Differentials in vitamin A supplementation among preschool-aged children in Ethiopia: evidence from the 2011 Ethiopian Demographic and Health Survey

Vitamin A supplementation coverage and its associated factors among children 6-59 months of age in Ethiopia: a systematic review and meta-analysis

Background

Vitamin A supplementation is a key strategy for preventing the consequences of vitamin A deficiency and childhood illnesses, notably in countries where vitamin A deficiency is a public health issue. However, studies in Ethiopia are inconsistent. Hence, this meta-analysis assessed coverage of vitamin A supplementation and associated factors among children aged 6-59 months in Ethiopia.

Methods

A search of articles from databases (PubMed, Science Direct, African Index Medicus, and HINARI), and search engines (Google Scholar, Google, and Worldwide Science) was done. All observational studies that report vitamin A supplementation and/or associated factors among children were included. The Joana Brigs quality appraisal checklist was used. To estimate the pooled effect size a random effect model was used. Heterogeneity was evaluated using I 2-test and Cochrane Q statistics. Subgroup and sensitivity analyses were conducted. Publication bias was assessed using Egger's test and funnel plot.

Results

A total of 14 studies, involving 43,047 children aged 6-59 months, were included. The pooled vitamin A supplementation coverage was 54.88% (95% CI: 47.34-62.42). The lowest coverage 43.71%% (95% CI: 42.71-45.14) was among children 6-35 months. Four or more antenatal care (AOR: 1.79, 95%CI: 1.59-2.01), Postnatal care (AOR: 1.43, 95% CI: 1.24-1.66), delivery at health facilities (AOR: 1.14 95%CI: 1.02-1.28), media exposure (AOR: 1.19, 95% CI: 1.08-1.31), time to reach health facilities (AOR: 1.90, 95% CI: 1.11-3.24), information about VAS (AOR: 2.99, 95%CI: 1.72-5.20), maternal secondary education and above (AOR: 1.32, 95% CI: 1.07-1.64), and (AOR: 2.31, 95% CI: 1.31-4.09) respectively, and fathers education above secondary school (AOR:1.92, 95% CI: 1.13-3.26) were significant factors.

Conclusion

The pooled vitamin A supplementation coverage is significantly below the WHO's recommendation of 80%. Antenatal care, postnatal care, health facilities delivery, media exposure, time to reach health facilities, Information about VAS, maternal and paternal secondary education, and above increase VAS. Hence, the national nutritional program is better to increase awareness of the community about VAS, particularly targeting parents with low educational status and no antenatal and postnatal care through social media and community meetings. Additionally, the EPI program should strengthen outreach supplementations including door-to-door distribution to address older children and socio-economically disadvantaged populations.

Systematic review registration

identifier CRD42024576200.

Trends and socioeconomic inequalities in receiving vitamin A supplementation among children aged 6-59 months in Bangladesh: analysis of nationwide cross-sectional data from 2004 to 2017

Introduction

The coverage of vitamin A supplementation (VAS) is still short of the target set by the government to reach 90% coverage of VAS in Bangladesh. The present study aims to examine the socioeconomic and geographical inequalities in receiving VAS among children aged 6-59 months in Bangladesh from 2004 to 2017.

Methods

The Bangladesh Demographic and Health Surveys for the years 2004-2017 were accessed through the WHO's Health Equity Assessment Toolkit. Inequalities were explored from socioeconomic and geographical perspectives. Specifically, it considered wealth quintile and education as socioeconomic dimensions and place of residence as geographical dimensions. We calculated difference, population attributable fraction (PAF), population attributable risk (PAR) and ratio as summary measures and their associated 95% CIs to quantify and assess the extent of health disparities.

Results

The study revealed a fluctuating trend over the years in the prevalence of receiving VAS among children in Bangladesh. The prevalence shifted from 78.68% in 2004 to a low of 62.09% in 2011, subsequently increasing to 79.29% in 2017. The PAF in 2017 for the variable wealth was 4.61 (95% CI 2.38 to 6.85), highlighting the extent of the disparity that favoured wealthier individuals. The study also detected inequalities based on educational levels; in 2017, the difference measure of inequality was 9.24 (95% CI 3.69 to 14.79), indicating a notable advantage for children from the higher educated group. Children from urban areas were also observed to have a higher likelihood of receiving VAS compared with their rural counterparts.

