Summary of Programs
The work of the Micronutrient Initiative in Africa. 1
Burkina Faso. 4
Mali 5
Niger 6
Nigeria. 7
Senegal 9
Ghana. 11
Angola. 12
Democratic Republic of Congo. 14
Ethiopia. 16
Kenya. 17
Mozambique. 19
South Africa. 21
Brief
profile of region:
1. Sub-Saharan Africa is the only region in the world where the
nutritional status of children is worsening and where infant and child
mortality rates continue to rise.
· Vitamin A deficiency (VAD) across the region is
extremely high, varying between 20 and 80%.
· Iodine deficiency disorders: Consumption of iodized
salt seems to have stalled at about 60%, with levels in some countries
effectively zero.
· Iron deficiency anemia: continues to be a major problem
especially in children over the age of 2 and pregnant women.
· Zinc deficiency: is widespread and contributes to the
high levels of morbidity and mortality in children
MI in the region:
2. MI works from a regional office in Johannesburg to support
programs in 8 countries in West, Southern and Eastern Africa, has a country
presence in the DR Congo, Ethiopia, Kenya, Nigeria and a sub-regional base in
francophone West Africa.
Activities in 2005:
· Africa-wide: MI
Africa was very active in advocacy to secure a place for micronutrient
malnutrition on the high-level agendas of the New Partnership for Africa’s
Development (NEPAD); the World Bank and the Commission for Africa. MI continued
to collaborate extensively with UNICEF and Helen Keller International HKI
throughout the region, strengthened ties with WHO (especially IMCI) and with
Red Cross National Societies, and continued to work closely with national
governments as well as with regional bodies such as WAHO and SADC.
· DR Congo: In 2005 MI’s work focused on supporting the delivery to
children aged 6-59 months of vitamin A supplements (VAS) supplied by the MI via
UNICEF
· Ethiopia: In
2005 MI’s work focused on supporting the delivery to children aged 6-59 months
of VAS supplied by the MI via UNICEF
· Kenya: In 2005
MI’s work focused on supporting the delivery to children aged 6-59 months of
VAS supplied by the MI via UNICEF, and on work to extend the utilization of
double fortified salt (salt fortified with both iron and iodine) for people
affected by emergencies
· Nigeria: In 2005 MI’s
work focused on advocacy to ensure the delivery to children aged 6-59 months of
VAS through the NIDS using capsules supplied by the MI via UNICEF, and on work
to extend the utilization of double fortified salt (salt fortified with both
iron and iodine) within the commercial market for salt
· Sahel region: In 2005 MI’s work focused on supporting the delivery to children aged 6-59
months of VAS delivered through the NIDS using capsules supplied by the MI via
UNICEF.
Programs to reduce VAD
Vitamin A Supplementation
3. Our major program during 2005 continued to be Vitamin A
supplementation accounts for 93% of our total spend in Africa. Where polio NIDs are still being
carried out, MI Africa wad part of joint efforts by partners at regional and
country levels to keep VAS effectively linked to delivery alongside oral polio
vaccine, and to set up the systems for future child health weeks. MI Africa developed and field-tested an
up-dated training toolkit of new and
existing materials for use by country coordinators and partners in planning and
implementing child health weeks in countries. Elsewhere MI Africa worked to extend the linkage of VAS to
EPI campaigns (such as measles), and specifically to support VAS delivery
within child health weeks in Malawi, Angola and Kenya.
Food Based Approaches
4. MI Africa supported pilot programs promoting the consumption
of red palm oil (RPO) and orange-flesh sweet potato (OFSP). Efficacy is demonstrably high but the
challenges of costs and effective delivery systems remain significant. Lessons from the RPO project were built
into a second phase scale up project. The OFSP report will be finalized in 2006. MI also supported VA fortification programs in Nigeria,
Burkina Faso and Mali although the release of donor funds has slowed progress.
Universal Salt Iodization Programs
5. Based on a series of assessment missions in key producing
countries MI defined a strategy aimed at ensuring a supply of adequately
iodized salt at production level, especially given extensive trade in salt
across national boundaries. The
assessment missions resulted in mapping of salt flows across Sub-Saharan Africa
(see box) together with an up-to-date analysis of the bottlenecks on the ground
(policy, standards, enforcement, producer capacity, consumer demand).
6. This has given MI Africa a strategic framework and plan for
actions over the coming 2-3 years that would maximize MI’s strengths and also
offer a valuable contribution by MI to the Iodine Network through which MI can
strengthen and broaden partnerships. Priority will be given to countries with low levels of iodized salt
production, moderate to high IDD prevalence in the markets they supply, low
coverage in terms of household use of iodized salt and factors such as the
extent to which salt producers are also exporters. MI is collaborating closely with WFP to help ensure that
rations include iodized salt.
