Integrating a Six-Month Contact Point for Vitamin A Supplementation, Infant and Young Child Feeding Counselling and Family Planning within Routine Health Services in Sierra Leone

Abstract

Objectives: Since 2004, twice-yearly mass vitamin A supplementation (VAS) has reached >85% of children 6-59 months.  Although VAS coverage is consistently high, an additional 2.4% reduction in infant mortality could be achieved if all children receive VAS as soon as they turn six months. Therefore, the effectiveness of integrating a six-month contact point with VAS into the routine EPI schedule was examined. Methods: Twelve health units matched according to staff levels, cadre and work load were assigned to provide either a ‘full package’ of 1)VAS, 2)Infant and Young Child Feeding counselling (IYCF), and 3)family planning (FP) counselling and commodities; a ‘mini package’ of 1)VAS and 2)IYCF  or  control’ with routine health services. 400 infants were enrolled into each group between birth and 3 weeks of age and followed until they were 12 months old. Caregivers of all enrolled children received modified child health cards with a six-month contact point Results: More children in the full (74.5%) and mini (71.7%) groups received VAS at six months compared with the control group (60.2%)(p<0.05).  At 9 and 12 months of age, mean WAZ was significantly higher for the full (0.24±0.98; 0.90±0.81), versus the mini (-0.05±1.05; 0.26±0.93) and control groups (-0.55±1.24; 0.39±1.41)(p<0.0001, p<0.01), respectively.  FP commodities were provided to 67.3% of mothers in the full group compared with 3.0% in the mini and control groups (p<0.0001). Conclusions: A six-month contact point integrated into the EPI schedule increased VAS coverage and provision of family planning commodities at six months and was associated with improved growth in late infancy.