Conclusion

This study identified a persistent regional inequality in receiving VAS in Bangladesh over time. These inequalities remained a concern, especially for children from poor wealth groups, low-educated families and rural regions. This understanding will inform the development of a comprehensive programme aimed at increasing the prevalence of VAS among all children in Bangladesh.

Coverage and associated factors of vitamin-A supplementation among children aged 6-59 months in Gondar City, Northwest Ethiopia, 2022: a community-based cross-sectional study

Introduction

vitamin A is a nutrient required for normal visual system function, growth, and development. Periodic vitamin A supplementation is a cost-effective strategy for preventing vitamin A deficiency in children. This study aimed to assess the coverage and associated factors of vitamin A supplementation among children aged 6-59 months in Gondar City, Northwest Ethiopia 2022.

Methods

a community-based cross-sectional study with a multistage random sampling technique was done on 587 mothers with 6-59-month-old children from October 20 to November 10, 2022, in Gondar City. The descriptive statistics are summarized by frequency, percent, and summary statistics. Binary logistic regression was performed, and variables with a P-value <0.05 were considered significantly associated.

Results

the vitamin A supplementation coverage was 34.4% (95% CI (30.3% - 38.3%)). Children aged 6-13 months [AOR=9.50, 95% CI; (4.59-9.66)], 14-27 months [95% CI; (3.07-12.03)], mothers who had an education level of certificate or above [AOR=3.79, 95% CI; (1.45-9.90)], mothers who learned in secondary schools [AOR=3.29, 95% CI; (1.28-8.45)], mothers who had four or more antenatal care visits [AOR=4.32 (95% CI: (1.54-11.97) and mothers' good knowledge towards vitamin A [AOR: 2.20 (95% CI: 1.60-4.10)] showed a statistically significant association.

Conclusion

the coverage of vitamin A supplementation exceeded the 70% UNISAFE threshold. A younger child's age, maternal education level, more than 4 antenatal visits, and good knowledge of vitamin A were significant factors. Extended and more integrated immunization programs with robust health education regarding vitamin A supplementation would play a prodigious role in getting higher coverage.

Vitamin A supplementation status and associated factors among children aged 6-59 months in Tanzania: a multi-level analysis

Background

Vitamin A supplementation every 4-6 months is an economical, rapid, and effective strategy to enhance vitamin A status and minimize child morbidity and mortality due to vitamin A deficiency in the long run. Therefore, this study was aimed at investigating the level as well as the factors influencing VAS status among children aged 6-59 months in Tanzania.

Methods

This analysis relied on data from the 2022 Tanzania Demographic and Health Survey (TDHS). The study used a weighted sample of 9,382 children aged 6-59 months. Given the effect of clustering and the binary character of the outcome variable, we employed a multilevel binary logistic regression model. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to determine statistical significance, considering the model with the lowest deviation that best fits the data.

Results

In this study, vitamin A supplementation among children aged 6-59 months was found to be 53.18% [95% CI: 52.17, 54.19]. Mother's/caregiver's working status; Working [AOR = 1.59, 95% CI: 1.34, 1.89], ANC follow-up [AOR = 1.71, 95%CI: 1.34, 2.2], and health facility delivery [AOR = 1.55, 95%CI: 1.25, 1.91] were individual-level factors associated with vitamin A supplementation. Whereas administrative zones of Western [AOR = 2.02, 95% CI: 1.16, 3.52], Southern highlands [AOR = 3.83, 95% CI: 2.02, 7.24], Southern administrative zone [AOR = 2.69, 95% CI: 1.37, 5.3], and South West highlands [AOR = 0.56, 95% CI: 0.33, 0.95] were community-level factors associated with vitamin A supplementation.

