Programmatic Effects of a Large-Scale Multiple-Micronutrient Supplementation Trial in Indonesia: Using Community Facilitators as Intermediaries for Behavior Change

Abstract

Systematic enhancements to the quality of implementation of SUMMIT led to significant increases in use of SBAs at delivery, resulting in a 30% reduction in early infant mortality independent of the impact of micronutrient supplementation. Therefore, if women were to consume multiple micronutrients on a regular basis and were to use a SBA at delivery, the risk of early infant mortality could be reduced by nearly 50%. The impacts of community facilitators in effecting changes in women's health behaviors are notable and are applicable to other health programs. Enhancements to program implementation should be driven by evidence, be accountable to the communities the program serves, and be evaluated on the basis of measurable gains in health for women and children.

Why don't some women attend antenatal and postnatal care services?: a qualitative study of community members' perspectives in Garut, Sukabumi and Ciamis districts of West Java Province, Indonesia

“…Efforts to strengthen community-based participatory programs might help to improve health service uptake, as shown in other studies [59-61]. Local community members could be encouraged to become actively involved.…”

What Works? Strategies to Increase Reproductive, Maternal and Child Health in Difficult to Access Mountainous Locations: A Systematic Literature Review

“…Shanker and colleagues (2009) present high quality evidence of community facilitators, recruited from local communities in Indonesia, displaying high levels of knowledge, care and thoroughness in their work, were able to motivate pregnant women for 85% compliance with micronutrient supplementation and increase in SBA utilisation from 35 to 53% with a resultant 33% reduction in early infant mortality (RR 0.67, 95%CI 0.49–0.92, p = 0.0117) [53].…”

Public Health Interventions to Combat Micronutrient Deficiencies

“…Recently, much attention has been devoted to using multiple micronutrient supplementations, rather than the traditional iron and folic acid only, for pregnant women; in some cases, signifi cant advantages have been seen. The best outcomes have been seen when the supplementation is coupled with community-based health facilitators' interventions, 11 arguing for more integrated, less vertical approaches. Supplements for institution based elderly and other institution based population groups such as long-term mental hospital patients or others in long-term care or custody should be considered as part of the nutritionrelated responsibilities of public health authorities.…”