Impacts of micronutrient intervention programs on effective coverage and lives saved: Modeled evidence from Cameroon.

Policymakers are committed to improving nutritional status and to saving lives. Some micronutrient intervention programs (MIPs) can do both, but not to the same degrees. We apply the Micronutrient Intervention Modeling tool to compare sets of MIPs for (1) achieving dietary adequacy separately for zinc, vitamin A (VA), and folate for children and women of reproductive age (WRA), and (2) saving children's lives via combinations of MIPs. We used 24-h dietary recall data from Cameroon to estimate usual intake distributions of zinc and VA for children 6-59 months and of folate for WRA. We simulated the effects on dietary inadequacy and lives saved of four fortified foods and two VA supplementation (VAS) platforms. We estimated program costs over 10 years. To promote micronutrient-specific dietary adequacy, the economic optimization model (EOM) selected zinc- and folic acid-fortified wheat flour, VA-fortified edible oils, and bouillon cubes, and VAS via Child Health Days in the North macroregion. A different set of cost-effective MIPs emerged for reducing child mortality, shifting away from VA and toward more zinc for children and more folic acid for WRA. The EOM identified more efficient sets of MIPs than the business-as-usual MIPs, especially among programs aiming to save lives.

Factors Affecting the Performance of Community Volunteers during Child Health Days in Douala, Cameroon.

Objectives: In the Littoral region of Cameroon, targeted awareness and social mobilization has increased coverage of vitamin A supplementation (VAS) during Child Health Days (CHDs) from 52.9%% in 2011 to 71.6% in 2012. Following this increase, coverage stagnated for the 2nd round of 2012 (71.0%) and the first round in 2013 (71.4%) thus falling short of the national target of 90% coverage of children 6-59 months. Methods: To determine barriers to high VAS coverage, targeted interviews were conducted with community volunteers participating in CHDs to identify factors contributing to CHD performance. Community volunteers were categorized as having "acceptable performance" or "poor performance" based whether their team met the daily target of reaching at least 120 children per day. Results: Interviews were conducted with 61 community volunteers with poor performance and 39 with acceptable performance from 6 health districts. The main factors found to influence performance were caretakers' awareness of the event and age of the volunteer (p<0.10). When asked how the campaign could be improved to reach all children, the most common response among both groups was better sensitization of parents (57%), ensuring stock (14%) and increasing the volunteer's allowance (12%). 37% of volunteers cited resistance by parents as the barrier that prevented teams from achieving universal coverage. Conclusions: Although door-to-door distribution is used to deliver services during CHDs to facilitate delivery, interviews with community volunteers indicate that better sensitization of caretakers prior to CHDs is still critical to achieving high coverage.