Search

In 2017, transition to routine vitamin A supplementation (VAS) commenced as an integrated reproductive and child health service including vaccinations, Albendazole for deworming, complementary feeding demonstrations, 'quality' family planning counselling and provision of modern contraceptives. After 10 months, a lot quality assurance sampling survey evaluated coverage of these interventions. Each of three districts was divided into five supervision areas (lots), and 19 villages were randomly selected in each lot proportional to population size. Households were randomly selected, and a questionnaire was administered to a caregiver of a child 6-11, 12-23 and 24-59 months in each village. Overall, caregivers of 855 children were interviewed, and 19 questionnaires were completed for each age group (6-11, 12-23 and 24-59 months) in each of the five lots in each district. All lots in one district passed the threshold of 80% for VAS and 75% coverage for Albendazole, and two lots failed for either VAS/Albendazole in the other two districts. Overall, weighted VAS coverage for children 6-59 months was 86.9%, and weighted Albendazole coverage for children 12-59 months was 80.9%. Most caregivers (77.2%) knew that complementary feeding should be introduced at 6 months, 44.9% were providing three or more (of six) food groups, 84.9% were aware of family planning and 37.5% were using a modern contraceptive. Integration of reproductive and child health services appears to be a suitable platform for routine VAS and Albendazole whilst improving complementary feeding practices and access to family planning., (© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd.)

Background: From mid-2015, reproductive and child health interventions were integrated into a routine 6-month contact point: vitamin A supplementation, nutrition counseling with the mother's participation in the preparation of a complementary food, and confidential family planning counseling with provision of modern forms of contraceptives. By mid-2017, these services had reached 28% of health facilities nationwide., Objective: To evaluate awareness and uptake of modern contraception and complementary feeding practices., Methods: All health facilities were visited, and the health worker "in-charge" were interviewed to ascertain their training status and supply chains. Within each catchment, community mothers of children 6 to 23 months of age were interviewed., Results: Interviews were conducted with 321 "in-charges" and 670 mothers. Advantages and different types of contraception were understood by 99.0% of mothers, and 52.7% reported they were utilizing depot injections, hormonal implants, or oral contraceptive pills (45.1%, 34.6%, and 20.6% of users, respectively). Uptake was higher among Christians (62.1%) versus Muslims (48.6%) and among those with secondary/tertiary (61.5%) or primary education (60.5%) versus no education (43.3%) (P < 0.005 and P < 0.05, respectively). Complementary feeding practices included minimal meal diversity, 49.2% (fed three or more of six food groups), and recommended minimal meal frequency appropriate for age, 52.6%. Health workers reported frequent stockouts of vitamin A capsules (8%), male condoms (1%), oral contraceptives (10%), depot injections (20%), and hormonal implants (30%)., Conclusion: In communities served by these integrated services, awareness and uptake of modern contraception exceeded national targets despite weak supply chains, and complementary feeding practices were favorable compared with the national survey., (© 2019 John Wiley & Sons, Ltd.)

Background: A baseline survey in 2007-2008 found lymphatic filariasis (LF) to be endemic in Sierra Leone in all 14 districts and co-endemic with onchocerciasis in 12 districts. Mass drug administration (MDA) with ivermectin started in 2006 for onchocerciasis and was modified to add albendazole in 2008 to include LF treatment. In 2011, after three effective MDAs, a significant reduction in microfilaraemia (mf) prevalence and density was reported at the midterm assessment. After five MDAs, in 2013, mf prevalence and density were again measured as part of a pre-transmission assessment survey (pre-TAS) conducted per WHO guidelines., Methods: For the pre-TAS survey, districts were paired to represent populations of one million for impact assessment. One sentinel site selected from baseline and one spot check site purposefully selected based upon local knowledge of patients with LF were surveyed per pair (two districts). At each site, 300 people over five years of age provided mid-night blood samples and mf prevalence and density were determined using thick blood film microscopy. Results are compared with baseline and midterm data., Results: At pre-TAS the overall mf prevalence was 0.54% (95% CI: 0.36-0.81%), compared to 0.30% (95% CI: 0.19-0.47) at midterm and 2.6% (95% CI: 2.3-3.0%) at baseline. There was a higher, but non-significant, mf prevalence among males vs females. Eight districts (four pairs) had a prevalence of mf < 1% at all sites. Two pairs (four districts) had a prevalence of mf > 1% at one of the two sites: Koinadugu 0.98% (95% CI: 0.34-2.85%) and Bombali 2.67% (95% CI: 1.41-5.00%), and Kailahun 1.56% (95% CI: 0.72-3.36%) and Kenema 0% (95% CI: 0.00-1.21%)., Conclusions: Compared to baseline, there was a significant reduction of LF mf prevalence and density in the 12 districts co-endemic for LF and onchocerciasis after five annual LF MDAs. No statistically significant difference was seen in either measure compared to midterm. Eight of the 12 districts qualified for TAS. The other four districts that failed to qualify for TAS had historically high LF baseline prevalence and density and had regular cross-border movement of populations. These four districts needed to conduct two additional rounds of LF MDA before repeating the pre-TAS. The results showed that Sierra Leone continued to make progress towards the elimination of LF as a public health problem.

Since 2004, twice-yearly mass vitamin A supplementation (VAS) has equitably reached over 85% of children 6-59 months old in Sierra Leone. However infants who turn 6 months after the event may wait until they are 11 months old to receive their first dose. The effectiveness of integrating VAS at 6 months into the Expanded Program of Immunization (EPI) in a revised child health card was studied. Health facilities matched according to staff cadre and work load were assigned to provide either a 'mini package' of VAS and infant and young child feeding (IYCF), a 'full package' of VAS, IYCF and family planning (FP), or 'child health card' only. 400 neonates were enrolled into each group, caregivers given the new child health card and followed until they were 12 months old. More infants in the full: 74.5% and mini: 71.7% group received VAS between 6 and 7 months of age compared with the new CH card only group: 60.2% (p = 0.002, p < 0.001 respectively). FP commodities were provided to 44.5% of caregivers in the full compared with <2.5% in the mini and new child health card only groups (p < 0.0001). Integration of VAS within the EPI schedule achieved >60% coverage for infants between 6 and 7 months of age. Provision of FP and/or IYCF further improved coverage. Funding was provided by the Canadian Department of Foreign Affairs, Trade and Development who had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.