| dc.description.abstract | Vitamin A deficiency is among the leading and preventable causes of childhood morbidity and mortality that may be attributable to low coverage of Vitamin A Supplementation among children 6-60 months. In Kenya, Vitamin A Deficiency is among the three most common forms of micronutrient deficiency. Vitamin A Supplementation coverage of >80% is recommended by WHO to address this problem. However, the coverage remains low in Kenya (71%). Kilifi County has one of the lowest coverage at 47.4%, with Ganze Sub-County having coverage of 31.3%. Despite the low coverage in Kilifi County and Ganze Sub-County, there exists limited information on its determinants .Most studies on VAS coverage in Kenya have been health facility-based which may not necessarily be representative of the general community. Community based studies are therefore needed to triangulate findings and fully understand VAS determinants within the population. This was therefore a community-based study whose overall objective was to investigate the determinants of Vitamin A Supplementation coverage among children aged 6- 60 months in Ganze Sub- County, Kilifi County, Kenya. The specific objectives were to determine the caregivers’ demographic and socio-economic factors; to assess the caregivers’ knowledge, attitude, and practices factors; to explore the caregivers’ cultural factors and to examine health system-related factors associated with Vitamin A Supplementation coverage among children aged 6-60 months in Ganze sub-county. A cross-sectional study design was used adopting both quantitative and qualitative techniques. For the quantitative survey, a semi-structured questionnaire was administered to 435 randomly sampled caregivers of children aged 6-60 months. The qualitative survey was implemented through key informant interviews (KII) with health workers and policy makers. Quantitative data was analyzed using SPSS version 24 to descriptively generate frequencies and percentages mainly for categorical variables. Chi-square and univariate analyses were done to determine the association between the independent and dependent variables. Variables that were found significant (p-value= <0.05) at this level of analysis were subjected to multivariable logistic regression analysis to identify the main determinants of VAS coverage. The mean age of caregivers was 29.4 (SD=6.8) years while that of the children was 29.7 (SD=15.1) months. Of the children, 228 (52.4%) were female and 207 (47.6%) male. The age-appropriate full VAS coverage was 49.0% and coverage was higher in children 6-11months (50; 89.3%) than in those aged 12-60months 163 (43.0%). Socioeconomic and demographic factors strongly associated with VAS coverage included the age of caregiver (AOR=0.29, 95% CI (0.09, 0.96), P-value=0.042); area of residence (AOR=2.08, 95% CI (1.04, 4.18), P-value=0.039 ) ; age of the child (AOR=0.08, 95% CI (0.03, 0.20), P-value<0.001) and the number of 6-60 months children in the household (AOR=2.11, 95% CI (1.24, 3.59), P value=0.006). From the KIIs, caregivers’ lack of in-depth knowledge on importance of VAS and illiteracy were factors contributing to low coverage. On cultural factors, disapproval of father as the household head was a key determinant of VAS coverage. On health system factors, door to door supplementation by Community Health Volunteers (CHVs) was the most effective approach for VAS delivery. In addition health workers’ friendly approach to the caregiver during VAS delivery (AOR=0.25, 95% CI (0.08, 0.74), P value=0.012 was also significantly associated with VAS. The study therefore recommends the need to increase VAS coverage through implementation of strategies targeting both rural and urban areas, caregivers of all age groups and children above 12 months, involvement of male household heads and knowledge enhancement on VAS for caregivers. There is also need to scale-up and sustain effective approaches and strategies for VAS delivery such as the door-to-door supplementation by CHVs. | en_US |
