ABSTRACT
Objectives: Coverage of nutrition interventions for pregnant women is poor, but potential for improvement is limited where health systems are weak. The Community-based Maternal and Newborn Health and Nutrition (CBMNH) program aims to increase utilization and quality of health and nutrition services for pregnant women and newborns by strengthening health systems. With the program's focus on increasing demand for prenatal and birth services, we implemented Knowledge, Attitudes and Practices (KAP) surveys to identify key individuals/factors influencing demand and use. Methods: As part of the baseline surveys, we randomly selected women with children 0-11 months. Using mixed methods, we assessed current KAP surrounding nutrition in antenatal care. Results: We identified gaps in the provision and utilization of services, particularly antenatal care (ANC), iron-folic acid supplements (IFA), among others. The proportion of women who had attended 4 ANC visits during pregnancy was 4.8% in Ethiopia, 43% in Kenya, and 50% in Senegal; about a fifth in Ethiopia and Kenya and 60.7% in Senegal attended ANC in the first trimester. Only 3.4% of women in Ethiopia, 36.7% in Kenya and 93.6% in Senegal had taken ≥90 IFA tablets during pregnancy. Qualitative data found that knowledge and attitudes of women regarding care seeking for ANC and benefits of IFA during pregnancy period was low. Conclusions: In all 3 countries, but particularly Ethiopia, health and nutrition services for pregnant women and newborns are under-provided and under-utilized. This evaluation revealed both demand and supply side barriers that are now being addressed as part of the on-going program.
ABSTRACT
Objectives: The broad objective was to assess components of the supply chain aiming at identifying facilitating factors and barriers to uninterrupted availability of IFA, oxytocic drugs, misoprostol, magnesium sulphate and calcium with a view of formulating innovative solutions. Methods: A cross-sectional design was used to conduct supply chain assessment in Kakamega County, Kenya. It included a random selection of 7 dispensaries, 8 health centres, 3 district hospitals and 1 referral hospital. Data was collected through record reviews, observations, key informant interviews and client exit interviews. Results: The study found glaring gaps in commodity forecasting and quantification, sub-optimal inventory management, and there were frequent prolonged stock outs. Commodity specific gaps were identified including lack of inclusion in the essential drugs list, absence of service delivery guidelines and a large proportion of commodities available in the market that did not meet the recommended dose composition for the intended purposes. For example, only 12% of the combined IFA formulations found in the market met the recommended doses for antenatal supplementation. There was also inadequate local manufacturing capacity of these commodities. Conclusions: In conclusion, there are glaring weaknesses in the supply chain. Streamlining the supply chain entails addressing policy issues, advocacy for local manufacture, strengthening forecasting and quantification capacity as well as a carefully thought out procurement processes.
ABSTRACT
Objectives: Further analysis of KDHS 2008/09. Methods: The study uses data from the 2008-09 Kenya Demographic and Health Survey, involving children aged 24-35 months, a weighted sample of 1029 children. Descriptive and logistic regression analyses were conducted. The outcome variable of interest is stunting, while the exposure variable of interest is ever receiving a dose of vitamin A supplement. Secondary outcomes include underweight and wasting status. Results: The prevalence of stunting in the study group was 46%; underweight 20%; and wasting 6%. The prevalence of ever receiving vitamin A supplement was 78%. Receiving vitamin A supplement was significantly negatively associated with stunting and underweight status, adjusting for other co-risk factors. The odds of stunting were 50% higher (p=0.038), while for underweight were 75% higher (p=0.013) among children who did not receive Vitamin A supplement compared with those who did. Conclusions: This study demonstrates that receiving vitamin A supplement may be beneficial to growth of young children in Kenya. However, though freely offered through immunization services to children 6-59 months, some children do not receive it, particularly after completing the immunization schedule. There is need to establish innovative and effective ways of maximizing utilization of this intervention.