Academic journal article Journal of Health Population and Nutrition

Coverage of Vitamin A Capsule Programme in Bangladesh and Risk Factors Associated with Non-Receipt of Vitamin A

Academic journal article Journal of Health Population and Nutrition

Coverage of Vitamin A Capsule Programme in Bangladesh and Risk Factors Associated with Non-Receipt of Vitamin A

Article excerpt

INTRODUCTION

Vitamin A deficiency is a major public-health problem in Bangladesh, where it is a leading cause of morbidity, mortality, and blindness among preschool children (1-3). Vitamin A is found as retinyl esters as in egg-yolk, whole milk, butter, and liver, or as provitamin A carotenoids, as in dark green-leafy vegetables, carrots, and red/orange/yellow-coloured fruits. Vitamin A deficiency can result in more severe infections and greater mortality due to diarrhoea and measles, especially in preschool children because vitamin A is essential for normal immune function. It is also essential for growth, reproduction, and vision (4).

Many developing countries worldwide have established programmes to provide periodic supplementation of high-dose vitamin A to increase child survival and reduce the incidence of nutritional blindness. Vitamin A supplementation is one of the most cost-effective interventions for child health (5) and is known to reduce mortality of preschool children by nearly one-quarter (6). The Millennium Development Goals (MDGs) include reducing child mortality by two-thirds between 1990 and 2015 (5,7), and the effective coverage of periodic supplementation programmes of high-dose vitamin A is considered one of the most cost-effective strategies in reaching this goal. The specific aims of this study were to characterize the coverage of the national vitamin A capsule programme in Bangladesh and to identify the factors associated with receipt or non-receipt of a vitamin A capsule within the last six months. For these, we examined population-based, demographic and health survey data from Bangladesh.

MATERIALS AND METHODS

The study subjects included preschool children and their families who participated in the Bangladesh Demographic and Health Survey (BDHS) 2004, a nationally representative survey of 10,500 households selected from 361 clusters throughout Bangladesh (8). The primary objective of the survey was to provide data to monitor the population and health situation in Bangladesh. The survey used a multistage cluster sample that was based upon the 2001 Bangladesh Census, and it produced estimates for six divisions of the country: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, and Sylhet. Data were collected during 1 January-24 May 2004, and the study was conducted under the authority of the National Institute for Population Research and Training of the Ministry of Health and Family Welfare, Government of Bangladesh.

Households were selected by multistage sampling. The primary sampling units for the BDHS 2004 were subdivisions, known as enumeration areas, and the BDHS 2004 sample was a stratified multistage cluster sample consisting of 361 primary sampling units--122 in the urban area and 239 in the rural area (8). The BDHS 2004 used four sets of questionnaire that collected household and demographic information, including whether children aged less than five years (under-five children) in the household had received a vitamin A capsule within the last six months, receipt of tetanus-diphtheriapertussis (DPT), oral poliovirus (OPV), and measles vaccines, and any history of neonatal, infant, or under-five child mortality in the family. For each child, mothers were asked if they had vaccination card for the child, and if so, to show the card to the interviewer. When the card was available, the interviewer entered the dates of immunization into the form in the questionnaire. If the card was not available or vaccinations were not recorded, mothers were asked questions to recall whether the child had received each vaccine. Twelve interviewing teams conducted fieldwork--each team consisting of one male supervisor, one female field editor, five female interviewers, two male interviewers, and one member of the logistics staff. Four quality-control teams of two persons each were used for monitoring the field teams (8).

The study protocol complied with the principles enunciated in the Helsinki Declaration (9). …

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