Sustaining vitamin A supplementation requires a new vision (original) (raw)
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Maintaining high vitamin A supplementation coverage in children: lessons from Niger
Food and nutrition bulletin, 2005
In 1997, the reduction of child mortality became a policy priority for the Government of Niger because Niger's child mortality rate was the highest in the world. The Ministry of Public Health, Helen Keller International (HKI), and UNICEF spearheaded a coalition-building process linking vitamin A deficiency (VAD) control to national child survival goals. An evidence-based advocacy strategy was developed around the child survival benefits of adequate and sustained VAD control with one unambiguous message: "VAD control can avert over 25,000 child deaths per year." As a result, in 1997 Niger became one of the first countries in Africa to effectively integrate vitamin A supplementation into National Immunization Days (NIDs) for polio eradication. The challenge was then to provide children with a second annual dose of vitamin A. This led in 1999 to the first ever National Micronutrient Days (NMDs) in Africa. NMDs are mobilization campaigns in which caregivers are actively en...
Vitamin A supplementation and child survival
The Lancet, 1992
Previous studies of the effect of 6-monthly vitamin A supplementation on child mortality have given conflicting results. In other trials, more frequent doses of vitamin A have significantly reduced mortality among children at risk of vitamin A deficiency. We have done a double-blind, placebocontrolled trial of vitamin A supplementation in the Sudan among 28 753 children aged 9-72 months at risk of vitamin A deficiency.
Public Health Nutrition, 2014
ObjectiveTo characterize the coverage of India's national vitamin A supplementation (VAS) programme and document its performance in reaching children in the districts with higher concentration of poor households (2006–2011).DesignAnalysis of VAS programme coverage data collated and collected using standardized bottom-up procedures, data from India's Office of the Registrar General and Census Commissioner, and data from India's District Level Household Survey to compute exposure (poverty) and outcome (full VAS coverage) variables.SettingSeven Indian states with the highest burden of mortality in children (74 % of all deaths among under-5s in the country in 2006).SubjectsChildren 6–59 months old.ResultsBetween 2006 and 2011, the mean full VAS coverage (two VAS doses per child per year) in these seven states increased from 44·7 % to 67·3 % while the number of districts with high (≥80 %) full VAS coverage increased from twenty-four (9·4 %) to 131 (51·4 %). The highest increa...
2015
Since 2004, twice-yearly mass vitamin A supplementation (VAS) has equitably reached over 85 % of children 6-59 months old in Sierra Leone. However infants who turn 6 months after the event may wait until they are 11 months old to receive their first dose. The effectiveness of integrating VAS at 6 months into the Expanded Program of Immunization (EPI) in a revised child health card was studied. Health facilities matched according to staff cadre and work load were assigned to provide either a 'mini package' of VAS and infant and young child feeding (IYCF), a 'full package' of VAS, IYCF and family planning (FP), or 'child health card' only. 400 neonates were enrolled into each group, caregivers given the new child health card and followed until they were 12 months old. More infants in the full: 74.5 % and mini: 71.7 % group received VAS between 6 and 7 months of age compared with the new CH card only group: 60.2 % (p = 0.002, p \ 0.001 respectively). FP commodities were provided to 44.5 % of caregivers in the full compared with \2.5 % in the mini and new child health card only groups (p \ 0.0001). Integration of VAS within the EPI schedule achieved [60 % coverage for infants between 6 and 7 months of age. Provision of FP and/or IYCF further improved coverage. Funding was provided by the Canadian Department of Foreign Affairs, Trade and Development who had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Routine vitamin A supplementation and other high impact interventions in Sierra Leone
Maternal & Child Nutrition, 2020
In 2017, transition to routine vitamin A supplementation (VAS) commenced as an integrated reproductive and child health service including vaccinations, Albendazole for deworming, complementary feeding demonstrations, ‘quality’ family planning counselling and provision of modern contraceptives. After 10 months, a lot quality assurance sampling survey evaluated coverage of these interventions. Each of three districts was divided into five supervision areas (lots), and 19 villages were randomly selected in each lot proportional to population size. Households were randomly selected, and a questionnaire was administered to a caregiver of a child 6–11, 12–23 and 24–59 months in each village. Overall, caregivers of 855 children were interviewed, and 19 questionnaires were completed for each age group (6–11, 12–23 and 24–59 months) in each of the five lots in each district. All lots in one district passed the threshold of 80% for VAS and 75% coverage for Albendazole, and two lots failed for...
