ABSTRACT
Objectives: EsIAN is designed to improve nutritional outcomes through a strong behavior change campaign and free distribution of nutritional products (micronutrient powders, MNP and/or a fortified complementary food, FCF) for children 6 m to 5 y of age living in poverty. Both products were distributed in rural areas and MNP only in urban. We assessed changes in the prevalence of anemia in children, in a pre-post effectiveness trial. Methods: EsIAN was implemented in 2008 in 91 health care centers in central Mexico. Effectiveness was assessed in 2012 using a mixed methods approach. Data from two crosssectional samples of children aged 6 to 59 months (Rural: 2008 n=802, 2012 n=356; 2008 n=569, Urban: 2012 n=546) were analyzed adjusting standard errors by health care center clusters. Results: In rural areas, the concentration of hemoglobin increased from 12.0±0.1 (mean±SE) in 2008 to 12.7±0.1 g/dL in 2012 (P˂0.001). The prevalence of anemia dropped significantly both in urban (23.1±2.5% in 2008; 16.1±2.0% in 2012; P<0.05) and rural areas (23.5±2.0% in 2008; 7.0±1.3% in 2012; P˂0.001). The drop was largest among children aged 6 to 23 months in rural areas (28.3±4.5% percentage points reduction). Conclusions: We document here a dramatic reduction in the prevalence of anemia in communities where EsIAN was implemented. Although this pre-post design does not allow for direct causal attribution, impact pathway review suggests that these changes are likely to be due to the EsIAN.
ABSTRACT
Objectives: To assess changes in physicians' and nurses nutrition knowledge and perceptions from EsIAN. EsIAN was developed to attend to the nutritional needs of Oportunidades beneficiary families. Oportunidades is the Mexican conditional cash transfer program. In Mexico, appropriate attention to undernutrition and anemia is needed simultaneous with attention to overweight and obesity. EsIAN includes nutritional supplements and a behavior change communication strategy with nutrition counseling tools. The strategy was implemented on pilot scale; we report here the effects on health-care providers' nutrition knowledge and perceptions. Methods: EsIAN was implemented in 2008 in 91 clinics in central Mexico. Effectiveness was assessed in 2012 using a mixed methods approach. Data from two cross-sectional samples were analyzed adjusting standard errors by health care center clusters. Results: Physicians' and nurses' (PN) perceived they have more than 90% capacity to implement the EsIAN in their everyday's practice. Compared to baseline, in 2012 a significantly higher proportion of PN reported recommending exclusive breastfeeding for 6 months (85.7% vs. 23.4%) and breastfeeding techniques (79.8% vs. 12.8%) (p<0.001). More than 88% monitored children growth using weight-for-height and height-for-age indicators as recommended by EsIAN. Nutritional supplements seemed appropriate to 97.8% and 92.3% urban and rural PN, respectively. Conclusions: EsIAN is a highly accepted strategy that can be nationally implemented and is effective to improve providers knowledge and perceptions of essential nutrition actions.