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

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.

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Deworming Coverage and its Predictors among Ethiopian Children Aged 24 to 59 Months: Further Analysis of EDHS 2016 Data Set

Global Pediatric Health ◽

10.1177/2333794x211022908 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2110229

Author(s):

Getahun Fentaw Mulaw ◽

Fentaw Wassie Feleke ◽

Seada Seid Ahmed ◽

Juhar Admama Bamud

Keyword(s):

Logistic Regression ◽

Vitamin A ◽

Family Size ◽

Media Exposure ◽

World Health ◽

P Value ◽

Vitamin A Supplementation ◽

Paternal Education ◽

Multivariable Logistic Regression ◽

History Of

Intestinal parasitic infections are the major public health problem globally, mostly in developing countries. World Health Organization recommends deworming to all at-risk people living in endemic areas as a prevention or intervention strategy. Therefore this study aimed to assess the deworming coverage and its predictors among Ethiopian children aged 24-59 months. The study analyzed retrospectively cross-sectional data on a weighted sample of 5,948 children aged 24-59 months nested within 645 clusters after extracting from the Ethiopian Demographic health survey. Bivariable and multivariable logistic regression was employed to assess the association of variables. Predictors at p-value < 0.25 were entered into the multivariable logistic regression model, and statistical significance was declared at P-value < 0.05. In this study, the prevalence of maternal reported deworming supplements among children aged 24-59 months was 15.1%. Predictive variables significantly associated with deworming supplementation include maternal media exposure, maternal control of household healthcare decisions, institutional healthcare delivery, and child vitamin-A supplementation. Having history of a diarrheal disease, maternal and paternal education, and family size were also statistically significant predictors of deworming supplements. Therefore, deworming supplementation among children is low. Maternal education and employment, paternal education, family size, decision-making process, maternal media exposure, place of delivery, vitamin-A supplementation, and a having history of diarrhea were predictors of deworming supplements. Multifaceted interventions aimed at those predictors should be given emphasis.

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Spatial distribution and associated factors of iron supplementation use among pregnant women in Ethiopia; Ethiopian Demographic and Health Survey 2016 data: spatial and multilevel logistic regression analysis

10.21203/rs.3.rs-27876/v1 ◽

2020 ◽

Author(s):

Chilot Desta Agegnehu ◽

Getayeneh Antehunegn Tesema ◽

Achamyeleh Birhanu Teshale ◽

Adugnaw Zeleke Alem ◽

Yigizie Yeshaw ◽

...

Keyword(s):

Logistic Regression ◽

Spatial Distribution ◽

Maternal Health ◽

Pregnant Women ◽

Iron Supplementation ◽

Community Education ◽

Media Exposure ◽

Wealth Index ◽

Maternal Health Services ◽

Household Wealth

Abstract Background Although the World Health Organization recommends for all pregnant women taking iron tablet should be a routine activity, more than 50% of anemia in pregnant women was occurred due to lack of iron supplementation and remains global public health problem and varies with in country. Lack of iron tablet supplementation during pregnancy leads to maternal anemia, which intern increases the risk of maternal death, obstetric complications, preterm birth and low birth weight. Therefore, studying spatial distribution and determinants of iron supplementation use among pregnant women in Ethiopia is vital to design appropriate maternal health services and preventing the determinants earlier. Method: A stratified two-stage cluster sampling technique was used in the Ethiopian Demographic Health Survey in 2016 data. A total of a weighted sample of 7589 pregnant women were included for analysis. Bernoulli model was used to explore the purely spatial clusters of pregnant women using SaTScan version 9.6 and ArcGIS version10.3.A multi-level logistic regression model was used to identify determinant factors of iron supplementation use among pregnant women. Results Spatial distribution of iron supplementation use among pregnant women was non –random in the country with Moran’s index 0.3 (p < 0.001). The primary cluster was in Southwest Somali and Central part of the Oromia region (LLR = 66.69, P < 0.001). ANC visit (AOR = 3.66, 95%CI: 3.21, 417), community education [AOR = 1.31, 95%CI, 1.07, 1.59), media exposure (AOR = 1.33, 95%CI: 1.15, 1.53), distance to health facility (AOR = 1.32, 95%CI: 1.16, 1.50), region and household wealth index were significantly associated with iron supplementation use among pregnant women in Ethiopia. Conclusion Spatial distribution of Iron supplementation use among pregnant women varies across the country. ANC visit, region, household wealth index, media exposure, distance to the health facility, and community education were significant predictors of iron supplementation use among pregnant women. Therefore, it needs great interventions in the hot spot areas and maternal health services should be delivered in all areas of our country.

