Vitamin A supplementation among 9-59 month old children in India: geospatial perspectives and implications for targeted coverage

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.

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.

Subnational estimates of vitamin A supplementation coverage in children: a geospatial analysis of 45 low- and middle-income countries

OBJECTIVES

Vitamin A supplementation (VAS) can protect children from the adverse health consequences of vitamin A deficiency. Granular data on VAS coverage can guide global and national efforts to achieve universal VAS coverage. To provide geographically precise targeting of VAS programs and to monitor progress in reducing geographic disparities, we aimed to create high-resolution (5 × 5 km2) maps of VAS coverage in children under 5 years across VAS priority countries.

STUDY DESIGN

We used cross-sectional data from the Demographic and Health Surveys (DHS) program.

METHODS

We used data from the DHS program for United Nations Children's Fund -designated VAS priority countries between 2000 and 2017 with data available from 2005 or later. The outcome variable was the proportion of children under 5 years who received a vitamin A dose in each sampled cluster. We applied a Bayesian geostatistical approach incorporating geographic, climatic, and nutritional covariates to estimate VAS coverage for each cell. We estimated and mapped absolute VAS coverage, Bayesian uncertainty intervals, and exceedance probabilities.

RESULTS

Our sample included countries from Latin America and the Caribbean, Asia, and Africa. Most countries had estimated VAS coverage levels <70%, and our exceedance probabilities indicated high certainty that our estimates fell below this threshold in most grid cells. International variations were most notable in the Latin America and the Caribbean region and Africa. Intranational variations were greatest in some South Asian and West and Central African countries.

CONCLUSIONS

These prevalence and exceedance maps, especially used with data on indicators of VAS need, could help to improve equity.