An Economic Model for Optimizing Effective Coverage of MN interventions: A Case Study of Cameroon.

Objectives: Micronutrient (MN) interventions are generally undertaken at national scale. New spatially disaggregated data on MN deficiencies in Cameroon suggest that subnational strategies may be more efficient, but methods to choose among alternative interventions are needed. We developed a tool to plan and manage sub-national MN interventions for Cameroon. Methods: Data from a nationally representative multi-stage cluster survey were used to determine the spatial distribution of MN deficiencies among population sub-groups at greatest risk. Macroregion-specific data (North, South, Douala/Yaoundé) on food intake were used to predict the effects of alternative MN intervention strategies on the prevalence of inadequate MN intake and absorption. MN supplements, fortified and biofortified foods, deworming and behavioral change communication to promote breastfeeding are among the interventions examined. Costs of alternative interventions were prepared. The costs and nutritional benefits of alternative interventions are included in an economic optimization model that chooses the best combination of MN interventions to ensure adequate MN intake, at regional level, over a ten-year planning horizon, given funding and other constraints. Results: Preliminary results indicate large spatial differences in MN deficiencies, e.g., estimated prevalence of vitamin A deficiency varied from ~62% (North region) to ~22% (Northwest region). Consumption of VA-rich foods and fortifiable foods also varies spatially. Hence, program efficiency may be enhanced by adopting targeted sub-national MN intervention strategies. Conclusions: Given spatial patterns in MN deficiencies, diet-driven effectiveness of alternative MN interventions, and costs of these interventions, sub-national MN interventions may offer efficiency gains that exceed the costs of planning and implementing them.

Factors Affecting the Performance of Community Volunteers during Child Health Days in Douala, Cameroon.

Objectives: In the Littoral region of Cameroon, targeted awareness and social mobilization has increased coverage of vitamin A supplementation (VAS) during Child Health Days (CHDs) from 52.9%% in 2011 to 71.6% in 2012. Following this increase, coverage stagnated for the 2nd round of 2012 (71.0%) and the first round in 2013 (71.4%) thus falling short of the national target of 90% coverage of children 6-59 months. Methods: To determine barriers to high VAS coverage, targeted interviews were conducted with community volunteers participating in CHDs to identify factors contributing to CHD performance. Community volunteers were categorized as having "acceptable performance" or "poor performance" based whether their team met the daily target of reaching at least 120 children per day. Results: Interviews were conducted with 61 community volunteers with poor performance and 39 with acceptable performance from 6 health districts. The main factors found to influence performance were caretakers' awareness of the event and age of the volunteer (p<0.10). When asked how the campaign could be improved to reach all children, the most common response among both groups was better sensitization of parents (57%), ensuring stock (14%) and increasing the volunteer's allowance (12%). 37% of volunteers cited resistance by parents as the barrier that prevented teams from achieving universal coverage. Conclusions: Although door-to-door distribution is used to deliver services during CHDs to facilitate delivery, interviews with community volunteers indicate that better sensitization of caretakers prior to CHDs is still critical to achieving high coverage.