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. Zlotkin, M. Nyamsuren, C.R. Hubbell, M. Chan, O. Purevsuren, C. MacDonald, N. Klaas
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 Foundation.