Nutrition in the First 1,000 Days - Save the Children

34 SaviNg liveS aND BUilDiNg a Better FUtUre: loW-coSt SolUtioNS that WorK
more than 3,400 temporary sites were organized to deliver vitamin A within
small, isolated communities. Frontline health and nutrition workers and
community volunteers in the 38 districts of Bihar were trained to administer
preventive vitamin A syrup to children and to counsel mothers on how
to improve the vitamin A content of their children’s diet. In 2009, Bihar’s
vitamin A supplementation program reached 13.4 million children under 5,
protecting 95 percent of children in this age group against the devastating
consequences of vitamin A deficiency.111 In 2010, national coverage for India
as a whole was estimated at only 34 percent.112
• Vietnam has a strong public health system at all levels that includes over
100,000 community health workers113 and a specific cadre called “nutrition
collaborators” who staff clinics and do home visits. These health workers
screen children for malnutrition, treat diarrhea and counsel mothers about
breastfeeding, balanced diet, hygiene and sanitation. With the help of these
health workers, Vietnam is making promising progress toward the MDGs.
By 2015 the country is almost certain to reach MDGs 4 and 5 related to
child and maternal mortality. Since 1990, Vietnam has cut child mortality
by 55 percent114 and maternal mortality by 66 percent.115 Over the past
two decades Vietnam has also cut child stunting by over 60 percent (from
61 percent in 1989 to 23 percent in 2010)116 and since 2005, the country has
nearly eliminated iodine deficiency in pregnant women and children.117
• In Mali, community health workers in one program helped ensure more
than 90 percent of mothers took daily doses of iron-folic acid and multiple
micronutrients.118 In nationwide efforts from 2002-2007, Mali’s government
trained 22,000 community health workers on several nutrition-related
interventions to improve child survival. Each health worker was responsible
for 35 households and was expected to visit each household monthly. The
health workers delivered vitamin A to women and children under 5. They
also discussed the benefits of exclusive breastfeeding in the first 6 months of
life and the risks of giving water instead of breast milk.119 Program-specific
results are not available, but national-level surveys have reported early initiation
of breastfeeding increased from 10 percent in 1995/96, to 43 percent in
2007. Exclusive breastfeeding rose from 8 to 34 percent.120
• In Mongolia, community health volunteers deliver multiple micronutrient
powders – known as “Sprinkles” – that can improve vitamin and mineral
intake among children over 6 months old. The powders contain up to 15
vitamins and minerals (such as iron, and vitamins A and D), are relatively
tasteless, odorless, colorless, and are safe and easy to use. They cost about 3
cents per sachet (one child typically gets 60 to 90 sachets per year). Mongolia
is introducing Sprinkles as part of an integrated approach to improve young
child feeding and reduce anemia and stunting. In 2001, when the country
began distributing Sprinkles as part of a pilot program, around 42 percent of
preschool-age children were anemic. Public health workers and community
volunteers gave 30 sachets monthly to children. One year into the program,
13,000 children, or more than 80 percent of those targeted, had received
multi-micronutrient powders, and anemia was reduced to half of baseline
levels.121 Mongolia is currently scaling-up the program nationally, aiming
to reach 49,480 children under age 2. Nurses, public health workers and
community volunteers are distributing sachets at health posts.122
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