Figure 1: Salt Flows across Africa
IDA control
7. In spite of widespread recognition of the huge problem of
anemia in most countries of Africa, MI Africa has very limited resources to
tackle this complex problem. Nonetheless MI continued to provide technical assistance and to support
ongoing fortification of cereals with iron and other vitamins and minerals,
reaching 2.3 million people in those countries where we already have a presence
or commitment (South Africa, Nigeria) and to conclude pilot projects for small
scale fortification (on-site fortification in a refugee camp in Zambia,
projects in Zimbabwe and Benin).
8. These investments are being used to develop new modalities,
for instance in collaboration with WFP to identify opportunities to fortify
food rations, and with World Vision to fortify monetized wheat. Fortification
is also an important potential strategy to anonymously improve the nutrition
quality in the diet of HIV infected populations.
9. MI’s double fortified salt project focused remained on Kenya
and Nigeria. An acceptability study was completed at two refugee camps in
Kenya. MI also supported a
technical review meeting where key concerns and questions posed by Kenyan
authorities were addressed and a decision on next steps is expected by
March.
Future Directions:
10. In
2006, MI Africa will continue efforts to mobilize additional resources to
ensure regular high coverage of VAS and reduce the costs of that coverage.
Increasingly MI will seek support through government-led programs (using
investments from World Bank loans and other sources). While the main focus of MI Africa’s work will continue
to be on protecting and expanding coverage of VA supplementation for children
6-59 months, work on scaling-up the coverage of iodized salt and on generating
funding for new programming, as well as increasing MI’s capacity to respond to
emergencies in Africa, will all increase significantly.
11. Burkina
Faso has a very high u5MR of 207/1000 live
births;
46% of children under five are deficient in Vitamin A. A thyromobile survey done in 1999 in 10
sites showed median urinary
iodine figures of 113.9 µg/L (range:
0 - 899) indicating a certain level of deficiency in some provinces. According to the DHS (2003), 68% of pregnant
women and 54% of women in their childbearing years are anaemic which is quite
high but comparable to other countries in the region. MI’s highest priority this year was to
maintain high VAS coverage through NIDs while helping set in motion a move to
child health weeks.
Reducing VAD in Burkina Faso
VAS
programs:
12. In
2005, polio NIDs+VA were held twice (May and November). More than 100% of the children 6-59
months were reached during both rounds (103% at both rounds). The target denominator for NIDs is
estimated to be 3.06 million. MI funds supported the integration of VA into NIDS, and a coverage
assessment survey following the November distribution MI also supported the
development and field testing of VAS materials to facilitate planning for child
health weeks and plans to adapt these to the Burkina Faso context.
VA
fortification programs:
13. Fortification
is expected to start only in 2006 due to delays in receipt of donor
funding. Two local industries are
targeted by the project, which are estimated to reach 50% of the population
(6.5 million) in the first year and 70% (9.1 million) during the subsequent
years.
Other VA programs:
14. MI
worked with Oxfam-Québec and the University of Montreal to promote the
production, commercialization and consumption of red palm oil which previously
showed a significant effect on reduction of VAD in school children. The current project is expected to
reach approximately 20,000 women of childbearing age and 18,000 children under
five years of age; with additional resources the project could reach 1.5
million people while contributing to increase revenue of small producers,
mainly women.
For
further information on MI’s work in Burkina Faso, please contact France Begin
fbegin@micronutrient.org.za
15. Mali has an u5MR of
220/1000 and a pattern of vitamin and mineral deficiencies similar to that in
Burkina Faso ; 47% of
children under five are deficient in Vitamin A; a thyromobile survey in 1999 in
9 sites showed median urinary
iodine figures of 203.3 µg/L (range 0.1-745.9) indicating a high level
of deficiency in some provinces. More recently, a national survey on IDD showed
the median urinary iodine level to be 68,6 µg/L indicating that Mali was now
affected by a low level of deficiency. According to the DHS III, 80% of pregnant women are anemic and 45% of
the women are vitamin A deficient. The overall prevalence of vitamin and mineral deficiencies are high but comparable to other
countries in the sub-region.
16. MI’s
highest priorities in this reporting year were to maintain high VAS coverage
through NIDs and SIAN (Semaine d’Intensification des Activités en Nutrition)
and initiate oil fortification with vitamin A.
Support to national actions to reduce and control VMD
17. MI
followed up an opportunity identified in 2004 to fortify cereal flours at small
scale level using a “multifunctional platform project” implemented by the
government with support from UNDP. An agreement was signed with UNDP to test the operational feasibility
and acceptability of fortification at the platform level. The work will begin in January 2006. UNDP will assist MI in mobilizing
resources for the expansion of the project once the pilot is concluded. The
African Bank of Development is a potential donor for the next phase of the
multifunctional platforms and therefore a potential donor for the fortification
component. There are currently 450
platforms established in rural areas and the Government of Mali is interested
in expanding the platforms to 5000 in the next ten years.
