Determinants of successful vitamin A supplementation coverage among children aged 6-59 months in thirteen sub-Saharan African countries

Objective: Vitamin A supplementation (VAS) for children aged 6-59 months occurs regularly in most sub-Saharan African countries. The present study aimed to explore child, household and delivery platform factors associated with VAS coverage and identify barriers to compliance in thirteen African countries. Design: We pooled data (n similar to 60 000) from forty-four household coverage surveys and used bivariate and multivariable regression analyses to assess the effects of supplementation strategy, rural v. urban residence, child sex, child age, caregiver education and campaign awareness on child VAS status. Setting/Subjects: Primary caregivers of children aged 6-59 months in thirteen countries. Results: Door-to-door distribution resulted in higher VAS coverage than fixed-site plus outreach approaches (91 v. 63 %) and was a significant predictor of supplementation in the adjusted model (OR=19.0; 95 % CI 17.2, 21.1; P<0.001). Having been informed about the campaign was the main predictor of VAS in the door-to-door (OR=6.8; 95 % CI 5.8, 7.9; P<0.001) and fixed-site plus outreach (OR=72.5; 95 % CI 66.6, 78.8; P<0.001) groups. Conclusions: Door-to-door provision of VAS may achieve higher coverage than fixed-site models in the African context. However, the phase-out of door-to-door polio immunization campaigns in most sub-Saharan African countries threatens the main distribution vehicle for VAS. Our findings suggest well-informed communities are key to attaining higher coverage using fixed-site delivery alternatives.