Geographical variation and associated factors of vitamin A supplementation among 6–59-month children in Ethiopia

Abstract

Introduction Vitamin A has been one of the most important micronutrients which are necessary for the health of the children. In developing countries, the supplementation of vitamins under a regular schedule had different constraints. Awareness, access, and resource limitations were usually the problem. In the current study, we analyzed the data from the demographic health survey (EDHS) 2016 to uncover the spatial distribution, predictors, and to provide additional information for policymaking and interventions. Methods In this analysis, we applied intra-community correlation to measure the random effect; global Moran’s I to test the nature of variance in the null model; proportional change in variance to check the variance of null and neighborhood in subsequent models. We used STATA 15 for prediction; ArcGIS 10.7 for the spatial distribution of vitamin A supplementation; SaTscan 9.6.1 to specify location of clustering were the applied soft wares. After confirming that the traditional logistic regression cannot explore the variances, we applied multilevel logistic regression to examine predictors where p-value <0.25 was used to include variables into the model and p-value<0.05 was used to declare associations. We presented the result using means, standard deviations, numbers, and proportions or percent, and AOR with 95% CI. Result The vitamin A coverage was 4,029.22 (44.90%) in Ethiopia in 2016. The distribution followed some spatial geo-locations where Afar, Somali were severely affected (RR = 1.46, P-value < 0.001), some pockets of Addis Ababa (RR = 1.47, p-value <0.001), and the poor distribution also affected all other regions partially. Place of delivery 1.2(1–1.34), primary and secondary education 1.3 (1–1.6), media exposure 1.2(1.1–1.4), having work 1.4(1.2–1.5), and all visits of ANC were positively influenced the distribution. Conclusion The distribution of vitamin A coverage was not random as per the EDHS 2016 data. Regions like Afar, Somali, and some pocket areas in Addis inquires immediate interventions. Pastoralist, agrarian, and city administrations were all involved from severe to the lesser coverage in order. Since factors like Place of delivery, education, ANC, media exposure, and having work were showed positive associations, interventions considering awareness, access, and availability of service need more attention than ever.

Assessing the potential determinants of national vitamin A supplementation among children aged 6–35 months in Ethiopia: further analysis of the 2019 Ethiopian Mini Demographic and Health Survey

“…Children from the Afar, Somali, SNNPR, and Addis Ababa regions were less likely to receive VAS than children from Tigray regions. This finding is supported by similar studies done in Ethiopia [24], especially in the regions of Afar and Somalia [30]. The possible explanation in the pastoralist regions (Afar and Somali) and SNNPR might be a shortage of healthcare providers and inequality in maternal healthcare service [31].…”

“…Mothers who had four or more ANC visits were two times more likely to give vitamin A capsules by their health worker to their children than mothers who had no ANC visits. The finding was supported by a study in Nigeria [23] and national studies [24][25][26]. This could be explained by the fact that while attending antenatal care during pregnancy, the health professionals encourage, educate, and counsel the mothers about the benefits of vitamin A supplementation and the consequences of VAD.…”

Spatial distribution of vitamin A rich foods intake and associated factors among children aged 6–23 months in Ethiopia: spatial and multilevel analysis of 2019 Ethiopian mini demographic and health survey

“…Children whose mother is in primary and higher educational status were 1.4 (AOR:1.39, 95% CI: 1.05, 1.85) and 3.1 (AOR:3.11, 95% CI: 1.73, 5.59) times more likely to intake vitamin A rich foods than children whose mothers had no formal education respectively. This finding is in line with a similar study conducted in Ethiopia [ 31 , 44 , 51 , 56 , 57 ], Nepal [ 58 ], and India [ 45 ]. A possible reason might be more educated women have good skills to access modern health services and more likely to understand messages about dietary diversity, health [ 43 ], and previous experience about minimum dietary diversity [ 59 , 60 ].…”

“…Those children whose mother lived in Afar, Amhara, Somali and Dire Dawa were 85%, 63%, 99.8%, and 51% less likely to intake vitamin A rich foods. This evidence is supported by a reports that Afar, Amhara, Somali regions and Dire Dawa city are negatively associated with adequate dietary diversity [ 44 ], pastoralist (Afar and Somali) and Amhara regions are had faced problems for high risk of vitamin A supplementation [ 56 ]. This might be due to these regions might be vulnerable for anthropometric failures [ 57 , 62 ], poor resource distribution, less access to services [ 56 ], and scarcity of vitamin A rich foods [ 8 ].…”

“…Plus, mothers who attend formal education might have a better know how about better child feeding, linkage between maternal knowledge and the quality of diet offered to their children [ 31 ], and higher educational status and over all literacy of mother influence children to meet infant feeding guidelines [ 61 ] might be a reason for this finding. Lastly, unable to access of information due to poor education most often connected to poor supplementation of vitamin A [ 56 ]. In this study, 45% of children’s where from mother who had no formal education.…”