Conclusion

The proportion of VAS among children in Tanzania is low compared to UNICEF's target of 80. Mother's/caregiver's working status, antenatal care, place of delivery, community-level media exposure, and administrative zones were significantly associated factors with vitamin A supplementation. Therefore, interventions should be designed to improve the uptake of VAS. Provision and promotion of ANC and institutional delivery and strengthening of routine supplementation are recommended to increase coverage of childhood vitamin A supplementation. Moreover, special focus should be given to regions in the south-western highlands.

Prevalence of multiple micronutrient powders consumption and its determinants among 6- to 23-month-old children in East Africa: a mixed effect analysis using the recent population based cross sectional national health survey

BACKGROUND

To address iron deficiency anemia, Multiple Micronutrient Powders (MMNPs) can be sprinkled onto any semisolid diet and given to young children. There is currently no data on actual MMNPs uptake by children; hence, the study's goal was to investigate MMNPs and determinants among children aged 6-23 months in East Africa.

METHODS

Data from the 2016-2022 East Africa demographic and health survey extracted from Kids Records (KR) files were used in this study. A total of 33,324 weighted 6- to 23-month-old child samples were included. For assessing model fitness and contrast, the intra-class correlation coefficient, median odds ratio, proportional change in variance, and deviance were used. A multilevel logistic regression model was applied to identify variables that may influence MMNPs intake. In the multivariable multilevel logistic regression analyses, variables were judged to be significantly linked with MMNPs intake if their p-values were < 0.05.

RESULTS

In East Africa, the prevalence of MMNPs intake among infants aged 6-23 months was 6.45% (95% CI, 6.19%, 6.22%). Several factors were found to be significantly associated with MMNPs consumption. These factors include older maternal age (AOR = 1.23, 95% CI, 1.09, 1.39) and (AOR = 1.46, 95% CI, 1.23, 1.73), poorer (AOR = 0.73, 95% CI, 0.64, 0.84), middle (AOR = 0.75, 95% CI, 0.66, 0.86), richer (AOR = 0.61, 95% CI, 0.52, 0.71), and richest (AOR = 0.49, 95% CI, 0.41, 0.59) as compared to poorest, having employment status (AOR = 0.65, 95% CI, 0.59, 0.71), mass media exposure (AOR = 1.61, 95% CI, 1.35, 1.78), longer birth interval (AOR = 1.19, 95% CI, 1.28, 1.36), place of delivery (AOR = 1.46, 95% CI, 1.28,1.66), and mothers from rural areas (AOR = 0.71, 95% CI, 0.62,0.80).

CONCLUSIONS

Overall, MMNPs intake was lower than the national and international recommendations. Only seven out of every hundred children received MMNPs. Improving maternal preventive health care and supporting marginalized women will have a positive impact.

A multilevel analysis of factors associated with vitamin A supplementation among children aged 6-35 months in Ethiopia

Background

Vitamin A deficiency is among the leading preventable causes of childhood morbidity and mortality that might be attributable to the low uptake of vitamin A supplementation (VAS). Factors contributing to its low utilization are not researched at the national level and with the appropriate model. Therefore, this study aimed at identifying the magnitude and the individual- and community-level factors associated with vitamin A supplementation among children aged 6-35 months in Ethiopia.

Methods

We have used the Ethiopian mini demographic and health survey data, which was conducted from 21 March to 28 June 2019. A weighted sum of 2,362 mothers having children aged 6-35 was extracted. Considering the hierarchical nature of the data, we fitted the multilevel multivariable logistic regression model. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported and variables with a p-value of < 0.05 were declared to be significantly associated factors.

Results

In this study, 43.4% (95% CI: 41.4-45.4%) of children have taken the VAS. Moreover, the 12-23 age of the child (AOR = 2.64; 95% CI: 1.88-3.72), 30-34 age of the mother (AOR = 3.34; 95% CI: 1.21-9.20), middle household wealth status (AOR = 1.75; 95% CI: 1.06-2.90), and four and above antenatal care (AOR = 2.90; 95% CI: 1.90-4.43) are the individual-level factors associated with VAS whereas being from Amhara (AOR = 2.20; 95% CI: 1.29-3.76) and Tigray (AOR = 2.16; 95% CI: 1.17-3.98) regions is a community-level factor significantly associated with the uptake of VAS.

