Abstract：
Vitamin A deficiency affects an estimated 29% of all children under 5 years of age in low/middle-income countries, contributing to child mortality and exacerbating severity of infections. Biannual vitamin A supplementation (VAS) for children aged 6-59 months can be a low-cost intervention to meet vitamin A needs. This study aimed to present a framework for evaluating the equity dimensions of national VAS programmes according to determinants known to affect child nutrition and assist programming by highlighting geographical variation in coverage.
We used open-source data from the Demographic and Health Survey for 49 countries to identify differences in VAS coverage between subpopulations characterised by various immediate, underlying and enabling determinants of vitamin A status and geographically. This included recent consumption of vitamin A-rich foods, access to health systems and services, administrative region of the country, place of residence (rural vs urban), socioeconomic position, caregiver educational attainment and caregiver empowerment.
Children who did not recently consume vitamin A-rich foods and who had poorer access to health systems and services were less likely to receive VAS in most countries despite potentially having a greater vitamin A need. Differences in coverage were also observed when disaggregated by administrative regions (88% of countries) and urban versus rural residence (35% of countries). Differences in vitamin A coverage between subpopulations characterised by other determinants of vitamin A status varied considerably between countries.
VAS programmes are unable to reach all eligible infants and children, and subpopulation differences in VAS coverage characterised by various determinants of vitamin A status suggest that VAS programmes may not be operating equitably in many countries.
We used open-source data from the Demographic and Health Survey for 49 countries to identify differences in VAS coverage between subpopulations characterised by various immediate, underlying and enabling determinants of vitamin A status and geographically. This included recent consumption of vitamin A-rich foods, access to health systems and services, administrative region of the country, place of residence (rural vs urban), socioeconomic position, caregiver educational attainment and caregiver empowerment.
Children who did not recently consume vitamin A-rich foods and who had poorer access to health systems and services were less likely to receive VAS in most countries despite potentially having a greater vitamin A need. Differences in coverage were also observed when disaggregated by administrative regions (88% of countries) and urban versus rural residence (35% of countries). Differences in vitamin A coverage between subpopulations characterised by other determinants of vitamin A status varied considerably between countries.
VAS programmes are unable to reach all eligible infants and children, and subpopulation differences in VAS coverage characterised by various determinants of vitamin A status suggest that VAS programmes may not be operating equitably in many countries.
摘要：
目标：在低收入/中等收入国家，维生素A缺乏影响到所有5岁以下儿童的估计29%。导致儿童死亡率和加重感染的严重程度。对于6-59个月的儿童，每半年补充维生素A（VAS）可以是满足维生素A需求的低成本干预措施。这项研究旨在提供一个框架，用于根据已知影响儿童营养的决定因素评估国家VAS计划的公平层面，并通过强调覆盖范围的地理差异来协助计划。
方法：我们使用了来自49个国家的人口与健康调查的开源数据，以确定不同即时数据特征的亚人群之间的VAS覆盖率差异。维生素A状况和地理上的潜在和有利决定因素。这包括最近食用富含维生素A的食物，获得卫生系统和服务，国家行政区域,居住地(农村vs城市)，社会经济地位,护理人员教育程度和护理人员赋权。
结果：在大多数国家，最近没有食用富含维生素A的食物以及获得卫生系统和服务的机会较差的儿童接受VAS的可能性较小，尽管可能有更大的维生素A需求。按行政区（88％的国家）和城市与农村居住地（35％的国家）分类时，也观察到了覆盖率的差异。以维生素A状况的其他决定因素为特征的亚群之间的维生素A覆盖率差异很大。
结论：VAS计划无法覆盖所有符合条件的婴儿和儿童，以维生素A状况的各种决定因素为特征的VAS覆盖率的亚种群差异表明，在许多国家，VAS计划可能无法公平运行。
方法：我们使用了来自49个国家的人口与健康调查的开源数据，以确定不同即时数据特征的亚人群之间的VAS覆盖率差异。维生素A状况和地理上的潜在和有利决定因素。这包括最近食用富含维生素A的食物，获得卫生系统和服务，国家行政区域,居住地(农村vs城市)，社会经济地位,护理人员教育程度和护理人员赋权。
结果：在大多数国家，最近没有食用富含维生素A的食物以及获得卫生系统和服务的机会较差的儿童接受VAS的可能性较小，尽管可能有更大的维生素A需求。按行政区（88％的国家）和城市与农村居住地（35％的国家）分类时，也观察到了覆盖率的差异。以维生素A状况的其他决定因素为特征的亚群之间的维生素A覆盖率差异很大。
结论：VAS计划无法覆盖所有符合条件的婴儿和儿童，以维生素A状况的各种决定因素为特征的VAS覆盖率的亚种群差异表明，在许多国家，VAS计划可能无法公平运行。
