PROCESS EVALUATION OF THE DISTRIBUTION OF MICRONUTRIENT SPRINKLES IN OVER 10,000 MONGOLIAN INFANTS USING A NON-GOVERNMENTAL ORGANIZATION (NGO) PROGRAM MODEL.
C. Schauer, S. Zlotkin1, M. Nyamsuren, C.R. Hubbell, M. Chan, O. Purevsuren, C. MacDonald, N. Klaas: The Hospital for Sick Children, Research Institute, Canada; Departments of Paediatrics, Nutritional Sciences, and Centre for International Health, University of Toronto; World Vision Mongolia; World Vision Canada.
Background Economic instability and severe winters have resulted in food shortages across Mongolia. As a result, micronutrient deficiencies (iron and vitamin D) are common among children. ‘Sprinkles’ containing iron and other micronutrients (including Vitamin D) were developed as an inexpensive micronutrient supplement. Objectives 1. To determine the prevalence of anemia and rickets in children <5 years. 2. To develop an NGO distribution model to deliver Sprinkles to infants 6-36 mo. and achieve 80% coverage. 3. To monitor and evaluate process and biological outcome indicators. Methods A cross-sectional baseline survey was conducted among 1478 children. Assessment of anemia was based on hemoglobin (Hb). Assessment of rickets was based on a physical examination. Program design, monitoring and evaluation were based on the Triple A Process (Assessment, Analysis, Action). A monitoring system was developed to measure indicators of project activities and outcomes. Monthly process evaluation included number of Sprinkles distributed, program coverage and random spot checks of families to assess adherence to the program by counting number of Sprinkles consumed by children. Results At baseline prevalence of anemia (Hb<115 g/L) and rickets were 42% and 33%, respectively. 13,301 eligible children in 8 regions were identified for participation in the program. Program outputs included adequate procurement, supply and delivery of Sprinkles to distribution points and training of 107 community volunteer nutrition workers who provide counseling and deliver Sprinkles bi-weekly to families Distribution began in August 2001; one year into the program, coverage reached 84% of eligible children in target regions. Level of acceptance and adherence to Sprinkles remains high with a mean of 74% of the monthly supply of daily Sprinkles being consumed by children. Conclusion Anemia and rickets are serious public health problems among Mongolian children. The NGO model for distribution is feasible. Sprinkles are being well accepted by the population. (Supported by World Vision Canada, CIHR and the HJ Heinz Company Fdt)