Development of a Home Fortification Programme for Young Children in Zambia
UNICEF Zambia (2012 – present)
While Zambia has made progress towards reducing under-nutrition among children, as measured by underweight, other indicators of nutritional status, particularly stunting and anaemia have remained unchanged over the past decades.
Repeated national surveys show that the global goal for the reduction of iron deficiency and anaemia has not been met in Zambia and that anaemia remains of public health significance among Zambian children. There has been no significant reduction in anaemia among children 6-59 months over the past two decades with an estimated prevalence of 60% in 19981, 53% in 20032, and 49% in 20093. Further, younger infants were found to be more affected than older children with an estimated prevalence of 81% in children 6-18 months in 1992 and 61% in children 6-24 months in 2009.
The home fortification with MNP program in Zambia has been designed as a multiphase project with the first phase consisted of two components, a feasibility study and a 30-day trial of MNP. The feasibility study included key informant interviews and focus group discussions, which assessed current feeding practices, perception of MNP, potential barriers to MNP introduction, knowledge of anaemia, and tested local package designs. This component was completed in May 2012. The second component, a 30-day trial of MNP, was completed in July 2012, and assessed the acceptability and utilisation of MNP among 60 households using two different delivery strategies. The findings of the feasibility study and the 30-day trial compiled in two separate reports have been integrated into the design of the pilot phase, which will ultimately inform how best to operationalise and scale up the MNP intervention in Zambia. Furthermore, the earlier work has been used to finalise the training manuals, training guidelines, instructions of use, FAQ, and communication & advocacy materials for MNP, for the pilot phase as well as the Zambian package design.
The second phase of the project began in April 2013; a 12-month pilot implementation of MNP for children 6-23 months of age in selected catchment areas of two districts of Northern Province was completed. It was estimated to reach approximately 5’000 children 6-23 months. An impact evaluation (effectiveness study) was embedded within the pilot programme to assess the effect of MNP plus IYCF intervention package in relation to the programme’s goals and outcomes of a sub-sample in the targeted areas under programmatic conditions. Impact evaluation was a periodic activity, and consisted of collecting and analysing data at baseline, mid-term (6-months), and end-line (12 months) of the project. Data was collected on a range of variables to allow for interpretation and understanding of programme impact pathways. Not all of the desired programme goals and outcomes may show an observable change across 12 months and therefore proxy indicators were also used.
The methods were developed in accordance with the overall pilot programme goals and objectives, taking into consideration the limitations of implementing a rigorous scientific design in resource poor settings where access, transportation and communication, are limited.
The main objective of the pilot program was to inform the design of the home fortification scale-up based on findings from the two components of the formative work and the pilot study.