fpartner_43","fdetails_43","fsector_44","fpartner_44","fdetails_44","fsector_45","fpartner_45","fdetails_45","fsector_46","fpartner_46","fdetails_46","fsector_47","fpartner_47","fdetails_47","fsector_48","fpartner_48","fdetails_48","fsector_49","fpartner_49","fdetails_49","action_id","theme","topic","new_topic","micronutrient","micronutrient_compound","target_group","age_group","place","delivery","other_delivery","dose_frequency","impact_indicators","me_system","target_pop","coverage_percent","coverage_type","baseline","post_intervention","social_det","social_other","elena_link","problem_0","solution_0","problem_1","solution_1","problem_2","solution_2","problem_3","solution_3","problem_4","solution_4","problem_5","solution_5","problem_6","solution_6","problem_7","solution_7","problem_8","solution_8","problem_9","solution_9","other_problems","other_lessons","personal_story","language" "6039","Chispitas program","English","National","","BOL","Bolivia (Plurinational State of)","Bolivia (Plurinational State of)","Urban|Rural|Peri-urban","on-going","01-2006","","
Ferrous sulfate syrup has been the major source of iron supplementation until 2006 for the Bolivian children. Although not documented in a systematic fashion, it was generally accepted in the country that acceptance of the syrup was low due to taste and frequently reported side effects. This and the persistently high prevalence of anemia provided the case for seeking alternative approaches to micronutrient supplementation. Stressing the importance of anemia prevention and control among children 6-59 months of age in Bolivia, the Pan American Health Organization (PAHO) and the Micronutrient Initiative (MI) proposed to the Ministry of Health and Sports (MSD) to replace syrup with Micronutrient powder (MNP) at the national level. The free distribution of MNP in Bolivia was integrated into the Desnutricion Cero (Zero Malnutrition) program, an integrated strategy to combat malnutrition in Bolivia, launched by the Morales government in 2006. The Centro de Abastecimiento de Suministros de Salud (CEASS), a national procurement agency for the MSD managed the distribution of the sachets to all 9 departments on behalf of the MSD.
","","","","Health","Ministry of Health and Sport/ Nutrition unit","","","","","","","","","","","","","","","","","Municipalities purchase directly from the manufacturers at prices ranging from 14.50Bs (US$2.07) to 15Bs (US$ 2.15) for a box of 60 sachets.","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6038","Iron and/or folic acid","Iron supplementation","","","","Infants and young children","6-23 months","N/A","Commercial|Primary health care center","Free distribution through the government’s universal health care program, Seguro Universal Materno Infantil (SUMI).","Each child is provided with 60 Chispitas sachets every year. Caregivers are recommended to provide one sachet everyday for 60 days to their children.
","Anemia prevalence
","Both qualitative and quantitative information were collected from three different sources to evaluate diverse aspects of the implementation of the Chispitas program with an objective to:1. Asses efficiency of logistics systems management across different departments and health districts,2. Assess the acceptability of Chispitas by the caregivers across urban and rural areas, and 3. Know the adequacy of Chispitas preparation by caregivers. An external evaluation was done by the Asociacion de Instituciones de Promocion y Educacion (AIPE), a private firm, to achieve the first three objectives using the program monitoring data and external survey data in 2008. In addition, a workshop was conducted in September 2009 by researchers from Cornell University, MI and MSD to review the Chispitas program and provide feedback to further strengthen it. Later in 2010, a study was conducted provide data to develop a communications strategy by a private firm (TICs Communications) contracted by MI, and allow a comparison post-implementation (focus groups were also conducted). All studies/reviews only looked at the program from the public health system distribution point of view. The 2010 TICs study collected data from households and public health centers in both rural and urban municipalities in Bolivia, in each of the 9 departments of the country. The sample sizes are not large enough however to be nationally representative.
","400000 (50%)","N/A","","","","None","","Intermittent iron supplementation in preschool and school-age children>>>Intermittent iron supplementation in preschool and school-age children>>http://www.who.int/elena/titles/iron_infants","Staff skills/training","Demonstration of Chispitas preparation at the health center and explaining the benefits of Chispitas to the caregivers were identified as key strategies that could be implemented to improve acceptance among caregivers. Important factors that affect the demand for Chispitas are the capacity of health personnel, availability of promotional material, incentives and support to staff, and availability of the product itself at the local level.","Staff retention","Demonstration of Chispitas preparation at the health center and explaining the benefits of Chispitas to the caregivers were identified as key strategies that could be implemented to improve acceptance among caregivers. Important factors that affect the demand for Chispitas are the capacity of health personnel, availability of promotional material, incentives and support to staff, and availability of the product itself at the local level.","Adherence","Demonstration of Chispitas preparation at the health center and explaining the benefits of Chispitas to the caregivers were identified as key strategies that could be implemented to improve acceptance among caregivers. Important factors that affect the demand for Chispitas are the capacity of health personnel, availability of promotional material, incentives and support to staff, and availability of the product itself at the local level.","Supplies","Demonstration of Chispitas preparation at the health center and explaining the benefits of Chispitas to the caregivers were identified as key strategies that could be implemented to improve acceptance among caregivers. Important factors that affect the demand for Chispitas are the capacity of health personnel, availability of promotional material, incentives and support to staff, and availability of the product itself at the local level.","","","","","","","","","","","","","","Inclusion of Chispitas in the Desnutricion Cero strategy strengthened nutrition policy and dialogue in Bolivia generally and the Chispitas distribution program took advantage of that for immediate national implementation. Smaller scale implementation initially with good quality monitoring may have facilitated the identification and timely resolution of problems related to supply, knowledge, acceptance and utilization. The decision to immediately implement at scale diverted financial and human resources from these necessary start-up activities and left little room for the in-depth monitoring required for the timely identification and resolution of problems with the program design and barriers to appropriate implementation. Because of the national scale of the program, implications and problems need to be identified and potential solutions explored at large scale, resulting in complexities and delays in the public health systematical ability to do so.The legal framework, i.e., change of the regulation and inclusion of Chispitas in the insurance commodity package was an important step towards national implementation of the program.
","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6042","Maternal, infant and young child nutrition","Breastfeeding promotion and/or counselling","","","","Women of reproductive age (WRA)","","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1. Train health 69 staff in lactation management, including HIV in relation to breastfeeding; 2. Support the formation of 95 mother-to-mother support groups and men’s groups; 3. Support assessment and designation of 6 facilities as Baby Friendly Health Institutions (BFHI); 4. Support follow up of HIV infected mothers through mother-to-support groups and CBSV to maintain exclusive breastfeeding and monitor nutritional status and growth of the infants; 5. Train HIV infected mothers on breastfeeding techniques to decrease risk of breat inflammation that may increase HIV transmission; 6. Intensify nutrition and health education at facility and community levels monthly
","% of children 0-6 exclusively breastfed in the previous 24 hours. % of infants fed mothers' milk within 1hour after birth % ofchildren(12-23mos) exclusively breastfed for 6 months
","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","79 communities with a total population of 77, 780 children under-five years of age and 19,445 pregnant women living in an area with a population of 388, 902 people and an estimated 64,817 households are benefiting from project interventions.","Missing","","Conducted","Midterm evaluation has been conducted and results are being analysed","Vulnerable groups","","Breastfeeding – exclusive breastfeeding>>>Breastfeeding – exclusive breastfeeding>>http://www.who.int/elena/titles/exclusive_breastfeeding","Staff skills/training","Project and GHS staffs have received training in lactation management. ","Insufficient staff","We have continued to advocate for increased numbers for the beneficiary districts. To meet this gap capacities of Mother-to-mother Supports Groups(MtMSGs),Traditional Birth Attendants(TBAs) and Community Based Surveillance Volunteers(CBSVs) been built to support the action. Community Health Planning and Services(CHPS) compounds are expected to be extened by the government to remote communities to address this challenge. ","Infrastructure","We have poor roads linking most communities. There are ,however,plans by the District Assemblies to improve road infrastructure.","Adherence","The slow adoption of appropriate feeding practices by caregivers remains a challenge. Community level education has therefore, been intensified to address the situation.","Financial resources","Government's financial support to District Health Management Teams (DHMTs) is sometimes delayed and this affects the smooth implementation of project interventions.","","","","","","","","","","","","","I have observed that grandmothers' and men's involvement in the action implementation is critical. In some communties for instance, father-to-father support groups have been formed to support the action. Capacity building for groups such as CBSVs, MtMSGs, TBAs, women's and men's groups, faith-based organizations(FBOs) etc at the community could contribute immensely to project outcomes.
