Can an Integrated Approach Reduce Child Vulnerability to Anaemia? Evidence from Three African Countries.

Addressing the complex, multi-factorial causes of childhood anaemia is best done through integrated packages of interventions. We hypothesized that due to reduced child vulnerability, a "buffering" of risk associated with known causes of anaemia would be observed among children living in areas benefiting from a community-based health and nutrition program intervention. Cross-sectional data on the nutrition and health status of children 24-59 mo (N = 2405) were obtained in 2000 and 2004 from program evaluation surveys in Ghana, Malawi and Tanzania. Linear regression models estimated the association between haemoglobin and immediate, underlying and basic causes of child anaemia and variation in this association between years. Lower haemoglobin levels were observed in children assessed in 2000 compared to 2004 (difference -3.30 g/L), children from Tanzania (-9.15 g/L) and Malawi (-2.96 g/L) compared to Ghana, and the youngest (24-35 mo) compared to oldest age group (48-59 mo; -5.43 g/L). Children who were stunted, malaria positive and recently ill also had lower haemoglobin, independent of age, sex and other underlying and basic causes of anaemia. Despite ongoing morbidity, risk of lower haemoglobin decreased for children with malaria and recent illness, suggesting decreased vulnerability to their anaemia-producing effects. Stunting remained an independent and unbuffered risk factor. Reducing chronic undernutrition is required in order to further reduce child vulnerability and ensure maximum impact of anaemia control programs. Buffering the impact of child morbidity on haemoglobin levels, including malaria, may be achieved in certain settings

Experience With Digital Entry Of National Iodine Survey Data In Senegal

There is growing evidence and enthusiasm for the use of technology to enhance accuracy and speed and minimize the costs of quantitative data surveys. Handheld computers have the potential to facilitate high quality data collection and timely analysis for large complex surveys in developing country contexts. The objective of this paper is to document the experience of using handheld computers for direct data capture in a national survey to monitor progress toward universal salt iodization in Senegal. Twenty-five personal digital assistants (PDAs) were programmed and used by five teams across 13 regions for entering data from 3768 households over a period of three weeks. The health staff selected to collect the data learned how to manipulate the PDAs within a short amount of time. The PDAs contributed to improved quality of data collection due to automatic skipping of non-applicable questions and selection of individuals eligible for goitre assessment. The PDAs also were programmed to randomly select one woman and one school-age child within each household for biochemical sample collection. Data on geographic locations were collected for 82% of households surveyed using the PDA’s in-built Global Positioning System (GPS) functionality, which showed the geographical dispersion of these households and which will be used for analysis of results for key indicators by location. Problems with household selection processes, identification coding and standardized interview methods were observed. While costs for printing questionnaires and manual data entry were saved, significant costs were incurred for PDA technical support by an international consultant. The use of PDAs significantly reduced data processing time. Data were stored and downloaded to a central database, with the full dataset and preliminary results available to stakeholders within one week following the survey completion. The PDAs are an excellent tool for enhancing capacity to collect complex household survey data and make it available for analysis in a timely manner. Quality training and adequate pre-testing of questionnaires are still essential. Increased use of direct data capture methods in health program design, monitoring and evaluation is recommended, along with efforts to build local technical capacity