Determinants of vitamin A Adherence in Children Aged 6-59 Months in Murehwa District, Zimbabwe

Abstract

Control of Vitamin A Deficiency (VAD) is a listed essential nutrition action by the Lancet series and Vitamin A Supplementation (VAS) is a cost-effective and proven intervention in the fight against child mortality. Zimbabwe has since 2005 incorporated VAS in its primary health care package as recommended World Health Organization and UNICEF for all countries with high child mortality rates. Despite years of investments, uptake remains suboptimal in Zimbabwe and this study investigated the determinants of vitamin A adherence at individual, household, community, and health system and enabling environment at large in Murehwa District, Mashonaland East Province, Zimbabwe. Murehwa was purposively selected as it has since 2018 launched a Vitamin A task-sharing delivery strategy where Village Health Workers (VHW) have a shared responsibility to supplement and report, together with Health Care Workers based at static facilities. An analytic cross-sectional design which employed quantitative data collection methods was applied in 11 Enumeration areas randomly selected from the 2012 Zimbabwe Statistics Agency (ZIMSTAT) master sample through probability proportional to size. A multistage cluster sampling approach was used to select the 11 EAs, and at second stage, the VHW register was used to create a line list of children in the age range of 6-59 months. Simple random sampling techniques were applied to select 201 primary caregivers where interviews were conducted at household level. Data was collected through interviewer-administered questionnaires programmed in android based hand-held devices and delivered in local language. The proportion of children who had received the recommended dose of VAS was 36.7% while another 70% has received at least one dose in the previous 12 months. Independent factors associated with low uptake of VAS were the caregivers’ level of education (POR=1.5; 95% CI: 1.4-2.0; p=0.046), the age of the child (POR=1.6; 95% CI=(1.3-2.0; p=0.012)), presence of functional difficulties (POR=0.3, 95% CI: =(0.10.8; p=0.027)) and distance to health facilities (POR=3.1; 95% CI: =(1.2-4.2; P=0.042)). Despite good coverage of VHW supported activities, and a good supply of vitamin A capsules, findings show suboptimal coverages, and therefore recommendations suggested here are to address both the service delivery and the demand aspects of VAS.