Demand for vitamin A supplementation among under-five children in Zambia
Kabwe, Fegus Kabaso
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Vitamin A deficiency (VAD) continues to be a major public health nutrition concern in Zambia affecting primarily infants and young children below the age of five years and women of child bearing age. It is estimated at 53 per cent and 13 per cent among the under-five children and women of childbearing age respectively. Among the intervention in place to combat VAD in Zambia are food fortification, dietary diversification and vitamin A supplementation (VAS). Of these interventions, bi-annual mass VAS which is given for free mainly during the bi-annual Child Health Weeks is the main government strategy to reduce VAD in Zambia. However, the uptake of VAS remains low and highly varied across regions despite it being free, making the policy goal of reaching 80 per cent of the target population difficult to achieve in order to significantly contribute to mortality reduction amongst the under-five children in Zambia. This study investigated the demand factors associated with the uptake of VAS among children of 6-59 months old, based on the investment variant of the Grossman‟s health demand model. In addition, the extent of inequality in the uptake of VAS among different socio-economic groups was examined. The study used the 2010 Living Conditions Monitoring Survey dataset collected by the Central Statistical Office. A mixed (multilevel) effects logit model was used to estimate the reduced form of demand for investment time spent on VAS. Concentration curves were used to examine income-related inequality in the demand for VAS programme. Out of the 7 382 children sampled, only 3 151 had responses on whether they did or did not receive VAS. Of these, 74 per cent reported having received vitamin A capsule within the last six months. Age of the child (p<0.001), education level (p=0.031) and employment status (p=0.013) of the mother were the key predictors for VAS demand in this study. Conversely, sex, education level and employment status of the household head were not significant predictors of demand for VAS. In addition, household size, residence and region were also insignificant in this study. However, the study showed a significant between-community level effect in demand for VAS while a small income-related inequality in demand for VAS was found with demand slightly greater among households with the highest income. Improving the education status of women is paramount in increasing the VAS demand. Further, equitable access to VAS should be enhanced through equitable distribution of resources and materials in all regions during each round of Child Health Week. Targeted and strengthened social mobilisation and community sensitisation activities using well-tailored campaign materials vigorously promoting the uptake of VAS among the younger children will be needed for the intervention to achieve its intended goals.