Conclusion

Overall, a low proportion of children have taken the VAS in Ethiopia. The higher age of the child and mother, full antenatal care, and improved wealth status positively influence VAS. Moreover, a child from the Tigray or Amhara regions was more likely to get VAS. Therefore, an intervention has to be designed to address the VAS uptake among young mothers, and working to improve the wealth status of the household would be helpful. Moreover, the advocacy of antenatal care and minimizing the regional disparity through encouraging the uptake in the rest of the regions would help increase the national-level uptake of VAS.

Assessing the potential determinants of national vitamin A supplementation among children aged 6-35 months in Ethiopia: further analysis of the 2019 Ethiopian Mini Demographic and Health Survey

Background

Vitamin A is a nutrient that is required in a small amount for normal visual system function, growth and development, epithelia’s cellular integrity, immune function, and reproduction. Vitamin A has a significant and clinically important effect since it has been associated with a reduction in all-cause and diarrhea mortality. The aim of this study was to determine factors associated with national vitamin A supplementation among children aged 6–35 months.

Method

The data for this study was extracted from the 2019 Ethiopian Mini Demographic and Health Survey. A total weighted sample of 2242 women with children aged 6–35 months was included in the study. The analysis was performed using Stata version 14.2 software. Applying sampling weight for descriptive statistics and complex sample design for inferential statistics, a manual backward stepwise elimination approach was applied. Finally, statistical significance declared at the level of p value < 0.05.

Result

The overall coverage of vitamin A supplementation among children aged 6–35 months for the survey included was 44.4 95% CI (40.15, 48.74). In the multivariable analysis, mothers who had four or more antenatal visits [AOR = 2.02 (95% CI: 1.34, 3.04)] were two times more likely to receive vitamin A capsules for their children than mothers who had no antenatal visits. Children from middle-wealth quintiles had higher odds of receiving vitamin A capsules in comparison to children from the poorest wealth quintile [AOR = 1.77 (95% CI: 1.14, 2.73)]. Older children had higher odds of receiving vitamin A capsules than the youngest ones. Other factors that were associated with vitamin A supplementation were mode of delivery and region.

Conclusion

The coverage of vitamin A supplementation in Ethiopia remains low and it is strongly associated with antenatal visit, household wealth index and age of child. Expanding maternal health services like antenatal care visits should be prioritized.

Trends in inequality in the coverage of vitamin A supplementation among children 6-59 months of age over two decades in Ethiopia: Evidence from demographic and health surveys

Objectives

There is a dearth of evidence on inequalities in vitamin A supplementation in Ethiopia. The goal of this study was to assess the magnitude and overtime changes of inequalities in vitamin A supplementation among children aged 6-59 months in Ethiopia.

Methods

We extracted data from four waves of the Ethiopia Demographic and Health Surveys (2000, 2005, 2011, and 2016). The analysis was carried out using the 2019 updated World Health Organization's Health Equity Assessment Toolkit software that facilitates the use of stored data from World Health Organization's Health Equity Monitor Database. We conducted analysis of inequality in vitamin A supplementation by five equity stratifiers: household economic status, educational status, place of residence, child's sex, and subnational region. Four summary measures-population attributable fraction, ratio, difference, and population attributable risk-were assessed. We computed 95% uncertainty intervals for each point estimate to ascertain statistical significance of the observed vitamin A supplementation inequalities and overtime disparities.

