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

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.

Informations de copyright

© 2021 The Authors. Health Science Reports published by Wiley Periodicals LLC.

Déclaration de conflit d'intérêts

The authors state that there is no competing interest and the contents are the responsibility of the authors and do not necessarily reflect the views of the Irish Aid, UNICEF, UNFPA or the Canadian Government. Habib I. Kamara affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.