Nicaragua

In Nicaragua (Mora, 2007), the Ministry of Health spearheaded an Integrated Anemia Control Strategy following discouraging results from a 1993 National Micronutrient Survey (NMS-93) that revealed that 27% of children and 34% of non-pregnant women were anemic. The Ministry of Health’s Department of Nutrition launched a sensitization campaign to generate awareness about the need to address micronutrient deficiencies, including iron deficiency, to MOH, politicians, academic institutions, health professionals, NGOs, community groups, media networks, and civil society in order to gain political commitment to address anemia and vitamin A and iodine deficiencies. The strategy encompassed a comprehensive approach to address the most important causes of anemia, including iron, vitamin A and other nutrient deficiencies as well as helminth infections. Although malaria control was underway, it did not become an explicit part of anemia control. The following interventions were included in the strategy: iron folic acid supplementation (IFA) for children < 5 years of age and pregnant women; periodic delivery of deworming to children 2-10 years of age; fortification of wheat flour with iron and B-vitamins; interventions to address vitamin A deficiency, which included vitamin A supplementation, through twice yearly National Health Rallies and routine visits, including immunizations (both were combined with IFA supplements); fortification of table sugar; and behavior change communications (BCCs) on micronutrients. Extensive training of health services personnel was conducted on micronutrient supplementation guidelines and use of BCC materials. Although a largely effective supply chain system was in place to ensure adequate supplies of IFA supplements, new guidelines were developed on forecasting for IFA supplement needs at all levels in the health system and on the use of information for decision-making regarding inventory replenishment at distribution points. Use of community volunteers (“brigadistas”) assisted in IFA supplement delivery and follow-up counseling. As a result of this program, coverage of IFA and vitamin A supplementation and deworming increased dramatically, and anemia rates in non-pregnant women decreased from 33.6% (1990’s) to 23.7% (2000).

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