Objectives
To generate population representative VAS coverage estimates and identify factors associated with high compliance in 13 African countries
Methods
Post-event coverage surveys (n=45) were conducted in 13 Sub-Saharan African countries during 2010 – 2015 to assess coverage rates achieved through door-to-door campaigns, fixed-plus-outreach Child Health Days (CHD), or combined delivery approaches. We pooled VAS coverage data from the 45 surveys (total of ~63,000 households) to compare coverage obtained by different delivery modes and identify barriers to VAS receipt
Results
Coverage ranged from 36%-97% across countries. A door-to-door strategy resulted in higher VAS coverage (90% vs. 61%) than the CHD approach (OR 5.92; 95% CI: 5.65, 6.21). Combined door-to-door and CHD delivery resulted in 28% higher compliance than the CHD strategy alone (OR 5.67; 95% CI: 5.20, 6.19). Key sources of information about supplementation were community health workers (24%), vehicle loudspeakers (21%), health center personnel (18%), and radio messages (16%). The main barriers to supplementation included lack of awareness (37%), child or caretaker absence (19%), and health workers not providing the supplement (14%)
Conclusions
Door-to-door provision of Vitamin A supplements to young children may achieve higher coverage than Child Health Days in the African context. Health workers, radio, and community broadcasts are important for creating awareness about VAS campaigns. As door-to-door campaigns are phasing out in most Sub Saharan African countries, it is essential to better address caretaker knowledge as a key determinant of compliance
