Liberia	Iodine	madascar Vitamin A	Iron	Malawi

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EPIDEMIOLOGICAL DATA

Clinical Vitamin A Deficiency

Most Recent Clinical VAD Survey:  National Survey conducted by MOH/USAID/Seecaline.

Date:

May 2000

Groups Surveyed:

Children 6-59 months and Women 15-49 years of age.

Sample Size:

900 (600 children and 300 mothers)

Sampling Method:

Survey implemented the General Census of the Population and habitat, out of which the women and children were separated into two stratified clusters.  Out of these two stratified clusters, 30 survey clusters were selected from each group.

Estimated Prevalence of VAD:    XN, X1B+XN, etc.

Region/Group	Sample size	Population in region/group       (if available)	Indicator(s) specify cutoff and/or median serum retinol	Prevalence in sample %
Women 15-49 years of age	586			31.6
XN				12.1
X1B				8.8
X2				0.7
Children 6-59 months of age	297			2.21
XN				1.7
X1B				0.51
National Total:	883

Sub-clinical Vitamin A Deficiency

Most Recent Sub-Clinical VAD Survey:    National Survey conducted by MOH/USAID/Seecaline.

Date:

May 2000

Groups Surveyed:

Children 6-59 months and Women 15-49 years of age.

Sample Size:

900 (600 children and 300 mothers)

Sampling Method:

Survey implemented the General Census of the Population and habitat, out of which the women and children were separated into two stratified clusters.  Out of these two stratified clusters, 30 survey clusters were selected from each group.

Estimated Prevalence of VAD:   Serum Retinol<0.7 mmole/L

Region/Group	Sample size	Population in region/group       (if available)	Indicator(s) specify cutoff and/or median serum retinol	Prevalence in sample %
Children 6-59 months	589			6.1
Women 15-49 years of age	211			8.1
National Total:	800

POLICY AND LEGISLATION

Legislation on VAD
	There is VAD legislation in Madagascar, and it was passed into law in 1998.
	The legislation, named 'Directives published by the Ministry of Health (MOH)", has been significantly revised, and focuses on supplemention.

Government Agency to Address VAD
	Ministry of Health/Nutrition Department.
	Contact Information: Dr. Simon Rakotonirina.

PROGRAM DATA

Supplementation
Supplementation
Program Description
	The first vitamin A supplementation, 'routine supplementation', is conducted in every public/private health center in the country and targets children 6-59 months and women within 8 weeks of delivery.
	The second vitamin A supplementation concerns a 'mass campaign' that was started along with NID in 1998 and occurs twice a year.

Targeting
	Children 6-59 months (Approx. 2.3 million children) and Women within 8 weeks of delivery (Approx. 735,000 women).

Capsule Information
	100,000 UI (631,413 capsules).
	200,000 UI (4,410,316 capsules).
Implementation
	Vitamin A supplementation given to children and women through public or private health care centers.
Fortification
Food Fortification
	No food are currently being fortified.
Implementation
Other Programs
Large scale or National Programs
	There are no large-scale or national programs implemented in Madagascar.

MONITORING

Clinical and Sub-clinical VAD
	Monitoring for vitamin A supplementation occurs with surveys in the 10 vitamin A sentinel sites.  Surveys are conducted every 2 years.
	Serum Retinol using fluorometric method is used in monitoring vitamin A supplementation.
	ICT (Impression Cytology with Transfer) is also used in monitoring vitamin A supplementation.

Supplementation
	Capsules for vitamin A supplementation are imported into Madagascar and are monitored.
	Monitoring of the 'routine supplementation' program is conducted by Health Statistics through health center activities.
	The Nutrition Department of the Ministry of Health receives reports by every District Health Service which monitors the supplementation of the 'mass campaign' program.

Fortification
	There is no fortification to monitor.

PROGRAM RESOURCES

Donor Agencies

Implementing Agency	Description of Activities	Expenditure and source of funds in current year
		Suppl.	Fortif.	Other (specify)
National/State Governments	Coordination, Monitoring, and evaluation of interventions.
External Agencies	1. UNICEF- Technical and finacial support as well as supplies (vitamin A capsules, laboratory agents, etc.)  2. Linkages- support in monitoring/evaluation and IEC tools.

Total VAD Program Funding History and Forecast for Country:herNot Reported