Reducing VAD in Mali
VAS
programs:
18. In
2005, polio NIDs with VAS were conducted twice: 77% of children 6-59 mo were
reached in round 1 but only 3 districts were covered in round 2 (25% of
national coverage) due to a variety of factors. Agency partners and the government are now discussing how to
institutionalize integrated nutrition weeks and improve future coverage.
VA
fortification programs:
19. The
oil fortification program has moved slowly due mainly to delays in finalizing
funding. MI assisted with the
process of selecting VA premix suppliers (the first batch of premix was
received in August 2005) and draft norms were developed and validated ready for
ratification by the National Council on Standardization and Quality
Control. Equipment has been
installed and a baseline survey involving serum retinol assessment conducted in
February 2006.
For
further information on MI’s work in Mali, please contact France Begin
fbegin@micronutrient.org.za
20. Niger has an u5MR of
262/1000 live births, ranking 2nd in the world. The prevalence of micronutrient
deficiencies in Niger is comparable to prevalence in other Sahelian
countries. Approximately 40% of
children under five are deficient in Vitamin A; median urinary
iodine figures of 270 µg/L
with 23% children iodine deficient (survey in 237 primary schools in 1998); and
a survey done in 1996 showed that 57% of children 6-59 months and 61% pregnant
women were anemic.
21. MI’s
highest priority in this reporting year was to maintain high VAS coverage
through NIDS, while paving the way for implementation of child health weeks in
the coming years involving regular delivery of a package of essential services
including VAS.
Reducing VAD in Niger
VAS
programs:
22. Two
rounds of NIDS with VAS were carried out in 2005. The numbers of children aged 6-59 months supplemented in the
first round was over 2.8 million, while just below 2.8 million were covered in
the second round (likely due to migration because of the food crisis). MI
support went to training, distribution, supervision and strengthening
integration with routine immunization. Efforts to implement new national VAS directives were
affected by the food crisis, but materials developed by HKI with MI support
were much in demand by organizations involved in food relief activities.
23. Advocacy
will continue in 2006 for adoption of VAS as a component of an essential
package for child survival.
VA
fortification programs:
24. Fortification
activities suffered a set back as the targets for fortification had to be
modified in line with significantly reduced production estimates. Investments are being diverted instead
to support fortification at multifunctional platforms in Mali.
For
further information on MI’s work in Niger, please contact France Begin
fbegin@micronutrient.org.za
25. Nigeria has an u5MR of 198/1000;
the Nigeria Food Consumption and Nutrition Survey (NFCNS) 2001-2003 reported
that the national prevalence of serological VAD was 26.8% among children under
5 with wide variation across the three agro-ecological zones, while none of the
zones had less than 18% prevalence. The same survey shows that anemia rates among pregnant women are 35.3%and
27.5% in children under five, with wide variation across states. The median
urinary iodine has continued to improve over the past years, from a value of
143 µg/L (median range: 10-200 µg/L) in 1998 to 150 µg/L in 2001. Several reports indicate that more than
90% of households have access to iodized salt. The prevalence of vitamin and
mineral deficiencies appear lower in Nigeria compared to the other countries of
the sub-region while the U5MR is among the highest.
26. Through
the MI coordinator, MI’s priorities in this reporting year was to maintain high
coverage of VAS to children under 5 years through support to NIDs and community
directed treatment with Ivermectin, and to start promote child health weeks as
an alternative delivery mechanism.
Support to national actions to reduce and control VMD
27. More
attention was focused on VMD control at national level; MI and other members of
the Nutrition Partners Group surfaced micronutrient-related issues and made
recommendations to the government.
Reducing VAD in Nigeria
VAS
programs:
28. VAS
was delivered through NIDS in May 2005 reaching almost 80% (28 million) of
children aged 6-59 months. However
in December 2005, sub-NIDS (instead of NIDS) reached only 55% (<19 million). Intensified supplementary immunization
activity (SIA) plans have been made for 2006, with some campaigns also planned
in 2007 for a few key areas to stop polio transmission. As there are wide variations in the
denominators used for targeting populations, MI will support a coverage assessment
survey during the first round in 2006. In addition to this survey, MI will support the implementation of child
health weeks in several states and continue advocacy in liaison with other
partners for wider adoption of this approach to VAS delivery.
