IMPACT OF NUTRITION EDUCATION AND MEGA-DOSE VITAMIN-A SUPPLEMENTATIONON THE HEALTH OF CHILDREN IN NEPAL

The impact on vitamin A deficiency (VAD), wasting malnutrition, and ex cessive childhood mortality of two alternative approaches -- nutrition education and mega-dose capsule distribution (6-12-month-olds: 100 00 0 IU; 1-5-year-olds: 200 000 IU) -- in communities in Nepal are compar ed. Approximately 40 000 children from 75 locations in seven districts in two ecological settings (lowland and hills) took part in the study and were randomly allocated to intervention cohorts or a control grou p. At 24 months after the implementation of the project the reduction of risk for xerophthalmia was greater among children whose mothers wer e able to identify vitamin-A-rich foods (relative risk (RR) = 0.25; 95 % confidence interval (CI) = 0.10-0.62) than among the children who re ceived mega-dose capsules (RR = 0.59; 95% CI = 0.41-0.84). The risk of mortality at 2 years was reduced for both the nutrition education (RR = 0.64; 95% CI = 0.48-0.86) and capsule distribution (RR = 0.57; 95% CI = 0.42-0.77) cohorts. The nutrition education programme was, howeve r, more expensive to deliver than the capsule distribution programme. High rates of participation for children in the supplementation progra mme were achieved quickly. The nutrition education messages also sprea d rapidly throughout the study population (regardless of intervention cohort assignment). Practices, however, were slower to change. In comm unities where maternal literacy was low and channels of communication were limited the capsule distribution programme appeared to be more ec onomical. However, there are economies of scale for nationwide educati on programmes that do not exist for capsule distribution programmes. A lthough nutrition education provides economies of scale and the promis e of long-term sustainability, a comprehensive national programme requ ires both dietary supplementation and nutrition education components.