Estimates of child mortality reductions attributed to vitamin A supplementation in sub-Saharan Africa: scale up, scale back, or refocus?

Abstract

Background Vitamin A supplementation (VAS) has been implemented in over 82 countries globally, primarily because of its beneficial effect in preventing child mortality. Secular reductions in child mortality and the implementation of alternative programs to promote Vitamin A intake have led to questions on the need of national VAS programs. Objectives This study aimed to estimate child mortality changes related to VAS using current, scale-back, and scale-up coverage scenarios. Methods Data related to demographic characteristics, fertility, intervention coverage, anthropometry, child mortality and cause-of-death structure was integrated into the Lives Saved Tool (LiST). We estimated the cause-specific (LiST model) and all-cause mortality reductions related to VAS based on evidence from recent meta-analyses. Results Between 2008 and 2018, VAS coverage declined in most sub-Saharan African (SSA) countries. In 2019 alone, a 12% and 24% reduction in all-cause mortality related to VAS is expected to avert from 105,332 to 234,704 child deaths in SSA, respectively; whereas the cause-specific mortality model (LiST) estimated that 141,670 child deaths were averted in 2019. Estimates of VAS related child mortality reductions were highly variable among countries. Our scaling-back scenario led to highly variable country-level results, with expected increases in mortality rate from a low of 0.04 to as high as 49.3/1000 live births, suggesting that some countries could start considering scaling-back, while others need to scale-up. Conclusion Excess child mortality preventable by VAS has declined, but is still significant in many SSA countries. While scale-up of VAS is needed for most of the countries, scaling-back can also start to be considered in some countries. Policy decisions, however, should be guided by more recent data on food consumption, vitamin A status, child health, and vitamin A fortification coverage data.

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“…a recent study by Baye et al 4 indicated that the estimated averted child deaths related to VA supplementation are highly variable among countries in the sub-Saharan African region. This can be partly explained by varying levels of all-cause mortality and VA supplementationamenable child morbidity and mortality.…”

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