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Baker MM, Janmohamed A, Toure D, Dissieka R, Ndiaye F, Khassanova R, Fofana ML, Doledec D. COVID-19 concerns among caregivers and vitamin A supplementation coverage among children aged 6-59 months in four countries in Western sub-Saharan Africa. Public Health Nutr 2023; 26:1935-1943. [PMID: 37395173 PMCID: PMC10564591 DOI: 10.1017/s1368980023001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/12/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To assess child vitamin A supplementation (VAS) coverage in 2019 and 2020 and explore key factors, including COVID-19 concerns, that influenced VAS status in four sub-Saharan African countries. DESIGN Data from eight representative household surveys were used to assess VAS coverage. Multivariable logistic regression models examined the effect of rural/urban residence, child sex and age, caregiver education, COVID-19 concern and household wealth on VAS status. SETTING Nine (2019) and 12 (2020) districts in Burkina Faso, Côte d'Ivoire, Guinea and Mali. PARTICIPANTS 28 283 caregivers of children aged 6-59 months. RESULTS Between 2019 and 2020, VAS coverage increased in Burkina Faso (82·2-93·1 %), Côte d'Ivoire (90·3-93·3 %) and Mali (76·1-79·3 %) and decreased in Guinea (86·0 % to 81·7 %). Rural children had a higher likelihood of VAS uptake compared with urban children in Burkina Faso (adjusted OR (aOR) = 4·22; 95 % CI: 3·11, 5·72), Côte d'Ivoire (aOR = 5·19; 95 % CI: 3·10, 8·70) and Mali (aOR = 1·41; 95 % CI: 1·15, 1·74). Children aged 12-59 months had a higher likelihood of VAS uptake compared with children aged 6-11 months in Côte d'Ivoire (aOR = 1·67; 95 % CI: 1·12, 2·48) and Mali (aOR = 1·74; 95 % CI: 1·34, 2·26). Moderate-to-high COVID-19 concern was associated with a lower likelihood of VAS uptake in Côte d'Ivoire (aOR = 0·55; 95 % CI: 0·37, 0·80). CONCLUSION The increase in VAS coverage from 2019 to 2020 suggests that COVID-19 concerns may not have limited VAS uptake in some African countries, though geographic inequities should be considered.
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Affiliation(s)
- Melissa M Baker
- Helen Keller International, P.O. Box 14195 – 00800, Nairobi, Kenya
| | | | | | | | | | | | | | - David Doledec
- Helen Keller International, P.O. Box 14195 – 00800, Nairobi, Kenya
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Berihun B, Chemir F, Gebru M, GebreEyesus FA. Vitamin A supplementation coverage and its associated factors among children aged 6-59 months in West Azernet Berbere Woreda, South West Ethiopia. BMC Pediatr 2023; 23:257. [PMID: 37221505 DOI: 10.1186/s12887-023-04059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Vitamin A deficiency is one of the major public health problems in low and middle-income countries including Ethiopia. Despite this fact, little attention was given to routine vitamin A supplementation in hard-to-reach rural areas and districts. Therefore, this study aimed to assess vitamin A supplementation coverage and its associated factors among children aged 6-59 months in West Azernet Berbere woreda, southern Ethiopia, 2021. METHODS A community-based cross-sectional study was conducted from April to May 2021. A total sample size of 471 study participants was involved in the study area. A simple random sampling technique was used to recruit the study subject. A pretested structured interviewer-administered questionnaire was used. Bivariable and multivariable logistic regression analyses were done to identify variables having a significant association with vitamin A supplementation. The variables having a p-value ≤ 0.05 with 95% CI were used to declare an association between factors and a dependent variable. RESULTS In this study, a total of 471 respondents were successfully interviewed with a response rate of 97.3%. The coverage of vitamin A supplementation was found to be 58.0%. Family monthly income [AOR = 2.565, 95% CI(1.631,4.032)], having PNC visit [AOR = 1.801, 95% CI (1.158, 2.801)], husbands disapproval about vitamin A supplementation [AOR = 0.324, 95% CI (0.129, 0.813)], information about vitamin A supplementation [AOR = 2.932, 95% CI (1.893, 4,542)] and ANC follow-up [AOR = 1.882, 95% CI (1.084, 3.266)] were factors significantly associated to vitamin A supplementation. CONCLUSION Vitamin A supplementation was found to be low and it is strongly associated with family monthly income, postnatal care, husband's disapproval of vitamin A supplementation, antenatal care follow-up, and information about vitamin A supplementation. Based on our findings, it is recommended to improve the monthly income of the household by actively engaging in various income-generating activities, enhance health information dissemination among mothers, particularly those who are underprivileged by using different strategies like local health campaigns, and mass media, advocacy of antenatal, and postnatal follow-up and promote the involvement of males/husband in childhood immunization service.
