RESUMO
Objectives: This operational research study compared MNP distribution approaches, Group 1: one time delivery of 60 sachets/six months; and Group 2: twice a delivery of 30 sachets/three months, to assess differences in coverage and adherence among children aged 6-23 months in Misamis Oriental province, the Philippines. Both groups received similar education on IYCF. Methods: Cross-sectional data from baseline and six months were compared. Results: All 5704 children in the intervention communities received MNP (100% coverage). The median (range) number of MNP consumed by children was significantly higher in group 1 (n=680) than group 2 (n=680), as assessed using compliance cards [58 (1-60) vs. 42 (1-60)] and empty sachets count [56 (1-60) vs. 35 (1-60)]. More mothers in group 1 than group 2 reported changes in food attributes after adding MNP (85.5% vs. 67.5%) and side-effects (18.3% vs. 13.3%), P<0.05. Anemia was significantly lower at endline (15.1%) than baseline (44.9%) in both groups. Health workers had different opinions about integrating MNP into other child health programs. Some felt such integration will make their work easier, save time and provide a comprehensive approach to preventing anemia. However, others suggested such integration may pose problems for mothers and health workers, including difficulty to provide multiple services to families at the same time. Conclusions: Supplying 30 dosages of MNP twice did not increase MNP intake, but yielded similar benefit on anemia compared to supplying 60 dosages once. Programs should emphasize good introduction of MNP, strong IYCF education and anticipate changes in food attributes and side-effects.
RESUMO
Vitamin A supplementation reduces child morbidity, mortality, and blindness. The coverage of the national vitamin A programme and risk factors for not receiving vitamin A were characterized using data from the Bangladesh Demographic and Health Survey 2004. Of 3,745 children aged 18-59 months, 3,237 (86.4%) received a vitamin A capsule each within the last six months. Children who missed vitamin A were more likely to be stunted (prevalence ratio [PR] 0.97, 95% confidence interval [CI] 0.95-1.00) and come from a family with a previous history of mortality of children aged less than five years (PR 0.95, 95% CI 0.91-0.99). Maternal education of ≥10 years (PR 1.09, 95% CI 1.04-1.13), 7-9 years (PR 1.08, 95% CI 1.04-1.12), and 1-6 years (PR 1.05, 95% CI 1.02-1.08) compared to no formal education was associated with the child not receiving vitamin A in a multivariate model, adjusting for potential confounders. Children missed by the vitamin A programme were more likely to come from families with lower maternal education. Special efforts are required to ensure that the coverage of the national vitamin A programme is increased further so that the most vulnerable children are also better protected against morbidity, mortality, and blindness.