Results

The findings suggest marked absolute and relative pro-rich (population attributable fraction = 29.51, 95% uncertainty interval; 25.49-33.53, population attributable risk = 13.18, 95% uncertainty intervals; 11.38-14.98) and pro-urban (difference = 16.55, 95% uncertainty intervals; 11.23-21.87, population attributable fraction = 32.95, 95% uncertainty intervals; 32.12-33.78) inequalities. In addition, we found education-related (population attributable risk = 18.95, 95% uncertainty intervals; 18.22-19.67, ratio = 1.54, 95% uncertainty intervals; 1.37-1.71), and subnational regional (difference = 38.56, 95% uncertainty intervals; 29.57-47.54, ratio = 2.10, 95% uncertainty intervals; 1.66-2.54) inequalities that favored children from educated subgroups and those living in some regions such as Tigray. However, no sex-based inequalities were observed. While constant pattern was observed in subnational regional disparities, mixed but increasing patterns of socioeconomic and urban-rural inequalities were observed in the most recent surveys (2011-2016).

Conclusion

In this study, we found extensive socioeconomic and geographic-based disparities that favored children from advantaged subgroups such as those whose mothers were educated, lived in the richest/richer households, resided in urban areas, and from regions like Tigray. Government policies and programs should prioritize underprivileged subpopulations and empower women as a means to increase national coverage and achieve universal accessibility of vitamin A supplementation.

Micronutrient intake status and associated factors among children aged 6-23 months in the emerging regions of Ethiopia: A multilevel analysis of the 2016 Ethiopia demographic and health survey

BACKGROUND

Micronutrient (MN) deficiency among children is recognised as a major public health problem in Ethiopia. The scarcity of MNs in Ethiopia, particularly in pastoral communities, might be severe due to poor diets mitigated by poor healthcare access, drought, and poverty. To reduce MNs deficiency, foods rich in vitamin A (VA) and iron were promoted and programs like multiple micronutrient powder (MNP), iron and vitamin A supplements (VAS) and or deworming have been implemented. Nationally for children aged 6-23 months, consumption of four or more food groups from diet rich in iron and VA within the previous 24 hours, MNP and iron supplementation within seven days, and VAS and >75% of deworming within the last 6 months is recommend; however, empirical evidence is scarce. Therefore, this study aimed to assess the recommended MN intake status of children aged 6-23 months in the emerging regions of Ethiopia.

METHODS

Data from the Ethiopia Demographic and Health Survey 2016 were used. A two-stage stratified sampling technique was used to identify 1009 children aged 6-23 months. MN intake status was assessed using six options: food rich in VA or iron consumed within the previous 24 hours, MNP or iron supplementation with the previous seven days, VAS or deworming within six months. A multilevel mixed-effect logistic regression analysis was computed, and a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were used to identify the individual and community-level factors.

RESULTS

In this analysis, 37.3% (95% CI: 34.3-40.3) of children aged 6-23 months had not received any to the recommended MNs sources. The recommended MNs resulted; VAS (47.2%), iron supplementation (6.0%), diet rich in VA (27.7%), diet rich in iron (15.6%), MNP (7.5%), and deworming (7.1%). Antenatal care visit (AOR: 1.9, 95% CI: 1.4-2.8), work in the agriculture (AOR: 2.2, 95% CI: 1.3-3.8) and children aged 13 to 23 months (AOR: 1.7, 95% CI: 1.2-2.4) were the individual-level factors and also Benishangul (AOR: 2.2, 95% CI: 1.3-4.9) and Gambella regions (AOR: 1.9, 95% CI: 1.0-3.4) were the community-level factors that increased micronutrient intake whereas residence in rural (AOR: 0.4, 95% CI: 0.1-0.9) was the community-level factors that decrease micronutrient intake.

CONCLUSIONS

Micronutrient intake among children aged 6-23 months in the pastoral community was low when compared to the national recommendation. After adjusting for individual and community level factors, women's occupational status, child's age, antenatal visits for recent pregnancy, residence and region were significantly associated with the MN intake status among children aged 6-23 months.