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Affiliation(s)
| | - Fantaye Chemir
- Department of Midwifery, College of Medicine and Health Sciences, Wolkite University, PO Box 07, Wolkite, Ethiopia
| | - Mehari Gebru
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, PO Box 07, Wolkite, Ethiopia
| | - Fisha Alebel GebreEyesus
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, PO Box 07, Wolkite, Ethiopia.
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Zegeye B, Olorunsaiye CZ, Ahinkorah BO, Ameyaw EK, Seidu AA, Budu E, Yaya S. 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. SAGE Open Med 2022; 10:20503121221094688. [PMID: 35558192 PMCID: PMC9087221 DOI: 10.1177/20503121221094688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/30/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health
Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | | | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of
Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of
Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health,
University of Cape Coast, Cape Coast, Ghana
| | - Eugene Budu
- Department of Population and Health,
University of Cape Coast, Cape Coast, Ghana
| | - Sanni Yaya
- Faculty of Medicine, University of
Parakou, Parakou, Benin
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Diouf JBN, Sougou NM. Vitamin A Supplementation in Children in Guédiawaye Health District, Senegal. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Miglietta A, Imohe A, Hasman A. Methodologies to measure the coverage of vitamin A supplementation: a systematic review. J Nutr Sci 2021; 10:e68. [PMID: 34527226 PMCID: PMC8411257 DOI: 10.1017/jns.2021.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022] Open
Abstract
Countries are increasingly transitioning from event-based vitamin A supplementation (VAS) distribution to delivery through routine health system contacts, shifting also to administrative, electronic-based monitoring tools, a process that brings certain limitations affecting the quality of administrative VAS coverage. At present, there is no standardised methodology for measuring the coverage of VAS delivered through routine health services. To address this gap, we conducted a systematic review of the literature to identify and recommend methods to measure VAS coverage, with the aim of providing guidance to countries on the collection of consistent data for planning, monitoring and evaluating VAS programmes integrated into routine health systems. We searched the PubMed®, Embase®, Scopus, Google Scholar and World Health Organization (WHO) Global Index Medicus databases for studies published from 1 January 2000 to 1 January 2021, reporting original data on VAS coverage and methodologies used for measurement. We screened 2371 original titles and abstracts, assessed twenty-seven full-text articles and ultimately included eighteen studies. All but two studies used a coverage cluster survey (CCS) design to measure VAS coverage, adapting the WHO Vaccination Coverage Cluster Surveys methodology, by modifying sample size and sampling parameters. Annual two-dose VAS coverage was reported from only four studies. Until electronic-based systems to collect and analyse VAS data are equipped to measure routine two-dose VAS coverage using administrative data, CCSs that comply with the 2018 WHO Vaccination Coverage Cluster Surveys Reference Manual represent the gold-standard method for effective VAS programme monitoring.
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Affiliation(s)
| | - Annette Imohe
- Nutrition Section, UNICEF Headquarters, New York, USA
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Sagalova V, Zagre NM, Vollmer S. 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. BMJ Open 2020; 10:e036350. [PMID: 32014882 PMCID: PMC7044985 DOI: 10.1136/bmjopen-2019-036350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Vera Sagalova
- Department of Economics, University of Goettingen, Goettingen, Germany
| | | | - Sebastian Vollmer
- Department of Economics, University of Goettingen, Goettingen, Germany
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Nordhagen S, Bauck A, Doledec D. Gender Equity and Vitamin A Supplementation: Moving Beyond Equal Coverage. Food Nutr Bull 2019; 41:38-49. [DOI: 10.1177/0379572119860310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Vitamin A supplementation (VAS) is currently implemented in over 80 countries worldwide, but little attention has been paid to gender equity in the design or implementation of these programs. Objective: This article describes the ways in which gender equity can impact or be impacted by VAS programs and suggests ways to ensure these programs better support gender equity in the future. Methods: We undertook a desk review of research on gender equity in health services and extrapolated findings to VAS, highlighting gender equity issues throughout the VAS implementation process and across delivery platform types. We also amassed secondary data on VAS coverage from 45 surveys in 13 countries and analyzed it to examine differences in VAS coverage between boys and girls. Results: Despite few significant differences in coverage between boys and girls, we identify numerous ways in which gender equity can impact or be impacted by VAS programs, including through the choice of VAS distributors and the communication materials used to promote VAS campaigns. Examining these different entry points reveals that there are several missed opportunities for better integration of gender within VAS. Conclusions: VAS program implementers and policymakers should revisit VAS approaches to identify opportunities for advancing gender equity through this wide-reaching platform.