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The magnitude and Associated Factors of Pneumonia Among Under-Five Children in Ethiopia: A Systematic Review and Meta-Analysis

10.21203/rs.2.21129/v1 ◽

2020 ◽

Author(s):

Yoseph Merkeb ◽

Fentahun Adane

Keyword(s):

Tract Infection ◽

Vitamin A ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Random Effect ◽

Random Effect Model ◽

Significant Heterogeneity ◽

Vitamin A Supplementation ◽

Under Five ◽

Under Five Children

Abstract Background Currently, Pneumonia is the leading cause of morbidity and mortality among under-five children in developing countries including Ethiopia. Despite, these problems are easily preventable and treatable it contributes to more than 18% of deaths of under-five children every year in Ethiopia. Regardless of these facts, there is a paucity of information regarding the magnitude and its predictors of pneumonia in Ethiopia. Thus, assessing the pooled magnitude of pneumonia and its predictors among under-five children in Ethiopia is the main objective of this review. Methods The international databases such as MEDLINE/PubMed, EMBASE, Google Scholar, Science Direct were scientifically explored. We considered all primary studies reporting the magnitude of pneumonia among under-five children and its predictors in Ethiopia. We retrieved all necessary data by using a standardized data extraction format spreadsheet. STATA 14 statistical software was used to analyze the data and Cochrane Q test statistics and I 2 test was used to assess the heterogeneity between the studies. There was significant heterogeneity between the studies so that a random effect model was employed. Result The pooled magnitude of Pneumonia Among Under Five Children was 20.68%, (I 2 = 97.9%%; P ≤ 0.001) from 12 included studies in Ethiopia. Children who unvaccinated [OR = 2.45], food cooking in the main house [OR = 2.46], Vitamin A supplementation status [OR = 2.85], malnutrition [OR = 2.98], mixed breast feeding [OR = 2.46], child history of respiratory tract infection [OR = 4.11] were a potential determinates of pneumonia. Conclusion and Recommendations This review showed that the magnitude of pneumonia was relatively high. Hence, appropriate intervention on potential determinates such as health education on exclusive breastfeeding and nutrition, place of food cooking, increase immunization and Vitamin A supplementation and early control of respiratory tract infection was recommended to prevent those risk factors.

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Factors associated with coverage of vitamin a supplementation among Bangladeshi children: mixed modelling approach

BMC Public Health ◽

10.1186/s12889-021-10735-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nahyatul Marjan ◽

Atikur Rahman ◽

Rumana Rois ◽

Azizur Rahman

Keyword(s):