Vitamin A supplementation and estimated number of averted child deaths in Ethiopia: 15 years in practice (2005-2019)

Vitamin A supplementation (VAS), started as a short‐term strategy pending dietary improvements, has been implemented in Ethiopia for the last 15 years. We aimed to describe the trends in VAS coverage and estimated the associated reductions in child mortality. VAS coverage data obtained from the District Health Information System and the Demographic and Health Surveys were linked to child mortality data from the United Nations Interagency Group for Child Mortality Estimation (UN IGME). The number of child deaths averted was modelled assuming 12% and 24% reductions in all‐cause mortality. From 2006 to 2011, VAS was delivered through campaigns, and coverage was above 85%. However, from 2011 onwards, VAS delivery was integrated to the routine health system, and the coverage declined to <60% with significant disparities by wealth quintile and rural–urban residence. VAS has saved between 167,563 to 376,030 child lives (2005–2019), but additional lives (>42,000) could have been saved with a universal coverage (95%). Inconsistent supply of vitamin A capsules, but more importantly, low access to health care, and the limited contact opportunities for children after 24 months may have contributed to the declining VAS coverage. Any changes in target or scale‐up should thus consider these spatial and socioeconomic variations. Increasing the coverage of VAS and closing the equity gap in access to nutrition services is critical. However, with alternative programmes like vitamin A fortification being set‐up, the benefits and safety of VAS need to be closely monitored, particularly in areas where there will be overlap.

Uptake of routine vitamin A supplementation for children in Humbo district, southern Ethiopia: community-based cross-sectional study

Background

In low- and middle-income countries routine vitamin A supplementation (VAS) is a key strategy for reducing vitamin A deficiency and mortality and morbidity of preschool children. However, in Ethiopia, there is paucity of evidence regarding the level and determinants of the uptake of the supplement. This study was designed to assess the coverage and predictors of VAS among preschool children in Humbo district, Southern Ethiopia.

Methods

A cross-sectional study was conducted in April 2016. A total of 840 mothers/caregivers having children 6–59 months of age were selected using multistage cluster sampling technique from six rural villages implementing routine VAS program. Data were collected using interviewer administered questionnaire. Possible predictors considered in the study include distance from the nearby health facility, household socio-economic status, type of the household (model vs non-model), maternal access to health education on VAS, and knowledge on vitamin A and VAS. Multivariable logistic regression analysis was performed to identify predictors of uptake of VAS. The outputs are presented using adjusted odds ratio (AOR) with the respective 95% confidence interval (CI).

Results

The coverage of VAS was 75.0% (95% CI: 72.1–77.9). Better knowledge of mothers about the importance of the supplement (AOR: 1.49, 1.02–2.17), obtaining VAS related information from frontline community health workers (AOR: 1.51, 1.34–2.72) than health professionals and being from households in the “rich” wealth tertile (AOR: 1.80, 95% CI: 1.07–3.03) were positively associated with uptake VAS.

Conclusion

The VAS coverage of the area was approaching the expected national target of 80%. However, the uptake can be enhanced though awareness creation and improving socio-economic status of the community.

Individual-level predictors of practices of nutrition-specific and nutrition-sensitive interventions for infants and young children in West and Central Africa: a cross-sectional study

OBJECTIVES

To explore the role of individual-level and household-level characteristics for practice of nutrition-specific and nutrition-sensitive interventions.

DESIGN

Secondary data analysis (cross-sectional).

SETTING

West and Central Africa.

PARTICIPANTS

Data are from the Demographic and Health Surveys in the time period between 1986 and 2016. The final sample included between 116 325 and 272 238 observations depending on the outcome.

PRIMARY AND SECONDARY OUTCOME MEASURES

Nutrition-specific and nutrition-sensitive interventions were identified based on the UNICEF Conceptual Framework for child undernutrition. These were early breastfeeding initiation, minimum dietary diversity, full age-appropriate immunisation, iodised salt usage, vitamin A supplementation, iron supplementation, deworming in children aged 1 to 5, clean cooking fuel, safe drinking water and improved sanitation. Explanatory variables include household, mother and child characteristics. Linear probability models were fitted for each outcome, both unadjusted as well as fully adjusted including primary sampling unit fixed effects.

