Baseline Vitamin A Coverage Survey in 6 Districts of Nepal

Abstract

Background: According to NDHS 2011, the vitamin A coverage is 90 percent among children aged 6-59 months. However, stratified analysis revealed that there is low coverage of vitamin A among the children age 6-8 months (70 percent) compared to the other age groups. The immediate objective of this baseline coverage survey is to establish baseline status of VAS among 6-11 months children in 6 districts. Methods: A pre-post test design with a comparison group was used to compare the vitamin A supplementation (VAS) coverage at baseline to that at end line (after one year of pilot intervention). The sample size in rural area for each district was 90 children aged 12-17 months and 360 in each arm of the urban areas. Population proportional to size (PPS) selection of 30 wards (clusters) were undertaken for each district/domain. Mothers of children/caregivers were interviewed. Health workers (ANM and AHW) of the health facilities of the selected cluster, female community health volunteers (FCHVs) of selected cluster, nutrition focal persons and District Public/Health Officers of the districts were also interviewed. In addition, Local Development Officers (LDOs) of the districts, Village Development Committee (VDC) secretaries/ward secretaries of the municipalities of selected clusters were also interviewed using key informant interview. Results: The proportion of children receiving first dose of vitamin A at 6-8 months (56% in intervention and 50% in control districts) were significantly lower as compared to total coverage (98% in intervention and 97% in control districts) in rural area. Among the children receiving vitamin A within 6-8 months, 83 % in intervention and 99 % in control districts received the first dose of vitamin A in campaigns and none received during measles vaccination. The vitamin A coverage of last supplementation i.e. within six months preceding the survey was 98% in intervention and 97% in control districts for children aged 12-17 months of rural. The first dose of vitamin A coverage among children 6-11 months of urban was 91% in intervention and 96% in control districts, however the proportions of children receiving first dose of vitamin A at 6-8 months were only 44% in intervention and 53% in control districts. The vitamin A coverage of last supplementation i.e. within six months preceding the survey was 91% in intervention and 88% in control districts for children 6-59 months of urban. First dose of vitamin A coverage among infants 6-11 months in Jumla and Kalikot was 100%, whereas the lowest coverage was in Chitwan (91%).The proportion of children receiving first dose of vitamin A at ages 6-8 months through vitamin A rounds were 78% in Kavre, 98% in Kathmandu, 84% in Chitwan, 100% in Bara, 90% in Jumla, and 100% in Kalikot. Only 8% mothers in intervention and less than 1% in control districts from urban area reported children were registered before the day of vitamin A distribution, whereas mothers receiving message about vitamin A campaign was more than 87%. About half of the health workers received training on vitamin A distribution, and almost all had knowledge of age providing first dose of vitamin A and most of health facilities have sufficient vitamin A stock. Most of the health workers have knowledge on VAS, and showed the need of monitoring and follow up of VAS. The proportion of vitamin A stock in health facilities of most of the study districts was maintained above Emergency Order Point (EOP) except in Jumla. Conclusions: To increase the coverage of the vitamin A among children aged 6-8 months, a new strategy is needed. Leadership and support of VDC and municipalities, quality supervision and monitoring, micro planning, sensitizing of health workers and volunteers, strengthening of recording and reporting mechanism are to be improved for further success of vitamin A programme. Keywords: baseline survey; children aged 6-8 months; health workers; mothers; vitamin A coverage.