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Affiliation(s)
- Stella Nordhagen
- Africa Regional Office, Helen Keller International, Dakar, Senegal
| | - Aubrey Bauck
- Africa Regional Office, Helen Keller International, Dakar, Senegal
| | - David Doledec
- Africa Regional Office, Helen Keller International, Nairobi, Kenya
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Aghaji AE, Duke R, Aghaji UCW. Inequitable coverage of vitamin A supplementation in Nigeria and implications for childhood blindness. BMC Public Health 2019; 19:282. [PMID: 30849959 PMCID: PMC6408825 DOI: 10.1186/s12889-019-6413-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Ada E Aghaji
- Paediatric Ophthalmology Unit, College of Medicine, University of Nigeria, Enugu, Nigeria. .,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Roseline Duke
- Calabar Children's Eye Centre, Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Coverage and factors associated with vitamin A supplementation among children aged 6-59 months in twenty-three sub-Saharan African countries. Public Health Nutr 2019; 22:1770-1776. [PMID: 30755287 DOI: 10.1017/s1368980018004056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Determinants of successful vitamin A supplementation coverage among children aged 6-59 months in thirteen sub-Saharan African countries. Public Health Nutr 2017; 20:2016-2022. [PMID: 28532531 DOI: 10.1017/s1368980017000684] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Vitamin A supplementation (VAS) for children aged 6-59 months occurs regularly in most sub-Saharan African countries. The present study aimed to explore child, household and delivery platform factors associated with VAS coverage and identify barriers to compliance in thirteen African countries. DESIGN We pooled data (n ~60 000) from forty-four household coverage surveys and used bivariate and multivariable regression analyses to assess the effects of supplementation strategy, rural v. urban residence, child sex, child age, caregiver education and campaign awareness on child VAS status. Setting/Subjects Primary caregivers of children aged 6-59 months in thirteen countries. RESULTS Door-to-door distribution resulted in higher VAS coverage than fixed-site plus outreach approaches (91 v. 63 %) and was a significant predictor of supplementation in the adjusted model (OR=19·0; 95 % CI 17·2, 21·1; P<0·001). Having been informed about the campaign was the main predictor of VAS in the door-to-door (OR=6·8; 95 % CI 5·8, 7·9; P<0·001) and fixed-site plus outreach (OR=72·5; 95 % CI 66·6, 78·8; P<0·001) groups. CONCLUSIONS Door-to-door provision of VAS may achieve higher coverage than fixed-site models in the African context. However, the phase-out of door-to-door polio immunization campaigns in most sub-Saharan African countries threatens the main distribution vehicle for VAS. Our findings suggest well-informed communities are key to attaining higher coverage using fixed-site delivery alternatives.
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Ouédraogo CT, Becquey E, Wilson SE, Prince L, Ouédraogo A, Rouamba N, Ouédraogo JB, Vosti SA, Brown KH, Hess SY. Factors Affecting the Validity of Coverage Survey Reports of Receipt of Vitamin A Supplements During Child Health Days in Southwestern Burkina Faso. Food Nutr Bull 2016; 37:529-543. [PMID: 27604622 DOI: 10.1177/0379572116666167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Assessment of high-dose vitamin A supplementation (VAS) coverage often relies on postevent coverage (PEC) surveys, but the validity of these methods has rarely been evaluated. OBJECTIVES To assess reported VAS coverage and factors associated with missed coverage and to investigate the reliability of the results. METHODS During a cross-sectional survey, 10 454 caregivers of children <27 months old were asked whether their child had received VAS in the past 6 months. During a 48-week longitudinal study of 6232 children 6 to 30 months old, caregivers were asked every 4 weeks if their child had received VAS in the past 4 weeks. RESULTS The cross-sectional study showed that 94.4% (95% confidence interval [CI]: 93.8%, 94.9%) of eligible children 6 to 26 months of age reportedly received VAS in the previous 6 months, as did 85.8% (CI: 84.5%, 87.2%) of ineligible, 0 to 5 months old children. The longitudinal study showed that 81.6% of children surveyed within 4 weeks following a VAS campaign reportedly received VAS during the campaign and 13.4% of caregivers incorrectly reported receiving VAS when no campaign had actually occurred. False-positive reporting was more likely when oral polio vaccine (OPV) was distributed during the reporting period (20.6% vs 5.4%; P < .001). Showing a photo of OPV during the interview reduced the odds ratio (OR) of false-positive reports (OR = 0.7 [0.6-0.8]). CONCLUSIONS The PEC surveys should include children outside the target age to assess targeting efficiency, and pictures of both VAS and oral vaccines distributed during the same period should be shown during interviews to enhance reporting accuracy.