VA
fortification programs:
29. Fortification
of oil, sugar, and flour with vitamin A is mandatory in Nigeria. MI’s support this year was limited to
strengthening the quality control system and increase awareness for fortified
food to some extent. A food
control workshop was conducted for the quality control/assurance managers of
the food manufacturers, premix suppliers and regulatory agencies to share and
disseminate a uniform testing procedure for fortified food. Indicative data from the cumulative market
share of the manufacturers suggest that 80% of flour, 70% of sugar and 55% of
vegetable oil consumed in Nigeria are fortified with vitamin A. Although the final report is not
yet available, it is estimated that approximately 35 million of people at risk
of deficiency are reached by fortified products. In 2006, MI will only be
providing limited technical assistance as GAIN funding has been secured to
support the national food fortification program for 2005-07.
Reducing IDA in Nigeria
30. It
is estimated that all the wheat flour produced in Nigeria is currently
fortified and that approximately 80% (99 million people) are covered to some
extent. But Nigeria does not consider the current flour fortification
program as a strategy to address iron deficiency anaemia, as the focus of the
fortification program has been on vitamin A. The current premix only provides 20 ppm of iron while
the recommended level should be about 3 times this amount. Neither does the flour contain any
folic acid. So in 2006, MI
will advocate for the inclusion of folic acid in flour as well as for
increasing the level of iron.
31. MI
developed a strategy to launch double fortified salt into the market in
collaboration with Royal Salt, Unilever and UNICEF. Initial market research is expected to be in progress
by March 2006.
Reducing IDD in Nigeria
32. Nigeria
is among the best performing countries in Africa with respect to salt
iodization with more than 90% households having access to iodized salt, due
mainly to good systems of monitoring and enforcement. MI participated in a pre-assessment review and assessment missions
to assess Nigeria’s readiness for USI certification. In 2006, MI will provide minimal support to the regulatory
agency for regular and continued USI/IDD situation assessment, monitoring and
enforcement.
Reducing VMD in Nigeria
33. The Home-Grown School
Feeding and Health Programme (HGSFHP) is a strategy within the Universal Basic
Education program aimed at ensuring quality learning outcomes; and Nigeria is one
of the countries identified by NEPAD for the Home-Grown School Feeding
Initiative. The (community-driven program)
HGSF&HP officially launched in September 2005 for piloting in 12
states. MI provided
support to develop funding proposals for addressing micronutrient needs within the framework of
HGSFHP - while considering the agro-ecological variation of the pilot states
along with the Federal ministry of Education of the Government of
Nigeria.
For
further information on MI’s work in Nigeria, please contact France Begin
fbegin@micronutrient.org.za
34. Senegal has an u5MR of
137/1000 live births. Approximately 61% of children under
five are estimated to be deficient in Vitamin A. The last IDD survey carried out in 1996 in the eastern and
south-eastern regions of Senegal known to be endemic zones of goiter showed
severe iodine deficiency rate of 21%, estimated from urinary iodine. DHS surveys recently conducted showed a
very high prevalence of anemia: 84% of children 6-59 months and 61% women.
35. MI’s
highest priorities in this reporting year was complete a pilot project to
support the delivery of VAS through the PAIN (Paquet d’activités intégrées
de nutrition) mechanism in one peri-urban
area where the population was hard to reach with services in spite of their
proximity to the city and provide an effective demonstration model for
implementing the government policy of integrating VAS into their routine health
services.
36. In
addition, because Senegal is a major salt producing country in West Africa with
around 80% of its current production targeted for export to other West African
countries, MI developed a partnership with CLM (Cellule the Lutte contre la
Malnutrition) housed in the Prime Minister’s
office and with WFP to accelerate USI in Senegal in collaboration with other
partners, including UNICEF.
Support to national actions to reduce and control VMD
37. MI
plans to assist, at the government’s request, in developing a national food
fortification strategy, and to implement a pilot zinc intervention in
collaboration with IZiNCG and local institutions. Otherwise MI’s main support will mainly be through provision
of capsules and advocacy to promote distribution of VAS twice a year through
outreach activities carried out by the PRN (Programme de Renforcement
Nutritionnel).
Reducing VAD in Senegal
VAS
programs:
38. MI
support for VAS was limited to the provision of capsules and to the conclusion
of a pilot study in a peri-urban area, from which preliminary results showed
that 81.1% of the target population was supplemented through outreach and
community-based services, compared to 57.8% a year ago. The intervention mainly consisted of
advocacy at the district and community level including awareness among the
administrative authorities, political and religious leaders, adequate
orientation/training to health workers and community agents (“relais
communautaires”) on the PAIN and VAS, supervision at various levels, adequate
supply of capsules at health facilities and health posts.
39. Monthly
reports sent by the health workers also showed that 70.5% of the children 12-59
months whose health cards were monitored received 2 doses of VA in one
year. VAS was recorded in the
child health card in 59% of the cases, a net improvement compared to the
previous year of 31%. Efforts are still needed to improve reporting over
time. A dissemination workshop
will be held early January to explore how this model can be expanded to other
health districts at national level.
