Coverage of vitamin A supplementation, deworming and immunisations: Associations with nutritional status among urban children younger than 5 years in Nelson Mandela Bay, Eastern Cape Province, South Africa

Background. Even though immunisation coverage is tracked through the district health system in South Africa (SA), limited information is available regarding interventions linked to the Expanded Programme on Immunisation (EPI) and the impact on the nutritional status of children <5 years of age.Objectives. To describe coverage of immunisations, vitamin A supplementation and deworming among children <5 years old in an urban area of Nelson Mandela Bay, Eastern Cape Province, SA. A secondary objective was to investigate whether a history of missed immunisations, vitamin A supplementation or deworming was associated with wasting or stunting in children.Methods. A descriptive study was conducted between September 2015 and February 2016, where cross-sectional anthropometrical data were collected from 1 513 children in 32 pre-schools, together with a retrospective analysis of the participants' Road-to-Health/clinic cards to collect data on immunisation, vitamin A and deworming. Participants were categorised into 3-month age intervals to facilitate data analysis. Ethical approval was obtained from the Nelson Mandela University Research Ethics Committee (Human). Results. Data of 1 496 children were included in the analysis. The prevalence of underweight was 2.5% (n=37), while 11.2% (n=167) were stunted and 1.1% (n=16) were wasted. There were associations between age category and delayed vitamin A supplementation (χ2=32.105; df=19; n=836; p=0.03) and deworming (χ2=45.257; df=17; n=558; p<0.001), but there was no association between delayed vaccinations and age category. There were no significant differences in anthropometrical indicators for children with delayed vitamin A supplementation, deworming and vaccinations compared with children in this sample who were up to date regarding the relevant indicators. However, weight-for-age, height-for-age and weight-for-height z-scores and stunting risk were associated with low birthweight (LBW) (odds ratio (OR) 4.658; p<0.001). Conclusion. Coverage of vitamin A supplementation and deworming but not immunisations was poorer among children in older age categories. A history of delayed vitamin A, deworming and vaccinations was not associated with the anthropometrical status of children. Children with LBW should be considered for more rigorous follow-up, as they are at higher risk of stunting.

Providing mothers with mobile phone message reminders increases childhood immunisation and vitamin A supplementation coverage in Côte d'Ivoire: a randomised controlled trial

We conducted a randomized controlled trial to assess the effect of providing mothers with mobile voice or text (SMS) reminder messages on health facility attendance at five infant immunization and vitamin A supplementation (VAS) visits. The study was conducted at 29 health facilities in Korhogo district. Mothers were randomized to receive a voice or text reminder message two days prior to each scheduled visit and two additional reminders for missed doses (n=798; intervention group), or no phone reminder messages (n=798; control group). Infants in the intervention group were 2.85 (95% CI: 1.85-4.37), 2.80 (95% CI: 1.88-4.17), 2.68 (95% CI: 1.84-3.91), and 4.52 (95% CI: 2.84-7.20) times more likely to receive pentavalent 1-3 and MMR/yellow fever doses, respectively, and 5.67 (95% CI: 3.48-9.23) times more likely to receive VAS, as compared to the control group. In the reminder group, 58.3% of infants completed all five visits, compared to 35.7% in the control group (P<0.001). Providing mothers mobile phone message reminders is a potentially effective strategy for improving immunization and VAS coverage in Cote d'Ivoire

Immunisation and Vitamin A Capsule Coverage in a Semi-Urban Area of KwaZulu-Natal Province; South Africa

Background. The Expanded Programme on Immunisation (EPI) in South Africa (SA) has had a large effect on vaccine-preventable illnesses; yet there is little in the literature describing access to and utilisation of the programme beyond 1 year of age. Coverage of vitamin A supplementation is examined through District Health Information System data; but this does not give a fair assessment of the lifetime coverage in a child or provide any correlation with the immunisation status of the child. Objectives. To describe utilisation and dropout rate with the vitamin A and immunisation programmes over the first 6 years of life among children aged 6 - 8 years in a semi-urban population in KwaZulu-Natal (KZN) Province; SA. A secondary objective was to investigate whether access and dropout rates are associated between these two programmes. Methods. A retrospective cohort analysis was performed on 923 anonymised Road-to-Health cards; extracting information on immunisation and vitamin A coverage. Results. Overall; 92.9% (95% confidence interval (CI) 91.2 - 94.6) and 88.5% (95% CI 86.4 - 90.5) of children were fully immunised by 12 months and 18 months of age; respectively. The percentage of children fully immunised by 6 years of age dropped to 44% (95% CI 41.2 - 47.6). The dropout rates for measles; and diphtheria; pertussis and tetanus 1 - 3 vaccination were 2.4% and 1.2%; respectively. Vitamin A had an overall coverage of 34.9% during 6 - 60 months of life for this population; with children receiving; on average; three doses (interquartile range 2 - 5). Conclusion. Despite good immunisation coverage in the first 18 months of life; there was relatively poor vitamin A coverage; suggesting a need for re-evaluation of the current vitamin A capsule distribution programme

Effect of Vitamin A Supplementation on Cause-Specific Mortality in Women of Reproductive Age in Ghana: a Secondary Analysis from the ObaapaVitA trial

Objective:To determine the effect of weekly low-dose vitamin A supplementation on cause-specific mortality in women of reproductive age in Ghana. Methods: A cluster-randomized; triple-blind; placebo-controlled trial was conducted in seven districts of the Brong Ahafo region of Ghana. Women aged 15-45 years who were capable of giving informed consent and intended to live in the trial area for at least 3 months were enrolled and randomly assigned; according to their cluster of residence; to receive oral vitamin A (7500 ?g) or placebo once a week. Randomization was blocked; with two clusters in each fieldwork area allocated to vitamin A and two to placebo. Every 4 weeks; fieldworkers distributed capsules and collected data during home visits. Verbal autopsies were conducted by field supervisors and reviewed by physicians; who assigned a cause of death. Cause-specific mortality rates in both arms were compared by means of random-effects Poisson regression models to allow for the cluster randomization. Analysis was by intention-to-treat; based on cluster of residence; with women eligible for inclusion once they had consistently received the supplement or placebo capsules for 6 months. Findings The analysis was based on 581 870 woman-years and 2624 deaths. Cause-specific mortality rates were found to be similar in the two study arms.Conclusion: Low-dose vitamin A supplements administered weekly are of no benefit in programmes to reduce mortality in women of childbearing age

Control of vitamin A deficiency in Africa

This paper presents a brief summary of vitamin A deficiency and xerophthalmia in Africa; and an overview of strategies for prevention and control. Indeed the epidemiological picture is complex in all dimensions. 18-20 countries in Sub-Saharan or Sahelian zones are estimated to have vitamin A deficiency problem of public health dimensions; and in a few more it is sporadically or occasionally present. Distribution of vitamin A supplements would be organized quite widely in Africa; especially in times of drought and emergencies

The Kamuli district Vitamin A fortification rapid assessment tool Survey for Sugar: an application of the fortification rapid assessment guidelines and Tool (FRAT) in Uganda

In this study; which describes the first documented used of the fortification Rapid Assessment guidelines and Tool (FRAT) in Uganda; a population based; cross-sectional survey to assess the suitability of sugar as a vehicle for vitamin A fortification for Kamuli District