{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:33:07Z","timestamp":1765823587351,"version":"3.48.0"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"GiveWell"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While recent data on vitamin A deficiency (VAD) prevalence is lacking, the 2004 C\u00f4te d\u2019Ivoire Nutrition and Mortality Survey reported that 26.7% of children aged 6\u201359 months were affected by VAD, and approximately 60% were at risk. Since 2016, the government has transitioned from mass campaigns to routine vitamin A supplementation (VAS) delivery integrated into health services. However, evidence on the cost-effectiveness of the routine distribution approaches is limited. This study evaluated the cost, coverage, and cost-effectiveness of three routine VAS delivery strategies across two health districts in northern C\u00f4te d\u2019Ivoire.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A mixed-methods study evaluated three routine VAS delivery strategies \u2013 routine-fixed, advanced community-based, and catch-up \u2013 across two health districts, Ferkess\u00e9dougou and Niakaramadougou, in northern C\u00f4te d\u2019Ivoire. The quantitative cost data were collected via a structured tool covering six cost categories: planning, procurement, training, social mobilization, distribution, and supervision. VAS coverage was assessed through a post-event coverage survey (PECS) via a two-stage cluster sampling methodology. A cost-effectiveness analysis determined the cost per child supplemented, the cost per DALY averted, and a sensitivity analysis tested the robustness of the findings under different cost scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The total program cost for July-December 2023 was 25.5 million FCFA, with personnel costs comprising over 70% of expenditures. In Ferkess\u00e9dougou, the routine advanced community-based strategy was the most cost-effective, at 458 FCFA per child in rural areas (versus 596 FCFA for the routine-fixed facility-based approach in the same area). In Niakaramadougou, the December catch-up was more cost-effective in rural areas (606 FCFA per child) than the routine-fixed approach (714 FCFA). Across both districts combined, the routine-fixed strategy averaged roughly 651 FCFA per child supplemented, and the cost per DALY averted ranged from 30,093 FCFA (advanced strategy in Ferkess\u00e9dougou) to 89,550 FCFA (catch-up Jul 2023 in Niakaramadougou) \u2013 all below C\u00f4te d\u2019Ivoire\u2019s cost-effectiveness threshold (0.5 x GDP per capita; approximately USD 1,265).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>All three strategies were cost-effective, though the advanced community-based strategy achieved the best balance of reach and efficiency. Scaling advanced strategies within health system constraints may enhance sustainability and coverage in low-resource settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0338784","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:29:03Z","timestamp":1765823343000},"page":"e0338784","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing vitamin A supplementation: A comparative cost-effectiveness analysis of routine distribution strategies in northern C\u00f4te d\u2019Ivoire"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0103-2093","authenticated-orcid":true,"given":"Melissa M.","family":"Baker","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lyonel Nerolin Doffou","family":"Assal\u00e9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Doledec","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Romance","family":"Dissieka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmenan Claude Liliane","family":"Konan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnes Helen Epse","family":"Assagou Mobio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6605-8595","authenticated-orcid":true,"given":"Koffi Landry","family":"Kouadio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oka Ren\u00e9","family":"Kouam\u00e9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ama Emilienne","family":"Yao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hubert","family":"Zirimwabagabo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"pone.0338784.ref001","volume-title":"C\u00f4te d\u2019Ivoire Demographic and Health Survey 2021","author":"DHS Program","year":"2021"},{"issue":"5","key":"pone.0338784.ref002","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0233615","article-title":"Association of vitamin A deficiency with early childhood stunting in Uganda: A population-based cross-sectional study","volume":"15","author":"P Ssentongo","year":"2020","journal-title":"PLoS One"},{"key":"pone.0338784.ref003","volume-title":"C\u00f4te d\u2019Ivoire Nutrition and Mortality Survey 2004","author":"Ministry of Health (C\u00f4te d\u2019Ivoire), United Nations Children\u2019s Fund (UNICEF)"},{"key":"pone.0338784.ref004","volume-title":"Global Guidelines for the Prevention of Vitamin A Deficiency [Internet]","author":"World Health Organization","year":"2017"},{"key":"pone.0338784.ref005","volume-title":"Routine and Advanced VAS Report","author":"Ministry of Health, C\u00f4te d\u2019Ivoire","year":"2024"},{"issue":"2","key":"pone.0338784.ref006","doi-asserted-by":"crossref","DOI":"10.1111\/mcn.13626","article-title":"Feasibility of delivering vitamin A supplementation (VAS) and deworming through routine community health services in Siaya County, Kenya: a cross-sectional study","volume":"20","author":"S Ochola","year":"2024","journal-title":"Matern Child Nutr"},{"key":"pone.0338784.ref007","volume-title":"Coverage at a Crossroads: New directions for vitamin A supplementation 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Case study of West and Central Africa","author":"A Laillou","year":"2024","journal-title":"BMJ Nutr Prev Health"},{"issue":"11","key":"pone.0338784.ref017","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1017\/S1368980017000684","article-title":"Determinants of successful vitamin A supplementation coverage among children aged 6-59 months in thirteen sub-Saharan African countries","volume":"20","author":"A Janmohamed","year":"2017","journal-title":"Public Health Nutr"},{"issue":"4","key":"pone.0338784.ref018","doi-asserted-by":"crossref","DOI":"10.1093\/cdn\/nzy006","article-title":"Delivering vitamin A supplements to children aged 6\u201359 months: comparing delivery through campaigns and routine health services in Senegal","volume":"2","author":"S Horton","year":"2018","journal-title":"Curr Dev Nutr"},{"issue":"1","key":"pone.0338784.ref019","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1186\/s12889-024-18707-3","article-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","volume":"24","author":"A Janmohamed","year":"2024","journal-title":"BMC Public Health"},{"key":"pone.0338784.ref020","article-title":"Barriers and facilitators to implementing vitamin A supplementation programs in Africa: a systematic review","author":"O Ezezika","year":"2024","journal-title":"Nutr Health"},{"issue":"1","key":"pone.0338784.ref021","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1186\/s12887-023-04059-1","article-title":"Vitamin A supplementation coverage and its associated factors among children aged 6\u201359 months in West Azernet Berbere Woreda, South West Ethiopia","volume":"23","author":"B Berihun","year":"2023","journal-title":"BMC Pediatrics"},{"issue":"3","key":"pone.0338784.ref022","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1177\/156482650702800307","article-title":"Estimating the global costs of vitamin A capsule supplementation: a review of the literature","volume":"28","author":"O Neidecker-Gonzales","year":"2007","journal-title":"Food Nutr Bull"},{"key":"pone.0338784.ref023","doi-asserted-by":"crossref","DOI":"10.1177\/0379572115598445","article-title":"Measuring the costs of vitamin A interventions: institutional, spatial, and temporal issues in the context of Cameroon","volume":"36","author":"J Kagin","year":"2015","journal-title":"Food Nutr Bull"},{"issue":"9","key":"pone.0338784.ref024","first-page":"755","article-title":"A proposed vitamin A supplementation programme for South Africa--design, coverage and cost","volume":"91","author":"R Saitowitz","year":"2001","journal-title":"S Afr Med J"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0338784","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T18:29:08Z","timestamp":1765823348000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0338784"}},"subtitle":[],"editor":[{"given":"Susan","family":"Horton","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,15]]},"references-count":24,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0338784","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,15]]}}}