","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6044","","Complementary feeding promotion and/or counselling","","","","Women of reproductive age (WRA)","","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1. Train 105 GHS staff and CBSVs in Community Based Growth Promotion (CBGP) 2. Institute CBGP in 15 poor and hard to reach communities including visits to OVCs under 5 to make sure these children go for growth monitoring3. Train 60 GHS, World Vision staff in Infant and Young Child Nutrition counselling4. Provide equipment for growth monitoring and counseling5. Carry out quarterly food demonstration sessions including low-labour nutritious meals that can be prepared/managed by mothers who are ill in communities using nutrient and energy dense locally available foods 6. Intensify monthly nutrition and health education for mothers and other caregivers, including appropriate messages for HIV+ve mothers through CBSV, CCC and health staff","% of children< 2 years underweight % of children 12-23 months who are still breastfeeding % of sick children 6-59 month who received increased fluids and continues feeding during an illness in the last 2 weeks % of children 6-59 month attending growth promotion sessions at least once every 3 months % of children 6-59 months who ate solid or semi-solid food at least the minimum recommended no. of times 24hrs preceding survey","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","89447","","","Conducted","Midterm evaluation has been conducted and results are being analysed.","Vulnerable groups","","Complementary feeding>>>Complementary feeding>>http://www.who.int/elena/titles/complementary_feeding","Staff skills/training","Project and GHS staffs have received training in lactation management. ","Insufficient staff","We have continued to advocate for increased numbers for the beneficiary districts. To meet this gap capacities of Mother-to-mother Supports Groups(MtMSGs),Traditional Birth Attendants(TBAs) and Community Based Surveillance Volunteers(CBSVs) been built to support the action. Community Health Planning and Services(CHPS) compounds are expected to be extened by the government to remote communities to address this challenge. ","Infrastructure","We have poor roads linking most communities. There are ,however,plans by the District Assemblies to improve road infrastructure.","Adherence","The slow adoption of appropriate feeding practices by caregivers remains a challenge. Community level education has therefore, been intensified to address the situation.","Financial resources","Government's financial support to District Health Management Teams (DHMTs) is sometimes delayed and this affects the smooth implementation of project interventions.","","","","","","","","","","","","","Cultural barriers could impede the action as mothers/caregivers who have acquired knowledge and are willing to feed their children appropriately could be prevented from doing so.","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6045","","Management of moderate malnutrition","","","","Infants and young children","","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based","","1. Purchase vegetable seeds and citrus seedlings2. Distribute vegetable seeds and seedlings to households and groups3. Purchase small animals 4. Distribute small animals to households and groups5. Train beneficiaries in the raising of small animals and crop production techniques6. Support the processing of vegetables materials)7. Produce/adapt & distribute IEC materials8. Carry out community education on animal husbandry and crop production","% of households producing fruits for their own consumption% of households producing vegetables for their own consumption% of households growing and using nutrient-dense drought-tolerant crops for their food sources e.g. cowpeas, green grams, groundnuts etc% of household rearing and using one or more type of high protein animal/poultry based foods sources eg. Chicken, fish etc.% of households practicing food preservation techniques% of women controlling some household resources e.g. animals, land etc","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","2400","","","Conducted","Midterm evaluation has been conducted and results are being analysed.","Vulnerable groups","","eLENA titles related to prevention or treatment of moderate acute malnutrition in children>>>Supplementary feeding in community settings for promoting child growth>>http://www.who.int/elena/titles/child_growth|Food supplementation in children with moderate acute malnutrition>>http://www.who.int/elena/titles/food_children_mam","Financial resources","Government's financial support to District Agriculture Development Unit is sometimes delayed and this affects the smooth implementation of project interventions. We continue to advocate for timely disbursement of funds.","Adherence","","Infrastructure","We have poor roads linking most communities. There are ,however,plans by the District Assemblies to improve road infrastructure.","","","","","","","","","","","","","","","Although, households with children under-five in particular are targeted, the provision of inputs has been demand-driven. Consquently, the response by households has not been at the level expected.","Continuous community level education by Agriculture Extension Agents (AEAs) has, however, brought about improvement in the implmentation of the action. Land availability for home gardening activities is a challege in some communities. Group garden activities are therefore being considered. ","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6046","Acute malnutrition","Growth monitoring and promotion","","","","Infants and young children","0-59months","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1.Support monthly growth monitoring2.Train 105 GHS staff and CBSVs in Community Based Growth Promotion (CBGP) 3.Institute CBGP in 15 poor and hard to reach communities including visits to OVCs under 5 to make sure these children go for growth monitoring","% of boys and girls underweight (WAZ<-2) % of children 6-59 month attending growth promotion sessions at least once every 3 months","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","77780","","","Conducted","Midterm evaluation has been conducted and results are being analysed","Vulnerable groups","","","Insufficient staff","","Supplies","","Stakeholder","","","","","","","","","","","","","","","","","","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6047","Stunting","Vaccination","","","","Infants and young children","0-59 months","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1. Support GHS in increasing immunization coverage among children < 5 years2. Support GHS in carrying out follow-ups on IMNCI activities at health facility and community levels3.Produce/adapt and distribute IEC materials on vaccine preventable diseases4.Carry out education on vaccine preventable diseases in communities
","% of children12-23 months fully immunized
","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","77780","","","Conducted","Midterm evaluation has been conducted and results are being analysed","Vulnerable groups","","","Insufficient staff","","Supplies","","","","","","","","","","","","","","","","","","","","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6048","Acute malnutrition","Oral rehydration solution promotion","","","","Infants and young children","0-59 months","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1. Purchase ORS2. Distribute ORS to CBSVs and health facilities 3. Support GHS in providing quality treatment to children with diarrhoea5.Train GHS and World Vision Staffs in IMNCI4. Support GHS in carrying out follow-ups on IMNCI activities at health facility and community levels5.Produce/adapt and distribute IEC materials on control of diarrhea6.Carry out education on environmental sanitation and personal hygiene in communities","1.% of children with diarrhoea in the previous 2 weeks(or last episode of diarrhoea) who received ORT 2. % of health facilities(or alternative access point) with no stock out for ORT in the previous three months","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","77780","","","Conducted","Midterm evaluation has been conducted and results are being analysed","Vulnerable groups","","","Insufficient staff","","Adherence","","Stakeholder","","","","","","","","","","","","","","","","","Mothers/caregivers have difficulties continuing feeding as well as increasing the amount of fluids given their children during illness.","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6049","Acute malnutrition","Distribution of insecticide-treated bednets","","","","Infants and young children","0-59 months","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1. Purchase LITNs2. Distribute LITNs to children under five years and pregnant women3. Support GHS in carrying out follow-ups on IMNCI activities at facility and community level4. Produce/adapt and distribute IEC materials on malaria5. Carry out education on malaria control in communities","% of children Under five sleeping under an LLITN the previous night% of pregnant women who slept under an LLITN the previous night","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","7,460 (children 0-59 months), 2615 PWs","","","Conducted","Midterm evaluation conducted and results are being analysed","Vulnerable groups","","Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>>Insecticide-treated nets to prevent malaria and anaemia in pregnant women>>http://www.who.int/elena/titles/bednets_malaria_pregnancy","Adherence","Community level education to encourage households to sleep under insecticide-treated bednets has been intensified.","","","","","","","","","","","","","","","","","","","","","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6050","","Vitamin A supplementation","","","","Infants and young children","","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1.Through monthly routine EPI2. Bi-annual spplementation
","% of children 6-59 months who received vitamin A capsules in previous 6 months
","1.Key performance indicator was baselined to establish coverage at the beginning of the project.2.Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders.3. Midterm and Endterm project evalutions will be conducted.