Logistic Regression ◽

Vitamin A ◽

Clustered Data ◽

Ratio Test ◽

Model Framework ◽

Vitamin A Supplementation ◽

Under Five ◽

Under Five Children ◽

Generalised Linear Mixed Model ◽

Modelling Approach

Abstract Background Vitamin A deficiency (VAD) is a prominent and widespread public health problem in developing countries, including Bangladesh. About 2% of all deaths among under-five children are attributable to VAD. Evidence-based information is required to understand the influential factors to increase vitamin A supplementation (VAS) coverage and reduce VAD. We investigated the potential factors affecting VAS coverage and its significant predictors among Bangladeshi children aged 6 to 59 months using the VAS clustered data extracted from the latest Bangladesh Demographic and Health Survey 2014. Methods Data were analysed using mixed logistic regression (MLR) modelling approach in the generalised linear mixed model framework. The MLR model performs better than logistic regression for analysing the clustered data because of its minimum Akaike information criterion value. The likelihood ratio test showed that the variance component was significant. Therefore, the clustering effect among children was inevitable to use. Results VAS coverage among under-five children was 63.6%, which is not optimal and below the WHO’s recommendation and the country’s target of 90%. Children aged 25 to 36 months (AOR = 2.07, 95% CI: 1.711 to 2.513), who had higher educated mothers (AOR = 1.37, p = 0.033, 95% CI: 1.026–1.820) and fathers (AOR = 1.32, p = 0.027, 95% CI: 1.032–1.683), whose mothers had media exposure (AOR = 1.22, p = 0.006, 95% CI: 1.059–1.408) and NGO membership (AOR = 1.24, p = 0.002, 95% CI: 1.089–1.422) were more likely to consume VAS. Conclusion The relevant authorities should create proactive awareness programs for highly vulnerable local communities, specifically targeted to educate the children’s mothers about the necessity and benefits of childhood nutrition.

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Household overcrowding and risk of SARS-CoV-2: analysis of the Virus Watch prospective community cohort study in England and Wales

10.1101/2021.05.10.21256912 ◽

2021 ◽

Author(s):

Robert W Aldridge ◽

Helen Pineo ◽

Ellen Fragaszy ◽

Max Eyre ◽

Jana Kovar ◽

...

Keyword(s):

Logistic Regression ◽

Fixed Effects ◽

Respiratory Infections ◽

Random Effect ◽

Mixed Effects ◽

P Value ◽

England And Wales ◽

Logistic Regression Models ◽

Household Level ◽

Increased Risk

Background: Household overcrowding is associated with increased risk of infectious diseases across cultures and countries. Limited data exist in England and Wales linking household overcrowding and risk of COVID-19. We used data collected from the Virus Watch cohort to examine the association between overcrowded households and infection to pandemic coronavirus SARS-CoV-2. Methods: The Virus Watch study is a household community cohort of acute respiratory infections in England & Wales that began recruitment in June 2020. We calculated the persons per room for each household and classified accommodation as overcrowded when the number of rooms was fewer than the number of people. We considered two primary outcomes - PCR-confirmed positive SARS-CoV-2 antigen tests and laboratory confirmed SARS-CoV-2 antibodies (Roche Elecsys anti-N total immunoglobulin assay). We used mixed effects logistic regression models that accounted for household structure to estimate the association between household overcrowding and SARS-CoV-2 infection. Results: The proportion of participants with a positive SARS-CoV-2 PCR result was highest in the overcrowded group (6.6%; 73/1,102) and lowest in the under-occupied group (2.9%; 682/23,219). In a mixed effects logistic regression model that included age, sex, ethnicity, household income and geographical region as fixed effects, and a household-level random effect, we found strong evidence of an increased odds of having a positive PCR SARS-CoV-2 antigen result (Odds Ratio 3.67; 95% CI: 1.91, 7.06; p-value < 0.001) and increased odds of having a positive SARS-CoV-2 antigen result in individuals living in overcrowded houses (2.99; 95% CI: 1.14, 7.81; p-value =0.03) compared to people living in under-occupied houses. Discussion: Public health interventions to prevent and stop the spread of SARS-CoV-2 should consider the much greater risk of infection for people living in overcrowded households and pay greater attention to reducing household transmission. There is an urgent need to better recognise housing as a leading determinant of health in the context of a pandemic and beyond.

