Impact evaluation of EPI-PLUS and WIBS approaches in controlling vitamin A deficiency in Tigray and Harari Regions, Ethiopia

Abstract

Abstract A comprehensive evaluative study on the impact of EPI-plus approach (vitamin A supplementation along with immunisation program) and WIBS approach (EPI-plus and other non health measures) in controlling vitamin A deficiency (VAD) was conducted in Harari and Tigray Regions. In each Region, one EPI-plus district and one WIBS district were randomly selected. In the pre-intervention survey conducted in May/June 1996, a total of 10964 children aged 6 to 72 months in randomly selected clusters of villages in the four districts were clinically examined for signs of xerophtalmia, while blood samples were collected from a sub-sample of 448 children for serum retinol analysis. In the post-intervention survey conducted in May/June 1997 in the same districts and same clusters of villages, 10460 children were clinically examined for signs of xerophtalmia, and blood was collected from a sub-sample of 580 children for serum retinol analysis. Results indicate that on the overall there is a substantial reduction in the prevalence of Bitot's spot in both regions (about 43% reduction in Harari and 66% in Tigrai). Over 4% reduction in Harari and about 30% reduction in Tigray was observed in the prevalence of children with low/deficient serum retinol levels. In Harari Region reduction in the prevalence of Bitot's spot was higher in WIBS area (about 54%) compared to the reduction in the EPIplus district (40%). In Tigray Region, however, the reduction in bitot's spot was almost similar in both districts (over 64% in WIBS and 70% in EPI-plus). There was a similar insignificant reduction in the proportion of children with low/deficient serum retinol level in both districts in Harari Region (WIBS, 4.1% and EPI-plus, 5.1%), while the reduction in the proportion of children with low/deficient serum retinol levels in both districts in Tigray Region (WIBS, 42.6% and EPI-plus, 18.2%) was significant. As there was no control group, it may be difficult to conclude with certainty that the observed significant improvement in vitamin A status is entirely due to the ongoing interventions. However the potential contributions of the two strategies to the observed improvement in vitamin A status can not be under-estimated.