","","","","","","Vulnerable groups","","Vitamin A supplementation in infants and children 6–59 months of age>>>Vitamin A supplementation in infants and children 6–59 months of age>>http://www.who.int/elena/titles/vitamina_children","Insufficient staff","Insufficient staffing levels of partner institutions particularly of Ghana Health Service(GHS) remains a challenge. We have continued to advocate for increased numbers for the beneficiary districts. Community Health Planning and Services(CHPS) compounds are expected to be extened by the government to remote communities to address this gap.Occassional stock out of vitamin A capsules at health facilities. Regular monitoring of stock levels and communication with the logistics department/stores at all levels in timely for support has beed encouraged.","Infrastructure","We have poor roads linking most communities. There are ,however,plans by District Assemblies to improve road infrastructure. Insuffient staffing levels of partner institutions particularly of Ghana Health Service(GHS) remains a challenge. We have continued to advocate for increased numbers for the beneficiary districts. Community Health Planning and Services(CHPS) compounds are expected to be extened by the government to remote communities to address this gap.Occassional stock out of vitamin A capsules at health facilities. Regular monitoring of stock levels and communication with the logistics department/stores at all levels in timely for support has beed encouraged.","Supplies","Occasional stock out of vitamin A capsules at health facilities. Regular monitoring of stock levels and communication with the logistics department/stores at all levels in timely for support has been encouraged.","","","","","","","","","","","","","","","","","","English" "6043","Integrated Malnutrition, HIV/AIDS & TB (IMHAT) Prevention and Control Project","English","Community/sub-national","","GHA","Ghana","Nadowli, Upper West, Ghana| Tolon, Kumbungu, Northern, Ghana| Kintampo South, Ghana|Brong Ahafo,Ghana|Northern, Ghana","Urban","on-going","01-2009","09-2013","The goal of the IMHAT Project is to contribute to the reduction and prevention of malnutrition, HIV/AIDS, TB and thereby contribute to reduction of child mortality rates in the Nadowli, Kintampo South and Tolon-Kumbungu districts. The specifc objectives of the project include the following: 1.Improved quality of diet for children under-five years and families 2.Improved access to essential health services and a healthy environment 3. Improved household food security 4. Strengthen capacity of World Vision, communities and partner institutions to implement programs to address malnutrition, health(including HIV/TB) and food security issues.
","","","","Cabinet/Presidency","","","","","","","","","","","","","","","","","","Budget(2009-2012)= US$667,757","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6051","Acute malnutrition","Preventive malaria treatment","","","","Pregnant women (PW)","","Nadowli, Tolon-Kumbungu, and Kintampo South districts respectively in the Upper West, Northern and Brong Ahafo regions of Ghana","Community-based|Hospital/clinic|Primary health care center","","1. Carry out education on malaria control in communities2.Support education to increase proportion of pregnant women accessing IPT service at health facilities","% of women who received two doses of SP during last pregnancy","Key performance indicators were baselined to establish coverage at the beginning of the project. Monitoring of project interventions are conducted monthly. Monthly, quarterly, semi-annual and annual reports(narrative and financial) are collated to inform management decisions. These reports are shared with key stakeholders. Midterm and endterm project evalutions will be conducted.
","19445","","","Conducted","Midterm evaluation has been conducted and results are being analysed","Vulnerable groups","","","Adherence","","","","","","","","","","","","","","","","","","","","","","","English" "6067","Integrated Nutrition Package","English","Community/sub-national","","LKA","Sri Lanka","Sri Lanka","Urban| Rural| Peri-urban","on-going","01-2009","01-2013","a) Prevalence of low birth weight reduced by 4 percentage point from 2006 level; b) Prevalence of underweight among children under 3 years of age reduced by 30%; c) Mean weight gain during pregnancy increased by 30 per cent from basline data to be established in 2009; d) Nutritional anaemia among children 6 to 24 months reduced by 30 per cent; e) Nutritional anaemia among adolescent reduced by 30 per cent;
","www.mri.gov.lk/nutrition
","","","","","","","","","","","","","National NGOs","Sarvodaya","","","","","","","Mainly by the UNICEF and shared with the Government, Ministry of Health","UN","United Nations Children's Fund (UNICEF)","Every other week for 4 months - 1 sachet per time
","Percentage of children 6 to 24 months with nutritional anaemia
","Quarterly and bi-annual review meetings at the district, provincial and national levels; External reviews at the mid-point of the project implementation; Final evaluation: During this phase, data will be collected and compared with baseline information. The same data collection techniques and instruments will be followed as in the baseline. The same group of interviewers will be re-trained before data collection and their work will be supervised at community level.
","","30.00%","","25%","not completed
","Sex","","","Adherence","","Supplies","","Communication","","","","","","","","","","","","","","","","","Very good coverage of the programme with poor adherence continously. Mid term review did not show much improvement
","Sri Lanka is having mild anaemia with very less moderate and hardly any severe anaemia. MMN was tested globally in moderate to severe set up. This may be the reason we did not see much improvement compared to other countries.
","English" "6085","Weekly iron and folic acid supplementation (WIFS)/de-worming program","English","Community/sub-national","","VNM","Viet Nam","Yen Bai, Vietnam","Rural","on-going","01-2006","","Periodical deworming and weekly supplementation of iron was offered free of charge to more than 52 000 women in the province. The acceptance of the intervention and the nutritional outcomes were followed up. In March 2008 the programme was expanded to cover 250 000 and the management handed over to provincial authorities.
","Pasricha SR, et al. Baseline Iron Indices as Predictors of Hemoglobin Improvement in Anemic Vietnamese Women Receiving Weekly Iron-Folic Acid Supplementation and Deworming (2009). American Journal of Tropical Medicine and Hygiene 81;1114-9.
Phuc TQ, et al. Lessons learned from implementation of a demonstration program to reduce the burden of anemia and hookworm in women in Yen Bai Province, Viet Nam. (2009). BMC Public Health.; 9: 266.
Casey GJ, et al. Long-term weekly iron-folic acid and de-worming is associated with stabilised haemoglobin and increasing iron stores in non-pregnant women in Vietnam. (2010) PLoS ONE 5, e15691.
Casey GJ., et al. Weekly iron-folic acid supplementation with regular deworming is cost-effective in preventing anaemia in women of reproductive age in Vietnam PLoS ONE [in print]
","","","Health","Provincial Health Department","World Health Organization (WHO)","","","","","","","","","","Research/academia","University of Melbourne","","","","","80 000 USD/ year initially provided by the University of Melbourne, as a starting up (including training activities and development of education material) after the first years the Provincial Health Department covered the running cost. WHO donated the deworming drugs.","Research/academia","","University of Melbourne","Government","","Provincial Health Department","UN","World Health Organization (WHO)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6084","Acute malnutrition","Iron and folic acid supplementation","","Folic acid|Iron","","Women of reproductive age (WRA)","15-45 years","Yen Bai province","Primary health care center","","Weekly iron-folic acid tablets; 200mg ferrous sulphaet/0.4 mg folic acid
Deworming every 4 months with one albendazole tablet (400 mg) in the first year and 6-monthly thereafter
","Anemia prevalence
","Periodical prevalence surveys and compliance monitoring by the research and training centre for community development.
","52000 (In March 2008 the programme was expanded to cover 250 000 and the management handed over to provincial authorities.)","missing","","STH infection 75%","(after 30 months) STH infection 22%","Vulnerable groups","","Intermittent iron and folic acid supplementation for menstruating women>>>Intermittent iron and folic acid supplementation for menstruating women>>http://www.who.int/elena/titles/iron_women","Adherence","Independent monitoring started early to be able to modify training and packaging","Financial resources","No solution","","","","","","","","","","","","","","","","","","","In March 2008 the programme was expanded to cover 250 000 and the management handed over to provincial authorities.
","English" "6085","Weekly iron and folic acid supplementation (WIFS)/de-worming program","English","Community/sub-national","","VNM","Viet Nam","Yen Bai, Vietnam","Rural","on-going","01-2006","","Periodical deworming and weekly supplementation of iron was offered free of charge to more than 52 000 women in the province. The acceptance of the intervention and the nutritional outcomes were followed up. In March 2008 the programme was expanded to cover 250 000 and the management handed over to provincial authorities.
","Pasricha SR, et al. Baseline Iron Indices as Predictors of Hemoglobin Improvement in Anemic Vietnamese Women Receiving Weekly Iron-Folic Acid Supplementation and Deworming (2009). American Journal of Tropical Medicine and Hygiene 81;1114-9.
Phuc TQ, et al. Lessons learned from implementation of a demonstration program to reduce the burden of anemia and hookworm in women in Yen Bai Province, Viet Nam. (2009). BMC Public Health.; 9: 266.
Casey GJ, et al. Long-term weekly iron-folic acid and de-worming is associated with stabilised haemoglobin and increasing iron stores in non-pregnant women in Vietnam. (2010) PLoS ONE 5, e15691.
