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Anemia is a serious and widely unrecognized health problem in developing countries, where anemia rates are staggering: 33% of men, 44% of women, 42% of preschoolers and 53% of school-age children. Although malaria and intestinal parasites also cause anemia, iron deficiency is the chief cause. Anemia puts babies at risk of permanent reduction in IQ, hampers children's learning, and reduces adult's intellectual acuity and productivity. The condition's most observable consequences are fatigue and weakness. Anemia is an underlying cause of childbirth-related death due to complications such as unstoppable bleeding (hemorrhage), collapse of the circulatory system (shock) and spontaneous abortion. Iron deficiency anemia can impair fetal development, so it is important that a mother's iron deficiency be corrected before becoming pregnant. Iron-deficiency anemia is preventable through interventions that increase a person's iron intake. Because anemia is so detrimental to the health of adolescent girls and young women, PSI has concentrated its efforts on reaching these girls and their families. PSI is on the cutting edge of the global effort to address this serious problem. In a project made possible by LINKAGES and USAID, PSI and its Bolivian affiliate PROSALUD launched the first social-marketed multivitamin supplement, VitalDía, in the world in Bolivia in 1999. The project has been highly successful, and social marketing was found to be an excellent means to increase awareness and use among low-income women. In 2000, VitalDía was also launched in neighboring Paraguay, where demand for the product has been so high that production has had to be increased. PSI has since introduced multivitamin social marketing programs in Togo, Pakistan, Venezuela, Zambia and India. In India the multivitamin product was launched in late 2002 with assistance from a USAID child survival grant. PSI has completed assessments of vitamin markets in all regions of the world, with consistent findings: Although shelves are crowded with vitamin products, closer inspection reveals them to be high-priced, exclusively high-end, with formulations typically containing so little iron that they are useless in addressing iron deficiency. Most are not packaged attractively nor promoted actively, nor is any effort made to educate low-income groups. In every country PSI has conducted market research, there is a clear unfilled niche for a multivitamin supplement affordable to low income people. The Bolivia project is a good example of how PSI multivitamin projects work. Bolivia is a country with high anemia rates and the highest maternal mortality in South America. With support from the LINKAGES Project and USAID, the PSI and PROSALUD project's objective was to make an appealing, affordable, iron-containing multivitamin supplement available to low-income women for the prevention of iron deficiency and to support it with effective awareness raising. The project sought to improve knowledge and to teach basic concepts in proper nutrition for women. The attractive yellow package, fruit logo, VitalDía name, tablet size and key messages were selected based on the findings of 22 focus group discussions and 126 interviews with target group women. A consistent theme for low-income women was the importance for the product of being natural, and this feeling is echoed in the brand's character. VitalDía was made widely available, not only through pharmacies - where a distribution survey confirmed that VitalDía was available in 90% of urban pharmacies as well as 58% of rural pharmacies - but also in markets and at PROSALUD clinics. Communications strategy included 900 broadcasts of a television advertisement, 10,000 broadcasts of radio spots and dramas. Promotional events were also held in PROSALUD clinic waiting rooms, educational seminars were held for medical professionals and medical detailing to doctors was conducted. In addition, after introduction of the supplement, and IEC campaign was conducted that included improvement of knowledge about food sources of iron and other essential micronutrients. A knowledge, attitudes, practices and behavior study conducted one year after introduction found that social marketing clearly succeeded in reaching low-income women, including those in the very lowest income strata. Among women with the lowest income, those with less than four years of education, awareness of vitamins increased by 25%, from 53% to 78%, ever-use of vitamins increased by 13%, from 43% to by 54%, and ever-use of multivitamins increased by 12%, from less than 1% to 12%. These are highly positive results after only one year of intervention. |
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