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Affiliation(s)
- Césaire T Ouédraogo
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso.,Helen Keller International, Dakar, Senegal
| | - Elodie Becquey
- Helen Keller International, Dakar, Senegal.,Department of Nutrition, University of California, Davis, CA, USA.,International Food Policy Research Institute, Washington, DC, USA
| | - Shelby E Wilson
- Department of Nutrition, University of California, Davis, CA, USA
| | - Lea Prince
- Department of Nutrition, University of California, Davis, CA, USA
| | - Amadou Ouédraogo
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Noël Rouamba
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | | | - Stephen A Vosti
- Department of Nutrition, University of California, Davis, CA, USA
| | - Kenneth H Brown
- Department of Nutrition, University of California, Davis, CA, USA
| | - Sonja Y Hess
- Department of Nutrition, University of California, Davis, CA, USA
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Sesay FF, Hodges MH, Kamara HI, Turay M, Wolfe A, Samba TT, Koroma AS, Kamara W, Fall A, Mitula P, Conteh I, Maksha N, Jambai A. High coverage of vitamin A supplementation and measles vaccination during an integrated Maternal and Child Health Week in Sierra Leone. Int Health 2014; 7:26-31. [PMID: 25316706 DOI: 10.1093/inthealth/ihu073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In May 2012, the twice-yearly Maternal and Child Health Week (MCHW) integrated vitamin A supplementation (VAS) and supplementary measles vaccination to reach all children 6-59 months in Sierra Leone. Following the MCHW, a post event coverage survey was conducted to validate VAS coverage and assess adverse events following immunization. METHODS Using the WHO Expanded Program on Immunization sampling methodology, 30 clusters were randomly selected using population proportionate to size sampling. Fourteen caregivers of children 6-59 months were interviewed per cluster for precision of ±5%. Responses were collected via mobile phones using EpiSurveyor. RESULTS Overall VAS and measles coverage was 91.9% and 91.6%, respectively, with no significant differences by age group, sex, religion or occupation. Major reasons given for not receiving VAS and measles vaccination were not knowing about the MCHW or being out of the area. Significantly more mild adverse events (fever, pain at injection site) were reported via the post event coverage survey (29.1%) than MCHW (0.01%) (p<0.0001). CONCLUSION The MCHW reached >90% of children in Sierra Leone with equitable coverage. Increased reporting of mild adverse events during the survey may be attributed to delayed onset after measles vaccination and/or direct inquiry from enumerators. Even mild adverse events following immunization requires strengthened reporting during and after vaccination campaigns.
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Affiliation(s)
- Fatmata F Sesay
- Helen Keller International, PO Box 369, Freetown, Sierra Leone
| | - Mary H Hodges
- Helen Keller International, PO Box 369, Freetown, Sierra Leone
| | - Habib I Kamara
- Helen Keller International, PO Box 369, Freetown, Sierra Leone
| | - Mohamed Turay
- Helen Keller International, PO Box 369, Freetown, Sierra Leone
| | - Adam Wolfe
- Columbia University, Mailman School of Public Health, New York, NY USA
| | - Thomas T Samba
- Child Health and Expanded Program on Immunization, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Aminata S Koroma
- Nutrition Program, Ministry of Health and Sanitation Sierra Leone, Youyi Building Brookfields, Freetown Sierra Leone
| | - Wogba Kamara
- National HIV/AIDS Secretariat, Ministry of Health and Sanitation, Kingharman Road Freetown, Sierra Leone
| | - Amadou Fall
- World Health Organization, Country Office, Sierra Leone and Inter Country Support Team for West Africa (IST-WA)
| | - Pamela Mitula
- World Health Organization, Country Office, Sierra Leone and Inter Country Support Team for West Africa (IST-WA)
| | - Ishata Conteh
- World Health Organization, Country Office, Sierra Leone and Inter Country Support Team for West Africa (IST-WA)
| | - Nuhu Maksha
- United Nations Children's Fund, Country Office, Sierra Leone
| | - Amara Jambai
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
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Screening for acute childhood malnutrition during the National Nutrition Week in mali increases treatment referrals. PLoS One 2011; 6:e14818. [PMID: 21731602 PMCID: PMC3121698 DOI: 10.1371/journal.pone.0014818] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 04/13/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate a pilot intervention designed to integrate mid-upper arm circumference (MUAC) screening for acute malnutrition into the semi-annual Child Nutrition Week (Semaine d'Intensification des Activités de Nutrition, or "SIAN") activities carried out in June 2008. DESIGN A cross-sectional survey was conducted in Kolokani and Nara, two health districts in the Koulikoro region of Mali, 4-5 months after the SIAN, using a population-proportionate, multi-stage random sample of: 1) health centers, and 2) households in communities linked to each of the selected health centers. Caregivers of 1543 children who were 6-59 months of age at the time of the SIAN, 17 community-based volunteers and 45 health center staff members were interviewed. RESULTS A total of 1278 children 6-59 months (83% of those studied) reportedly participated in SIAN. Of the participating children, 1258 received vitamin A (98% of SIAN participants; 82% of all eligible children), 945 received anti-helminth tablets (84% of participants; 71% of eligibles), and 669 were screened for acute malnutrition (52% of participants; 43% of eligibles). 