Strategies to introduce in the clinical practice the delayed clamping of the umbilical cord to diminish child anemia

Child nutritional anemia in Bolivia is a public health problem.  According to 2003 DHS data, 88% of children between 6 and 23 months had some degree of anemia; 5 years later, a study carried out by the Ministry of Health (2007), showed that prevalence had not changed (89%).
 From 2003 to 2007, the Ministry of Health implemented nutritional programs for iron supplementation, without results.  The absence of a response is due to cultural and logistical factors that limit regular consumption of these supplements.    

 Delayed clamping of the umbilical cord is an evidence-based intervention that can prevent the emergence of child anemia as it provides an additional two months of essential iron reserves of for the first year of life. 
 Between May and August 2008, the Management and Quality in Health Project, implemented by John Snow, Inc., , used two different strategies to incorporate the delayed clamping of the umbilical cord in the practice of health providers at three hospitals in Bolivia, one of them was a two days workshop and the other the workshop followed by one month peer supervision.  Preliminary results from the observation of more than 1.000 vaginal deliveries showed significant increase in the number of deliveries in which delayed clamping was practiced (from 1% to 48%).  The most effective strategy was that which incorporated peer supervision (54% more than workshop only).

 The expansion of this experience can contribute to a decrease in child anemia and should be introduced in “service delivery guidelines” and health providers’ practice, especially in countries where nutritional anemia has a high prevalence.