RESULTS

Prevalence of early breastfeeding initiation was 54.31% (95% CI: 53.22% to 55.41%), minimum dietary diversity 13.89% (95% CI: 13.19% to 14.59%), full age-appropriate immunisation 13.04% (95% CI: 12.49% to 13.59%), iodised salt usage 49.66% (95% CI: 46.79% to 52.53%), vitamin A supplementation 52.87% (95% CI: 51.41% to 54.33%), iron supplementation 10.73% (95% CI: 10.07% to 11.39%), deworming 31.33% (95% CI: 30.06% to 32.60%), clean cooking fuel usage 3.02% (95% CI: 2.66% to 3.38%), safe drinking water 57.85% (95% CI: 56.10% to 59.59%) and improved sanitation 42.49% (95% CI: 40.77% to 44.21%). There was a positive education and wealth gradient for the practices of all interventions except deworming. Higher birth order was positively associated with the practice of early breastfeeding initiation, minimum dietary diversity, vitamin A supplementation and negatively associated with full immunisation and improved sanitation.

CONCLUSIONS

Household, maternal, and child-level characteristics explain practices of nutrition-specific and nutrition-sensitive interventions beyond intervention delivery at the regional level.

Inequitable coverage of vitamin A supplementation in Nigeria and implications for childhood blindness

Background

Vitamin A deficiency (VAD) is of major public health significance; it is a risk factor for childhood deaths from diarrhoea and measles in low and middle-income countries and an important cause of preventable childhood blindness in low income countries. Vitamin A supplementation (VAS) is being implemented in many LMICs and high coverage reduces the prevalence of blinding corneal diseases in children. However, national estimates of coverage may not reveal any inequities in intra country coverage. The aim of this study is to assess factors influencing VAS coverage and also assess the relationship between VAS coverage and childhood corneal blindness in Nigeria.

Methods

Data were collected from the Nigeria Demographic and Health Survey (NDHS) 2013 and the published literature on population-based childhood blindness surveys in Nigeria. The main outcome measure was the proportion of eligible children who received VAS in the last 6 months preceding the survey. Study factors comprised a range of socioeconomic, and individual factors. Data were analysed using STATA V.12.1 (Statcorp, Texas). To explore the effects of the independent variables on VAS coverage, bivariate and multivariate regression was done. Variables with p < 0.05 in the final multivariable model were considered as independent factors. For the population-based childhood blindness surveys, aggregated and disaggregated data were used. Causes of blindness were stratified into corneal blindness and ‘others’. Odds ratios were computed to determine the odds of developing corneal blindness in each geopolitical region. Tests of significance were set at the 95% level.

Results

The total VAS coverage in 2013 was 41.5%. VAS coverage was inequitable. Children with very educated mothers (OR 3.27 p < 0.001), from the south-south region (OR 2.38 p < 0.001) or in the highest wealth quintile (OR 2.81 p < 0.001) had higher odds of receiving VAS. The northwest zone had the lowest VAS coverage and the highest prevalence of corneal blindness.

Conclusion

Regional and socioeconomic inequities in VAS exist in Nigeria and these may have grave implications for the causes of childhood blindness. The development and implementation of context specific and effective strategies are needed to reduce these inequities in VAS.

Coverage and factors associated with vitamin A supplementation among children aged 6-59 months in twenty-three sub-Saharan African countries

OBJECTIVE

The present study aimed to give an overall view of the pattern of high-dose vitamin A supplementation (VAS) coverage in twenty-three sub-Saharan African countries and factors associated with receipt of VAS among children aged 6-59 months.

DESIGN

Cross-sectional data from the twenty-three Demographic and Health Surveys conducted from 2011 to 2015 in twenty-three sub-Saharan African countries were pooled. A multilevel logistic regression model was used to explore factors associated with VAS.

SETTING

Twenty-three sub-Saharan African countries.ParticipantsChildren (n 215 511) aged 6-59 months.

RESULTS

The overall coverage of VAS among children aged 6-59 months for the surveys included was 59·4 %. In the multivariable analysis, children whose mothers had primary (adjusted OR (aOR)=1·43; 95 % CI 1·39, 1·47) or secondary or above (aOR=1·72; 95 % CI 1·67, 1·77) educational status were more likely to receive VAS than children whose mothers had no formal education. Other factors associated with significantly increased likelihood of VAS were: living in urban areas; children of working mothers; children whose mothers had higher media exposure; children of older mothers v. children of mothers aged 15-19 years; and older children v. children aged 6-11 months. At the country level, lower media exposure was significant and negatively associated with VAS.