Casey GJ., et al. Weekly iron-folic acid supplementation with regular deworming is cost-effective in preventing anaemia in women of reproductive age in Vietnam PLoS ONE [in print]
","","","Health","Provincial Health Department","World Health Organization (WHO)","","","","","","","","","","Research/academia","University of Melbourne","","","","","80 000 USD/ year initially provided by the University of Melbourne, as a starting up (including training activities and development of education material) after the first years the Provincial Health Department covered the running cost. WHO donated the deworming drugs.","Research/academia","","University of Melbourne","Government","","Provincial Health Department","UN","World Health Organization (WHO)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","8875","","Deworming","","","","Women of reproductive age (WRA)","15-45","Yen Bai ","Community-based","","","Hookworm prevalence
","","250000","missing","","","","Vulnerable groups","","Deworming to combat the health and nutritional impact of soil-transmitted helminths>>>Deworming to combat the health and nutritional impact of soil-transmitted helminths>>http://www.who.int/elena/titles/deworming","","","","","","","","","","","","","","","","","","","","","","","","English" "6098","Labelling of foods with nutritional information","English","Other","","TUN","Tunisia","Tunisia","Urban|Rural|Peri-urban","planned","","","Food labelling including nutritional information has been specified by a decree issued on September 2008 by the Ministry of Public Health, the Ministry of Trade and Handicrafts and the Ministry of Energy and Small and Medium Enterprises. Educate consumers to read food labels before buying in order to make healthy choice is an action included in the national strategy to combat obesity and promote healthy life. Ministry of public health and representatives from all relevant government institutions, and private sector are partners in this programme.
","WHO Global Nutrition Policy Review 2009-2010, Module 6, Id:195, Respondent: Pr Jalila EL ATI National Institute of Nutrition and Food Technology 11 rue Jebel Lakhdar - Bab Saadoun 6 1007 Tunis, Tunisie
","","","","","","","","","","","","","","","","","","","","","Not yet available.","Government","","Food labelling including nutritional information has been specified by a decree issued on September 2008 by the Ministry of Public Health, the Ministry of Trade and Handicrafts and the Ministry of Energy and Small and Medium Enterprises. Educate consumers to read food labels before buying in order to make healthy choice is an action included in the national strategy to combat obesity and promote healthy life. Ministry of public health and representatives from all relevant government institutions, and private sector are partners in this programme.
","WHO Global Nutrition Policy Review 2009-2010, Module 6, Id:195, Respondent: Pr Jalila EL ATI National Institute of Nutrition and Food Technology 11 rue Jebel Lakhdar - Bab Saadoun 6 1007 Tunis, Tunisie
","","","","","","","","","","","","","","","","","","","","","Not yet available.","Government","","the school nutrition programme is to ensure that all school aged children have access to nutritious foods and beverages whilst on the school compound.
","","","","","","","","","","","","","","","","","","","","","","A costed plan of action is being developed to support implementation of the policy","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","6106","","School feeding programmes","","","","School age children (SAC)","","","Community-based","","","number of schools fully implementing the policy
","","all schools","Approx. 15%","","","","None","","","Insufficient staff","","Staff skills/training","","Adherence","","","","","","","","","","","","","","","","","","","English" "8907","Suplementacion con Hierro y Acido Folico a Embarazada y Puerperas","Spanish","National","","GTM","Guatemala","Guatemala","Urban|Rural|Peri-urban","on-going","","","Entrega de tabletas de hierro y acido folico a mujeres embarazadas y puerperas
","","","Plan Hambre Cero","Health","Direcciones de Areas de Salud y su red de servicios","","","","","","","","","","","","","","","","","El costo de la tableta de Hierro es de Q0.12El costo de la tableta de Acido Folico es de Q0.18Se entregan 52 tabletas al año por mujer de hierro y acido folico","Government","Finance","A travéz del presupuesto del Ministerio de Salud Publica y Asistencia Social","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","8906","","Iron and folic acid supplementation","","Folic acid|Iron","Tableta de Sulfato Ferroso y tableta de acido folico","Pregnant women (PW)","Mujeres embarazadas y puerperas","Guatemala","Hospital/clinic|Primary health care center","","Se entregan 52 tabletas de hierro y 52 tabletas de acido folico por año mujer
13 tabletas de cada una de forma trimestral para que la mujer consuma una tableta a la semana.
","Numero de embarazadas y puerperas con entrega de hierro y acido folico * 100
Numero de embarazadas y puerperas
","A travéz del registro en el Sistema de Información Gerencial en Salud -SIGSA-
","90,491","90%","Period","Mujeres embarazadas y puerperas con entrega de hierro y acido folico","Mujeres embarazadas y puerperas suplementadas con hierro y acido folico","Vulnerable groups","","","Adherence","","","","","","","","","","","","","","","","","","","","","","","Spanish" "11483","The MOST Project","English","Multi-national","","ETH|GHA|ZAF|UGA|ZMB","Ethiopia|Ghana|South Africa|Uganda|Zambia","Ethiopia|Ghana|South Africa|Uganda|Zambia","Urban|Rural|Peri-urban","completed","01-1997","01-2001","Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Twice a year, at designated times, the three programs distribute capsules to children aged six months to five years. Each program follows a campaign model based upon intensified social mobilization and service delivery over two to seven days. The twice-yearly events have created a cadre of field-tested personnel in the three countries, who are skilled at working with the local communities and at promoting their support and active participation. All three programs have been associated with National Immunization Days (NIDs), a WHO global program to eradicate polio. Since NIDs were held annually, however, they provided an opportunity for only one dose of vitamin A each year. Because children with vitamin A deficiency should receive a supplement at least twice a year (every four to six months), another mechanism was needed for the second dose. Relying exclusively upon facility-based distribution to deliver the second dose was not a viable option for several reasons, but in particular because healthfacility attendance for older children was not high enough to ensure adequate coverage in the one-to-five-year age group.
In Zambia, the first non-NIDs vitamin A supplementation program was launched in August 1999, and later renamed Child Health Week (CHW) to make the focus on the child more explicit. It was also felt that, instead of limiting activities to a vertical vitamin A supplementation program, the opportunity should be seized to deliver an integrated service that included not only vitamin A capsules but also other health services such as de-worming, health education, immunization, family planning, prenatal care, and growth monitoring. Districts were encouraged to provide an integrated package of services commensurate with their local capacity and need — as long as vitamin A supplementation remained the core activity during that week. In Zambia, the first NIDs campaign took place in 1997, and was a nationwide undertaking. The program was scaled down to about half the districts in recent years. Since 1999, the focus has shifted to priority districts, where communities have been at a constant risk of cross-border polio infections due to civil-war-related migrations from neighboring countries. This narrower focus is referred to in Zambia as sub-NIDS.
The first round of vitamin A supplementation in Ghana was integrated into NIDs in 1996. By 1999, a detailed plan was developed to implement a nationwide stand-alone supplementation program for the second round. In 2000, the Ministry of Health (MOH) carried out the first vitamin A standalone capsule distribution in the country’s ten regions. Since that date, the program has become a two- to three-day stand-alone event used to deliver a second dose of vitamin A to all children 6 to 59 months of age. Volunteers from the Ghana Education Service, along with personnel from other decentralized departments, assist with the supervision and capsule-distribution effort. Community-based volunteers are in direct contact with caregivers and children and also work very closely with health workers, assemblymen, chiefs, opinion leaders, gong-gong beaters, and other community leaders to mobilize beneficiaries, administer vitamin A, and maintain distribution records.
In contrast to Zambia and Ghana, Nepal followed a phased approach to program implementation. Integration of vitamin A into NIDs in Nepal was initiated in 1997,
four years after a supplementation program was established in 8 of the country’s 75 districts. The second distribution campaign has since been phased in at a rate of eight to ten districts per year. By 2001, the program covered all but three politically unstable districts. Under the program, high-dose vitamin A capsules are distributed to all children aged 6 to 59 months during a twoday event.
","
Ghana
A monitoring team consisting of national, regional, and district supervisors carries out organized and random spot checks. Where necessary, vitamin A capsule administrators are assisted in performing their tasks. Capsule-distribution teams use all means of transportation available within the region and district, whether these be 4x4 vehicles, 2x4 pickups, motorcycles, or bicycles. MOH, district assemblies, decentralized departments, and local and international NGOs provide fuel and contribute to vehicle maintenance. At the end of each day, tally sheets are counted and summary sheets completed. Data are compiled by sub-district and district health management teams. After all figures are checked for accuracy, district coverage is calculated. District coverage data are sent to the regional nutrition officers and senior medical officers of public health, who compile regional coverage figures before sending them to the Nutrition Unit in Accra. Using regional figures, the Nutrition Unit estimates national coverage.