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The determinant of National Vitamin A supplementation in Ethiopia: A Multilevel Logistic Regression Analysis

10.21203/rs.3.rs-17477/v1 ◽

2020 ◽

Author(s):

Mohammed M. Oumer ◽

Zelalem Mengestu ◽

Sewbesew Yitayih ◽

Malede Mequanent ◽

Ayenew Molla

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Vitamin A ◽

Low Income ◽

Associated Factors ◽

Vitamin A Deficiency ◽

Public Health Problem ◽

Linear Mixed Effect Model ◽

Mixed Effect ◽

Vitamin A Supplementation

Abstract Background: Vitamin A deficiency is a public health problem in many low-income countries including Ethiopia. Globally, the prevalence of vitamin A deficiency is estimated to be 190 million among children under-five age causing one up to two million deaths annually.Its periodic supply is a major intervention program to reduce the morbidity, mortality, and blindness among the children in Ethiopia. Objective: The aim of this study was to determine associated factors of national vitamin A supplementationamong children aged 6-59 monthsusing the 2016 Ethiopian Demographic and Health Survey Data. Methods: A population based cross-sectional study design wasperformed to determine factors associated with the vitamin A supplyamong children aged between 6 and 59 monthswithin the last six months before the start of the survey. A univariateanalysis, bivariate analysis, binary logistic regression, and generalized linear mixed effect model were appliedto analyze the data. Results: After adjusting for covariates; the odds of taking vitamin A supply were 1.3 times, 1.7 times, and 1.8 times higher among the women who had two, three, and four and above antenatal care visits, respectively. The mothers’ employment status, health cheek up after their delivery,and theirhealth facility delivery were positively influence the uptake of the vitamin A capsule. In addition,women residing in the communities with high proportion of the media exposure[AOR (Adjusted Odds Ratio) = 1.17 (95%CI: 1.00, 1.37)]were positively associated with the receipt of vitamin A capsule.Random effects indicated that the variation on the uptake of vitamin A supplementation between the communities was statistically significant in all stage of the models. Conclusions: The individual and community level characteristics had a significant influence on the uptake of vitamin A supplementation. Therefore, these factors should be considered in policy formulation and programming in order to improve the coverage of vitamin A supplementation in Ethiopia. Keywords: Vitamin A supply, associated factors, multilevellogistic regression analysis, Ethiopia

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Magnitude and Predictors of Pneumonia among Under-Five Children in Ethiopia: A Systematic Review and Meta-Analysis

Journal of Environmental and Public Health ◽

10.1155/2020/1606783 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Yoseph Merkeb Alamneh ◽

Fentahun Adane

Keyword(s):

Tract Infection ◽

Vitamin A ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Vitamin A Supplementation ◽

Under Five ◽

Under Five Children

Background. Pneumonia is currently the leading cause of morbidity and mortality among under-five children in developing countries, including Ethiopia. Although these problems are easily preventable and treatable, it contributes to more than 18% of deaths of under-five children every year in Ethiopia. Regardless of these facts, there is a paucity of information regarding the magnitude and its predictors of pneumonia in Ethiopia. Therefore, the main objective of this review is to determine the pooled magnitude of pneumonia and its predictors among under-five children in Ethiopia. Methods. The international databases such as MEDLINE/PubMed, EMBASE, Google Scholar, and Science Direct were scientifically explored. Articles were also searched by examining the gray literature on institutional databases and by reviewing reference lists of already identified articles. We considered all primary studies reporting the magnitude of pneumonia among under-five children and its predictors in Ethiopia. We retrieved all necessary data by using a standardized data extraction format spreadsheet. STATA 14 statistical software was used to analyze the data, and Cochrane’s Q test statistics and I2 test were used to assess the heterogeneity between the studies. Significant variability was found between the studies in such a way that a random-effect model was used. Result. The pooled magnitude of pneumonia among under-five children was 20.68% (I2 = 97.9%; P≤0.001) out of 12 studies in Ethiopia. Children who have unvaccinated (OR = 2.45), food cooking in the main house (OR = 2.46), vitamin A supplementation status (OR = 2.85), malnutrition (OR = 2.98), mixed breastfeeding (OR = 2.46), and child history of respiratory tract infection (OR = 4.11) were potential determinates of pneumonia. Conclusion and Recommendations. This review showed that the magnitude of pneumonia was relatively high. Hence, appropriate intervention on potential determinates such as health education on exclusive breastfeeding and nutrition, place of food cooking, increased immunization and vitamin A supplementation, and early control of respiratory tract infection was recommended to prevent those risk factors.

