title: Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries.
abstract: Background:The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking.Objective:The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries.Methods:Programs were implemented in Ghana, Cote d'Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices.Results:Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand.Conclusions:Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap.
authors.affiliation: Global Alliance for Improved Nutrition, Geneva, Switzerland; and.
authors.forename: Magali
authors.identifier: 0000-0003-0455-197X
authors.initials: M
authors.lastname: Leyvraz
authors.affiliation: Global Alliance for Improved Nutrition, Geneva, Switzerland; and.
authors.forename: Grant J
authors.initials: GJ
authors.lastname: Aaron
authors.affiliation: Global Alliance for Improved Nutrition, Geneva, Switzerland; and.
authors.forename: Alia
authors.initials: A
authors.lastname: Poonawala
authors.affiliation: Global Alliance for Improved Nutrition, Geneva, Switzerland; and.
authors.forename: Marti J
authors.initials: MJ
authors.lastname: van Liere
authors.affiliation: Global Alliance for Improved Nutrition, Geneva, Switzerland; and.
authors.forename: Dominic
authors.initials: D
authors.lastname: Schofield
authors.affiliation: Brixton Health, Llawryglyn, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Myatt
authors.affiliation: Global Alliance for Improved Nutrition, Geneva, Switzerland; and lneufeld@gainhealth.org.
authors.forename: Lynnette M
authors.identifier: 0000-0003-2652-9108
authors.initials: LM
authors.lastname: Neufeld
mesh_terms: D001459:Bangladesh; D002675:Child, Preschool; D007560:Cote d'Ivoire; D004032:Diet; D005247:Feeding Behavior; D005527:Food, Fortified; D005869:Ghana; D006296:Health Services / Q000592:standards*; D006801:Humans; D007194:India; D007223:Infant; D018977:Micronutrients / Q000008:administration & dosage*; D018673:Nutrition Policy; D009752:Nutritional Status; D011203:Poverty; D015397:Program Evaluation; D014744:Vietnam
chemical_list: D018977:Micronutrients
keywords: coverage; fortified complementary foods; infant and young child nutrition; micronutrient powders; program evaluation; program monitoring; supplements