Sight and Life Magazine 1/2011

SIGHT AND LIFE | VOL. 25 (1) | 2011 THE FEASIBILITY OF DELIVERING VITAMIN A TO NEWBORNS 3333figure 3: FCHV Dosing ModelAntenatal contactwith pregnant womenIron distribution by FCHVspecial technical support visits, and interview health workersand mothers whose babies have received the VA. In addition, theeffectiveness of the intervention is being evaluated using twopopulation-based cross-sectional surveys at baseline (September2009) and end-line (February 2011).FCHV notified at birth byfamilyFHCV visits newborn’shome within 48 hoursof birthFCHV doses newbornwith vitamin A andrecordsfigure 4: Mother Dosing ModelANC visitHFOutreachclinicFCHV visitwithin48 hours ofdeliveryAntenatal contactwith pregnantwomenNVAS dispensingto pregnant womenat 8 months ofpregnancy by HFstaff or FCHVNVAS dosing within48 hours of deliveryby mothers/familymembersConfirmationof newborn dosingand dosing if missedand recordingDelivery at healthinstitutionNewborn dosed withvitamin A within 48 hoursof birthPostnatal visit by FCHV toconfirm if dosed at HFIrondistributionby FCHV andcounselingNVASDelivery athealthinstitutionNewborndosed withvitamin APreliminary findings. Through the initial nine months of implementationin the four pilot districts, >18,000 newborns havebeen supplemented. Preliminary findings suggest that 62% ofnewborns are reached in the female community health volunteer(FCHV) and community health worker dosing model, and only45% in the mother/family member dosing model.Interesting preliminary observations frommonitoring surveys include:> High NVAS coverage in districts where institutional deliveriesare high, and where other community-based services targetingnewborns have been well established (e.g. in Banke).> Low ANC attendance, especially the last visit at eight months’gestation, appears to lead to low NVAS coverage.> In the “Mother/Family Member Dosing” model, ~11% of mothersare reluctant to dose their newborns. Instead, they waitfor the community health worker (i.e. the FCHV) to visit anddose the newborn.> Fewer than one percent of mothers and about one percent ofhealth workers reported a bulging fontanel in dosed infants.All cases were transitory and recovered without treatment.BangladeshBackground. The Ministry of Health and Family Welfare (Mo-HFW) in Bangladesh has extensive experience in consideringresearch findings, establishing a permissive policy, pilotingmodels to test implementation feasibility, and scaling up interventions.In December 2009, the Government of Bangladesh approvedpilot feasibility testing activities for NVAS in three districts(Tangail, Pirojpur and Nilphamari), and six sub-districtsdivided between the Directorate General of Family Planning andRevitalization of Community Health Care Initiative/CommunityClinic, Bangladesh (Figure 5).Delivery models. In Bangladesh >80% of births occur in thehome,