Reducing IDD in Senegal
40. Following a Consultation to Accelerate USI in West
Africa organized by the MI and UNICEF, MI decided to focus its activities on
two main producers in West Africa: Ghana and Senegal and on support to the CLM
for coordination, generating political commitment through advocacy and
awareness creation, and for implementing monitoring and evaluation. It is estimated that 90% of the salt produced will adequately be iodized
by the end of 2007 covering an additional 10 million people.
Reducing
IDA in Senegal
41. We
previously supported a pilot project to test the feasibility and efficacy of
weekly micronutrient supplementation on anaemia and school performance among
Senegalese school children. The
results showed that iron supplements (60 mg) were more efficacious in reducing
anaemia compared to a supplement containing 30 mg and to a multiple
micronutrient supplement (also containing 30 mg of iron) and the placebo. In a sub-sample, both the 60 mg iron
supplement and the multiple micronutrient supplement were efficacious in
reducing anaemia as compared to the iron supplement containing 30 mg iron and
the placebo. In addition, vitamin
A deficiency was reduced by half in the multiple micronutrients
supplement. Unfortunately, the
sample size was too small to assess the impact of the intervention on school
performance. A summary
report will soon be shared with the government and the partners so that results
of the intervention can be taken into account during the next phase of the
World Bank-funded School Health and Education Program.
Reducing zinc and other deficiencies
42. Fortification
to address VMD: MI supported a rapid assessment survey in Senegal that showed that several
commodities including wheat flour, vegetable oil, bouillon cubes and tomato paste to be consumed frequently
by the majority of the population and thus appropriate vehicles for
fortification. The flour, oil, and
sugar industries have all shown interest in fortification. MI will provide modest technical and
other assistance directly to the industries in 2006.
43. Zinc
intervention: MI will support pilot testing in 2006 of the
integration of preventive supplemental zinc (most likely in combination with
other micronutrients) within the scope of the ongoing national nutrition
program, in collaboration with IZiNCG and local institutions.
For
further information on MI’s work in Senegal, please contact France Begin
fbegin@micronutrient.org.za
44. Ghana
has one of the lowest U5MR in the West Africa region: 49/1000 live births. However Ghana is also one of the main
salt producers in the region and pivotal to regional salt iodization efforts.
Reducing IDD in Country
Iodized
salt:
45. MI support to USI in Ghana is aimed towards increasing the
supply of iodised salt by 62,500MT by the end of 2006, which is in turn
expected to result in the coverage of a further 15.6 million people from the
end of 2006 onwards. The
program is expected to expand to support smaller producers by 2007.
For
further information on MI’s work in Ghana, please contact France Begin
fbegin@micronutrient.org.za
46. Angola has an u5MR of 260.
The prevalence of VA deficiency amongst children under five is 64% and
lactating women 77%. Until 2003, VA supplementation took place during
immunization campaigns. In 2004, within the new context of peace, Angola
elaborated a five year strategic health plan focusing on the integrated
delivery of primary health care services. Providing VA during “municipal child
health days” is key to extending coverage of a package of services to
communities with little access to formal health services. Iodine intake among the general
population is insufficient and household consumption of iodised salt is
estimated at 35%.
47. In
2005, MI partially funded the first Child Health Week (CHW). This event was
delayed several times and took place early in 2005. In this reporting year,
MI’s highest priority in this reporting year was to support the
institutionalization of child health days and to strengthen planning and
implementation. The second dose of VA was given as part of a measles/polio
campaign. Coverage of this is not yet available, but 80% is anticipated. MI
also undertook a salt iodization assessment mission to identify key constraints
and bottlenecks in achieving USI.
Reducing VAD in Angola
48. Angola’s
first child health week took place early in 2005 in all provinces and municipalities targeting
children aged 6 to 59 months with a package of services including de-worming,
yellow fever, DPT, polio, measles and TT. Given that Angola has a long history of war and largely vertical
service delivery, implementation of the CHW was successful once it
happened. It showed that
integration of interventions is feasible and the CHW offered the opportunity to
train health care workers and increase their capacity to deliver services. Although the actual event was delayed
twice, micro-planning was comprehensive. Over 1,998,640 children received a
dose of vitamin A during the child health week, 96% of children under one, but
only 61% of children over one year. However in some provinces coverage was as low as 29% as distribution
took place during the rainy season and reaching rural communities was very
challenging. A second VA dose was
provided in August 2005 during a polio campaign.
49. Angola’s
next Child Health Day is scheduled for October 2006. MI will support planning and implementation through a VA
coordinator based in UNICEF.
