ABSTRACT
Vitamin A supplementation reduces child morbidity, mortality, and blindness. The coverage of the national vitamin A programme and risk factors for not receiving vitamin A were characterized using data from the Bangladesh Demographic and Health Survey 2004. Of 3,745 children aged 18-59 months, 3,237 (86.4%) received a vitamin A capsule each within the last six months. Children who missed vitamin A were more likely to be stunted (prevalence ratio [PR] 0.97, 95% confidence interval [CI] 0.95-1.00) and come from a family with a previous history of mortality of children aged less than five years (PR 0.95, 95% CI 0.91-0.99). Maternal education of ≥10 years (PR 1.09, 95% CI 1.04-1.13), 7-9 years (PR 1.08, 95% CI 1.04-1.12), and 1-6 years (PR 1.05, 95% CI 1.02-1.08) compared to no formal education was associated with the child not receiving vitamin A in a multivariate model, adjusting for potential confounders. Children missed by the vitamin A programme were more likely to come from families with lower maternal education. Special efforts are required to ensure that the coverage of the national vitamin A programme is increased further so that the most vulnerable children are also better protected against morbidity, mortality, and blindness.
ABSTRACT
Although it has been thought that child immunization programs may miss the children who are in greatest need, there are little published quantitative data to support this idea. We sought to characterize malnutrition and morbidity among children who are missed by the childhood immunization program in Indonesia. Vaccination and morbidity histories, anthropometry, and other data were collected for 286,500 children, aged 12-59 months, in rural Indonesia. Seventy-three point nine percent of children received complete immunizations (3 doses of diphtheria-pertussis-tetanus, 3 doses of oral poliovirus, and measles), 16.8% had partial coverage (1-6 of 7 vaccine doses), and 9.3% received no vaccines. Of children with complete, partial, and no immunization coverage, respectively, the prevalence of severe underweight (weight-for-age Z score < -3) was 5.4, 9.9, and 12.6%, severe stunting (height-for-age Z score < -3) was 10.2, 16.2, and 21.5%, and current diarrhea was 3.8, 7.3, and 8.6% (all p < 0.0001), respectively. In families where the child had complete, partial, and no immunizations, the history of infant mortality was 6.4, 11.4, and 16.5%, and under-five child mortality was 7.3, 13.4, and 19.2% (both p < 0.0001). Expanded programmatic coverage is needed to reach children who are missed by childhood immunizations in rural Indonesia, as missed children are at higher risk of morbidity and mortality.