International Eye Foundation -- vitamin A for child survival project, Malawi : final evaluation report -- August 15-25, 1994

The USAID/Bureau for Humanitarian Response Child Survival(CS)/Office of Private and Voluntary Cooperation (PVC) program provided $823,107 for the project, which was implemented in the Chikwawa District of the Lower Shire Valley in Malawi's Southern Region. The CS interventions provided include Vitamin A supplementation, nutrition and AIDS education, condom distribution and promotion of oral rehydration therapy (ORT) and immunizations. A 3-year extension of funding has recently been granted to the project through 1997. The area is densely populated, with high infant (136/1000) and child mortality rates (240/1000) and a high prevalence of chronic malnutrition (49% of children were less than 90% height for age in a recent survey). The population is only now recovering from the 1991-1992 drought and is further burdened by the integration of persons displaced by the political strife in adjacent Mozambique. HIV infection is highly prevalent, especially in trade centers and among workers at the valley's sugar plantation. The project served an estimated 77,000 children under six and 74,000 women of childbearing age. The major causes of death among children under five are malnutrition, pneumonia, measles, malaria, and diarrhea. Trachoma, Vitamin A deficiency, and cataracts are the leading causes of blindness, affecting 1.55% of the population. AIDS is increasingly a cause of mortality in children and adults. Since it began its work in the Lower Shire Valley in the early 1980's, IEF has shifted its emphasis from tertiary eye care to more community-based approaches to child health and prevention of blindness. Since 1985, IEF has helped to expand and develop community infrastructure for delivery of CS interventions. The most recent project shifted and expanded project activities from 45 villages in Chikwawa and the adjacent Nsanje District to provide services to 474 villages in Chikwawa district. Highlights among project achievements include the development of new health infrastructure in more than 470 additional villages. Despite the demands of the ambitious efforts to expand geographically, the project also achieved impressive improvements in indicators of immunization knowledge and coverage, ORT use, vitamin A supplementation coverage, and practice of exclusive breastfeeding. The project's leadership role in national awareness and policy reform regarding infant feeding practices has undoubtedly had a far-reaching impact beyond the project area. Project activities also led to expansion of regional AIDS control programs and influenced the development of strategies for the CS project implemented by Adventist Relief and Development Agency (ADRA) in an area south of IEF's project area. IEF's efforts to integrate vitamin A distribution in under-fives' clinics has led to nationwide use of a simple health card-based system to remind providers to provide semi-annual supplements. The project staff has also provided leadership in coordinating PVO efforts in support of the drought relief and national AIDS prevention programs. The extension of this project for a final 3 years beginning in September will offer an opportunity to consolidate these impressive gains and assure sustainability. USAID and World Bank funding will provide ongoing training and salaries for the Health Surveillance Assistants (HSAs) to continue their work through the Ministry of Health (MOH). The next 3 years must be used to work with the district's health facilities and the beneficiary communities to assure continued support and supervision of these HSAs and the network of Village Health Volunteers (VHVs) with whom they work. (Author abstract)