Evaluation of the maternal anaemia [anemia] : Project HOPE

The project is being implemented by Project HOPE in collaboration with MotherCare and the London School of Hygiene and Tropical Medicine. Evaluation covers the period 6/1995-3/98 against a PACD of 6-7/98. The project has developed in two phases. Phase I consisted of operational research to determine the prevalence, causes, and risk factors of anaemia in WRA in the impact area. Phase II has implemented interventions, based on Phase I findings, to reduce by 50% the prevalence of mild to moderate anaemia in pregnant and recently delivered women in the impact area, and by 30% the prevalence of severe anaemia in pregnant women and recently delivered women in the impact area. The interventions have included training health care providers (hospital/health center and community levels); developing and disseminating information, education, and communication (IEC) materials; and iron trials. The program has contributed positively to improving women's reproductive health. Community members have been sensitized to the dangers of maternal anaemia, and the interventions to address the problem have been well received. Prenatal care efforts to prevent and treat maternal anaemia have been implemented satisfactorily as compared with postnatal activities. A consistent supply of iron tablets has motivated mothers to attend prenatal care. Compliance with taking iron tablets has generally been good, despite the side effects experienced and some rumors and misconceptions. Providers and supervisors involved in implementing program interventions both at hospital/health center and community levels are working diligently despite constraints. The following problems need to be addressed. (1) Postnatal follow-up has not been reinforced, and community members are generally unaware of the need for it. Most women have begun prenatal care after 24 weeks gestation despite intensified IEC on early prenatal attendance. Problems in accessibility to health care facilities and cultural beliefs have been the contributing factors. (2) IEC materials are appropriate, but health care providers have not used them consistently during individual counseling sessions. Most health care providers did not have adequate one-to-one counseling with clients because it was time-consuming. (3) IEC messages on preventing maternal anaemia has focused on taking iron tablets, with less emphasis on eating required nutrients. Apart from taking iron tablets, community members have used traditional methods of treating anaemia, using leaves from guava, mlombwa, and avocado pears. (4) Distribution of iron tablets has been good, but the current recordkeeping system makes it difficult to account for the amount of iron tablets consumed. Supervision of health care providers has been inadequate due to transport problems. (5) Dependence on donor funding has hampered the sustainability of program activities. Effective sustainability plans are needed.