[Choice of nutritional interventions in Congo: an approach for primary health care centres and for the community].

This research is aimed at testing and adapting a comprehensive and participatory approach to identification, selection and evaluation of nutritional interventions in Congo. The mains tools utilized here are a causal model, a ranking table and a HIPPOPOC table. The causal model was built by a multi-sectional team of 35 persons and used to conceptualize the nutrition of young children in Congo, to identify vulnerable determinants and relevant interventions. Three main determinants were identified: i) Food consumption of the child; ii) Health status of the child and iii) Caring practices of children and mothers. Each determinant was developed into a sub-model. For each sub-model, the team identified vulnerable factors and relevant interventions. The identification of six interventions was based on experience, scientific knowledge and on-going interventions of the members of the group during participatory discussions. As resources were limited, it was not possible to implement all of the six interventions; thus a selection of the most appropriate interventions was made using a ranking table. Before building the ranking table, a choice of the most appropriate criteria was made by the group: technical feasibility, acceptability by the population, acceptability by health workers, financial feasibility, short-term impact, potential of participation and sustainability. The ranking table for intervention selection allows a critical discussion on each intervention and leads to prioritization. Once the table was completed, the three most appropriate interventions were selected: communication for behavior change, improvement of quality of care, and promotion of improved complementary foodstuff production. Two of the interventions (psychosocial stimulation and community-based) identified needed more research for implementation. In order to determine clear objectives for intervention and to set up a monitoring and evaluation system, a practical tool was used: the HIPPOPOC table. This table represents a simplified view of the intervention in which project inputs (resources), processes (activities), outputs (immediate results), outcomes (short- or mid-term effects) and impacts (long-term effects) are clearly defined. The approach used here is based firstly on completeness as a way of guaranteeing the success of the design, implementation and evaluation of an intervention. Completeness means that all factors that may affect actions and their impact are taken into account. Secondly, participation is a key element of the process. All actors playing an active role in the decision-making process are present during the planning and evaluation process. This approach is meant to empower individuals and the community as a whole and develop within the community an awareness and a competence for problem solving. It involves multiple stakeholders (target groups, supervisors, sponsors, central as well as peripheral workers, experts, etc.) in design, implementation, needs assessment, monitoring and evaluation.