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Adherence to Diabetes Self-Management and the Associated Factors among Type 1 Diabetic Adolescents Attending Outpatient Diabetic Clinic at Public Hospitals in Addis Ababa, Ethiopia, 2021

10.21203/rs.3.rs-1092496/v1 ◽

2021 ◽

Author(s):

Yomilan Geneti ◽

Kalkidan Wondwossen ◽

Mekonen Adimasu ◽

Dereje Deressa ◽

Fekadu Aga ◽

...

Keyword(s):

Social Support ◽

Type 1 Diabetes ◽

Logistic Regression ◽

Regression Analysis ◽

Associated Factors ◽

Addis Ababa ◽

Public Hospitals ◽

Self Management ◽

P Value

Abstract Objectives The purpose of this study was to determine the level of adherence to diabetes self-management and associated factors among type 1 diabetic adolescents attending outpatient diabetic clinics at Public Hospitals in Addis Ababa, Ethiopia. Methods An institutional-based cross-sectional study was carried out among 422 adolescents with type 1 diabetes attending outpatient diabetic clinics at four randomly selected public hospitals in Addis Ababa. The adolescents were interviewed using pretested questionnaires to give information on socio-demographic characteristics, medical factors, knowledge about type 1 diabetes, adherence to diabetes self-management, self-efficacy, and social support related to type 1 diabetes. A variable that has a P-value of <0.2 in bi-variable logistic regression analysis was subjected to multivariable logistic regression analysis to control the confounding factors. The level of significance was pronounced at P-value <0.05. Results In this study, a total of 414 diabetic adolescents were interviewed making a 98.1% response rate. About 218 participants (52.7%) had poor adherence to overall diabetes self-management. Self-efficacy (AOR=8.7, 95% CI:1.9-14.1, P=0.005), social support (AOR=4.6, 95%CI:1.5-13.5, P=0.006), age (AOR=0.2, 95%CI:0.1-0.4, P=0.001), good knowledge of the disease (AOR=9.046, 95%CI:3.83-13.5, P=0.000), moderate knowledge (AOR=6.763, 95%CI:2.18-12.921, P=0.001), and time since diagnosis of type 1 diabetes (AOR=0.1, 95%CI:0.02-0.2, P=0.005) were significantly associated with adherence to diabetes self-management. Conclusions and Recommendations: More than half of this population had poor adherence. The finding suggested that implementing a comprehensive guideline of adherence and expanding the recurrence of follow-up visits could be important for this population.

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Perception and Associated Factors for the Implementation of Telemedicine During COVID-19 Pandemic Among Health Professionals Working at the Government Health Facility in Resource Limiting Setting, Ethiopia, 2021: A Cross-section study.

10.21203/rs.3.rs-464595/v1 ◽

2021 ◽

Author(s):

Bayou Tilahun Assaye ◽

Tewabe Manaye ◽

Zegeye Regasa ◽

Gizaw Hayiley ◽

Kirubel Biruk ◽

...