Zambia
Monitoring teams consisting of national, provincial, and district staff carry out systematic or random observations, depending on what they are monitoring. Where necessary, vitamin A capsule administrators are assisted in performing their tasks. At the end of each day, tally sheets are counted, summary sheets completed, and data compiled. District figures are then checked for accuracy, after which district coverage is calculated and the results forwarded to NFNC.
","Ghana: 3.5 million children ","Ghana: Exceeded target in May 2001; Zambia: 28 percent in 1999, 88 in Febraury 2002","","serum retinol levels of &lt;20 ug/dl,night-blindness prevalence,vitamin A supplementation coverage for children,subclinical vitamin A deficiency,","serum retinol levels of <20 ug/dl,night-blindness prevalence,vitamin A supplementation coverage for children,subclinical vitamin A deficiency,","Vulnerable groups","","Vitamin A supplementation in neonates>>>Vitamin A supplementation in neonates>>http://www.who.int/elena/titles/vitamina_neonatal","Insufficient staff","In Zambia and Ghana, it has been somewhat more difficult to generate a consistent cadre of volunteers for the vitamin A distribution. In each country, districts mobilize health post and sub-health post staff, identify extended outreach sites (including clinics, schools, and community centers),and then recruit community members to assist them with their activities. In Ghana, this has been relatively successful since there have been adequate clinic staff and a manageable number of outreach sites. In spite of this, many districts have continued to do some house-to-house visits to ensure high coverage. In Zambia, it has been more difficult to recruit community volunteers, and the clinic staff have been stretched to cover outreach sites.","","","","","","","","","","","","","","","","","","","","","Robin Houston (2003). Why They Work: An analysis of three successful public health interventions - Vitamin A supplementation programs in Ghana, Nepal, and Zambia
Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Five data collection methods were used:
During the fieldwork, the enumerators worked in pairs. The enumerators were not allowed to use the instruments in the facilities where they worked. Each pair spent a full day at a health facility. Field supervisors supported the enumerators during the data collection and checked the questionnaires for consistency and completeness. This was to ensure that the data collected was accurate as possible.
","""""Many pregnant mothers do not come to ANC because they had several normal pregnancies and think all will continue to go on well always.”
- Health worker, Apac
“ The health worker at the health centre is very rude, she has no time for us; so we fear even asking questions or discussing any issue about our health. So I go all the way to Naguru health clinic and only here if I have no money for transport.”
- A pregnant woman, Kojja, Mukono
“ I think these tablets for blood should be given only to pregnant women who have no blood. It may cause a high blood level and lead to high blood pressure.”
- TBAs, Kyampisi
“ Women with increased blood should not take these tablets (iron and folic acids) because their heartbeats will increase and they will sweat very much.”
- TBAs, Seeta Nazigo
“ Some mothers say it smells and they throw away the tablets soon after the clinic.”
- Pregnant mothers, Kojja
“ Some mothers do not like taking tablets when they are pregnant.”
- Pregnant mothers, Seeta Nazigo
Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Ethiopia
MOST is providing technical and implementation support to the Ministry of Health in the development of a national micronutrient program. The program is a cooperative effort between the MOH, USAID/Ethiopia, MOST, and UNICEF. Program components include strengthening of the newly formed nutrition division at the MOH and the micronutrient committee; development of a locally designed vitamin A supplementation strategy and its pilot test; support for initial trials of vitamin A sugar fortification in one of the country's four sugar factories; and support for information, education, and communication activities.
South Africa
MOST is working with counterparts at the University of the Western Cape (UWC) to support and strengthen a new vitamin A supplementation program being started by the Department of Health in Eastern Cape province. MOST is also supporting a pilot initiative by UWC that aims to incorporate micronutrient interventions into the Eastern Cape Integrated Nutrition Program.
.
","","","","","","","Vulnerable groups","","Vitamin A supplementation in neonates>>>Vitamin A supplementation in neonates>>http://www.who.int/elena/titles/vitamina_neonatal","","","","","","","","","","","","","","","","","","","","","","","","English" "11483","The MOST Project","English","Multi-national","","ETH|GHA|ZAF|UGA|ZMB","Ethiopia|Ghana|South Africa|Uganda|Zambia","Ethiopia|Ghana|South Africa|Uganda|Zambia","Urban|Rural|Peri-urban","completed","01-1997","01-2001","Background
Micronutrient deficiency adversely affects the health and economic and social development of individuals, communities, and nations. Given their high prevalence in developing regions, deficiencies in vitamin A, iron, and iodine have great public health significance.
Vitamin A deficiency weakens the immune system and, hence, increases the severity of infections. It is also the most common cause of blindness among children in developing countries. Iron deficiency anemia impairs immunity and reduces physical and mental capacities of populations. Iodine deficiency is the leading cause of mental and physical retardation in infants and children worldwide. As with vitamin A and iron, iodine deficiency increases the risk of death in newborns.
Programs that promote improved micronutrient status can alleviate the disability, morbidity, and mortality—particularly among young children and women—that are the consequences of micronutrient deficiency.
The MOST Mission
The MOST mission is to 1) maintain and enhance USAID's global leadership position in addressing micronutrient malnutrition, particularly vitamin A deficiency; 2) implement and evaluate state-of-the-art interventions to alleviate micronutrient deficiencies; and 3) provide technical guidance and coordination to other USAID projects with micronutrient-related components.
The MOST Strategy
The MOST strategy is built upon a framework of global and country-level results:
The global agenda focuses on 1) promoting a revised global agenda in collaboration with other organizations worldwide committed to reducing micronutrient malnutrition; 2) translating scientific knowledge into policy and program action; and 3) maximizing lessons learned through USAID’s extensive field program experience.
Country-level results address deficiencies in vitamin A, iron, and iodine: 1) vitamin A coverage of at least 80 percent of deficient children under 6 years of age; 2) moderate to severe anemia decreased by 30 percent in pregnant women and children 6–24 months of age; and 3) percentage of the population with symptoms of iodine deficiency reduced by 30 percent.
Country Activities
For micronutrient delivery at the country level, MOST’s role is to provide technical support to countries to guide the use of not only USAID funds, but also the full range of financial and human resources needed to eliminate micronutrient deficiencies from the list of public health problems.
In the design of country activities, MOST seeks the appropriate balance between supplementation, food fortification, and other food-based approaches to deliver micronutrients to at-risk populations in an effective, yet affordable way. Country activities are based upon analyses of a variety of relevant information:
—Prevalence and severity of micronutrient deficiencies
—Awareness of effects of micronutrient deficiencies
—Nutrition policies and programs
—Providers’ motivation, knowledge, and practices
—Food consumption data
—Production, distribution, and marketing of staple foods
—Estimates of the costs of alternative interventions
Key Areas of Activity
—Application of behavior change techniques to create demand for micronutrient programs and services
—Enhancement of the effectiveness and sustainability of supplementation programs
—Sound planning, implementation, and quality control of fortification programs
—Inclusion of other food-based approaches in programs
—Application of appropriate economic analysis to guide the evolution of country programs
—Use of monitoring and evaluation to improve program operations
—Development of public and private sector alliances to enhance the effectiveness of interventions
Target Groups
MOST focuses on the improvement of the micronutrient status of children under 6 years of age and women of childbearing age. Several intervention options available to address micronutrient deficiency, such as food fortification, will benefit not only those target groups, but also school-age children and adult males.
The MOST Team
The MOST team consists of five organizations led by the International Science and Technology Institute, Inc. (ISTI) as the primary contractor. ISTI's partners are the Academy for Educational Development, Helen Keller International, the International Food Policy Research Institute, and Johns Hopkins University.
In addition, five resource institutions have joined MOST for in-country implementation and technical tasks: CARE, International Executive Service Corps, Population Services International, Program for Appropriate Technology in Health, and Save the Children.
","Government agencies encouraged the initial development of fortification: NFNC promoted initial research, sponsored meetings, and coordinated activities related to fortification; MOH researched the legal framework; the National Institute for Scientific and Industrial Research (NISIR) provided technical guidance; the Food and Drug Control Laboratory (FDCL) conducted monitoring and evaluation; and the Zambian Revenue Authority (ZRA) examined the tax structure. Industry acceptance allowed planning to begin, but donor support was critical to the development of the program: the U.S. Agency for International Development (USAID) was the lead financer of the project and provided technical assistance, UNICEF provided spare parts, and the Japanese International Cooperation Agency (JICA) provided spectrophotometers for Zambia Sugar and the FDCL.
