Elsevier

Public Health

Volume 129, Issue 6, June 2015, Pages 748-754
Public Health

Original Research
Differentials in vitamin A supplementation among preschool-aged children in Ethiopia: evidence from the 2011 Ethiopian Demographic and Health Survey

https://doi.org/10.1016/j.puhe.2015.03.001Get rights and content

Abstract

Background

Vitamin A supplementation is one of the best proven, safest and most cost-effective interventions in public health. However, childhood vitamin A supplementation has not reached adequate levels of coverage in developing countries. This study aimed to identify factors associated with childhood vitamin A supplementation in Ethiopia.

Study design

Cross-sectional study with stratified, two-stage cluster design.

Methods

Analysis of data from the 2011 Ethiopian Demographic and Health Survey (EDHS) was used to identify factors associated with childhood vitamin A supplementation. Data for 9276 children aged 6–59 months were included in the analysis. Binary and multivariable logistic regression models were used.

Results

Over half [54.5%, 95% confidence interval (CI) 53.48–55.51%] of children aged 6–59 months had received vitamin A supplementation in the last six months. Regional differences were found, ranging from 28.1% in Somali to 83.2% in Tigray (P < 0.001). Children in the poorest wealth index category [adjusted odds ratio (AOR) 0.60, 95% CI 0.47–0.77], children with mothers who did not attend any antenatal care (ANC) appointments (AOR 0.56, 95% CI 0.48–0.67), infants aged 6–11 months (AOR 0.52, 95% CI 0.42–0.65), children with mothers who did not have a postnatal medical check-up (AOR 0.69, 95% CI 0.56–0.86) and children with mothers who had not worked in the last year (AOR 0.86, 95% CI 0.76–0.97) were less likely to have received vitamin A supplementation in the last six months.

Conclusion

Coverage of childhood vitamin A supplementation was not optimum in Ethiopia and regional differences were found. Lack of a maternal postnatal medical check-up, lack of ANC attendance, poorest wealth index, mother who had not worked in the last year and infant in youngest age group were associated with lower odds of receiving vitamin A supplementation over the last six months. Provision and promotion of ANC and postnatal care, and strengthening routine immunization activity, especially among infants in the youngest age group, are recommended to increase coverage of childhood vitamin A supplementation.

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.

Section snippets

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.

References (16)

  • R.D. Semba et al.

    The role of expanded coverage of the national vitamin A program in preventing morbidity and mortality among preschool children in India

    J Nutr

    (2010)
  • A. Sommer et al.

    Vitamin A deficiency: health, survival, and vision

    (1996)
  • World Health Organization

    Global prevalence of vitamin A deficiency in populations at risk 1995–2005. WHO global database on vitamin A deficiency

    (2009)
  • V. Aguayo et al.

    Vitamin A deficiency and child survival in sub-Saharan Africa: a reappraisal of challenges and opportunities

    Food Nutr Bull

    (2005)
  • T. Demissie et al.

    Magnitude and distribution of vitamin A deficiency in Ethiopia

    Food Nutr Bull

    (2010)
  • Ethiopian PROFILES Team et al.

    Why nutrition matters. Powerpoint presentation on the Ethiopian profiles analysis

    (2005)
  • National guideline for control and prevention of micronutrient deficiencies

    (2004)
  • UNICEF

    Tacking progress on child and maternal nutrition. A survival and development priority

    (2009)
There are more references available in the full text version of this article.
View full text