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Concurrent coverage and determinants of vitamin A supplementation and deworming among children aged 12-59 months in
Thomas Kidanemariam Yewodiaw1, Mequanint Dessie Bitewa2, Abiyu Abadi Tareke3
1Medical Officer at International Medical Corps, Amhara Region Emergency Operation Center, Gondar Field Office, Gondar, Ethiopia.
Insights
Co-coverage of vitamin A supplementation and deworming reached only 44% of children in 15 Sub-Saharan African countries. Improving integrated child health strategies is crucial to increase access to these vital interventions and reduce child morbidity.
Area of Science:
- Global Health
- Pediatrics
- Public Health Interventions
Background:
- Vitamin A supplementation (VAS) and deworming (DW) are critical, cost-effective interventions for child health.
- Sub-optimal co-coverage of VAS and DW limits their potential impact on reducing child morbidity and mortality.
- Understanding co-coverage determinants is vital for enhancing integrated child health strategies in Sub-Saharan Africa.
Purpose of the Study:
- To assess the co-coverage of VAS and DW among children aged 12-59 months in 15 Sub-Saharan African countries.
- To identify individual, household, community, and country-level determinants of VAS and DW co-coverage.
Main Methods:
- Analysis of Demographic and Health Surveys (DHS) data from 107,725 children across 15 Sub-Saharan African countries.
- Weighted descriptive statistics and mixed-effects logistic regression were employed to determine factors influencing co-coverage.
- Multilevel modeling accounted for survey design, clustering, and included theoretically relevant variables (p < 0.20).
Main Results:
- Pooled co-coverage of VAS and DW was 44.0%, significantly lower than individual intervention coverage (57.1%).
- Coverage varied widely by country, with Rwanda (84.7%) and Lesotho (58.4%) showing high co-coverage, while Sierra Leone (10.3%) and Gabon (13.2%) lagged.
- Factors associated with higher co-coverage included child's age (24-47 months), full immunization, educated mothers with antenatal care access, media exposure, and higher household wealth.
Conclusions:
- Co-coverage of VAS and DW remains low in the studied Sub-Saharan African countries, falling short of WHO targets.
- Significant disparities in co-coverage exist across and within countries, highlighting the need for targeted interventions.
- Strengthening integrated campaigns, routine service delivery, and outreach programs is essential to improve equitable child health outcomes.
Background:
Vitamin A supplementation (VAS) and deworming (DW) are proven, cost-effective interventions that protect children against preventable morbidity, mortality, and the burden of micronutrient deficiencies and parasitic infections. Nevertheless, many children fail to receive both interventions simultaneously, limiting the potential health gains. Assessing co-coverage and its determinants is crucial for guiding integrated child health strategies and closing persistent gaps across Sub-Saharan Africa.
Methods:
We analyzed DHS data from 15 Sub-Saharan African countries, including 107,725 children aged 12-59 months. The primary outcome was co-coverage of vitamin A supplementation and deworming within six months. Weighted descriptive statistics and mixed-effects logistic regression assessed determinants at individual, household, community, and country levels, accounting for survey design and clustering. Variables with p < 0.20 or deemed theoretically relevant were included in the multilevel model (p < 0.05, 95% CI).
Results:
The pooled co-coverage of vitamin A supplementation (VAS) and deworming (DW) among children aged 12-59 months was 44.0% (95% CI: 43.4-44.6%), despite individual coverage of 57.1% for each intervention. Approximately 13% of children received either Vitamin A or deworming as a single intervention. Nearly 30% of children received neither intervention. Co-coverage was lowest in Sierra Leone (10.3%) and Gabon (13.2%), moderate in Burkina Faso (28.6%), Côte d'Ivoire (31.0%), Mozambique (44.0%), and Tanzania (44.7%), and highest in Lesotho (58.4%) and Rwanda (84.7%). Vitamin A supplementation coverage was lowest in Gabon (15.7%), Sierra Leone (16.5%) and highest in Rwanda (89.1%) and Lesotho (73.6%), while deworming alone was lowest in Sierra Leone (30.3%) and Burkina Faso (36.7%) and highest in Rwanda (89.4%) and Lesotho (62.4%). Co-coverage of vitamin A supplementation and deworming was higher among children aged 24-47 months (AOR = 1.07), fully immunized children (AOR = 1.41), and those with older, educated mothers who attended antenatal care (AORs 1.14-1.59) or had media exposure (AOR = 1.13). Household wealth also increased the likelihood (AORs 1.27-1.64), while urban residence reduced it (AOR = 0.84). At the country level, compared with Burkina Faso, Rwanda (AOR = 20.05), Mauritania (AOR = 4.30), and Lesotho (AOR = 3.92) had the highest odds, whereas Gabon (AOR = 0.36) and Sierra Leone (AOR = 0.22) had the lowest inter-country disparities in integrated child health coverage. The intraclass correlation coefficient (ICC) indicated that approximately 21.6% of the variance in concurrent coverage was attributable to between-country differences.
Conclusion:
Co-coverage of vitamin A supplementation and deworming in 15 sub-Saharan Africa countries is low, with only 44% of children aged 12-59 months receiving both interventions, far below the WHO 80% target. Coverage varied widely, with Rwanda leading and Sierra Leone and Gabon lagging. Strengthened harmonized campaigns, routine service integration, and targeted outreach are essential to improve equitable child health outcomes.
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