While legislation was still being developed, Zambia Sugar went ahead with the launch of fortified Whitespoon Sugar on May 15, 1998. Zambia Sugar began its fortification program at 15 mg/kg, but cost considerations led the company to reduce the level to 10 mg/kg within three months. In May 1997, one year before fortification began, a consultant estimated the cost of fortifying 100,000 metric tons of sugar at 16 mg/kg to be around $1 million U.S., while fortifying at 20 mg/kg would cost almost $1.25 million.24 Reducing the level from 16 to 10 mg/kg could thus have reduced costs by approximately $375,000 a year.
","Modified Relative Dose Response Test (MRDR) in children
","The first outside tests of fortificant levels in sugar were controversial. Four months after the launch of fortified sugar, a team consisting of representatives from the MOH, the NFNC, and NISIR visited the Zambia Sugar mill. The team tested samples from the mill at the FDCL; these tests showed far lower levels of vitamin A than those shown in tests by Zambia Sugar. The government’s tests indicated a range of 0–13.6 mg/kg, while Zambia Sugar’s tests indicated a range of 9–21 mg/kg for the same samples. Zambia Sugar believes that the samples suffered sedimentation in the transport to the government laboratory and that this explains the different results.
MOST, the USAID micronutrient program, sponsored the creation of training manuals for health inspectors and Food and Drug enforcement officers, as well as a national training workshop from September 24 to October 7, 2000. The workshop focused on inspection procedures and methods, provided laboratory training where appropriate, and included a trip to the Zambia Sugar plant. Since the implementation of that program, Zambia Sugar has expressed satisfaction with law enforcement efforts. UNICEF subsequently funded workshops at the district level, using reproductions of the training manuals that had been produced with MOST funding.
","nationwide","..","","","","Vulnerable groups","","","Financial resources","","Communication","","Financial resources","","Adherence","","","","","","","","","","","","","","","","","English" "11489","Nutritional Improvement for children in urban Chile and Kenya (NICK) Project","English","Multi-national","","KEN","Kenya","Mombasa, Kenya","Urban","on-going","01-2010","01-2013","NICK (Nutritional Improvement for children in urban Chile and Kenya) is a three year study that started in October 2010 with funding from the UK Government Department for International Development (DFID) through the Economic and Social Research Council. This study helps the cities of Mombasa in Kenya and Valparaíso in Chile reduce child malnutrition using participatory action research to broaden stakeholder participation at municipal level to change the social determinants. These determinants control the everyday conditions in which people are living and include education, income, working conditions, housing, neighbourhood and community conditions, and social inclusion. It is envisaged that this study will contribute to existing knowledge and also serve as a useful guide for action not only in Kenya and Chile but also in other countries with high levels of child malnutrition.
The NICK project is being implemented in one Mombasa informal settlement (with one matched control settlement). The project, which started on October 1st 2010 and ends on September 30th 2013, is guided by the following central question: Can child malnutrition amongst families living in poverty in informal settlements and slums in Mombasa and Valparaíso be reduced through broadening community and stakeholder participation to change the social determinants of nutritional status?
The project seeks to address the following research questions:
Given the recognition that the determinants of child malnutrition are systemic and require multi-disciplinary concerted efforts to address, the Kenyan research team decided to explore ways of ensuring that the project is integrated into the national efforts that focus on child nutrition. The initial steps, therefore, involved holding discussions with the Nutrition Division in the Ministry of Public Health and Sanitation (MOPHS). During these discussions (in January 2011), it emerged that there are multiple efforts being put in place to strengthen interventions on child malnutrition and related problems among the urban poor. One such initiative was the proposed formation of Urban Nutrition Working Groups (UNWG).
The Kenyan NICK team considered that establishing an UNWG in Mombasa was critical entry point that would help to make NICK activities an integral part of local initiatives with a high possibility of sustainability. This UNWG would function as the participatory action research (PAR) group that was needed for the NICK Project. The team, therefore, sought the support of the national nutrition office to do the following:
Following the granting of permission to work with the Provincial Nutrition Officer, several meetings were held in Mombasa to plan for an initial meeting with local stakeholders to introduce the project and form a Participatory Action Research (PAR) group. The agreement was that the UNWG would also serve as the PAR group. The research group also met with Dr. Shariff,3 the Director of Medical Services, in the Ministry of Public Health and sanitation (MOPHS) who was supportive of NICK and emphasized the need for the project to enhance the implementation of national nutrition priorities. The team also met with members of the Kenya Food Security Steering Group (KFSSG) who had just completed a national survey on Urban Food Security.
The preparatory phase was also utilized to carry out literature reviews and interviews to consolidate the situational analysis. A research permit was acquired, which was granted by the National Council for Science and Technology. With this permit, the Kenyan research team was able to plan for the baseline survey.
(i) Formation of the Provincial Nutrition Technical Committee and UNWG
This meeting was held in Mombasa on April 29th 2011. It brought together 24 participants who were drawn from the participating government departments and other partners. During this meeting, the team agreed to form the Provincial Nutrition Technical Committee under the leadership of the Provincial Nutritionist. Thirteen members were also nominated to form the UNWG under the leadership of the District Nutrition Officer. The members were supportive of this group due to the potential to have a coordinated approach to addressing child nutrition in the region.
(ii) Conduct of the baseline survey
During the initial meeting, it was agreed that the UNWG would be involved in carrying out the baseline survey. As part of community service, the members agreed that anthropometric measurements would be done for every child up to 5 years in the two study sites of Chaani (intervention) and Kongowea (control). Over 900 children were weighed and measured. Data from children 12-59 months indicate higher than national averages for stunting, with Chaani worse off than Kongowea.
The KDHS indicates high levels of stunting and underweight in the Coastal Province.
A household baseline survey was conducted (between June and July 2011) during which over 800 households were interviewed. The main issues addressed were child nutrition, health seeking behaviour and coping mechanisms. Data analysis is ongoing. The Kenyan team is now facilitating the UNGWA through three 6-monthly cycle of action and reflection to develop, implement and improve a range of small scale multisectiorial action to change the social determinants of child undernutrition.
(iii) 1st UNWG/PAR workshop – July 2011
This was a three-day meeting that was attended by 16 participants including the London-based researchers. A follow-up meeting for the UNWG was held on 20th July during which the first multisectorial action plan was finalised.
(iv) Community level activities
Community sensitization is ongoing. The UNWG has held meetings with health officials and village elders in Chaani (the intervention site). A public meeting was held with the community members on 7th November 2011, which was attended by over 250 people. So far 17 formalized groups have been identified and the next steps are to assess the training and research needs of these groups. Support for this group, in the form of training and provision of seed funds will be initiated in January 2011.
","
","","","Over 800 households; Over 900 children","","Anthropometric measurements","","Vulnerable groups","","Complementary feeding>>>Complementary feeding>>http://www.who.int/elena/titles/complementary_feeding","Others, please specify below","Competing interestsThe UNWG members are very busy with multiple responsibilities, which limits the amount of time they have for NICK activities, which are seen as not being directly part of their mandates. The implementation of national level campaigns, such as the polio campaign, interfered with planned programme activities.","Others, please specify below","Time constraints among Government officialsIt was difficult for the research team to interview the district level officers as key respondents for the baseline survey due to time constraints. Although some of them are interested in research they are hard pressed to put aside an hour for an interview.","Management","Managing expectationsIt has been difficult due to the low project budget. In Kenya, there is a tendency for officers to be given allowances when they attend meetings. Doing this would deplete the project budget completely. The research team has shared the project budget with the UNWG and an agreement has been reached to facilitate travel but not to provide ‘sitting allowances’ as a compromise.","Adherence","Balancing between studies and field activitiesCombining the field activities and the research activities of the extension research project on domestic violence and child undernutrition led to some delay in the implementation of community level activities and the 2nd PAR workshop. These activities will be initiated in earnest in January 2012. The PAR workshop will be held in February 2012","","","","","","","","","","","","","","
The current project implementation process introduces a different mechanism of working in partnership at the community level for the implementation partners. Although the project has experienced some challenges, the achievement to-date indicates that with more support and additional training, the UNWG is in a position to implement sustainable interventions to address the social determinants of child nutrition. The baseline survey tools that will be used at the end of the project will be a good measure of whether this approach will have borne the anticipated outcome of multiple implementers working together for the common good.
