title: Socioeconomic differentials in supplementation of vitamin A: evidence from the Philippines.
abstract: The efficacy of supplementation of vitamin A in child survival has been well-demonstrated. However, the effectiveness of a programme of vitamin A supplementation at the population level has been rarely examined. Understanding how programmes reach disadvantaged children can help improve the design of initiatives of vitamin A supplementation. The differentials in receipt of vitamin A by socioeconomic status were assessed using data from the Philippines. Factors associated with receipt of vitamin A during the last six months were examined using the Philippines Demographic and Health Surveys conducted in 1993 and 1998. In total, 6,970 and 6,118 children aged 12-59 months were included in 1993 and 1998 respectively. Logistic regression was used for identifying associations between the outcome and the household socioeconomic variables. The coverage of national-level vitamin A supplementation increased from 27% in 1993 to 79% in 1998. However, children whose mothers did not complete primary education and children living in poor households were less likely to receive supplementation. This disparity increased between the surveys: the adjusted odds of vitamin A intake by poor households compared to middle-class households declined from 0.73 [95% confidence interval (CI) 0.61-0.87) in 1993 to 0.52 (95% CI 0.42-0.63)] in 1998, resulting in an increased health inequity. The vitamin A programme in the Philippines was not uniformly successful in reaching the most vulnerable children. Approaches targeting vulnerable households or approaches not requiring mothers to travel to distribution centres may be more promising.
authors.affiliation: Department of Population and Family Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, E4132, Baltimore, MD 21205, USA. ychoi@jhsph.edu
authors.forename: Yoonjoung
authors.initials: Y
authors.lastname: Choi
authors.forename: David
authors.initials: D
authors.lastname: Bishai
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hill
mesh_terms: D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010679:Philippines / Q000453:epidemiology; D011159:Population Surveillance; D015397:Program Evaluation; D012423:Rural Health; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014801:Vitamin A / Q000008:administration & dosage* / Q000600:supply & distribution* / Q000627:therapeutic use; D014802:Vitamin A Deficiency / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D014801:Vitamin A