Original ResearchDifferentials in vitamin A supplementation among preschool-aged children in Ethiopia: evidence from the 2011 Ethiopian Demographic and Health Survey
Introduction
Vitamin A is an essential nutrient needed in small amounts for normal functioning of the visual system, immune system, growth and development in humans.1 Vitamin A deficiency (VAD) is a major nutritional concern in lower-income countries. In Africa and South-East Asia, it has been reported that approximately 190 million preschool-aged children are affected by VAD.2 Globally, reported prevalence rates of subclinical VAD and night blindness among preschool-aged children are 33.3% and 0.9%, respectively.2 The World Health Organization (WHO) estimated a prevalence of night blindness among preschool-aged children of 2.0% in Africa.2 It is estimated that approximately 42% of children under five years of age are at risk of VAD in Sub-Saharan Africa.3
VAD is a serious public health problem in Ethiopia. Reported national prevalence rates of Bitot's spots and night blindness among children are 1.7% and 0.8%, respectively, and the prevalence of subclinical deficiency in children is 37.7%.4 Thirty-two percent of child deaths in Ethiopia are attributable to vitamin A deficiency.5 Improving the vitamin A status of children increases their resistance to disease, and thus in countries such as Ethiopia, where diarrhoea, acute respiratory infection and measles are among the major causes of child mortality, improved vitamin A status will play a critical role in reducing child mortality.6
In countries where vitamin A deficiency is a public health problem, the provision of high-dose vitamin A supplementation to children aged 6–59 months is being implemented as a child survival strategy.7 Universal vitamin A supplementation is a relatively short-term, low-cost and highly effective strategy for improving the vitamin A status of children aged 6–59 months.6 In Ethiopia, vitamin A is delivered routinely via the Expanded Program of Immunization (EPI). Children aged 6–59 months should receive vitamin A supplementation twice per year.6 However, the distribution of vitamin A supplementation is not optimum in Ethiopia when evaluated against WHO's target and the Ethiopian micronutrient guidelines. This study aimed to identify the differentials for uptake of vitamin A supplementation among preschool-aged children in Ethiopia.
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Study setting and design
The sample for the 2011 Ethiopian Demographic Health Survey (EDHS) was designed to provide population and health indicators at national and regional levels. The study employed a cross-sectional approach with a stratified two-stage cluster design. The sample included 624 enumeration areas, of which 187 were in urban areas and 437 were in rural areas. Representative samples of 17,817 households were selected for the 2011 EDHS. However, the analysis for this study was based solely on children aged
Sociodemographic, obstetric and health-service-related characteristics
Two thousand, eight hundred and thirty-four (30.6%) households were in the poorest wealth index category, and orthodox was the predominant religion [3617 (31.4%)]. Most (7699) (83.0%) of the study participants lived in rural areas, and 7629 (82.2%) households were headed by males. In total, 4783 (52.5%) fathers and 6531 (70.4%) mothers had no formal education (Table 1).
The majority [9043 (97.5%)] of study respondents had a vaginal delivery. Seven thousand, nine hundred and forty-five (85.7%)
Discussion
Coverage of childhood vitamin A supplementation was 54.5% (95% CI 53.48–55.51%) among children aged 6–59 months in the last six months. In Ethiopia, the annual target is >80% coverage with two annual doses of vitamin A in children aged 6–59 months.7 As such, vitamin A supplementation is not optimum in Ethiopia, and regional differences were found. Lowest coverage was found in the pastoralist regions, Ethiopian Somali and Afar. Pastoralist communities have a dispersed settlement pattern and
Acknowledgements
The authors wish to thank Measure DHS for granting access to the data.
Ethical approval
Ethical approval for the survey was provided by the EHNRI Review Board, the National Research Ethics Review Committee at the Ministry of Science and Technology, the Institutional Review Board of ICF International, and the Centers for Disease Control and Prevention.
Funding
None declared.
Competing interests
None declared.
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