Strategies to achieve adequate vitamin A intake for young children: options for Cameroon
Annals of the New York Academy of Sciences, 2019
Meeting children's vitamin A (VA) needs remains a policy priority. Doing so efficiently is a fiscal imperative and protecting at-risk children during policy transitions is a moral imperative. Using the Micronutrient Intervention Modeling tool and data for Cameroon, we predict the impacts and costs of alternative VA intervention programs, identify the least-cost strategy for meeting targets nationally, and compare it to a business-as-usual (BAU) strategy over 10 years. BAU programs effectively cover ∼12.8 million (m) child-years (CY) and cost ∼$30.1 m; ∼US$2.34 per CY effectively covered. Improving the VA-fortified oil program, implementing a VA-fortified bouillon cube program, and periodic VA supplements (VAS) in the North macroregion for 3 years effectively cover ∼13.1 m CY at a cost of ∼US$9.5 m, or ∼US$0.71 per CY effectively covered. The tool then identifies a sequence of subnational policy choices leading from the BAU toward the more efficient strategy, while addressing VA-attributable mortality concerns. By year 4, fortification programs are predicted to eliminate inadequate VA intake in the South and Cities macroregions, but not the North, where VAS should continue until additional delivery platforms are implemented. This modeling approach offers a concrete example of the strategic use of data to follow the Global Alliance for VA framework and do so efficiently.
Nutrition and Food Processing , 2024
Introduction: Vitamin A supplementation (VAS) is one of the most cost-effective interventions with the greatest impact in reducing child mortality. Mass campaigns are costly, donor-driven, and heavily dependent on funding for mass immunization campaigns. We analyzed routine community-based VAS (rVAS) coverage using the pilot approach of strengthening community participation versus the mass campaign strategy during the "Mother and Child Health and Nutrition Action Week" (MCHNAW). Methods: This was a descriptive study among from children under five prospectively followed up in a VAS program in Kaele and Guidiguis health districts. We performed a descriptive analysis of data from routine VAS program after capacity building of Community Health Workers (CHW) and compared them with data from the MCHNAW in the period October 2019 and May 2020. Data were collected in the health facilities from the registers to ODK Kobocollect and analyzed by Microsoft Excel 2010. Results: rVAS showed 95.29% (92.49% Kaele; 98.49% Guidiguis) coverage for children aged 6-11 months (first dose). And 98.29% (97.71% Kaele & 98.77% Guidiguis) coverage for children aged 12-59 months (2nd dose). In comparison, VAS coverage in the mass campaign was lower with 68.46% (61.80% Kaele 72.42% Guidiguis) for 6-11 months and 62.57% (61.27% Kaele & 63.28% Guidiguis) for 12-59 months. These coverages are also lower, compared to the national target coverage (80%). rVAS showed high coverage (>92%) compared to Mass campaign and national target among 6-59-months age children in both health district in the far North Cameroon. However, this study has not analyzed the cost of both strategies of VAS. Conclusion: Reinforce the routine community-based VAS showed the best coverage to reach children under-five compared to the mass campaign VAS. However, there is need more cost-effectiveness studies to confirm whether strengthening community-based VAS could be a better practice versus mass campaign.
Background: The delivery of vitamin A supplements in Ethiopia has been shifting from Child Health Days (campaigns) to routine delivery via the community health services. Objective: The objective of this study was to compare the cost and effectiveness of these 2 delivery methods. No previous studies have done this. Methods: A mixed method approach was used. Quantitative data on costs were collected from interviews with key staff and coverage data from health facility records. Qualitative data on the 2 modalities were collected from key informants and community members from purposefully sampled communities using the 2 modalities. Results: Communities appreciated the provision of vitamin A supplements to their under 5-year-old children. The small drop in coverage that occurred as a result of the change in modality can be attributed to normal changes that occur with any system change. Advantages of campaigns included greater ease of mobilization and better coverage of older children from more remote communities. Advantages of routine delivery included not omitting children who happened to miss the 1 day per round that supplementation occurred and not disrupting the availability of other health services for the 5 to 6 days each campaign requires. The cost of routine delivery is not easy to measure nor is the cost of disruption to normal services entailed by campaigns. Conclusion: Cost-effectiveness likely depends more on effectiveness than on cost. Overall, the routine approach can achieve good coverage and is sustainable in the long run, as long as the transition is well planned and implemented.