Last Updated: 22/07/2024

Improving vitamin A coverage through co-implementation with seasonal malaria chemoprevention: Applying an effective, integrated health campaign in Nigeria

Objectives

To design and implement in collaboration with key stakeholders, an integrated seasonal malaria chemoprevention (SMC) plus vitamin A supplementation (VAS) campaign at scale and in diverse settings (rural and urban) in Bauchi state as part of the existing SMC program.
To assess the feasibility (including effectiveness, equity, efficiency, safety and cost) and acceptability of integrating VAS with SMC among caregivers, CDDs and health workers as well as policy makers.
To develop and implement a research uptake plan
To provide policy makers and stakeholders with a body of evidence to inform decision about integrated SMC and VAS in Nigeria

Principal Institution

Principal Investigators / Focal Persons

Rationale and Abstract

About 190 million children under five are affected by vitamin A deficiency (VAD) globally while in Nigeria, the prevalence of VAD among children under-5 was estimated to be about 30% – a “severe public health problem”. VAD is considered a major risk factor for child survival as children with clinical signs of vitamin A deficiency are 3-12 times more likely to die than those non-deficient. High-dose vitamin A supplementation (VAS) delivered twice per year is a proven low-cost intervention which can reduce all-cause mortality in children by 24%. Consequently, WHO has recommended bi-annual high-dose VAS given every 4-6 months to children aged 6-59 months who are at risk of VAD.

VAS campaigns in place in Nigeria has largely been ineffective. A UNICEF assessment (2016) revealed that poor implementation of the strategy for the Maternal New Born and Child Health (MNCH) week among the states as per guidelines and no evidence was found that the Week significantly contributed to coverage of essential MNCH interventions. In 2018, VAS coverage in Nigeria was 45% with wide variations sub-nationally, ranging from 6 to 86% – suggesting inequity in coverage. The number of states meeting the effective coverage threshold of 70% has been on the decline since 2014. Addressing the poor coverage of VAS among this vulnerable group is key for child survival in Nigeria and critical for universal health coverage.

Integrating community interventions for multiple diseases increases coverage, improves health outcomes, and is cost-effective. VAS has been delivered as a plus during the National Immunization Plus Days riding on the polio vaccine delivery, however, with the success of the Global Polio Eradication program, this platform is no longer a viable option in Nigeria. Seasonal malaria chemoprevention (SMC), a recent strategy to prevent malaria deaths and infection in the Sahel region, introduced in Nigeria in 2013 provides an existing viable and promising platform within which VAS could be fully integrated to achieve higher coverage. SMC is the intermittent administration of full treatment courses of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) to children 3-59 months during the period of high seasonal malaria transmission. SMC is delivered using a door-to-door strategy, where teams of community drug distributors (CDDs) visit each household.

Study Design

An implementation research study using a convergent mixed methods approach to test the integration of VAS with an SMC program on a larger scale, providing information to fill knowledge gaps and provide pragmatic evidence that can be used to inform policy adoption and subsequent scale-up or expansion.

Project Outputs

Research brief: Improving coverage of vitamin A supplementation through integration with seasonal malaria chemoprevention delivery

External reference

Project Brief

Thematic Categories

Drug-based Strategies
Social Science

Date

Apr 2021 — Jun 2022

Total Project Funding

$150,000

Funding Details

Bill and Melinda Gates Foundation (BMGF), United States