Integrating a Six-Month Contact Point for Vitamin A Supplementation, Infant and Young Child Feeding Counselling and Family Planning within Routine Health Services in Sierra Leone
Mary Hodges *
Helen Keller International, Freetown, Sierra Leone.
Fatmata Fatima Sesay
Helen Keller International, Freetown, Sierra Leone.
Habib Kamara
Helen Keller International, Freetown, Sierra Leone.
Emmanuel D. Nyorkor
Helen Keller International, Freetown, Sierra Leone.
Mariama Bah
Helen Keller International, Freetown, Sierra Leone.
Aminata Shamit Koroma
Nutrition Program, Ministry of Health and Sanitation, Freetown, Sierra Leone.
Adam Wolf
Columbia University, Mailman School of Public Health, New York, USA.
Joseph Kandeh
District Health Management Team, Western Area, Freetown, Sierra Leone.
Rasmata Ouédraogo
West African Health Organization, Young Professional Internship Program, Bobo Diolassou, Burkina Faso.
Heather I. Katcher
Helen Keller International Regional Office, P.O. Box 13904-00800, Nairobi, Kenya.
Jessica L. Blankenship
Helen Keller International Regional Office, P.O. Box 13904-00800, Nairobi, Kenya.
Shawn Baker
Helen Keller International Regional Office, BP 29.898, Dakar-Yoff, Senegal.
*Author to whom correspondence should be addressed.
Abstract
Objectives: Since 2004, twice-yearly mass vitamin A supplementation (VAS) has reached >85% of children 6-59 months. Although VAS coverage is consistently high, an additional 2.4% reduction in infant mortality could be achieved if all children receive VAS as soon as they turn six months. Therefore, the effectiveness of integrating a six-month contact point with VAS into the routine EPI schedule was examined.
Methods: Twelve health units matched according to staff levels, cadre and work load were assigned to provide either a ‘full package’ of 1)VAS, 2)Infant and Young Child Feeding counselling (IYCF), and 3)family planning (FP) counselling and commodities; a ‘mini package’ of 1)VAS and 2)IYCF or control’ with routine health services. 400 infants were enrolled into each group between birth and 3 weeks of age and followed until they were 12 months old. Caregivers of all enrolled children received modified child health cards with a six-month contact point
Results: More children in the full (74.5%) and mini (71.7%) groups received VAS at six months compared with the control group (60.2%)(p<0.05). At 9 and 12 months of age, mean WAZ was significantly higher for the full (0.24±0.98; 0.90±0.81), versus the mini (-0.05±1.05; 0.26±0.93) and control groups (-0.55±1.24; 0.39±1.41)(p<0.0001, p<0.01), respectively. FP commodities were provided to 67.3% of mothers in the full group compared with 3.0% in the mini and control groups (p<0.0001).
Conclusions: A six-month contact point integrated into the EPI schedule increased VAS coverage and provision of family planning commodities at six months and was associated with improved growth in late infancy.