National Immunization Day: a strategy to monitor health and nutrition indicators.
OBJECTIVE
To achieve the Millennium Development Goals it is necessary to set up low-cost, real-time monitoring systems which can provide feedback to managers and policy-makers in a timely fashion. The gold-standard approach for monitoring nutritional situations is to conduct household surveys. However, they are costly, time consuming and do not furnish information about smaller disaggregated units.


METHODS
Brazil pioneered National Immunization Days (NIDs) in the 1980s, and later integrated them with vitamin A supplementation. This report discusses implementation of five large-scale Health and Nutrition Days (HNDs) using NIDs as a platform to monitor nutritional status and estimate coverage of health and social welfare services, including conditional cash transfer benefits.


METHODS
Brazil is composed of 26 states, one federal district and 5564 municipalities, with around 18 million children under five years of age. It was decided that HNDs would be carried out among high-risk populations: children from the semi-arid north-eastern region; agrarian reform settlements; isolated rural black communities or quilombolas and municipalities of Amazonas state.


RESULTS
It was possible to draw inferences for almost 3 million children from different subgroups of underprivileged populations who had never before been studied in such detail, including state-level data.


CONCLUSIONS
Implementation of large scale HNDs in conjunction with NIDs proved to be feasible in Brazil and resulted in data which are very relevant for policy-makers, obtained over a short period of time and at reasonably low cost. It is sensible to conclude that the experience reported here could be reproduced wherever NID coverage is very high.
Santos
Leonor Maria Pacheco
LM
Ministry of Social Development and the Fight Against Hunger, Esplanada dos Ministérios, Brasília, DF, Brazil. leonor.pacheco@mds.gov.br
Paes-Sousa
Rômulo
R
Silva Junior
Jarbas Barbosa da
JB
Victora
César Gomes
CG
D000846:Anniversaries and Special Events; D001938:Brazil; D006305:Health Status Indicators; D006801:Humans; D017589:Immunization Programs; D015166:Monitoring, Immunologic / Q000379:methods*; D009749:Nutrition Surveys