","","English" "23202","LVIA-MMI programme communautaire: Prise en Charge de la Malnutrition Aiguë dans le district de Koudougou","English","Community/sub-national","","BFA","Burkina Faso","koudougou, burkina faso","Rural","on-going","05-2013","","L’Association de Solidarité et Coopération Internationale (LVIA) et son partenaire Medicus Mundi Italie (MMI) apportent un soutien à la Direction Régionale de la Santé du Centre-Ouest et au District sanitaire de Koudougou depuis mai 2013 pour la mise en oeuvre de la Prise en Charge Intégrée de la Malnutrition Aiguë (PCIMA). L’appui de LVIA-MMI au District Sanitaire (DS) de Koudougou porte principalement sur le renforcement des capacités des agents de santé pour la mise en oeuvre de la PCIMA, l’appui au DS pour la réalisation des campagnes de dépistage trimestrielles, la subvention totale de la prise en charge des complications en interne (frais de transport, traitement diététique et médical, alimentation de l’accompagnant), l’acheminement et le stockage des Aliment Thérapeutique Prêt à l’Emploi (ATPE), et la fourniture de farines enrichies pour la consolidation après guérison des cas de MAS.
","Ce programme a été identifié par le biais du projet «Coverage Monitoring Network» (CMN). Le projet CMN est une initiative inter-agence qui vise à accroître et d'améliorer le suivi de la couverture de la gestion communautaire de la malnutrition aiguë (CMAM) programmes à l'échelle mondiale, et renforce les capacités des professionnels nationaux et internationaux de la nutrition. Sa vocation est de fournir un support technique et des outils aux programmes de PCMA afin de les aider à évaluer leur impact, de partager et capitaliser les leçons apprises sur les facteurs influençant leur performance. Le projet met l'accent sur le renforcement des compétences en méthodologie SQUEAC et SLEAC. Il est mis en œuvre par un consortium dirigé par ACF International, et comprend Save the Children, Concern Worldwide, International Medical Corps, Helen Keller International et Valid International. Le projet est financé par la Commission européenne, Direction générale de l'aide humanitaire et de la protection civile (ECHO) et le Bureau du Foreign Disaster Assistance des États-Unis (OFDA) de l'USAID. Pour en savoir plus, s'il vous plaît visitez le site Web de la CMN à
http://www.coverage-monitoring.org/
Veuillez suivre le lien ci-dessous pour accéder au rapport complet du CMN sur la couverture du projet PCMA dans le district de Koudougou:
http://www.coverage-monitoring.org/wp-content/uploads/2014/05/SQUEAC_Rapport_KOUDOUGOU_2014.pdf
","","","","","","","Other","Medicus Mundi Italie (MMI)","","","","","National NGOs","Association de Solidarité et Coopération Internationale (LVIA)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23201","","Management of severe acute malnutrition","","","","SAM child","Enfants de 6 à 59 mois","District de Koudougou","Primary health care center","","La prise en charge ambulatoire des cas de MAS est assurée au niveau des 62 Centre de Santé et de Promotion Sociale (CSPS) du district, ainsi que de 7 Centre de Récupération et d'Education Nutritionnelle (CREN) gérés par des organisations confessionnelles. La prise en charge des complications en interne (PCI) est assurée au niveau du CHR de la ville de Koudougou et du Centre Médical Maximilien Kolbé de Sabou.
","La SQUEAC c´est une évaluation semi‐quantitative parce que combinant des données quantitatives et qualitatives:
Données quantitatives: données de routine (admissions, abandons, indicateurs de performance) et données collectées (cas couverts et cas non couverts) au cours d’enquêtes sur petites et grandes zones.
Données qualitatives: informations (opinions, connaissances sur la malnutrition, connaissances du programme de PEC, perception de la malnutrition, recours aux soins, facteurs limitant la PEC…) collectées auprès la communauté, des acteurs et bénéficiaires impliqués dans le service.
","Une investigation de la couverture du programme de prise en charge de la MAS dans le district a été conduite du 17 février au 14 mars 2014 en utilisant la méthodologie « Semi Quantitative Evaluation of Access and Coverage » (SQUEAC). L´outil SQUEAC permet d´assurer à moindre coût un monitoring régulier des programmes et d´identifier les zones de couverture faible ou élevée ainsi que les raisons expliquant ces situations. L’ensemble de ces informations permet de planifier des actions spécifiques et concrètes dans le but d’améliorer la couverture des programmes concernés.
La méthodologie SQUEAC se compose de trois étapes principales:
L’étape 1 consiste à identifier les zones de couverture élevée ou faible et des barrières à l’accessibilité
L’étape 2 permet de vérifier des hypothèses sur les zones de couverture faible ou élevée au moyen d’enquêtes sur petites zones
L’étape 3 permet d’estimer la couverture globale à travers la construction d’un « a priori » (basé sur les barrières et les boosters), de l’Évidence Vraisemblable et d’un « post priori » basé sur la recherche de cas.
Les principales barrières étaient en lien avec le contexte socio-culturel (méconnaissances sur la malnutrition, stigmatisation et honte, recours à la medicine traditionnelle en lien avec les croyances, voyage et déplacements des mères, manqué d’implication des hommes dans la santé des enfants) et avec des insuffisances au niveau de la qualité de la prise en charge (enfants MAS dans le programme MAM, sous notification des abandons, dépistage passif non systématique, manque d’informations données aux mères).
Parmi les facteurs influençant positivement l’accessibilité, la couverture géographique des formations sanitaires est à souligner. Le niveau de couverture constaté est également le résultat des actions entreprises dans le cadre du passage à l’échelle appuyé par LVIAMMI et les organisations locales : les campagnes de dépistage, la gratuité de la prise en charge, les actions de sensibilisation ont favorisé une bonne connaissance de l’existence du traitement, et une réaction en chaîne face à l’efficacité du celui-ci.
","","English" "23207","LVIA-MMI programme communautaire: Prise en Charge de la Malnutrition Aiguë Sévère dans le district de Nanoro","English","Community/sub-national","","BFA","Burkina Faso","Nanoro, burkina faso","Rural","on-going","05-2012","","L’Association de Solidarité et Coopération Internationale (LVIA) et son partenaire Medicus Mundi Italie (MMI) apportent un soutien à la Direction Régionale de la Santé du Centre-Ouest et au District sanitaire de Nanoro depuis mai 2012 pour la mise en oeuvre de la Prise en Charge Intégrée de la Malnutrition Aiguë (PCIMA). L’appui de LVIA-MMI au District Sanitaire (DS) de Nanoro porte principalement sur le renforcement des capacités des agents de santé pour la mise en oeuvre de la PCIMA, l’appui au DS pour la réalisation des campagnes de dépistage, la subvention des traitements pour la prise en charge des complications, l’acheminement des ATPE et la fourniture de farines enrichies pour la consolidation après guérison des cas de MAS.
","Ce programme a été identifié par le biais du projet «Coverage Monitoring Network» (CMN). Le projet CMN est une initiative inter-agence qui vise à accroître et d'améliorer le suivi de la couverture de la gestion communautaire de la malnutrition aiguë (CMAM) programmes à l'échelle mondiale, et renforce les capacités des professionnels nationaux et internationaux de la nutrition. Sa vocation est de fournir un support technique et des outils aux programmes de PCMA afin de les aider à évaluer leur impact, de partager et capitaliser les leçons apprises sur les facteurs influençant leur performance. Le projet met l'accent sur le renforcement des compétences en méthodologie SQUEAC et SLEAC. Il est mis en œuvre par un consortium dirigé par ACF International, et comprend Save the Children, Concern Worldwide, International Medical Corps, Helen Keller International et Valid International. Le projet est financé par la Commission européenne, Direction générale de l'aide humanitaire et de la protection civile (ECHO) et le Bureau du Foreign Disaster Assistance des États-Unis (OFDA) de l'USAID. Pour en savoir plus, s'il vous plaît visitez le site Web de la CMN à
http://www.coverage-monitoring.org/
Veuillez suivre le lien ci-dessous pour accéder au rapport complet du CMN sur la couverture du projet PCMA dans le district de Nanoro:
http://www.coverage-monitoring.org/wp-content/uploads/2014/05/SQUEAC_Rapport_NANORO_2014.pdf
","","","","","","","Other","Medicus Mundi Italie (MMI)","","","","","National NGOs","Association de Solidarité et Coopération Internationale (LVIA)","","","","","","","","Bilateral and donor agencies and lenders","European Commission Humanitarian Aid & Civil Protection (ECHO)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23206","","Management of severe acute malnutrition","","","","SAM child","Enfants de 6 à 59 mois","District de Nanoro","Primary health care center","","Sur le plan sanitaire, le district est divisé en 20 aires de santé. La structure de santé de référence est le Centre Médical avec Antenne chirurgicale (CMA) de Nanoro, géré par les religieux camiliens.
