The impact on key indicators of reproductive and child health after changes in program modalities in Sierra Leone, 2019

Abstract

Background and aims In 2018, the transition to routine vitamin A supplementation (VAS) was integrated with caregivers' preparation of nutritious complementary food from local produce and confidential counseling and provision of modern contraceptives. In 2019, funding for complementary food ceased and Community Health Workers (CHWs) were trained to track defaulters, while national efforts to improve Health Management Information Systems, supply chains and reduce teenage pregnancies were intensified. We report on key indicators after these changes and in comparison, to those previously published. Methods The same Lot Quality Assurance Sampling methodology was used in both assessments: 19 villages were randomly selected in each of five lots in each of three districts then caregivers of children 6‐59 months age randomly selected and interviewed. Results Coverage of VAS, Albendazole, and Pentavalent 3 before and after these changes was over 80%, 75%, and 80% respectively, equitable by sex, age, caregiver's religion, and educational status. Comparison with 2018 found more lots failed to reach 80% VAS by verbal affirmation (10 vs 2), and coverage in one district (Bo) had dropped (77.5% vs 92.3%). Fewer caregivers were aware that VAS should be taken every 6 months (27% vs 50%), that complementary feeding should start at 6 months (63% vs 77%) or were providing minimal dietary diversity (27% vs 45%). There was an increase in caregivers using modern contraception (45% vs 35%), obtaining information about contraception from a friend (14% vs 9%), while fewer thought country rope/herbs (traditional contraceptives) were “effective” (11% vs 21%) and stockouts of contraceptives at health facilities had dropped (24% vs 55%). Stipends for CHWs cost approximately $750 K vs complementary food: $112 K. Conclusion Overall coverage for VAS, Albendazole, and Pentavalent remained effective but VAS had dropped significantly in one district. Complementary feeding practices had declined. Awareness, uptake, and contraceptives supply chains had improved.

Association between exposure to family planning messages on different mass media channels and the utilization of modern contraceptives among young women in Sierra Leone: insights from the 2019 Sierra Leone Demographic Health Survey

“…In post Ebola and post-conflict context, young women have continued to face profound structural exclusion, poverty, traditional norms related to gender and low literacy levels which factors have negatively affected access to reproductive health services including modern contraceptives utilization [21,22]. Furthermore, the country's health system faces frequent stock outs of medical supplies, limited integration of health services, shortage of skilled health workers and poor remuneration of health workers [23][24][25][26]. These challenges have contributed to the practice of charging patients including family planning client's unofficial fees, which is contrary to the official government policy of free reproductive and maternal child health services for all.…”

Vitamin A Supplementation in Madagascar: Coverage and Multifaceted Analysis of Influencing Factors During Transition to Routine Mode

“…Kassa et al [28] expressed concerns about the potential decline in VAS coverage during the transition from campaign-based to routine service delivery. Additionally, Koroma et al [29,30] discussed the integration of VAS with other reproductive and child health services during the transition to routine VAS, emphasizing the need for comprehensive approaches emphasizing the popularity of accessing routine [31], confidential "quality" family planning counselling at the same point of contact, indicating the potential for integrating VAS with other services to improve coverage.…”