Validation of Vitamin A Supplementation Coverage Using Post-event Coverage Surveys in 11 Sub- Saharan African Countries.

Objectives: Twice-yearly child health days (CHDs) have had remarkable success reaching children twice-yearly with life-saving interventions, including vitamin A supplementation (VAS). In 2012, over 80% of targeted children in Sub-Saharan Africa received VAS according to tally-sheet data. All countries implementing CHDs use tally-sheet data to measure coverage; however, coverage measured from tally-sheets is prone to errors due to inaccurate census data, incorrect tallying and mathematical errors totaling coverage across districts and regions. Methods: To validate coverage reported by tally-sheets, Helen Keller International implemented Post-Event Coverage Surveys (PECS) using a 30x30 cluster design and standard WHO EPI cluster sampling methodology in 11 countries in sub-Saharan Africa. For each survey, 900 caretakers of children 6-59 months were interviewed within six weeks of CHDs to reduce recall bias. Results: Thirty-five post event coverage surveys were conducted between January 2010 and July 2013. PECS coverage was lower than administrative coverage in 33/35 (94%) of cases. PECS and administrative coverage data were within a 5% margin of difference in 5 cases (14%), and within >5-10% in 8 cases (23%). However, in 11 cases (31%), results differed by >10-20%, and in 11 cases (31%), results differed by 21-82%. Conclusions: PEC surveys indicate considerable over-reporting of coverage by tally-sheets and provide critical data that is essential to evaluate and improve VAS distribution during CHDs. The continued use of PEC surveys is recommended in areas where tally-sheet data has not been confirmed or has been shown to be unreliable.

Reaching the Hard to Reach with Vitamin A Supplementation in Low-performing Health Zones of DR Congo.

Objectives: Since 2002, mass campaigns have been held twice-yearly to reach children 6-59 months with vitamin A supplementation (VAS) and deworming, with coverage consistently over 80% in the majority of DR Congo's 515 health zones (HZ). However, between 2006-2010, 25 HZ achieved coverage <80% in at least 4/10 rounds, and were selected for formative research to identify barriers and motivators to receipt of VAS and inform delivery strategy. Methods: Based on the formative research findings, a communication strategy was implemented to address barriers (husband disapproval, rumors, access to services) and motivators (will of God, self-motivation) in six low-performing HZ. A post-event coverage survey was conducted in December 2012 after two rounds of implementation using a WHO EPI methodology 30x30 cluster design to evaluate the effectiveness of these activities and identify remaining barriers to receipt. Results: Eighty-five percent of caretakers reported their child received VAS during the last campaign (n=909) compared with administrative coverage of 104% and previous round administrative coverage of 72.8%. The primary sources of campaign information were town criers (65%), television (40%) and radio (40%). The most commonly cited reason for not receiving VAS was that the caretaker or child was not home when the distributors passed (37%). Conclusions: Use of criers and television/radio spots broadcast in local languages were most effective in increasing awareness of the campaigns. Both community and national radio and television stations played a variety of communication advertisements prior to and during the campaign, which helped achieve coverage of over 80% to meet child mortality reduction guidelines.