Evaluation of Peruvian Government Interventions to Reduce Childhood Anemia

Background: In Peru, anemia has been a persistent health problem that is known to lead to irreversible cognitive and developmental deficits in children. The Peruvian government has recently made anemia a primary health concern by passing legislation in 2017 that makes anemia an intersectoral priorit...

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Autores principales:	Axel J. Berky, Emily Robie, Ernesto J. Ortiz, Joel N. Meyer, Heileen Hsu-Kim, William K. Pan
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2020
Materias:	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/4e9ec8fd444443c7bdd31c9737f7aa49
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spelling	oai:doaj.org-article:4e9ec8fd444443c7bdd31c9737f7aa492021-12-02T13:07:53ZEvaluation of Peruvian Government Interventions to Reduce Childhood Anemia2214-999610.5334/aogh.2896https://doaj.org/article/4e9ec8fd444443c7bdd31c9737f7aa492020-08-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/2896https://doaj.org/toc/2214-9996Background: In Peru, anemia has been a persistent health problem that is known to lead to irreversible cognitive and developmental deficits in children. The Peruvian government has recently made anemia a primary health concern by passing legislation in 2017 that makes anemia an intersectoral priority. This new legislation fortifies previous programs while creating new programs that target specific age groups. Objectives: Evaluate the effectiveness of government programs in Madre de Dios, Peru to reduce anemia prevalence and increase hemoglobin levels among children ages 2–11 years old. Methods: Propensity scores are used to match 688 children enrolled in 2018, after the legislation, and 2,140 children enrolled in previous studies our team conducted in the region between 2014 and 2017, based on sex, age (years), intervention status (prior/post), community income, presence of a health post in the community (yes/no), community type (indigenous, non-indigenous rural, non-indigenous urban) and road access (fraction of the number of months out of the year with road access). A pseudo matched case-control analysis to evaluate changes in anemia prevalence and hemoglobin was conducted using t-tests and multivariate models. Program effectiveness is evaluated overall, by age groups (2–4, 5–7 and 8–11 years old), and community type (indigenous vs. urban). Findings: The adjusted odds ratio indicated lower odds of anemia (OR = 0.31, 95%CI 0.17–0.54) for children exposed to the anemia prevention programs vs. those not exposed. The effect was not significantly different across age groups; however, the intervention effects significantly differed by community type among children 8–11 years old, with urban children less likely to benefit from anemia interventions (OR = 0.69, 95% CI 0.38–1.25) compared to indigenous children (OR = 0.21, 95% CI 0.08–0.56). Conclusion: Government programs to reduce anemia in Madre de Dios were found to be associated with reduced anemia prevalence in the study communities. However, the lack of program monitoring precludes the attribution of anemia decline to specific interventions or program components. In addition, regional anemia prevalence remains high according to the 2019 Demographic and Health Survey, suggesting impaired population impact. Program monitoring and evaluation is a key component of health interventions to improve program implementation effectiveness.Axel J. BerkyEmily RobieErnesto J. OrtizJoel N. MeyerHeileen Hsu-KimWilliam K. PanUbiquity PressarticleInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 86, Iss 1 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Axel J. Berky Emily Robie Ernesto J. Ortiz Joel N. Meyer Heileen Hsu-Kim William K. Pan Evaluation of Peruvian Government Interventions to Reduce Childhood Anemia
description	Background: In Peru, anemia has been a persistent health problem that is known to lead to irreversible cognitive and developmental deficits in children. The Peruvian government has recently made anemia a primary health concern by passing legislation in 2017 that makes anemia an intersectoral priority. This new legislation fortifies previous programs while creating new programs that target specific age groups. Objectives: Evaluate the effectiveness of government programs in Madre de Dios, Peru to reduce anemia prevalence and increase hemoglobin levels among children ages 2–11 years old. Methods: Propensity scores are used to match 688 children enrolled in 2018, after the legislation, and 2,140 children enrolled in previous studies our team conducted in the region between 2014 and 2017, based on sex, age (years), intervention status (prior/post), community income, presence of a health post in the community (yes/no), community type (indigenous, non-indigenous rural, non-indigenous urban) and road access (fraction of the number of months out of the year with road access). A pseudo matched case-control analysis to evaluate changes in anemia prevalence and hemoglobin was conducted using t-tests and multivariate models. Program effectiveness is evaluated overall, by age groups (2–4, 5–7 and 8–11 years old), and community type (indigenous vs. urban). Findings: The adjusted odds ratio indicated lower odds of anemia (OR = 0.31, 95%CI 0.17–0.54) for children exposed to the anemia prevention programs vs. those not exposed. The effect was not significantly different across age groups; however, the intervention effects significantly differed by community type among children 8–11 years old, with urban children less likely to benefit from anemia interventions (OR = 0.69, 95% CI 0.38–1.25) compared to indigenous children (OR = 0.21, 95% CI 0.08–0.56). Conclusion: Government programs to reduce anemia in Madre de Dios were found to be associated with reduced anemia prevalence in the study communities. However, the lack of program monitoring precludes the attribution of anemia decline to specific interventions or program components. In addition, regional anemia prevalence remains high according to the 2019 Demographic and Health Survey, suggesting impaired population impact. Program monitoring and evaluation is a key component of health interventions to improve program implementation effectiveness.
format	article
author	Axel J. Berky Emily Robie Ernesto J. Ortiz Joel N. Meyer Heileen Hsu-Kim William K. Pan
author_facet	Axel J. Berky Emily Robie Ernesto J. Ortiz Joel N. Meyer Heileen Hsu-Kim William K. Pan
author_sort	Axel J. Berky
title	Evaluation of Peruvian Government Interventions to Reduce Childhood Anemia
title_short	Evaluation of Peruvian Government Interventions to Reduce Childhood Anemia
title_full	Evaluation of Peruvian Government Interventions to Reduce Childhood Anemia
title_fullStr	Evaluation of Peruvian Government Interventions to Reduce Childhood Anemia
title_full_unstemmed	Evaluation of Peruvian Government Interventions to Reduce Childhood Anemia
title_sort	evaluation of peruvian government interventions to reduce childhood anemia
publisher	Ubiquity Press
publishDate	2020
url	https://doaj.org/article/4e9ec8fd444443c7bdd31c9737f7aa49
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Evaluation of Peruvian Government Interventions to Reduce Childhood Anemia

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