| Popis: |
ObjectivesTo assess the relevance, effectiveness, efficiency, impact, sustainability, learning and replicability of the transition from mass vitamin A supplementation to a routine six monthly contact point, integrated with complementary feeding and family planning counselling.Study designProgram performance was assessed taking into consideration the knowledge, attitudes and practices of both healthcare providers and caregivers to understand barriers and enablers to service uptake. A cross sectional qualitative survey with 63 key informant interviews with stakeholders and implementation staff and focus group discussions with 60 caregivers. Data was transcribed then coded through a framework analysis (developing themes from specific objectives) and thematic analysis (developing emerging themes not identified by the objectives). MethodsThe ‘routine six-monthly contact point’ included vitamin A, Albendazole, growth monitoring plus the promotion of optimal infant and young child feeding practices with complementary feeding demonstrations, the promotion of personal and food hygiene, access to confidential, family planning counselling and the provision of modern contraceptives for caregivers including hormonal implants. ResultsThe six-monthly contact point was found to be highly relevant, effective, efficient, with a positive impact on maternal and child health and sustainable. Lessons for replicability focus mainly on the extensive need for sensitisation of men/husbands and religious leaders regarding family planning. The challenges that prevent health seeking behaviour included distance to the facilities, poor roads, difficulty/cost of transportation and workload. The participatory complementary feeding demonstrations and community health workers encouraged attendance and appear to have contributed to the reduction of malnutrition but stockouts of essential commodities remain discouraging. ConclusionsThe program has been fully adopted by all levels of the health sector. The integration of family planning and its acceptance by caregivers is commendable and there has been an increase in the uptake of modern especially hormonal implants. This integrated approach was thought to have contributed to the reduction of childhood malnutrition. Recommendations include increasing awareness of affordable, accessible local foods for complementary feeding, more training for health workers on reporting and family planning counselling for the provision of long-term reversible contraceptives and further sensitisation of men and religious leaders on the importance of child spacing. |
