We know much about what to do but little about how to do it: experiences with a weekly multimicronutrient supplementation campaign.

BACKGROUND: Global population growth is concentrated in urban areas, but there is little understanding of how to implement the necessary interventions to control food and nutrition insecurity. In the urban area of Peru, food insecurity is characterized mainly by micronutrient deficiencies and not by energy deficiency. OBJECTIVE: To increase the effectiveness and cost-effectiveness of weekly multimicronutrient supplementation programs in poor urban communities. METHODS: A series of operational studies were conducted of preventive weekly multimicronutrient supplementation to reduce micronutrient-deficiency anemia in a population consisting of 8,081 children under 5 years of age and 20,082 women and adolescent girls of reproductive age (12 through 44 years). RESULTS: This is one of a series of papers that describe in as much detail as possible the experiences of a multimicronutrient intervention program for poor urban mothers and their young children and summarizes the lessons learned for consideration of future programming. CONCLUSIONS: This paper shows that such programs can achieve a high compliance with good training of program staff involvement of the community, education and motivation of beneficiaries, adequate supplies, and careful monitoring.

Effectiveness of distribution of multimicronutrient supplements in children and in women and adolescent girls of childbearing age in Chiclayo, Peru.

BACKGROUND: There is a need to better understand the coverage of scaled-up multimicronutrient supplementation programs. OBJECTIVE: The coverage of the distribution of multimicronutrient supplements in 26 urban communities among women and adolescent girls 12 through 44 years of age and children under 5 years of age was evaluated for purposes of scaling-up. METHODS: Formative research and descriptive statistics were used to analyze the distribution of supplements. RESULTS: Despite a delayed memorandum of understanding with the health sector and delayed delivery by the producer of the supplement, a high coverage rate of supplement distribution to the children (88% on average during the 3 months of supplementation) was still achieved as a result of the strong commitment of the community and the Integrated Food Security Program. The lower coverage rate among women and adolescent girls (47% on average) was the result of too short a period of enrollment in the program. There was no decrease of coverage during the 3 months of supplementation in both groups. CONCLUSIONS: Effective, sustainable, large-scale micronutrient supplementation programs require broad partnerships with commitments of governmental and nongovernmental organizations, communities, and the private sector. Availability of the supplements and communication materials must be secured well ahead of the supplementation campaign and distribution of the supplement.

Effectiveness of the communication program on compliance in a weekly multimicronutrient supplementation program in Chiclayo, Peru.

BACKGROUND: Compliance with daily micronutrient supplementation is usually poor and the question arises whether compliance with a weekly regimen would be better. OBJECTIVES: The inputs (messages and channels), output (increase of knowledge), and outcome (behavior changes) ofa communication campaign in a micronutrient supplementation program for women and adolescent girls 12 through 44 years of age and children under 5 years of age (primary audience) were analyzed. METHODS: The communication program addressed not only the primary, but also the secondary (facilitators) and tertiary audiences. Formative research and descriptive statistics were used to analyze the communication campaign. RESULTS: Nearly all women and adolescent girls (89%) and children (91%) took at least 75% of the supplements over the 3-month period. The incidence rates of reported negative side effects of supplementation in children and in women and adolescent girls were less than 10%. Knowledge of micronutrient nutrition among facilitators of all ages and education levels increased significantly (p <.001). CONCLUSION: . A thoroughly planned and implemented nutrition communication program can secure high compliance of the beneficiaries of micronutrient supplementation programs. The necessary supplies should be available at least 3 months before program implementation. With an adequate communication program, supplementation programs can be used to foster food-based approaches for the target audience.

Lessons learned from the scaling-up of a weekly multimicronutrient supplementation program in the integrated food security program (PISA).

BACKGROUND: Weekly multimicronutrient supplementation was initiated as an appropriate intervention to protect poor urban populations from anemia. OBJECTIVE: To identify the lessons learned from the Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]) weekly multimicronutrient supplementation program implemented in poor urban populations of Chiclayo, Peru. METHODS: Data were collected from a 12-week program in which multimicronutrient supplements were provided weekly to women and adolescent girls 12 through 44 years of age and children under 5 years of age. A baseline survey was first conducted. Within the weekly multimicronutrient supplementation program, information was collected on supplement distribution, compliance, biological effectiveness, and cost. RESULTS: Supplementation, fortification, and dietary strategies can be integrated synergistically within a micronutrient intervention program. CONCLUSIONS: To ensure high cost-effectiveness of a weekly multimicronutrient supplementation program, the following conditions need to be met: the program should be implemented twice a year for 4 months; the program should be simultaneously implemented at the household (micro), community (meso), and national (macro) levels; there should be governmental participation from health and other sectors; and there should be community and private sector participation. Weekly multimicronutrient supplementation programs are cost effective options in urban areas with populations at low risk of energy deficiency and high risk of micronutrient deficiencies.

Documenting the reasons people have for choosing their food.

Understanding the reasons that people have for choosing their food, and why these choices vary, may affect the dietary advice and assumptions about the nutrient adequacy of future food intake. One group of respondents living in Jakarta, Indonesia completed two interviews with the same combined food frequency and qualitative technique, called Food Choice Map (FCM) over a one-month period. Another group of Indonesian respondents from a town in Java completed an FCM interview and a 24-hour recall interview. The Food Choice Map identified the same major foods as contributing to individual intakes as are identified by a 24-hr recall interview. The FCM also identified reasons for changes in food choice. The reasons for food choices varied less than the different food items chosen. The FCM links data on dietary behaviours with perceptions that respondents use to explain of those behaviours. Such data can be used to develop communication strategies for health promotion.

Complementary feeding patterns in Pondok Labu, South Jakarta, Indonesia.

This paper explores the sociocultural aspects in the reasons mothers gave for terminating exclusive breastfeeding. These sociocultural aspects were anticipated to influence the variance between actual breastfeeding practice and the current recommendations for exclusive breastfeeding. The complementary feeding patterns and the reasons for introducing complementary foods were assessed using a dietary recall called the Food Choice Map, in a sample of 40 mothers living in a sub-district of South Jakarta. The results showed that the most common reason for introducing first foods in this study was 'insufficient breastmilk'. The influential social factors, including parents, friends and medical professionals were identified. The feeding pattern of the infants in the first six months was highly variable, and commercial baby food was frequently used. We suggest that, even though current exclusive breastfeeding recommendations are beneficial, their promotion should be more sensitive to the social reality of the mothers.

The relationships between selected anthropometric and socio-economic data in schoolchildren from diferent social strata in Rio de Janeiro, Brazil

O estado nutricional, de acordo com os dados antropométricos, foi avaliado em 756 escolares de cinco escolas estaduais de baixa renda e uma escola particular, na mesma área geográfica do Rio de Janeiro, Brasil. A prevalência de déficit de estatura/idade e de peso/altura (pontos de corte: 90% estatura/idade e 80% peso/estatura) encontrada nas escolas estaduais foi de 6,2 a 15,2% e 3,3 a 24,0% respectivamente, enquanto que na escola particular foi de 2,3 a 3,5%, respectivamente. Maior número de obesos foi encontrado na escola particular (18%). Os problemas nutricionais parecem ocorrer mais assiduamente com o aumento da idade das crianças. Recomenda-se avaliar os escolares dentro do contexto de um sistema de vigilância nutricional