Subnational estimates of vitamin A supplementation coverage in children: a geospatial analysis of 45 low- and middle-income countries

Abstract

Objectives: Vitamin A supplementation (VAS) can protect children from the adverse health consequences of vitamin A deficiency. Granular data on VAS coverage can guide global and national efforts to achieve universal VAS coverage. To provide geographically precise targeting of VAS programs and to monitor progress in reducing geographic disparities, we aimed to create high-resolution (5 × 5 km²) maps of VAS coverage in children under 5 years across VAS priority countries.

Study design: We used cross-sectional data from the Demographic and Health Surveys (DHS) program.

Methods: We used data from the DHS program for United Nations Children's Fund -designated VAS priority countries between 2000 and 2017 with data available from 2005 or later. The outcome variable was the proportion of children under 5 years who received a vitamin A dose in each sampled cluster. We applied a Bayesian geostatistical approach incorporating geographic, climatic, and nutritional covariates to estimate VAS coverage for each cell. We estimated and mapped absolute VAS coverage, Bayesian uncertainty intervals, and exceedance probabilities.

Results: Our sample included countries from Latin America and the Caribbean, Asia, and Africa. Most countries had estimated VAS coverage levels <70%, and our exceedance probabilities indicated high certainty that our estimates fell below this threshold in most grid cells. International variations were most notable in the Latin America and the Caribbean region and Africa. Intranational variations were greatest in some South Asian and West and Central African countries.

Conclusions: These prevalence and exceedance maps, especially used with data on indicators of VAS need, could help to improve equity.

Keywords: Child health; Epidemiology; Vitamin A supplementation.