Micronutrient and Health Project: Ethiopia and Malawi

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Micronutrient and Health Project Ethiopia and
Malawi

• An Assessment of The Distribution of Benefits
  Among People of Various Asset Classes
• Harry Cummings, University of Guelph
• Linda Beyer, University of Guelph
• Tariq Bhanjee, School of Public Health,
  University of Sydney
• Carolyn Macdonald, World Vision Canada
• Cathy Brousseau, University of Guelph
• Comments hca_at_web.Ca

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Thank You!

• Reaching the Poor Project for funding the
  research
• CIDA for funding the MICAH project
• World Vision Canada, WVEthiopia, WVMalawi for
  supporting the research and project
• University of Guelph

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The MICAH Project

• A five country African intervention focused on
  Micronutrients
• Funded by CIDA 1995-2002 (Phase 1)
• Phase 2 currently underway
• This research focused on 2 MICAH countries
• The characteristics of the two projects

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Ethiopia Program Activities(Cad. 10 Million, 6
Years)

• Focused on vitamin A status of children and
  mothers
• Vit. A capsules for children and mothers
• Improving availability of Vitamin A rich foods
• Reducing disease through improved sanitation and
  water source development
• Extension materials and education around
  micronutrients for teachers, HCW, villagers
• Working with schools, clinics and local NGOs
• Provision of small animals for dietary
  improvement using a revolving fund approach

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Malawi MICAH Activities(Cad. 8.2 Million Over 6
Years)

• Reduce anemia and iron deficiency
• Fortification, supplementation, dietary
  diversification
• Education on diet and infant feeding
• Improved health and sanitation through pit
  latrines, clean water, treatment for malaria,
  hookworm and schistosomiasis
• Reduce iodine deficiency by advocating salt
  iodization through all channels

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Methodology (1)

• Main data set involved large household surveys
  done in 2000 in both countries
• Key informant and focus group interviews carried
  out to supplement quant. data
• Supported by secondary data on national incidence
  levels
• Extensive reports on baseline conditions in MICAH
  areas available

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Methodology (2)

• Analysis focused on assessing distribution of
  beneficiaries and participants across asset
  classes
• Comparison to start of project condition and/or
  national statistics where possible
• Assets analysis involved recording
  presence/absence of 13 asset variables for survey
  households
• Principal components analysis (PCA) applied to
  asset data and summary asset level for each
  household calculated
• Summary asset level from PCA divided by household
  size to standardize asset per member

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Methodology (3)

• Summary asset variable used to produce a new 1 to
  5 variable representing asset quintiles
• Asset level (quintile) compared to key outcome
  and participation variables for MICAH to
  determine program effect or potential affect by
  asset quintile

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Results Ethiopia (1)

• Asset Class is not a factor, chi-square 1.366 not
  significant, poor/rich ratio 1.08
• MICAH supported community workers went directly
  to homes of pregnant mothers with Vitamin A and
  developed data base

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Results Ethiopia (2)

• Asset Class is a factor, chi-square 30.79,
  significant, poor/rich ratio .92, correlation
  coefficient .08
• Lower asset classes less likely to know of cause
  of night blindness (Vit. A related) and less
  likely to act
• Education around night blindness promoted by
  MICAH and Vit A coverage for children in MICAH
  areas (67) better than in country (54, DHS,
  2000)

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Results Malawi (1)

• Asset Class is not significant, chi-square 4.614,
  poor/rich ratio .98, correlation coefficient not
  significant
• Effective targeting of the poor by MICAH
  volunteers

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Results Malawi (2)

• Asset Class is significant, chi-square 31.975,
  poor/rich ratio .87, correlation coefficient .109
  and significant
• Better coverage for Micah (76.5) than for DHS
  (2000) survey (46.0) but coverage still favors
  high asset classes

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What Works (1)?

• Identify the needy using participatory techniques
  and deliver program to them with volunteers
• For each outcome desired, have a target
  associated with the asset poor
• Mobilize and empower community volunteers for
  tablet distribution and effective program
  targeting
• Mass campaigns covering all targeted group using
  volunteers and Govt Health Workers
• Establish appropriate community committees i.e.
  water, Vitamin A

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What Works(2)?

• Have those that can afford pay (for tools, seeds)
  and provide extra support from the money received
  to reach the lower asset groups
• Government agencies and NGOs work together to
  extend their reach
• Other

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Questions.