Keyword(s):

Logistic Regression ◽

Health Facility ◽

Health Professionals ◽

Associated Factors ◽

Addis Ababa ◽

Health Professions ◽

Structured Interview ◽

Outcome Variable ◽

P Value ◽

Multivariable Logistic Regression

Abstract Background: The novel coronavirus(COVID-19) pandemic has been dramatically affecting healthcare organizations across the world. Accessing modern health care is still limited in developing countries due to different factors. Within physical distancing, telemedicine has become the preferred communication channel between health professions and patients. Therefore, this study was aimed to assess Perception and Associated factors for the implementation of telemedicine during the COVID-19 Pandemic among Health Professionals Working at Governmental health facility in Addis Ababa, Ethiopia, 2021.Methods: -Institutional-based cross-sectional study design was conducted among 845 study participants. A structured interview administrative questionnaire using ODK(open data kit) was used. A pre-test was done on 5% of the total sample size. The quality of data was assured by checking its completeness and consistency. Descriptive statistics Bivariable and multivariable logistic regression were fitted. Variables having P-value less than 0.25 during bi-variable logistics regression were entered into multivariable logistic regression. Adjusted odds ratio (AOR) with 95% confidence level (CL) were used to declare association between dependent and the outcome variable. Model fitness and multicollinearity was checked using by using Hosmer-Lemeshow AND Variable inflation factors(VIF) respectively.Result:- Over all 60.9% (95% CI: [57.5, 64.4]) of health professionals had a good perception towards telemedicine with response rate of 737( 87.2%). Health professionals who had IT supporting staff (AOR:7.13, 95% CI: 4.264-13.201), health professionals ’ being certified concerning with ICT (AOR:4.42, 95%CI: 2.69-7.524), frequency of using social media platforms (AOR=3.263, 95% CI: 1.621-6.561) were variables significantly associated with the perception of telemedicine among health professionals for control and prevention of COVID-19.Conclusion:- More than half of respondents had a good perception of telemedicine. being trained with ICT, accessibility of computers,s and Having IT support staff in their health facility were significantly associated with the level of telemedicine perception in the era of the COVID-19 pandemic. Therefore, the Ministry of health recommended to encourage the health professions and the stakeholders to collaborate on promotion of safe and evidence-based use of telemedicine during the current COVID-19 pandemic and future outbreaks.

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Coverage and factors associated with vitamin A supplementation among children aged 6–59 months in twenty-three sub-Saharan African countries

Public Health Nutrition ◽

10.1017/s1368980018004056 ◽

2019 ◽

Vol 22 (10) ◽

pp. 1770-1776

Author(s):

Anselm S Berde ◽

Petra Bester ◽

Iolanthé M Kruger

Keyword(s):

Vitamin A ◽

Scale Up ◽

Multivariable Analysis ◽

Media Exposure ◽

Demographic And Health Surveys ◽

High Dose ◽

African Countries ◽

Vitamin A Supplementation ◽

Factors Associated ◽

Sub Saharan

AbstractObjectiveThe present study aimed to give an overall view of the pattern of high-dose vitamin A supplementation (VAS) coverage in twenty-three sub-Saharan African countries and factors associated with receipt of VAS among children aged 6–59 months.DesignCross-sectional data from the twenty-three Demographic and Health Surveys conducted from 2011 to 2015 in twenty-three sub-Saharan African countries were pooled. A multilevel logistic regression model was used to explore factors associated with VAS.SettingTwenty-three sub-Saharan African countries.ParticipantsChildren (n 215 511) aged 6–59 months.ResultsThe overall coverage of VAS among children aged 6–59 months for the surveys included was 59·4 %. In the multivariable analysis, children whose mothers had primary (adjusted OR (aOR)=1·43; 95 % CI 1·39, 1·47) or secondary or above (aOR=1·72; 95 % CI 1·67, 1·77) educational status were more likely to receive VAS than children whose mothers had no formal education. Other factors associated with significantly increased likelihood of VAS were: living in urban areas; children of working mothers; children whose mothers had higher media exposure; children of older mothers v. children of mothers aged 15–19 years; and older children v. children aged 6–11 months. At the country level, lower media exposure was significant and negatively associated with VAS.ConclusionsBroader VAS coverage is needed according to our data. More efforts are needed to scale up coverage, focusing mostly on groups at risk of non-receipt of vitamin A.

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