Overestimation of Vitamin a Supplementation Coverage from District Tally Sheets Demonstrates Importance of Population-Based Surveys for Program Improvement: Lessons from Tanzania.

Tanzania has conducted a national twice-yearly Vitamin A supplementation (VAS) campaign since 2001. Administrative coverage rates based on tally sheets consistently report >90% coverage; however the accuracy of these rates are uncertain due to potential errors in tally sheets and their aggregation, incomplete or inaccurate reporting from distribution sites, and underestimating the target population. The post event coverage survey in Mainland Tanzania sought to validate tally-sheet based national coverage estimates of VAS and deworming for the June 2010 mass distribution round, and to characterize children missed by the national campaign. WHO/EPI randomized cross-sectional cluster sampling methodology was adapted for this study, using 30 clusters by 40 individuals (n = 1200), in addition to key informant interviews. Households with children 6-59 months of age were included in the study (12-59 months for deworming analysis). Chi-squared tests and logistic regression analysis were used to test differences between children reached and not reached by VAS. Data was collected within six weeks of the June 2010 round. A total of 1203 children, 58 health workers, 30 village leaders and 45 community health workers were sampled. Preschool VAS coverage was 65% (95% CI: 62.7-68.1), approximately 30% lower than tally-sheet coverage estimates. Factors associated with not receiving VAS were urban residence [OR = 3.31; p = 0.01], caretakers who did not hear about the campaign [OR = 48.7; p<0.001], and Muslim households [OR<3.25; p<0.01]. There were no significant differences in VAS coverage by child sex or age, or maternal age or education. Coverage estimation for vitamin A supplementation programs is one of most powerful indicators of program success. National VAS coverage based on a tally-sheet system overestimated VAS coverage by ∼30%. There is a need for representative population-based coverage surveys to complement and validate tally-sheet estimates

Linear programming can help identify practical solutions to improve the nutritional quality of food aid.

OBJECTIVES: To assess the nutritional quality of food aid delivered by food banks in France and to identify practical modifications to improve it. DESIGN: National-level data were collected for all food aid distributed by French food banks in 2004, and its nutrient content per 2000 kcal was estimated and compared with French recommendations for adults. Starting with the actual donation and allowing new foods into the food aid donation, linear programming was used to identify the minimum changes required in the actual donation to achieve the French recommendations. RESULTS: French food-bank-delivered food aid does not achieve the French recommendations for dietary fibre, ascorbic acid, vitamin D, folate, magnesium, docosahexaenoic acid, alpha-linolenic acid and the percentage of energy from saturated fatty acids. Linear programming analysis showed that these recommendations are achievable if more fruits, vegetables, legumes and fish were collected and less cheese, refined cereals and foods rich in fat, sugar and/or salt. In addition, new foods not previously collected are needed, particularly nuts, wholemeal bread and rapeseed oil. These changes increased the total edible weight (42%) and economic value (55%) of the food aid donation, with one-third of its edible weight coming from fruits and vegetables, one-third from staples, one-quarter from dairy products and approximately a tenth from meat/fish/eggs. CONCLUSIONS: Important changes in the types and amounts of food collected will improve the nutritional quality of food-bank-delivered food aid in France. Such changes are recommended to improve the diets of deprived French populations

Madagascar face au défi des Objectifs du millénaire pour le développement

L’engagement pris par 147 chefs d’État d’accorder un « soutien indéfectible » à la réalisation des Objectifs du millénaire pour le développement (OMD) a eu un impact fort sur la structuration de l’aide, sur la définition des politiques promues et sur leur mise en œuvre par les gouvernements des pays du Sud depuis dix ans. Mais quel en a été l’impact sur le développement des pays concernés et quelle distance reste-t-il à parcourir pour que les OMD soient atteints à l’échéance de 2015 ? Cet ouvrage propose un bilan à mi-parcours de l’état de réalisation des cinq premiers objectifs pour Madagascar. Outre un diagnostic chiffré des évolutions récentes observées en matière de pauvreté, de scolarisation, de santé ou encore d’égalité des sexes, il présence les résultats de recherches originales sur des thématiques aussi diverses que la demande d’éducation, les discriminations, la fécondité, l’occupation spatiale du territoire… Au travers d’analyses minutieuses d’économistes, de démographes, d’agronomes et de géographes, les facteurs de blocage susceptibles de freiner la marche de Madagascar vers la réalisation des OMD sont mis en lumière. Il est aujourd’hui certain que les OMD ne pourront pas être atteints en 2012, en partie du fait de la crise politique qui sévit à Madagascar depuis le début de l’année 2009. Mais en adoptant une perspective de long terme, ce livre apporte des éléments concerts, utiles pour la mise en place de politiques de lutte contre la pauvreté et la conduite d’actions de développement, dont il faudra tenir compte une fois la crise résolue