Barriers and facilitators to the implementation of vitamin A supplementation programs in Africa: A systematic review

Background: Vitamin A deficiency (VAD) impacts over 50% of children aged 6-59 months in sub-Saharan Africa, causing severe health issues. Despite the importance of vitamin A supplementation (VAS) programs, barriers limit their effectiveness, making it essential to understand these factors for better outcomes. Aim: This systematic review aimed to identify the barriers and facilitators to VAS programs in Africa, using the Consolidated Framework for Implementation Research (CFIR) to conceptualize the findings. Methods: A comprehensive search was conducted across OVID Embase, OVID Medline, Web of Science Core Collection, Scopus, CINAHL and CAB Direct. Studies were excluded if they did not report VAS administration via capsules or droplets in large-scale programs or omitted discussions on implementation barriers and facilitators. Results: The search yielded 4377 citations, with 10 studies meeting eligibility criteria, published from 2002 to 2021 across 12 countries. The most frequently represented were Ethiopia and Zimbabwe. A total of nine barriers and seven facilitators to VAS programs were identified. The most frequently cited barriers were capsule stock-outs, limited resources and lack of incentive for staff, while the most frequently cited facilitators were Child Health Days and involvement of community-based health workers. The key CFIR constructs associated with these findings were Tailoring Strategies, Incentive Systems and Available Resources. Conclusion: The barriers and facilitators identified in this review offer valuable insights for improving VAS coverage and implementation in Africa. Tailoring implementation strategies based on these findings can enhance the effectiveness and coverage of VAS programs.