An adequacy evaluation of a 10-year, four-country nutrition and health programme

Abstract

Background Evaluations of large-scale health and nutrition programmes in developing countries are needed for determining the effectiveness of interventions. This article critically analyses a non-governmental organization (NGO)-led large-scale, multi-country, 10-year micronutrient and health (MICAH) programme with an ‘adequacy evaluation’, that is, a documentation of time trends in the expected direction.Methods MICAH was implemented from 1996 to 2005 in selected areas of Ethiopia, Ghana, Malawi and Tanzania, reaching >6 million people with numerous health and nutrition interventions. Coverage and impact were monitored through surveys at baseline, midpoint and end of funding. The data were subjected to post-hoc methods of quality determination, and, if of suitable quality, included in the adequacy evaluation.Results Most collected data were of moderate or high quality and therefore included in the adequacy evaluation. There were moderate to large improvements in vitamin A status in Ethiopian school-age children, children <5 years of age in Tanzania and Ghana and mothers in Ghana. Iodine status improved in Malawi and Tanzania. Anaemia rates and malaria prevalence decreased in women, pregnant women and pre-school children in Ghana, Malawi and Tanzania, but anaemia increased in Ethiopian women. Large increases were reported for rates of exclusive breastfeeding and immunization. Child growth improved to the maximum that would be predicted with the given interventions.Conclusions Numerous nutrition and health impacts were observed in the intervention areas, often of a magnitude equal to or larger than observed in controlled interventions or trials. These results show the value of integrated long-term interventions.

Multisector intervention to accelerate reductions in child stunting: an observational study from 9 sub-Saharan African countries

“…SDs of HAZ per site indicated data quality similar to other studies that reported on HAZs of children ,2 y of age (9,28,33). Stunting prevalence at baseline ranged from 25% to 77%.…”

“…Predictive models suggested that by combining food and micronutrient supplementation, fortification, and disease-control interventions, stunting prevalence could be reduced by one-third (7). Although a number of global health initiatives have attempted to deliver such multicomponent interventions in sub-Saharan Africa, large-scale evaluations have shown limited effects on stunting even with high levels of coverage (8)(9)(10)(11).…”

Increasing prevalence of asthma and allergy in Beijing pre-school children: Is exclusive breastfeeding for more than 6 months protective?

“…However, several studies have found that maternal recall of breastfeeding is reliable [67,68], even 20 years after the time of breastfeeding [69]. Another limitation is our inability to thoroughly evaluate the possible role of Reverse Causation.…”

Multiple‐micronutrient supplementation: Evidence from large‐scale prenatal programmes on coverage, compliance and impact

“…Cases in Nicaragua (Mora, ), Nepal (Pokharel et al, ), Northwest Vietnam (Casey et al, ; Passerini et al, ) and Ghana (MacDonald et al, ) outlined the role of local and international NGOs as both active forces in filling public‐health system at macro and microlevels, capacity building of human resource, and implementing health activities. They covered a broad range of tasks from providing regular, intensive technical support and training, funds, staff and expert consultants to conducting monitoring and adequacy evaluations or undertaking large‐scale health interventions as observed in the MICAH programme (Berti, Mildon, Siekmans, Main, & Macdonald, ). Most importantly, the selected cases evidenced that during the implementation period, anaemia and potentially related complications such as maternal or infant mortality and low birth‐weight, showed a significant decrease that occurred concurrently to the increase of women of reproductive age taking IFA and attending ante‐natal care.…”