The State of the World's Children 1998: Focus on Nutrition

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Panel 9

Triple A takes hold in Oman

Photo: A woman reviews her child's growth chart with a volunteer nutrition adviser, part of a community-based effort to promote better child nutrition in Oman.

Over the last 27 years, Oman has made great strides in child survival and development. Child mortality dropped from 215 per 1,000 live births in 1970 to 25 in 1995. School enrolment, particularly among girls, has increased dramatically. Revenues from oil have pro vided an economic foundation-Oman's GNP per capita in 1995 was $4,820 - but these gains would not have been pos sible without the Government's com mitment to improving people's lives.

Progress has been slower, however, in terms of child nutrition. The Ministry of Health, with support from UNICEF, has been working to address this challenge since 1993. To improve children's nutritional status, a community-based programme of growth monitoring, counselling and nutrition education was devised. A particular focus is 105 villages of Al Dakhiliya, an arid, rocky region in upper-central Oman where a 1995 survey found that nearly one third of the children under the age of five were underweight.

The results to date are impressive. Since the project's inception, there has been a significant drop in the number of underweight children, according to an appraisal in 1996. Later the same year another appraisal described the project as well focused, effectively managed and clearly build ing a momentum towards nationwide nutritional improvement. Motivation, commitment and participation were high among mothers and community volunteers. And women enjoy the op portunity the programme offers to meet together and find common ground in helping their children grow better.

The driving force of the programme is called 'triple A': three consecutive steps in a problem-solving cycle of Assessing the problem, Analysing its causes and initiating Actions to improve children's nutrition. Triple A is an iterative process that repeats the cycle of reassessment, re-analysis and re-action, leading to regular modifications and im provements in the approaches taken.

True to this model, the people of the small villages and nomadic or semi-nomadic settlements of Al Dakhiliya were involved from the very start, attending meetings to identify the problems, discuss solutions and select from among themselves the volunteers who would be central to the effort.

Every month throughout the region, at public meetings or during visits to homes, these volunteers weigh children and chart their growth, referring severely underweight children to health care centres. They advise families on how to feed children and to improve caring practices, on how to keep children healthy and manage illness when it occurs and on how to space births. They also reinforce other public health activities, encouraging pregnant women to reg ister early for antenatal care, for example, and helping in community immunization cam paigns and national health days.

Regional trainers were brought in to teach the volunteers about the incidence and causes of malnutrition, and how to improve and support appropriate feeding and caring practices, using the triple A methodology to solve problems. A programme coordinator at the regional level links the communities with programme support structures at the national level and supervises, monitors and trains trainers. There are programme coordinators at the district level as well. Finally, back-up support for the volunteers is provided by teams of health staff from nearby health centres.

A nutritional monitoring system has also been created: At the monthly weighing sessions, the volunteers fill out forms for all chil dren, recording their age and weight. The information on the nutritional status of all the children in a village goes on the form volunteers send every month to the district health supervisor, who then reports the status of the district's children to the regional coordinator.

The tangible change for families and children in Al Dakhiliya has been so positive that the programme is being expanded to additional villages in the region and has been introduced in another five regions of the country.

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