Childhood Vitamin A Capsule Supplementation Coverage in Nigeria: A Multilevel Analysis of Geographic and Socioeconomic Inequities

Abstract

Vitamin A deficiency (VAD) is a huge public health burden among preschool-aged children in sub-Saharan Africa, and is associated with a high level of susceptibility to infectious diseases and pediatric blindness. We examined the Nigerian national vitamin A capsule (VAC) supplementation program, a short-term cost-effective intervention for prevention of VAD-associated morbidity for equity in terms of socioeconomic and geographic coverage. Using the most current, nationally representative data from the 2008 Nigerian Demographic and Health Survey, we applied multilevel regression analysis on 19,555 children nested within 888 communities across the six regions of Nigeria. The results indicate that there was variability in uptake of VAC supplement among the children, which could be attributed to several characteristics at individual, household, and community levels. Individual-level characteristics, such as maternal occupation, were shown to be associated with receipt of VAC supplement. The results also reveal that household wealth status is the only household-level characteristic that is significantly associated with receipt of VAC, while neighborhood socioeconomic disadvantage and geographic location were the community-level characteristics that determined receipt of VAC. The findings from this study have shown that both individual and contextual socioeconomic status, together with geographic location, is important for uptake of VAC. These findings underscore the need to accord the VAC supplementation program the much needed priority with focus on characteristics of neighborhoods (communities), in addition to individual-level characteristics.

Individual and community level determinants of childhood full immunization in Ethiopia: a multilevel analysis

“…This finding is consistent with the findings of previous studies conducted by Lerebo (2010), which disclosed that; in comparison to children whose region of residence was Affar region, children from Addis Ababa and Dire Dawa City, Tigray, Harari, Amahara, Gambella, SNNP, Oromia, Somalia and BEGU regions had higher chance of being fully immunized [ 26 ]. Similarly, different studies conducted elsewhere had found the significant effect of regional variations on childhood full immunization status [ 14 , 23 , 31 – 33 ]. This may be due to the fact that the 9 regional states and 2 city administrative councils found in Ethiopia consists of different religious, cultural, population size, geographic nature and levels of development.…”

“…Previous studies had identified factors associated with childhood full immunization which include, child place of delivery [ 14 – 18 ], age of child [ 17 , 19 , 20 ], birth order of the child [ 15 , 18 , 21 , 23 – 25 ], number of under 5 years children in the household [ 22 ], maternal age [ 14 , 19 , 20 ], parental education [ 7 , 18 – 20 , 22 , 23 , 25 – 27 ], family wealth index [ 13 – 15 , 23 , 25 , 28 ], parental employment status [ 19 , 29 ], maternal marital status [ 15 , 17 , 19 , 25 ], antenatal care (ANC) and tetanus toxoid (TT) [ 17 ], religious affiliation [ 14 , 26 , 28 ], and exposure to mass media [ 13 ] and at the community level place of residence [ 7 , 17 , 19 , 20 , 23 , 26 , 29 , 30 ], geographic region [ 21 , 23 , 26 , 31 – 33 ], community maternal hospital delivery [ 21 , 31 ], community/neighborhood poverty [ 33 ], community maternal unemployment and illiteracy [ 19 ], distance from health facility [ 31 ] and community maternal ANC services utilization were found to be associated with immunization status.…”

The influence of socioeconomic status on women's preferences for modern contraceptive providers in Nigeria: a multilevel choice modeling

“…Second, use of an asset based index as a surrogate measure of household wealth may be criticized. However, the use of an asset based index as a proxy for household wealth has been shown to be reliable 30,45. These limitations notwithstanding, the strength of this study is in the novelty of its findings, which provide a new insight into the existing body of evidence in the research area examined.…”

Uptake of routine vitamin A supplementation for children in Humbo district, Southern Ethiopia: Community-based cross-sectional study

“…According to the Ethiopian DHS 2016, percentage given VAS in the past 6 months increased from 41% among children from the poorest households to 58% to those from richest households [5]. Aremu et al in Nigeria also identi ed household wealth status as the only household-level characteristic that signi cantly affect receipt of vitamin A capsule [27]. Better household wealth standing may improve uptake of the supplement through advancing access to health information and mitigating economic barters for seeking health care.…”