RESUMEN
Objectives: Iodine deficiency disorders have been a prevailing problem in Nepal. With the objective to improve household use of adequately iodized salt, Nepal Government endorsed a strategy to promote adequately iodized salt with two child logo in poor performing districts of Nepal from 2007 to 2011. Methods: Social Marketing approach used a methodology of community mobilization under public private partnership, engaging mother credit and saving groups with interpersonal communication to each beneficiary. In this process, 650 women group mobilized with IEC/ BCC component, intensive supervision monitoring to promote iodized packet salt. Results: As a result of iodized salt social marketing campaign, household use of two child logo salt in intervention areas increased from 31% in 2005 to 55% in 2011. This increase in use of two child logo salt directly translated into the increase in household use of adequately iodized salt (with 15 ppm or more iodine) from 52% in 2005 to 70% in 2011. On overall, this increase contributed in the improvement of national use of adequately iodized salt up to 80% level (and that of salt with any iodine to over 95%) in 2011. Conclusions: Community Group mobilization is an effective tool to increase iodized salt consumption in Nepal, which established a direct relationship between iodized packet salt promotions with the household use of adequately iodized salt. With the result achieved, Nepal is on the verge of meeting universal salt iodization goal - 90% household using adequately iodized salt.
RESUMEN
Objectives: To examine the effect of antenatal iron-folic acid (IFA) supplements on the risk of childhood mortality in Nepal using pooled data from 3 Nepal Demographic and Health Survey (DHS) 2001, 2006 and 2011. Methods: Survival information was used from 13,009 singleton most recent live-born infants. Primary outcomes were mortality indicators in children <5 years and the main exposure variable was any use of IFA supplements. Data was analysed by using STATA 13 and adjusted for the cluster sampling design. Analyses used multivariate Cox proportional hazards regression adjusted for 24 potential confounders based on Mosley and Chen framework for childhood survival in developing countries. Results: Any use of IFA supplements significantly reduced risk of early neonatal deaths by 45% (aHR: 0.55, 95% CI: 0.38, 0.79), and total neonatal deaths by 42% (aHR: 0.58, 95% CI: 0.39, 0.85). Similarly, the risk of infant and under-5 mortality was significantly reduced by 32% and 48%, respectively. For mothers who started ≤4 months of pregnancy and used ≥150 supplements under- 5 mortality was significantly reduced by 57% (aHR: 0.43, 95% CI: 0.23, 0.78). Population attributable risk estimates found 15% of under-5 deaths were attributed to non-use of IFA, and 29,000 under-5 deaths could be prevented in the next 5 years with universal IFA coverage. Conclusions: Antenatal IFA supplementation significantly reduces the risk of neonatal and under- 5 deaths in Nepal. The greatest impact on child survival was found in women who started early in pregnancy and took ≥150 supplements. Universal IFA coverage could improve childhood survival.