Vitamin A Supplementation in Madagascar: Coverage and Multifaceted Analysis of Influencing Factors During Transition to Routine Mode

Abstract

Vitamin A supplementation (VAS) is a key public health intervention to reduce child mortality and morbidity. In Madagascar, the VAS program has transitioned from a vertical program to integration into the routine health system (RHS). This study assesses the coverage of VAS and its associated factors during the last campaign mode and first implementation into routine. A national cross-sectional household survey selected 4410 households using multistage random sampling. After consent, mothers of children aged 6–59 months were interviewed using a pre-tested questionnaire. In addition to socioeconomic and program information from selected communities, 2,972 children aged 6-59 months were verified for vitamin A capsule uptake within the six months before the survey and during the April 2019 campaign. Bivariate analysis and multilevel mixed logistic regression were used to estimate VAS coverage and its associated factors. Overall, VAS coverage was 79.1% (CI 95%: 76.6%-82.0%) in the campaign and 50.6% (CI 95%: 47.7%-53.5%) in routine mode. In regression analysis adjusted for confounders, community exposure to mass media campaigns on VAS, Vitamin A knowledge, Antenatal care visits, household wealth index, and urban residence were positively associated with VAS uptake in routine mode. In contrast, the number of children under 5 per household and age was negatively associated. This study suggests that VAS coverage in Madagascar is suboptimal and that improving the identified socioeconomic and programmatic factors associated with VAS uptake is recommended. These findings can inform strategies to increase VAS coverage during the transition to the RHS.