Vitamin A supplementation programmes are missing children from scheduled castes and scheduled tribes. New evidence from India

Abstract

Surveys have indicated that 62 % of preschool-age Indian children suffer from sub-clinical vitamin A deficiency (VAD), with a threefold higher prevalence of severe forms of VAD among children from schedule castes (SC) or schedule tribes (ST). The objective of this analysis is to assess whether India’s national vitamin A supplementation (VAS) programme is reaching the districts with higher concentration of SC/ST children in the seven states with the largest burden of under-five mortality (74 % of India’s under-five deaths). Disaggregated analyses of trends in and outcome VAS coverage and full VAS coverage were conducted between 2006 and 2011 by state and SC/ST concentration quintile using three data sources—India’s national VAS programme, Office of the Registrar General and Census Commissioner, and District-Level Household Survey—to compute exposure (SC and/or ST concentration) and outcome (VAS coverage and full VAS coverage) were conducted. Between 2006 and 2011, all SC/ST concentration quintiles reported significant increases in full VAS coverage (two doses/child/year). The mean full VAS coverage over the 6-year period was positively correlated with the SC/ST concentration quintile: the district quintile with the highest concentration of SC/ST households reported the highest full VAS coverage (62.5 %), while the district quintile with the lowest concentration of SC/ST households reported the lowest coverage (47.9 %). The estimated number of children not fully covered by the VAS programme decreased by 39.0 % among children from SC/ST households and by 51.7 % among children from non-SC/ST households. The mean annual number of SC/ST children not fully covered was similar across SC/ST concentration quintiles (1.1 to 1.3 million). Indian states have achieved significant progress in expanding the coverage of the VAS programme. However, a large proportion of children are not benefitting from this child survival intervention, particularly among SC/ST children. These children are potentially among the most vulnerable to VAD and its consequences. India’s national VAS programme needs to be strengthened in sub-district-level units (i.e. blocks and villages) with higher concentrations of SC/ST children, with particular emphasis on SC children.