Key failure factors in Vitamin A Supplementation: Lessons from Nigeria

Background: Vitamin A deficiency remains prevalent among children under 5 years in Nigeria and vitamin A supplementation (VAS) is organized bi-annually during Maternal, Newborn, and Child Health Week campaigns. In 2021, Helen Keller International, Nigeria, supported the implementation of two rounds of VAS campaigns in six states covering approximately 5 million children each. The aim of this research was to assess VAS coverage and identify factors affecting coverage and campaign success. Methods: Post-event coverage surveys (PECS) were administered after the second round of VAS to determine coverage and highlight factors affecting coverage. Using the WHO population probability to size, 30 households, one community leader, and one health worker, from 30 communities each were randomly sampled and interviewed in Akwa-Ibom, Benue, and Nasarawa states (2880 persons in total). Data was collected by trained enumerators using ODK (Open Data Kit) and analyzed using thematic analysis techniques and descriptive statistics. Results: A total of 2,433,117 children in the three states (target = 2,807,261) received VAS during the second round. Coverage in Akwa-Ibom, Benue, and Nasarawa states was 64.1%, 68.1% and 76.1%, respectively. Factors affecting coverage include (i) poor community mobilization for the MNCHW which was most frequently cited, (ii) late arrival of commodities and insufficient commodities due to inadequate health worker forecasting capacity, (iii) insecurity and communal clashes which made some communities inaccessible, (iv) disruption due to other competing interventions i.e., Covid-19 mass vaccination campaign, (v) shift from door-to-door implementation strategy (started in 2020 due to the covid-19 pandemic) back to facility-based supplementation. Conclusion: VAS coverage was moderate and fell below the effective coverage of 80% in the 3 states assessed. Factors affecting coverage were related to the program, health system, and insecurity. Adequate community mobilization, proper planning, coaching of health workers, and integration of VAS with other health activities can mitigate these factors and potentially increase coverage.