","La SQUEAC c´est une évaluation semi‐quantitative parce que combinant des données quantitatives et qualitatives:
Données quantitatives: données de routine (admissions, abandons, indicateurs de performance) et données collectées (cas couverts et cas non couverts) au cours d’enquêtes sur petites et grandes zones.
Données qualitatives: informations (opinions, connaissances sur la malnutrition, connaissances du programme de PEC, perception de la malnutrition, recours aux soins, facteurs limitant la PEC…) collectées auprès la communauté, des acteurs et bénéficiaires impliqués dans le service.
","Une investigation de la couverture du programme de prise en charge de la MAS dans le district a été conduite du 17 février au 14 mars 2014 en utilisant la méthodologie «Semi Quantitative Evaluation of Access and Coverage» (SQUEAC). L´outil SQUEAC permet d´assurer à moindre coût un monitoring régulier des programmes et d´identifier les zones de couverture faible ou élevée ainsi que les raisons expliquant ces situations. L’ensemble de ces informations permet de planifier des actions spécifiques et concrètes dans le but d’améliorer la couverture des programmes concernés.
La méthodologie SQUEAC se compose de trois étapes principales:
L’étape 1 consiste à identifier les zones de couverture élevée ou faible et des barrières à l’accessibilité
L’étape 2 permet de vérifier des hypothèses sur les zones de couverture faible ou élevée au moyen d’enquêtes sur petites zones
L’étape 3 permet d’estimer la couverture globale à travers la construction d’un « a priori » (basé sur les barrières et les boosters), de l’Évidence Vraisemblable et d’un « post priori » basé sur la recherche de cas.
Ces différentes barrières soulignent la complémentarité nécessaire entre une prise en charge de qualité au niveau des formations sanitaires et des activités de mobilisation communautaire adaptées au contexte. La poursuite et le réajustement des actions entreprises, sur la base des constats dégagés par l’investigation, permettront d’atténuer les barrières et d’améliorer la couverture de la PCIMAS. Pour être suivies d’effet, les réorientations proposées nécessiteront une implication de tous les acteurs impliqués dans la prise en charge de la malnutrition.
Facteurs positifs (boosters):
- Appréciation de la prise en charge: Gratuité, Perception positive du traitement, Efficacité du traitement
- Recours au CSPS pour le traitement de la malnutrition, traitement connu
- Connaissances sur la malnutrition
- Implication des acteurs clés au niveau de la communauté (ASC, TPS, leaders)
- Activités des ASC : campagnes de dépistage, suivi des cas
L’histoire de la PCIMA dans le district d’Amdam avait commencé avec l’arrivée de MSF-Hollande, Septembre 2007 avec un programme de soins de santé primaire (consultation curative, CPN), nutrition sous clinique mobile et appui en personnel à l’hôpital du district. En 2010, avec l’appui d’ECHO, International Medical Corps redémarrera la PCIMA avec 16 sites et depuis Novembre 2012 jusqu'à nos jours, le district compte actuellement 19 sites de prise en charge CNA/CNS et 1 centre de stabilisation à l’hôpital du District. Parmi les 19 sites CNA/CNS, 3 sont fixes et 16 cliniques mobiles.
","Ce programme a été identifié par le biais du projet «Coverage Monitoring Network» (CMN). Le projet CMN est une initiative inter-agence qui vise à accroître et d'améliorer le suivi de la couverture de la gestion communautaire de la malnutrition aiguë (CMAM) programmes à l'échelle mondiale, et renforce les capacités des professionnels nationaux et internationaux de la nutrition. Sa vocation est de fournir un support technique et des outils aux programmes de PCMA afin de les aider à évaluer leur impact, de partager et capitaliser les leçons apprises sur les facteurs influençant leur performance. Le projet met l'accent sur le renforcement des compétences en méthodologie SQUEAC et SLEAC. Il est mis en œuvre par un consortium dirigé par ACF International, et comprend Save the Children, Concern Worldwide, International Medical Corps, Helen Keller International et Valid International. Le projet est financé par la Commission européenne, Direction générale de l'aide humanitaire et de la protection civile (ECHO) et le Bureau du Foreign Disaster Assistance des États-Unis (OFDA) de l'USAID. Pour en savoir plus, s'il vous plaît visitez le site Web de la CMN à
http://www.coverage-monitoring.org/.
Veuillez suivre le lien ci-dessous pour accéder au rapport complet du CMN sur la couverture du projet PCMA dans le district de Amdam:
","","","","","","","","","","","","","","","","","","","","","","Bilateral and donor agencies and lenders","European Commission Humanitarian Aid & Civil Protection (ECHO)","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","23251","","Management of severe acute malnutrition","","","","SAM child","Enfants de 6 à 59 mois","District de Amdam","Community-based|Primary health care center","","Le District d’Amdam compte 4 zones de responsabilité et selon les possibilités du financement International Medical Corps était en mesure de mettre en oeuvre son programme de nutrition dans toutes les zones de responsabilité d’Amdam avec 2 CNA fixes et 11 cliniques mobiles (des Juillet 2010 jusqu’en Octobre 2012) Depuis Novembre le réseau de clinique mobile a été augmentée avec l’ouverture de 6 nouveaux sites, ce qui donne un total de 16 cliniques mobiles et 3 CNA fixe sur l’ensemble du District.
","La SQUEAC c´est une évaluation semi‐quantitative parce que combinant des données quantitatives et qualitatives:
Données quantitatives: données de routine (admissions, abandons, indicateurs de performance) et données collectées (cas couverts et cas non couverts) au cours d’enquêtes sur petites et grandes zones.
Données qualitatives: informations (opinions, connaissances sur la malnutrition, connaissances du programme de PEC, perception de la malnutrition, recours aux soins, facteurs limitant la PEC…) collectées auprès la communauté, des acteurs et bénéficiaires impliqués dans le service.
Une investigation de la couverture du programme de prise en charge de la MAS dans le district a été conduite du du 14 mars au 3 avril 2014 en utilisant la méthodologie «Semi Quantitative Evaluation of Access and Coverage» (SQUEAC). Une première enquête utilisant la méthodologie SQUEAC était réalisée par International Medical Corps en Avril 2012 et avait trouvé un taux de couverture de 34%. L´outil SQUEAC permet d´assurer à moindre coût un monitoring régulier des programmes et d’identifier les zones de couverture faible ou élevée ainsi que les raisons expliquant ces situations. L’ensemble de ces informations permet de planifier des actions spécifiques et concrètes dans le but d’améliorer la couverture des programmes concernés.
La méthodologie SQUEAC se compose de trois étapes principales:
L’étape 1 consiste à identifier les zones de couverture élevée ou faible et des barrières à l’accessibilité
L’étape 2 permet de vérifier des hypothèses sur les zones de couverture faible ou élevée au moyen d’enquêtes sur petites zones
L’étape 3 permet d’estimer la couverture globale à travers la construction d’un « a priori » (basé sur les barrières et les boosters), de l’Évidence Vraisemblable et d’un « post priori » basé sur la recherche de cas.
Certaines insuffisances ont été identifiées lors de cette enquête notamment l’insuffisance d’engagement du personnel soignant du Ministère de la sante travaillant dans les centres de santé fonctionnels pour le succès du programme. Ceux-ci nous ont semblé considérer le programme de Nutrition comme étant une affaire des ONG. Le travail mené par les relais communautaires nécessite un suivi rapproché bien qu’il y a nécessité d’augmenter leur nombre il faut d’abord encadrer ceux qui existent déjà afin d’améliorer leur performance dans le travail.
Il y a une certaine adéquation entre les tendances des admissions et le calendrier saisonnier. Ce qui signifierait que le programme répond d’une manière ou d’une autre aux besoins mais cela est à prendre avec réserve parce qu’étant donné que l’hypothèse de la distance et l’inaccessibilité font partie des barrières majeures au programme il y a lieu de penser que ces tendances d’admissions traduiraient juste une indication sur la réalité.
L’amélioration de la sensibilisation communautaire à travers une augmentation du nombre des relais communautaires, l’augmentation de sites dans les villages lointains ainsi que le renforcement de la clinique mobile surtout dans les zones éloignées: Teleguey et Koutoufare constituent pour le moment des solutions incontournables pour l’amélioration de la couverture nutritionnelle dans le district d’Amdam.
","","French"