Determinants of high vitamin A supplementation coverage among pre-school children in Mali: the National Nutrition Weeks experience

Abstract

Objectives: To assess vitamin A supplementation (VAS) coverage of children aged 6 -59 months and the factors that favour or limit this coverage during the National Nutrition Weeks in Mali. Design: Cross-sectional study. Interviews about demographic factors and children's adherence to the vitamin A capsule distribution programme were conducted. Professionals' knowledge of vitamin A and various aspects related to the supplementation strategy were assessed. Setting: Five regions out of the eight regions in the country, in addition to Bamako District. Three rural communes were selected in three regions to represent rural areas. Subjects: Parents or caregivers of children under 5 years of age, health agents who participated in the weeks, and community and administrative leaders. Results: At least 80% of the children received the supplement. More 'traditional' communication channels (town criers, friends and family members) appeared to be more effective in reaching the target groups than modern methods, i.e. radio and television. Mothers' possession of a radio (Pearson x 2 ¼ 5.03; P ¼ 0.025) and fathers' education (Pearson x 2 ¼ 19.02; P , 0.001), possession of a radio (Pearson x 2 ¼ 8.93; P ¼ 0.003) and listening to it (Pearson x 2 ¼ 7.62; P ¼ 0.006) all appeared to be statistically and significantly associated with children's coverage. In multivariate logistic regression analysis, only the study site (urban/rural) (P ¼ 0.004), 'traditional channels' (P ¼ 0.02) and fathers' education (P ¼ 0.04) were significantly associated with children's coverage. Knowledge about VAS was high among community and administrative leaders, and health professionals. The planning and implementation of activities at the district level were found to be good in general. Conclusion: National Nutrition Weeks provide a successful example of a periodic VAS strategy with high coverage among children aged 6-59 months in Mali. Campaigns aimed at informing and sensitising populations during the Nutrition Weeks should also target children's fathers. Keywords Vitamin A supplementationChild survival National Nutrition Weeks MaliVitamin A repletion was shown to reduce the mortality of children aged 6-59 months by 23-34% in areas where vitamin A deficiency (VAD) is prevalent 1 -4 . In sub-Saharan Africa, it is estimated that 42% of children under 5 years of age are at risk of VAD and that adequately controlling this deficiency can avert over 645 000 child deaths per year in the region . This prevalence is higher than the cut-off point of 5%, indicating that VAD is a public health problem in a population 7 . In order to tackle this situation, Mali developed and applied strategies q The Authors 2007

Individual-level predictors of practices of nutrition-specific and nutrition-sensitive interventions for infants and young children in West and Central Africa: a cross-sectional study

“…Yet little is known about predictors for their practices at the individual level (in this study, we define household, maternal and child-level characteristics as ‘individual’ characteristics of a child, as they affect each child uniquely in their combination). Existing studies focus mainly on identifying local or regional-level characteristics of their practice3–14: a comparatively larger body of evidence is available for the Nigerian setting (eg, Begum et al 3 for iron–folic acid supplementation, Odusanya et al 4 and Adeloye et al 6 on vaccination coverage and Ogbo et al 8 on breast feeding). Haile et al 9 and Belew et al 13 investigate vitamin A supplementation (VAS) and dietary diversity and meal frequency, respectively, in Ethiopia (or its subregions).…”

“…Haile et al 9 and Belew et al 13 investigate vitamin A supplementation (VAS) and dietary diversity and meal frequency, respectively, in Ethiopia (or its subregions). Ayoya et al 7 contribute evidence on vitamin A supplementation coverage in Mali, Bendech et al 10 on the same indicator in Guinea, Chirawurah et al 12 on iodised salt usage in rural north Ghana and Mutua et al 14 on immunisation coverage in Nairobi, Kenya. Whenever data are being pooled, it is not done so consequently for the entire Sub-Saharan African (SSA) region or its subregions West, Central, East and Southern Africa—for example, Janmohamed et al 5 pool data from 13 SSA countries to investigate VAS and its determinants.…”

“…These studies oftentimes focus on a few particular risk factors of poor outcomes, such as most prominently antenatal and postnatal care attendance, low maternal education, income/wealth and intervention-specific knowledge (for a systematic review on this question cf Bhutta et al 2008 and 201315 16). For the West and Central African regions most of the available studies rely on publicly available data such as the Demographic and Health Surveys (DHS); however, only looking at separate countries (as illustrated above), while some studies rely on own data collection with smaller numbers of observations7 10 14 and no national or regional representativeness. To the best of our knowledge this is the first study considering several high-impact intervention outcomes and their individual-level and household-level predictors on a supranational level for the entire West and Central African region.…”

Childhood Vitamin A Capsule Supplementation Coverage in Nigeria: A Multilevel Analysis of Geographic and Socioeconomic Inequities

“…Understanding the pattern of VAC supplementation program coverage is important for improving the health outcome of children and their survival. Although numerous studies in sub-Saharan Africa [22,23,24] and globally [25,26,27,28] have examined and documented disparities in coverage of VAC supplementation based on individual characteristics, the influence of neighborhoods and the socioeconomic characteristics on coverage of VAC supplements has received less attention, whereas contextual characteristics of neighborhoods where these children reside may in themselves constitute a major disadvantage. For instance, it has been shown that residents of socioeconomically disadvantaged communities tend to have a higher mortality risk regardless of their individual demographic and socioeconomic characteristics [29,30].…”

Screening for Acute Childhood Malnutrition during the National Nutrition Week in Mali Increases Treatment Referrals

“…A previous study in Mali found that vitamin A supplementation coverage during the SIAN was increased by using traditional communication channels [14], so this should be considered in future SIAN social mobilization plans. In the current study, prior participation in nutritional education activities was associated with greater participation in the SIAN, although it is conceivable that caregivers who participated in educational programs were those who were more motivated in general and therefore would have been more likely to utilize nutritional screening services anyway.…”