Reducing IDA in Angola
50. Many mills were destroyed during the war; but the
government of Angola is now interested in launching a fortification programme.
The World Food Program in Angola started fortification in one wheat mill and is
distributing fortified flour to beneficiaries. MI assisted the WFP providing a
consultant to explore the feasibility of fortification and potential
opportunities.
Reducing IDD in Angola
Iodized
salt:
51. An assessment of salt iodisation was
conducted, enabling MI to get an accurate situation analysis and to inform a
strategy aimed at increasing the iodized salt supply by 10,000MT through
support to salt industry.
For
further information on MI’s work in Angola, please contact Julia Moorman
jmoorman@micronutrient.org.za
52. The
DRC has an u5MR of 205 and is a high priority country for MI. Over 60% of children under five are deficient in
Vitamin A. A survey done in 2000 showed that over 57% of children are anemic.
In one province this prevalence was as high as 90%. VAD is high for the
sub-region and over 550,000 children under five die each year. MI’s highest
priorities in this reporting year were to strengthen the capacity of the
government to coordinate VA supplementation activities and improve planning,
data collection and evaluation of coverage. In 2005 MI funds contributed 42% of
funds used during a VA and de-worming campaign in May, which achieved an
overall coverage of 89.5% coverage. VA was given during an EPI campaign in November. Although coverage
figures from this second distribution are not complete, an 85% national
coverage has been projected.
Support to national actions to reduce and control VAD
53. In
2005, MI provided support to VAS campaigns alongside as less than 30% of the
population has access to health services in the DRC, and national campaigns
continue to be the only way to achieve high coverage. The 1st dose of VAS was given during a combined mebendazole/VA campaign in nine out of
eleven provinces; in two provinces, Orientale and Equateur, vitamin A was given
with polio vaccine as part of a sub-national campaign. Coverage was high and 10.1M
children were supplemented, and the wide provincial variation seen in 2004 was much less marked. Only one
province reported coverage less than 80%. Door to door distribution took place in all provinces except in Bas
Congo and the two Kasai provinces where an advanced fixed post strategy was
tried. In the two Kasai provinces, attendance was very low on the first two
days so they switched to resume door to door distribution. One of the important
lessons learned during this campaign was the importance in collaborating with
both NGO’s and EPI at the provincial level.
54. The second dose of VA was given
during a combined national polio and measles campaign. Although the data
available is incomplete, coverage is estimated to have been over 85% in all
provinces. Preliminary
results indicate that coverage is over 89%. However attention will need to be paid to assessing the
accuracy of coverage figures. MI
concentrated on providing technical support to the government through a country
coordinator. In 2006, our focus
will likely remain on strengthening planning and data collection, as well as
identifying new partners to raise funds for supplementation.
55. MI and the National Onchocerciasis
Task force received funding from the African APOC for the integration of VA and
Mectizan in three CDTI project areas. APOC funded these pilot projects for one
year to reach 1,150,356 children in three provinces. The first integrated distribution is expected to take
place in early 2006.
Reducing IDA in DR Congo
Iron
fortified foods:
56. Iron
deficiency anemia is reported to be extremely high. In one province (Bas Congo)
over 90% children under the age of five are reported to be anemic. A large wheat mill is interested in
fortifying the 26,000 tonnes of wheat imported into the DRC each month. MI undertook a preliminary
assessment mission to look at the feasibility of fortification; it has been
estimated that over 4,000,000 peri urban consumers could be reached by this
initiative.
For
further information on MI’s work in DRC, please contact Julia Moorman
jmoorman@micronutrient.org.za
57. Ethiopia
has an u5MR of 169;
30% of children under six are deficient in Vitamin A and the anemia rate among
children under five is 85%. VAD is low for the sub-region while IDA is the
highest for the sub-region. Iodine
intake among the general population is insufficient with only 2% households
consuming adequately iodized salt.
58. MI’s
highest priorities this year were to boost coverage with VAS in districts
(woredas) not already covered by the Enhanced Outreach Strategy (EOS), to
resolve bottlenecks impeding progress in VA supplementation, to assess the
situation of iodized salt in the country and support the implementation of the
recommendations arising from the assessment. Support to USI program is a priority for 2006 and an assessment
was conducted to prepare an intervention strategy and identify key weaknesses
within the USI program.
Reducing VAD in Ethiopia
59. MI
focused its support on the “non-EOS” woredas, providing technical assistance for planning, training and monitoring
VAS delivery in these areas. In
the first half year, coverage of 80% was achieved in the selected areas (over 2
million children under 5 years of age), comparing favourably with the coverage
rates of over 90% reportedly achieved in the EOS areas. Although no coverage verification was
conducted in 2005, MI plans to support its two focus regions in conducting
coverage validation surveys in 2006.
