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Introduction: Controlling vitamin A deficiency and soil-transmitted helminth infections are public health imperatives. We aimed at revealing some caregiver and child-related determinants of uptake of vitamin A supplementation and deworming, and examine their programmatic implications in Kenyan context. Methods: A cross-sectional study of randomly selected 1,177 households with infants and young children aged 6-59 months in three of the 47 counties of Kenya. The number of times a child was given vitamin A supplements and dewormed 6 months and one year preceding the study was extracted from mother-child health books. Results: Coverage for age-specific deworming was considerably depressed compared to corresponding vitamin A supplementation and for both services, twice-yearly provisions were disproportionately lower than half-yearly. Univariate and multivariate analyses showed relatively younger children, of Islam-affiliated caregivers (vis a vis Christians) and those who took less time to nearest health facilities as more likely to be supplemented with vitamin A. Similar observations were made for deworming where additionally, maternal and child ages were also determinants in favour of older groups. Other studied factors were not significant determinants. Programmatic allusions of the determining factors were discussed. Conclusion: Key to improving uptake of vitamin A supplementation and deworming among Kenyan 6-59 months olds are: Increasing access to functional health facilities, expanding outreaches and campaigns, dispelling faith-related misconceptions and probably modulating caregiver and child age effects by complementing nutrition literacy with robust and innovative caregiver reminders. Given analogous service points and scheduling, relative lower uptake of deworming warrants further investigations.
Study design and context: Between June and July 2016, data were collected from caregivers of infants and young children aged 6-59 months in a cross-sectional study aimed at benchmarking for vitamin A supplementation and deworming multi-year program – a baseline survey. The study covered 3 (Siaya, Kilifi and Kwale) of the 47 counties. Kilifi and Kwale are adjacent counties in the Coastal region, South Eastern part of the country while Siaya County is in the Nyanza region in the Western part of Kenya. Regions are made up of counties and are for the purpose of DHS and not official administrative boundaries. Sample size determination and sampling: DHS presents vitamin A supplementation and deworming data only up to regional level. Proxy county vitamin A supplementation and deworming coverage values (regional estimates) were the ‘p’ in the Fisher equation [10, 11]. Between the coverage for vitamin A and deworming for each county, one that yielded highest sample size was considered – 366 households in Siaya, 384 in Kilifi and 378 in Kwale County. A contingency of 5% generated a total sample size of 1,184 households of which 7 questionnaires were excluded due to age data inconsistencies and missing data, leaving a total of 1,177 cases for analysis. Where: N = the desired sample size; Z= the standard normal deviate (1.96 for 95% confidence interval); p = the proportion of the under five years old children reached with vitamin A supplementation or dewormed; q = proportion of the population that does not have the characteristic (i.e. 1-p)- the value for q is 1- 0.284 = 0.716; and d = the level of accuracy desired, or sampling error, set at 0.05. A household was defined as a unit of persons who share house or houses, have a common household head and cook and eat from the same pot. Counties are divided into sub-counties, which are further subdivided into wards. A sub-county was selected randomly from every county and half of the wards in it randomly selected. As a result 4-5 wards were covered. The wards were apportioned equal number of households due to lack of ward-level population data. The population data would have essentially allowed for a proportionate approach. Each ward was divided roughly into quadrants using roads or other key landmarks and equal sample size drawn from each quadrant. At the center of each quadrant a direction was randomized by throwing a pen up. All households with children 6-59 months old in the villages in the direction of the pen were considered until the apportioned sample size for that quadrant was achieved. When the data enumerators (research assistants) reached the end of the quadrant without achieving the needed sample size, they determined a different direction and repeated the process to attain the apportioned number of households in that quadrant. Data sets collected: Using structured questionnaires in Swahili (local/national) language, caregivers of children aged 6-59 months were asked to produce their mother-child health books for the enumerators to extract the number of times their children had been given vitamin A supplements and deworming drugs 6 months and one year preceding the survey. Samples of vitamin A supplements and dewormers were carried by enumerators to assist in caregiver recall when the mother-child health books were not available. Also collected was data on maternal knowledge on vitamin A and deworming scheduling (nutrition literacy), distance away from the health facility, maternal education level and other socio-economics data. Data handling and statistical analysis: Coded data was entered into Statistical Package for Social Scientist (SPSS) for windows version 21. The 3 counties were predominantly rural and in resource-poor settings. Due to their relative similarity in economic status, data from the locales were aggregated for analysis of the determinants. Children aged 6-11 and 12-59 months who were given the vitamin A supplements once and twice in the year preceding the survey, respectively, were considered to have been supplemented as scheduled (age-appropriate supplementation). Age-appropriation for vitamin A supplementation allowed for single supplementation indicator. Cross tabulations of proportion supplemented and dewormed with caregiver or child factors were presented with p-values based on Phi and Cramers Statistics and the Odds Ratios (OR) with 95% confidence interval (95% CI). The multivariate regression modelling considered the supplementation or deworming as a dependent variable while the potential determinants as the independent variable while controlling for the locations (counties) and points of care (health facility, ECD Centre or at home), adjusted Odds Ratios (aOR) reported, 95% CI. Ethical considerations: The assessment was approved by the Ministry of Health (Nutrition Division) research committee at national level. Additional approval was obtained from the county-level Ministries of Health. Anonymity and confidentiality of the study participants was ensured throughout the data collection period. Only mothers who consented to the study were interviewed.
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