Childhood mortality impact and costs of integrating vitamin A supplementation into immunization campaigns

Ching, Pamela; Birmingham, Maureen; T, Goodman; Sutter, Roland W.; Loevinsohn, Benjamin

doi:10.2105/ajph.90.10.1526

Cited by 35 publications

(6 citation statements)

References 9 publications

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“…Anthelminthic treatment demonstrated to be very popular and well-received, because it often brings about immediate visible effects to the recipients or their relatives in the form of expelled intestinal worms in the faeces. This study confirmed that, as already shown in other populations,13 satisfaction of target individuals is higher when multiple health services are provided at the same time. Packaging of anthelminthics distribution and vaccination not only allows deworming to achieve a higher coverage through the use of the extensive communication and distribution channels that are well-established by the EPI but also allows the immunization campaigns to reach a higher number of people who are attracted by the addition of de-worming.…”

Section: Discussionsupporting

confidence: 91%

Integration of deworming into an existing immunisation and vitamin A supplementation campaign is a highly effective approach to maximise health benefits with minimal cost in Lao PDR

Boselli

Yajima

Aratchige³

et al. 2011

International Health

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Infection with soil-transmitted helminths (STHs) is a major public health problem in many developing countries; pregnant women and children are particularly at risk. Preventive chemotherapy (PC) -the intervention currently recommended by the World Health Organization (WHO) against the main helminth infections, including those caused by STHs -aims at reducing morbidity through periodical administration of anthelminthic drugs either alone or in combination.The Expanded Programme on Immunization (EPI) is one of the most widely implemented health programmes in the world and has a well-established access to children and women. The present study investigated the cost of the provision of anthelminthic drugs during existing immunization campaigns.In Lao PDR the use of this integrated approach compared to implementation of the vertical deworming campaign alone allowed reduction of the individual cost of deworming by 10 times (from US$0.25 in the vertical deworming campaign to US$0.02 in the integrated campaign). Burden posed on health workers by the integration process was perceived as minimal and manageable. Besides, delivery of anthelminthic drugs during the immunization campaigns enabled Authors' contributions: All the authors conceived and designed the study; GB conducted the questionnaire survey; GB, PEA, KF, AZ, KP, KS, CC and SP collected the budget data; GB and AY carried out data analysis; GB, AY, AFG, CP and AM interpreted the results of the analysis; GB and AY prepared the draft manuscript, all the authors critically reviewed and gave final approval of the version to be published. AM is the guarantor of the paper. Conflicts of interest: None declared.Ethical approval: As the study was carried out as a part of the vaccination campaign, ethical approval was not required. Informed consent was obtained by all the interviewees prior to the questionnaire survey. Europe PMC Funders Group Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts campaign teams to directly observe drug intake, which assured safety. Our findings prove that integration is an opportunity to maximize health benefits through the delivery of multiple health products and the attainment of a high coverage.

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Section: Discussionsupporting

confidence: 91%

Integration of deworming into an existing immunisation and vitamin A supplementation campaign is a highly effective approach to maximise health benefits with minimal cost in Lao PDR

Boselli

Yajima

Aratchige³

et al. 2011

International Health

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“…The cost estimates for the Child Health Day package delivered during the JSE campaign, at ∼1.25 US$/child excluding the cost of supplies, are similar to estimates for other African countries after taking account of inflation ( 4 , 5 , 17 ). Some previous studies present lower cost estimates than this as they consider the program to be incremental and do not impute salary costs for health workers ( 15 , 18 ). Previous studies have estimated that vitamin A distribution accounts for ∼25% of the overall cost of the Child Health Day ( 5 ).…”

Section: Discussionmentioning

confidence: 92%

Delivering Vitamin A Supplements to Children Aged 6–59 Months: Comparing Delivery through Campaigns and through Routine Health Services in Senegal

Horton

Blum

Diouf³

et al. 2018

Current Developments in Nutrition

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BackgroundUsing twice-yearly campaigns such as Child Health Days to deliver vitamin A supplements has been a key strategy over the last 2 decades, and was an important component in helping reach the Millennium Development Goals in child health. As countries move to strengthen their routine health services under the Sustainable Development Goals, efforts are underway to shift supplementation from campaign to routine delivery.ObjectiveThe aim of this study was to compare cost, coverage, and user satisfaction between twice-yearly campaigns and routine delivery of vitamin A supplements in Senegal.MethodsInformation was collected on cost, coverage, and user satisfaction with both types of delivery, using administrative data, interviews at various levels in the health system, and focus group discussions with caregivers. Both qualitative and quantitative information were obtained, for 2 regions using routine delivery and 2 regions using campaign delivery.ResultsRoutine delivery receives fewer dedicated resources. Coverage is lower, especially of children >12 mo of age. Districts undertake outreach (“mini-campaigns”) to try to improve coverage in regions using routine delivery, in effect using a hybrid approach. Some mothers prefer the administration of supplements at a health facility as it is perceived as more hygienic and involving professional health workers, but others, especially those living further away, prefer house-to-house delivery which was the norm for the campaign mode.ConclusionsAdvance planning for the shift to routine delivery is important in maintaining coverage, as is strengthening the primary health care system by having an appropriate ratio of salaried workers to population. When the system relies heavily on volunteers, and the small incentive payments to volunteers are discontinued, coverage suffers. Routine delivery also relies on good record-keeping and hence literacy. Community understanding of, and support for, supplementation are even more important for routine than for campaign delivery.

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“…Increasing evidence of vitamin A's role in immunoregulation suggests that it is necessary for mucosal integrity and host defense (Rojanapo, Lamb, and Olson 1980;Tei et al 2000;Wiedermann et al 1996). Not surprisingly vitamin A deficiency (VAD) plays a causative role in increased susceptibility and severity of infectious diseases, correlating with nearly 250,000 childhood deaths annually (Ching et al 2000).…”

Section: Vitamin a Major Physiologic Functions And Consequences Of Deficiencymentioning

confidence: 99%

The role of micronutrients in the response to ambient air pollutants: Potential mechanisms and suggestions for research design

Miller

Rayalam

2017

Journal of Toxicology and Environmental Health, Part B

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People living in regions of low socioeconomic status are thought to be prone to higher exposures to environmental pollutants, poor nutrition, and numerous preventable diseases and infections. Poverty correlates with pollution and malnutrition; however, limited studies examined their interrelationship. The well-studied, deleterious health effects attributed to environmental pollutants and poor nutrition may act in combination with produce more severe adverse health outcomes than any one factor alone. Deficiencies in specific nutrients render the body more susceptible to injury which may influence the pathways that serve as the mechanistic responses to ambient air pollutants. This review (1) explores specific micronutrients that are of global concern, (2) explains how these nutrients may impact the body's response to ambient air pollution, and (3) provides guidance on designing animal models of nutritional deficiency. It is likely that those individuals who reside in regions of high ambient air pollution are similarly malnourished. Therefore, it is important that research identifies specific nutrients of concern and their impact in identified regions of high ambient air pollution.

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Childhood mortality impact and costs of integrating vitamin A supplementation into immunization campaigns

Cited by 35 publications

References 9 publications

Integration of deworming into an existing immunisation and vitamin A supplementation campaign is a highly effective approach to maximise health benefits with minimal cost in Lao PDR

Integration of deworming into an existing immunisation and vitamin A supplementation campaign is a highly effective approach to maximise health benefits with minimal cost in Lao PDR

Delivering Vitamin A Supplements to Children Aged 6–59 Months: Comparing Delivery through Campaigns and through Routine Health Services in Senegal

The role of micronutrients in the response to ambient air pollutants: Potential mechanisms and suggestions for research design

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