60. In
2006, MI aims to provide additional support to these regions by providing funds
for VA distribution, coverage validation surveys, mid-term reviews, capacity
building, social mobilization and advocacy. In these regions vitamin A will be delivered via periodic
outreach events and as part of a minimum integrated package with
deworming.
Reducing IDD in Ethiopia
61. As
a result of MI’s salt assessment mission to Ethiopia in 2005, MI will support
the two largest salt producers to iodize about 100,000 MT by the end of
2006. An additional seven salt
producers have also expressed an interest in iodizing their salt. A team of engineers will visit in early
2006 to assess the technical support required; further support will then also
be extended to smaller producers wishing to iodize their salt. MI’s focus on production and supply
will complement the advocacy, awareness-raising and social mobilization
activities planned by other USI partners including UNICEF. Enforcement and monitoring will also be
strengthened.
62. It
is anticipated that MI’s support to Ethiopia’s USI program will result in the
availability of an additional 100,000 MT of iodized salt by the end of 2006
thereby benefiting about 25 million people.
For
further information on MI’s work in Ethiopia, please contact Edna Berhane eberhane@micronutrient.org.za
63. Kenya
has an u5MR of 123;
70% of children under five are deficient in Vitamin A.
The anemia rate among children under five is 60%. VAD is high for the
sub-region (average is 46%) while IDA is low for the sub-region (average is
72%). Iodine intake among the general
population is considered optimal with over 95% households consuming iodized
salt; but there is a need to ensure coverage is maintained.
64. MI’s
highest priorities in the year were to resolve the bottlenecks impeding
progress to universal coverage, and specifically to raise the VAS coverage to
70%, to maintain the USI levels and complete the acceptability and efficacy
studies for DFS. As a result of a high-level advocacy visit to
Kenya in 2005, the Permanent Secretary of the MOH committed himself to tabling
a paper to cabinet/parliament, highlighting the need for greater attention to
issues of nutrition and micronutrient insecurity.
VA
Supplementation
65. Kenya
decided in 2005 to implement a twice-yearly Child Health Week/VAS event
throughout the country. MI
provided funds to support both the first and second rounds (June/July and
December 2005), and provided technical support to field-testing a
district-level VAS tool kit for planning Child Health Weeks, and to supply and
logistics and monitoring and evaluation. No coverage verification was undertaken during the reporting period, so MI will support a
coverage validation survey and a cost-analysis study are planned for 2006.
66. Some of the lessons learned in 2005 from the Child
Health Week experience were the importance of political commitment; the
critical nature of adequate planning; the importance of partnerships, and the
importance of social mobilization. The MI will build on this in support for
round 1 in 2006, while round 2 will be linked to a national measles campaign
planned for August 2006.
VA Fortification
67. Kenya is one of the countries profiled within MI’s
Africa-wide industry-based food fortification strategy, and will be one of the
initial countries in which this strategy will be tested. MI will support the
creation on an enabling environment for food fortification – particularly
through advocacy and provision of technical assistance to the food industry.
Improving iron intake with double fortified salt
(DFS)
68. An
acceptability study on DFS was conducted at 2 refugee camps in collaboration
with UNICEF, WFP and UNHCR. The
findings have triggered interest from WFP to consider DFS in targeted feeding
programs, but progress still requires necessary clearances from regulatory
bodies in the country to allow DFS within the public food act – this may
be decided as early March 2006.
Universal salt iodization
69. In
2005, MI provided financial and technical support to maintain Kenya’s high
coverage of iodized salt. During
the course of the year, the MI coordinator provided technical support to
National IDD awareness day events and regulatory and monitoring agencies. In
2006, MI will continue to provide technical support to the USI program and
identify the causes of continued IDD prevalence in some areas of the country.
For
further information on MI’s work in Kenya, please contact Edna Berhane eberhane@micronutrient.org.za
70. Mozambique has an u5MR of 313. Almost 70% of children under five are
deficient in vitamin A. There is mild iodine deficiency, yet iodine intake
among the general population is insufficient with only 62% households consuming
adequately iodized salt.
71. MI’s
highest priorities this year were to continue to support routine
supplementation in Mozambique but to look at ways to substantially increase
coverage through routine services. MI also conducted a comprehensive salt iodization assessment mission in
preparation for the USI program in 2006.
Reducing VAD in Mozambique
VAS
programs:
72. Mozambique adopted in 2002 a
strategy of supplementation through routine services as it was felt that the campaign approach was
hugely disruptive to health services and a policy decision was made to
strengthen routine services as much as possible. However routine coverage has improved only slightly in
the years between 2002 and 2004, from 42.8% children receiving one dose of VA
in 2002, 44% in 2003 and 57% in 2004. In 2005,
28% of children were reached in the first half of the year; however a measles
campaign was undertaken in the second half of the year for which coverage is
not yet available but is expected to be over 80%.
