The MICAH Program has been implemented in the past five years along with DAP, in CARE's operational area of West Hararghe and East Hararghe. The program had a significant impacts on the community: VAD has been reduced significantly among preschool and school aged children, knowledge of mothers about key micronutrients and nutrition has improved considerably. However, micronutrient deficiencies still remain significant public health problems due to recurrent droughts and high prevalence of infectious diseases that affect the health and micronutrient status of the people. The overall objectives of the second phase of the program is, therefore, to consolidate the gains achieved during the First Phase and further improve the micronutrient and health status of mothers and children. 3.1 Goal Statement The long- term program goal is to improve the micronutrient and health status of mothers and children through the most cost - effective and sustainable intervention means.3.2. Project Activities by outputs Purpose 100: Reduce prevalence of micronutrient deficiencies through increased access to and intake of micronutrients.110 Output - Increased intake through supplementation All children aged six months to 14 years old will be supplemented with preventive VACs every six months. The recommended dose of VACs for children aged 6-12 month old is 100,000 IU while those of 1 - 14 years old is 200,000 IU. Concomitant with VAC supplmentation children aged 2 - 14 years old, will be de-wormed. The modality of supplementation/de-worming is campaign. Trained and supervised community health workers (CHWs), teachers and DAs will be mobilized along local health workers to take an active part in these activities. Pregnant women will be supplemented with VACs of 10,000 IU through antenatal follow-up sessions or through organized home-based distributions. Women who deliver in health institutions will be given a single dose of 200, 000 IU of VAC before discharged while those who deliver at home will be reached and receive same 200,000 IU during home visits by trained traditional birth attendants (TTBAs), health workers during outreach services. Previously trained TBAs, CBDAs and CAHs but not functioning will be reinvigorated to participate in the distribution activity. 112 Iron supplementation to prevent occurrence of anemia, iron folate will be distributed to pregnant women during the first two trimesters. More than 50 % of pregnant women area will receive iron folate. This will be carried out either through home visit using TTBAs, CBDAs and CHAs, or during antenatal check ups at health facilities by health professionals. 120 Increased intake thru fortification: promotion of universal salt iodinationThe project will promote iodination of salt. In the effort sensitization workshop will conducted for key government officials and community leaders. Focus of the workshop will be causes and prevention of goitre. To ensure that salts circulating in the community is iodinated, samples of salt from HHs, retailers and wholesalers will be checked every quarter. Feedback will be given to traders, community members and decision makers so that a collective action is taken to import iodated only. 130 Output - Increased intake of MN through Dietary Diversification and Modification (DDM)A nursery centre will be established in a central place in the project operational area to serve as seedling multiplication centre. A total of 1500 HHs will initiate promotion of garden vegetables and fruits rich in vitamin A and minerals. Vegetables of particular importance to the local program include carrots, kale , lettuce, Swiss chard, yellow-fleshed sweet potatoes and green peppers, while fruits of high vitamin A activities are mangoes, papaw and avocado. By the end of the project period, over 30% of the HHs will have adopted the horticultural promotion as a result of a spill over effect. Women as a group will be encouraged to take up the seed distribution activity at a local level through a revolving fund scheme to be developed. In the initial phase, vegetable seeds, as start-up capital in kind, will be provided to the group who provide collaterals. The groups will be encouraged to sell the vegetable seeds that they are able to produce and use the funds to purchase other vegetable seeds that they are unable to reproduce in their vicinity. The project will provide the necessary technical support to both individuals and groups who undertake this activity. Since consumption of goat milk is culturally acceptable in the area, it is planned to promote the local species of goats that have significant milk output. In this endeavor, four PAs will be piloted each with about 50 dairy goats (4X50 = 200) , where each HH will receive one goat. 140 Output - Increased intake through appropriate feeding practices. In order to promote exclusive breastfeeding during the first 6 months and initiate timely complementary feeding, the project will provide continued training for pregnant and lactating women. Volunteer mothers will be trained and supported as Nutrition Promoters. A total of 100 will receive training on appropriate child care and feeding practices. Purpose 200. To reduce prevalence of diseases that affects Micronutrient status or predispose to micronutrient malnutrition.The primary aim of the water and sanitation component is to increase access to clean potable water supplies and improve environmental, personal and domestic hygiene. The ultimate aim is to reduce water - borne diseases that aggravate or compound micronutrient deficiency diseases and improve the quality of life of people. To achieve this goal, the project will assist the communities in the construction of water points, sanitation facilities and ensure their proper use through education. Main tools of educating the community are lectures, dramas and IEC material production and distribution. In the effort three ( 3) water points will be developed during the period benefiting about 2000 household ( 10,000 people). In as much as possible, a water scheme will consist a collection chamber, distribution points and washing basins. Depending upon the amount of water yield, the scheme will include a cattle trough and possibly shower points. Although priority is for drinking, where financially feasible however, the overflow will be developed and used for small scale irrigation schemes to increase the production of vitamin and mineral rich foods. In a similar manner, the project will help communities and schools in the construction and use of culturally acceptable and appropriate latrines. The latrine most preferred and appropriate is VIP, made entirely from locally available materials. A total of 300 HHs will be technically supported in the construction of individual latrines. By the end of the project period, iIt is anticipated that about 10% of HHs in the target community is will have constructed latrines in their own, owing to 'spill over effect'. In addition, one school, is targeted for construction of communal latrines. 220 Output - Increased access to control of parasites, malaria andamp; measles (EPI).The project will help in the control and prevention of malaria in the area by way of environmental management ( weekly) and supply of ant-malarial drugs. Intestinal parasites will also be controlled via periodic de-worming of children coupled with latrine construction. To this end over 23,000 children aged 2 - 14 years old will be de-wormed. 223 EPI and control of ARI andamp; DD: The local health office will be assisted to immunize children under two year old. Critical inputs in this regards include provision of fuel/kerosene, spare parts for cold chain and motor bikes, IEC materials and training of frontline health workers. Communities will be mobilised by project staff, primarily by extension agents and community health workers for EPI services. Purpose 300: To build partners capacity to deliver micronutrient and health programming. Training will be provided to influential community members, project staff and relevant counterpart staff. The focus of the training will be micronutrient deficiencieis , nutrition -including timely initiation of breastfeeding and introduction of complementary feeding- EPI, ARI, and CDD.
