{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T20:06:55Z","timestamp":1789070815012,"version":"build-2803163510"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,4,27]],"date-time":"2024-04-27T00:00:00Z","timestamp":1714176000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,27]],"date-time":"2024-04-27T00:00:00Z","timestamp":1714176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"GiveWell"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Vitamin A deficiency (VAD) is a leading contributor to the poor health and nutrition of young children in sub-Saharan Africa. Funding constraints are compelling many countries to shift from longstanding campaigns to integrating vitamin A supplementation (VAS) into routine health services. We assessed child VAS coverage and associated factors for integrated delivery systems in Mozambique, Senegal, and Sierra Leone and for a campaign-based delivery strategy in Tanzania.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Data were obtained using representative household surveys administered to primary caregivers of <jats:italic>N<\/jats:italic>\u2009=\u200916,343 children aged 6\u201359 months (Mozambique: <jats:italic>N<\/jats:italic>\u2009=\u20091,659; Senegal: <jats:italic>N<\/jats:italic>\u2009=\u20097,254; Sierra Leone: <jats:italic>N<\/jats:italic>\u2009=\u20094,149; Tanzania: <jats:italic>N<\/jats:italic>\u2009=\u20093,281). Single-dose VAS coverage was assessed and bivariate and multivariable associations were examined for child VAS receipt with respect to rural or urban residence; child age and sex; maternal age, education, and VAS program knowledge; and household wealth.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>VAS coverage for children aged 6\u201359 months was 42.8% (95% CI: 40.2, 45.6) in Mozambique, 46.1% (95% CI: 44.9, 47.4) in Senegal, 86.9% (95% CI: 85.8, 87.9) in Sierra Leone, and 42.4% (95% CI: 40.2, 44.6) in Tanzania and was significantly higher for children 6\u201311 vs. 24\u201359 months in Mozambique, Senegal, and Tanzania. In Sierra Leone, children aged 12\u201323 months (aOR\u2009=\u20091.86; 95% CI: 1.20, 2.86) and 24\u201359 months (aOR\u2009=\u20091.55; 95% CI: 1.07, 2.25) were more likely to receive VAS, compared to those 6\u201311 months. Maternal awareness of VAS programs was associated with higher uptake in Mozambique (aOR\u2009=\u20094.00; 95% CI: 2.81, 5.68), Senegal (aOR\u2009=\u20092.72; 95% CI: 2.35, 3.15), and Tanzania (aOR\u2009=\u200914.50; 95% CI: 10.98, 19.17). Increased household wealth was associated with a higher likelihood of child VAS in Senegal and Tanzania.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our findings indicate routine delivery approaches for VAS are not achieving the level of coverage needed for public health impact in these settings. Intensive outreach efforts contributed to the higher coverage in Sierra Leone and highlight the importance of reducing the burdens associated with seeking supplementation at health facilities. As countries move towards incorporating VAS into routine health services, the essentiality of informed communities and potential losses for older children and socio-economically disadvantaged populations are key considerations in the sub-Saharan African context.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12889-024-18707-3","type":"journal-article","created":{"date-parts":[[2024,4,27]],"date-time":"2024-04-27T08:02:37Z","timestamp":1714204957000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Vitamin A supplementation coverage and associated factors for children aged 6 to 59 months in integrated and campaign-based delivery systems in four sub-Saharan African countries"],"prefix":"10.1186","volume":"24","author":[{"given":"Amynah","family":"Janmohamed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Doledec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romance","family":"Dissieka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umu H.","family":"Jalloh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sugandh","family":"Juneja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maguette","family":"Beye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatou","family":"Ndiaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresia","family":"Jumbe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa M.","family":"Baker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,27]]},"reference":[{"key":"18707_CR1","doi-asserted-by":"publisher","first-page":"950","DOI":"10.3390\/nu14050950","volume":"14","author":"T Zhao","year":"2022","unstructured":"Zhao T, Liu S, Zhang R, Zhao Z, Yu H, Pu L, et al. Global burden of vitamin A deficiency in 204 countries and territories from 1990\u20132019. Nutrients. 2022;14:950. https:\/\/doi.org\/10.3390\/nu14050950.","journal-title":"Nutrients"},{"key":"18707_CR2","unstructured":"UNICEF, Vitamin A. January webpage. https:\/\/data.unicef.org\/topic\/nutrition\/vitamin-a-deficiency\/. Accessed 2024."},{"key":"18707_CR3","volume-title":"Guideline: vitamin a supplementation in infants and children 6\u201359 months of age","author":"World Health Organization","year":"2011","unstructured":"World Health Organization. Guideline: vitamin a supplementation in infants and children 6\u201359 months of age. Geneva: World Health Organization; 2011."},{"issue":"3 Suppl","key":"18707_CR4","doi-asserted-by":"publisher","first-page":"S248","DOI":"10.1177\/15648265100313S304","volume":"31","author":"NP Oliphant","year":"2010","unstructured":"Oliphant NP, Mason JB, Doherty T, Chopra M, Mann P, Tomlinson M, et al. 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Research ethics approval was obtained from the Mozambique National Committee for Bioethics in Health, Senegal National Ethics Committee for Health Research, Sierra Leone Ethics and Scientific Review Committee, and Tanzania National Health Research Ethics Review Committee.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed consent was obtained from all subjects.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1189"}}