73. Although coverage is low, some
progress has been made by Helen Keller International working with the support
of the MI to institutionalise vitamin A at district level and raise awareness,
both among health care workers and communities about its importance. IEC
materials were developed and micronutrient bulletins were produced on a
quarterly basis and distributed to districts. Mobile teams were supported in
two provinces – Niassa and Manica and demonstrated that this strategy
could substantially increase coverage. Some of the challenges Mozambique faces are poor access to health
services and a great shortage of skills at the provincial level.
Increasing vitamin A intake with orange-fleshed sweet
potatoes
74. A
pilot project to determine whether a food based intervention strategy can lead
to sustainable, year round intake of VA rich OFSP is on going. This project, in three districts of drought-prone Zambezia
province, also considers whether increased consumption of OFSP can successfully
reduce fluctuations in the seasonal calorie supply and lead to an overall
improvement in the nutritional status of vulnerable populations. The baseline survey showed over 70% of
children to be deficient in VA, 25% to be anemic and over 50% to be chronically
malnourished.
75. This
project has successfully integrated nutrition and agricultural interventions.
Three strategies have been used to ensure the increased consumption of OFSP by
children: improving access to improved and acceptable varieties of OFSP,
introducing OFSP into the diets of communities through nutrition education and
social mobilization and establishing a market for OFSP which provides a source
of income for families and ensures the sustained adoption of new varieties.
76. To
date vines have been distributed to almost 1,000 households. Households have
improved knowledge about VA and its importance and the median intake of VA rich
foods was seven times higher in intervention districts. Consumption of OFSP by
children under five increased and preliminary data analysis has shown a
significant (albeit moderate) increase in serum retinol levels in intervention
children. Data analysis is not yet complete but the final results are expected
early in 2006. Overall however,
OFSP was accepted by communities and the study has shown that market
development and commercialization are essential components to ensure the
permanent adoption of this crop into the farming system.
77. The
results and lessons learned from this pilot project will be used to develop
proposals for NEPAD to expand the intervention in other drought prone areas of
Mozambique.
Reducing IDA in Mozambique
Iron fortified foods:
78. The
MI will explore with World Vision opportunities to fortify monetized wheat
flour nationally. An initial industry assessment was undertaken in 2005 and
shown that industry is willing to consider fortification and has the capacity
to fortify. Bread is widely consumed in Mozambique, although the potential
reach has yet to be calculated.
Reducing IDD in Mozambique
79. An
assessment of salt iodization was conducted in Mozambique to inform the program
plan for USI is planned for 2006-2007.
For
further information on MI’s work in Mozambique, please contact Julia Moorman
jmoorman@micronutrient.org.za
80. South
Africa has an u5MR of 77. Although micronutrient deficiency
prevalence rates are not high in comparison with the region overall, VAD, IDD,
and IDA deficiencies are still considered a public health problem, especially
in rural areas. In 1994, 33% of
children between 6 and 71 months were found to be VA deficient and more recent
studies have shown that over 30% of women in some provinces are anemic. These
high prevalence rates led to the mandatory fortification of wheat and maize
flour in 2004.
81. MI’s
highest priority in this reporting year was to continue to support the National
Fortification Alliance and the fortification of wheat and maize flour with 9
vitamins and minerals, including VA, iron and folate. Consumption of iodized
salt at household level remains at 65%.
Reducing VAD in South Africa.
82. MI has
had little opportunity to contribute to Vitamin A supplementation in South
Africa. As a result of an MI funded strategic planning workshop in 2004, the
training of health care workers was identified as a priority. The government
has subsequently received financial substantial support from MOST in 2005 which
has contributed to this activity.
Support to national actions to reduce and control VMD
83. The
fortification of wheat and maize flour has been mandatory in South Africa since
October 2003. In January, South Africa received a GAIN grant of $2.8 million
over three years to support the implementation and monitoring of the
fortification program which had received extensive technical assistance from MI
in prior years. GAIN’s contribution is now enabling the completion of
these. MI continues to complement
GAIN funding through assistance to smaller millers to enable them to comply
with the legislation.
Reducing IDD in South Africa
84. MI
conducted a salt iodisation assessment mission to identify the bottlenecks
which have stalled iodised salt consumption of household at 65%. MI worked closely with the SA IDD
network providing technical support in planning intervention strategies and funded the Medical Research Council of SA to analyse salt samples
collected from a National wholesale, retail and household survey aimed at
identifying channels for trade and use of non-iodised salt. The results will be available by
February 2006.
For
further information on MI’s work in South Africa, please contact Julia Moorman
jmoorman@micronutrient.org.za