CONCLUSIONS

Broader VAS coverage is needed according to our data. More efforts are needed to scale up coverage, focusing mostly on groups at risk of non-receipt of vitamin A.

Causes of severe visual impairment and blindness in students in schools for the blind in Northwest Ethiopia

Objectives

To determine the causes of severe visual impairment and blindness (SVI/BL) among students in schools for the blind in Northwest Ethiopia and to identify preventable and treatable causes.

Method

Students attending nine schools for the blind in Northwest Ethiopia were examined and causes assigned using the standard WHO record form for children with blindness and low vision in May and June 2015.

Results

383 students were examined, 357 (93%) of whom were severely visually impaired or blind (<6/60 in their better eye). 253 (70.9%) were aged 16 years or above and 228 (63.9%) were males. 100 students aged <16 years were blind and four were SVI, total 104. The major anatomical site of visual loss among those 0-15 years was cornea/phthisis (47.1%), usually due to measles and vitamin A deficiency, followed by whole globe (22.1%), lens (9.6%) and uvea (8.7%). Among students aged 16 years and above, corneal/phthisis (76.3%) was the major anatomical cause, followed by lens (6.3%), whole globe (4.7%), uvea (3.6%) and optic nerve (3.2%). The leading underlying aetiology among students aged <16 years was childhood factors (39.4%) (13.5% measles, 10.6% vitamin A deficiency), followed by unknown aetiology (54.8%), perinatal (2.9%) and hereditary factors (2.9%). In the older group, childhood factors (72.3%) (25% measles, 15% vitamin A deficiency) were major causes, followed by unknown aetiology (24.1%), perinatal (2.4%) and hereditary factors (0.8%). Over 80% of the causes were avoidable with majority being potentially preventable (65%).

Conclusion

Corneal blindness, mainly as the result of measles and vitamin A deficiency, is still a public health problem in Northwest Ethiopia, and this has not changed as observed in other low-income countries. More than three-fourth of causes of SVI/BL in students in schools for the blind are potentially avoidable, with measles/vitamin A deficiency and cataract being the leading causes.

Vitamin-A deficiency and its determinants among preschool children: a community based cross-sectional study in Ethiopia

Background

Vitamin A deficiency is the leading cause of preventable visual impairments in children. It is also an underlying cause for nearly one-fourth of global child mortality associated with measles, diarrhea, and malaria. The limited literature available in Ethiopia shows severe public health significance of vitamin-A deficiency. Hence the aim of the current study was to assess the prevalence and factors determining vitamin-A deficiency among preschool children in Dembia District, northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted among preschool children of Dembia District from January to February, 2015. A multi-stage sampling, followed by a systematic sampling technique was employed to select study participants. A structured interviewer-administered questionnaire was used to collect data. Using a binary logistic regression model, multivariable analysis was fitted to identify the associated factors of vitamin-A deficiency. The adjusted odds ratio (AOR) with a 95 % confidence interval was computed to assess the strength of the association, and variables with a p value of <0.05 in multivariable analysis were considered as statistically significant.

Results

Six hundred eighty-one preschool children were included in the study, giving a response rate of 96.5 %. The overall prevalence of xerophthalmia was 8.6 %. The result of the multivariable analysis revealed that nonattendance at the antenatal care clinic [AOR 2.65,95 % CI (1.39,5.07)], being male [AOR 1.81, 95 % CI (1.01,3.24)], and in the age group of 49–59 months [AOR 3.00, 95 % CI (1.49,6.02)] were significantly associated with vitamin-A deficiency.

Conclusions

Vitamin-A deficiency is a severe public health problem in the study area. Further strengthening antenatal care utilization and giving emphasis to preschool children will help to mitigate vitamin-A deficiency in the study area.