Trends in inequality in the coverage of vitamin A supplementation among children 6–59 months of age over two decades in Ethiopia: Evidence from demographic and health surveys

Abstract

Objectives: There is a dearth of evidence on inequalities in vitamin A supplementation in Ethiopia. The goal of this study was to assess the magnitude and overtime changes of inequalities in vitamin A supplementation among children aged 6–59 months in Ethiopia. Methods: We extracted data from four waves of the Ethiopia Demographic and Health Surveys (2000, 2005, 2011, and 2016). The analysis was carried out using the 2019 updated World Health Organization’s Health Equity Assessment Toolkit software that facilitates the use of stored data from World Health Organization’s Health Equity Monitor Database. We conducted analysis of inequality in vitamin A supplementation by five equity stratifiers: household economic status, educational status, place of residence, child’s sex, and subnational region. Four summary measures—population attributable fraction, ratio, difference, and population attributable risk—were assessed. We computed 95% uncertainty intervals for each point estimate to ascertain statistical significance of the observed vitamin A supplementation inequalities and overtime disparities. Results: The findings suggest marked absolute and relative pro-rich (population attributable fraction = 29.51, 95% uncertainty interval; 25.49–33.53, population attributable risk = 13.18, 95% uncertainty intervals; 11.38–14.98) and pro-urban (difference = 16.55, 95% uncertainty intervals; 11.23–21.87, population attributable fraction = 32.95, 95% uncertainty intervals; 32.12–33.78) inequalities. In addition, we found education-related (population attributable risk = 18.95, 95% uncertainty intervals; 18.22–19.67, ratio = 1.54, 95% uncertainty intervals; 1.37–1.71), and subnational regional (difference = 38.56, 95% uncertainty intervals; 29.57–47.54, ratio = 2.10, 95% uncertainty intervals; 1.66–2.54) inequalities that favored children from educated subgroups and those living in some regions such as Tigray. However, no sex-based inequalities were observed. While constant pattern was observed in subnational regional disparities, mixed but increasing patterns of socioeconomic and urban–rural inequalities were observed in the most recent surveys (2011–2016). Conclusion: In this study, we found extensive socioeconomic and geographic-based disparities that favored children from advantaged subgroups such as those whose mothers were educated, lived in the richest/richer households, resided in urban areas, and from regions like Tigray. Government policies and programs should prioritize underprivileged subpopulations and empower women as a means to increase national coverage and achieve universal accessibility of vitamin A supplementation.

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].…”

“…The possible explanation might be better household wealth standing may improve uptake of the supplement through advancing access to health information and mitigating economic barriers for seeking health care. Different studies report Socioeconomic inequality is a major determinant for maternal health service utilization [30][31][32], which indicates maternal health service utilization is low in the poor. One study showed children from the poorest family are more vitamin A deficient compared to those in richer family [33].…”

Trends and inequalities in children aged 6–59 months who received Vitamin A supplementation: evidence from the 2003, 2008 and 2014 Ghana Demographic and Health Survey

“…Consistently across the survey periods, our study revealed that children in higher wealth quintiles reported higher proportion of Vitamin A supplementation. Similar findings have been reported in Ethiopia [ 14 ] and India [ 15 ]. A plausible explanation for this finding could be that parents in higher wealth quintile households are more likely to have easy access to healthcare facilities [ 16 ].…”

“…Vitamin A supplementation was consistently high among children born to mothers with secondary or higher education across the various survey points. This finding mirrors results from previous studies that have found high Vitamin A supplementation among children whose mothers have secondary or higher education [ 14 , 15 ]. The result from this study may be explained from the perspective that formal education and higher education mothers’ awareness of health and nutritional requirements contribute positively toward Vitamin A supplementation [ 5 ].…”

“…The current proportion of Vitamin A supplementation in Ghana (65.2%) is lower than reports from other SSA countries, such as Namibia (83.6%), Rwanda (86.4%), Sierra Leone (83.2%), Senegal (88.4%), and Togo (81.7%) [ 5 ]. However, the result from this study is higher than reports from a related study conducted in Ethiopia [ 14 ].…”