The World Health Report 2002 CHILDHOOD UNDERNUTRITION (AND BREASTFEEDING Interventions The childhood interventions were not evaluated in the a subregions where chile undemutrition is not a major cause of burden. Complementary feeding One-time intensive counselling is provided to mothers on the appropriate complementary feeding practices and on the importance of continued breast eding. In addition, all infants aged 6 months to 1 year, regardless of nutritional status, are provided with ready-to-mix complementary food, which is collected every two months from a health centre by the carer. The intervention is estimated to shift positively the overall distribution of weight-for-age for children less than one year of age by 0. 16 standard devia ions(adapted from Caulfield Huffman)(29). It was then assumed that each cohort of children exposed to this intervention would continue to reap the benefits subsequently because of the knowledge and attitudes retained by the carer. Complementary feeding with growth monitoring and promotion. All carers are given an initial intensive counselling session on appropriate complementary feeding prac tices and the importance of continued breastfeeding Carers are provided with growth charts and, during quarterly visits, the weight of the child is plotted and any deviations from ex pected weight gain is discussed. Solutions are suggested and targets for weight gain are set In addition, ready-to-mix complementary food is provided to all children from 6 months to ear of age who have been identified to have poor weight gain or are underweight. Results The impact of the two types of interventions is identical, but the costs of the more fo- used approach of complementary feeding with growth monitoring and promotion are considerably lower than those for complementary feeding alone. Complementary feeding itself is not cost-effective, while complementary feeding with growth monitoring is cost effective in most regions. It is assumed that the benefits of the intervention in terms of carers knowledge gained and attitudes changed will persist until the child is five years old Interactions are considered beloy RON DEFICIENCY Interventions Iron fortification Iron, usually combined with folic acid, is added to the appropriate food vehicle made available to the population as a whole. Cereal flours are the most com on food vehicle and are the basis of the analysis, but there is also some experience with introducing iron to other vehicles such as noodles, rice, and various sauces(30). The pro- portion of the population that consumes the food vehicle in sufficient quantities to absorb sufficient iron varies by region, from 65%to 95%, and this chapter explores the costs and effects in the event that fortification reaches 50%, 80% and 95% of the targeted population Because of likely problems with absorption, fortification is considered only 50% as effica cious as supplementation in the people who are covered, consistent with the assumptions of Chapter 4 Iron supplementation. Iron is provided to pregnant women during antenatal visits The assumed dose follows WHO guidelines, with daily supplementation of 60 mg elemen tal iron, for six months during pregnancy and three months postpartum(31). Three differ- ent levels of coverage are included-50%, 80% and 95%-and it is assumed that only 67% of these women receive an effective dose because of less than perfect adherence(32). Fo110 The World Health Report 2002 CHILDHOOD UNDERNUTRITION (AND BREASTFEEDING) Interventions The childhood interventions were not evaluated in the A subregions where childhood undernutrition is not a major cause of burden. Complementary feeding. One-time intensive counselling is provided to mothers on the appropriate complementary feeding practices and on the importance of continued breast￾feeding. In addition, all infants aged 6 months to 1 year, regardless of nutritional status, are provided with ready-to-mix complementary food, which is collected every two months from a health centre by the carer. The intervention is estimated to shift positively the overall distribution of weight-for-age for children less than one year of age by 0.16 standard devia￾tions (adapted from Caulfield & Huffman) (29). It was then assumed that each cohort of children exposed to this intervention would continue to reap the benefits subsequently because of the knowledge and attitudes retained by the carer. Complementary feeding with growth monitoring and promotion. All carers are given an initial intensive counselling session on appropriate complementary feeding prac￾tices and the importance of continued breastfeeding. Carers are provided with growth charts and, during quarterly visits, the weight of the child is plotted and any deviations from ex￾pected weight gain is discussed. Solutions are suggested and targets for weight gain are set. In addition, ready-to-mix complementary food is provided to all children from 6 months to 1 year of age who have been identified to have poor weight gain or are underweight. Results The impact of the two types of interventions is identical, but the costs of the more fo￾cused approach of complementary feeding with growth monitoring and promotion are considerably lower than those for complementary feeding alone. Complementary feeding by itself is not cost-effective, while complementary feeding with growth monitoring is cost￾effective in most regions. It is assumed that the benefits of the intervention in terms of carer’s knowledge gained and attitudes changed will persist until the child is five years old. Interactions are considered below. IRON DEFICIENCY Interventions Iron fortification. Iron, usually combined with folic acid, is added to the appropriate food vehicle made available to the population as a whole. Cereal flours are the most com￾mon food vehicle and are the basis of the analysis, but there is also some experience with introducing iron to other vehicles such as noodles, rice, and various sauces (30). The pro￾portion of the population that consumes the food vehicle in sufficient quantities to absorb sufficient iron varies by region, from 65% to 95%, and this chapter explores the costs and effects in the event that fortification reaches 50%, 80% and 95% of the targeted population. Because of likely problems with absorption, fortification is considered only 50% as effica￾cious as supplementation in the people who are covered, consistent with the assumptions of Chapter 4. Iron supplementation. Iron is provided to pregnant women during antenatal visits. The assumed dose follows WHO guidelines, with daily supplementation of 60 mg elemen￾tal iron, for six months during pregnancy and three months postpartum (31). Three differ￾ent levels of coverage are included – 50%, 80% and 95% – and it is assumed that only 67% of these women receive an effective dose because of less than perfect adherence (32). For