186 of the children screened (27%) were reportedly identified as acutely malnourished. SIAN screening covered a significantly greater proportion of children than were examined in both community-based (22% of children) and health center-based screening activities (5% of children) combined during the 4-5 months after the SIAN (P<0.0001). In general, community volunteers and health personnel positively evaluated their experience adding MUAC screening to SIAN. CONCLUSION Integrating MUAC screening for acute malnutrition in SIAN permits the assessment of a large number of children for acute malnutrition, and should be continued.
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Shankar AV, Asrilla Z, Kadha JK, Sebayang S, Apriatni M, Sulastri A, Sunarsih E, Shankar AH. Programmatic effects of a large-scale multiple-micronutrient supplementation trial in Indonesia: using community facilitators as intermediaries for behavior change. Food Nutr Bull 2010; 30:S207-14. [PMID: 20496613 DOI: 10.1177/15648265090302s204] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical trials can serve as an opportunity gateway for enhanced health benefits to the target population, above and beyond the specific intervention being tested. OBJECTIVE The Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT), a randomized, controlled clinical trial in Lombok, Indonesia, found that supplementation during pregnancy with multiple micronutrients reduced 90-day infant mortality by nearly 20% as compared with iron-folic acid. This trial was designed as both a program and research trial and used community facilitators to serve as liaisons between the study and the pregnant women. This analysis documents the programmatic impacts of SUMMIT on health-seeking and early infant mortality resulting from community facilitators' field activities. METHODS Data on compliance, human resource practices, health-seeking, and health outcomes from the 31,290 SUMMIT enrollees were analyzed. RESULTS Overall compliance with either iron-folic acid or multiple micronutrients was high in the program, at 85.0%. Early prenatal care visits increased significantly. Sixty-three percent of primiparous women used a skilled birth attendant (SBA); among multiparous women, the rate of use of a SBA rose from 35% for the last birth to 53%. Use of a SBA resulted in a 30% reduction in early infant mortality (RR, 0.70; 95% CI, 0.59 to 0.83; p < .0001), independently of any reductions due to multiple micronutrients. The community facilitators played a central role in improving health-seeking; however, the quality of the community facilitators' performance was associated with the impact of the micronutrient supplement on infant health. In a subsample of community facilitators, better-performing facilitators were found to markedly improve the overall impact of the multiple micronutrients on early infant mortality (RR, 0.67; 95% CI, 0.49 to 0.92; p = .0117). In contrast, infants of women with poorly performing community facilitators were found to derive no additional benefit from the multiple micronutrients (RR, 1.04; 95% CI, 0.64 to 1.72; p = .8568). CONCLUSIONS Systematic enhancements to the quality of implementation of SUMMIT led to significant increases in use of SBAs at delivery, resulting in a 30% reduction in early infant mortality independent of the impact of micronutrient supplementation. Therefore, if women were to consume multiple micronutrients on a regular basis and were to use a SBA at delivery, the risk of early infant mortality could be reduced by nearly 50%. The impacts of community facilitators in effecting changes in women's health behaviors are notable and are applicable to other health programs. Enhancements to program implementation should be driven by evidence, be accountable to the communities the program serves, and be evaluated on the basis of measurable gains in health for women and children.
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Affiliation(s)
- Anita V Shankar
- SUMMIT Institute of Development, Gedung Pusat Penelitian Bahasa dan Kebudayaan (P2BK), University of Mataram, Jalan Pendidikan No. 37, Mataram, NTB, Indonesia.
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In this issue Parents as teachers. Public Health Nutr 2007. [DOI: 10.1017/s1368980007835439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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