Determinants of good vitamin A consumption in the 12 East Africa Countries using recent Demographic and health survey

  • PLoS ONE, Volume 18, No. 2 February, Year 2023

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Study Justification:
– Vitamin A deficiency is a common form of micronutrient deficiency in East African countries.
– Limited evidence exists on the determinants of good vitamin A consumption in these countries.
– Understanding the factors that influence vitamin A consumption is crucial for addressing the issue of deficiency.
Study Highlights:
– The study assessed the magnitude and determinants of good vitamin A consumption in 12 East African countries.
– A total of 32,275 study participants were included in the analysis.
– The pooled magnitude of good vitamin A consumption was 62.91%.
– Burundi had the highest proportion of good vitamin A consumption (80.84%), while Kenya had the lowest (34.12%).
– Factors such as women’s age, marital status, maternal education, wealth index, maternal occupation, children’s age, media exposure, literacy rate, and parity were significantly associated with good vitamin A consumption.
Recommendations for Lay Reader and Policy Maker:
– Health education through mass media should be prioritized to increase good vitamin A consumption.
– Enhancing the economic status of women is recommended to improve access to vitamin A-rich foods.
– Planners and implementers should give attention and priority to the identified determinants to enhance good vitamin A consumption.
Key Role Players:
– Health educators and communicators for mass media campaigns.
– Women’s empowerment organizations and initiatives.
– Government agencies responsible for nutrition and public health.
– Non-governmental organizations working on nutrition and food security.
Cost Items for Planning Recommendations:
– Production and dissemination of educational materials for mass media campaigns.
– Training and capacity building for health educators and communicators.
– Support for women’s empowerment programs and initiatives.
– Monitoring and evaluation of interventions to track progress and effectiveness.
– Research and data collection to inform evidence-based interventions.
– Coordination and collaboration among relevant stakeholders and organizations.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study used a recent Demographic and Health Survey (DHS) of twelve East African countries, which provides a large sample size and representative data. The study also employed a multilevel logistic regression model to estimate the association between good vitamin A consumption and various factors. However, the abstract does not provide specific details about the statistical methods used, such as the significance level or the adjustment for confounding variables. Additionally, the abstract does not mention any limitations of the study or potential sources of bias. To improve the evidence, the abstract should include more information about the statistical methods used and address any limitations or potential sources of bias in the study.

Background Vitamin A one of the important micronutrients that it cannot be made in the human body and must be taken from outside the body through the diet. Ensuring that vitamin A is available in any form in sufficient quantities remains a challenge, especially in regions where access to vitamin A-containing foods and healthcare interventions is limited. As a result, vitamin A deficiency (VAD) becomes a common form of micronutrient deficiency. To the best of our knowledge, there is limited evidence on determinants of good Vitamin A consumption in East African countries. Therefore, this study aimed to assess the magnitude and determinants of good vitamin A consumption in East African countries. Methods A recent Demographic and Health Survey (DHS) of twelve East African countries were included to determine the magnitude and determinants of good vitamin A consumption. A total of 32,275 study participants were included in this study. A multilevel logistic regression model was used to estimate the association between the likelihood of good vitamin A-rich food consumption. Both community and individual levels were used as independent variables. Adjusted odds ratio and its 95% confidence interval were used to see the strength of the association. Result The pooled magnitude of good vitamin A consumption was 62.91% with a 95% CI of 62.3 to 63.43. The higher proportion of good vitamin A consumption 80.84% was recorded in Burundi and the smallest good vitamin A consumption 34.12% was recorded in Kenya. From the multilevel logistic regression model, women’s age, marital status, maternal education, wealth index, maternal occupation, children’s age in a month, media exposure, literacy rate, and parity were significantly associated with good vitamin A consumption in East Africa. Conclusion The magnitude of good vitamin A consumption in twelve East African countries is low. To increase good vitamin A consumption health education through the mass media and enhancing the economic status of women is recommended. Planners and implementers should give attention and priority to identified determinants to enhance good vitamin A consumption.

The data was obtained from the measure DHS program at www.measuredhs.com after preparing a concept note about the project. The DHS program collects data across over 90 low- and middle-income countries across the world. The collected data is comparable for each country. The program implemented the same variable code, variable name, manual, data collection tool, and sampling procedure. Therefore, this study was performed according to relevant DHS statistics guidelines [30]. The Demographic and Health Survey (DHS) data were pooled from the 12 East Africa Countries from 2008 to 2017. The recent DHS of Country-specific datasets was extracted during the specified time. The 12 East Africa Countries from which data were extracted include Burundi, Ethiopia, Kenya, Comoros, Madagascar, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. The DHS program adopts standardized methods involving uniform questionnaires, manuals, and field procedures to gather information that is comparable across countries in the world. DHSs are nationally representative household surveys that provide data from a wide range of monitoring and impact evaluation indicators in the area of population, health, and nutrition with face-to-face interviews of women aged 15 to 49. The surveys employ a stratified, multi-stage, random sampling design. Information was obtained from eligible women aged 15 to 49 years in each country. “The DHS program surveyed according to following sampling procedures. The surveys employ a stratified, multi-stage, random sampling design. First stage: Enumeration Areas (EA) are generally drawn from each country’s Census files. Second stage: in each EA selected, a sample of households is drawn from an updated list of households. Information was obtained from eligible women aged 15 to 49 years in each country. Detailed survey methodology and sampling methods used in gathering the data have been reported elsewhere [31]. A total of 32,275 study participants were included in this study. This include Burundi (4,323), Ethiopia(3,240),Kenya(5,576),Comoros(870),Madagascar(1,725),Malawi(1,641),Mozambique(3,500),Tanzania(1,195),Rwanda(3,082),Uganda(1,429),Zambia(3,811),and Zimbabwe(1,877). Missing data were excluded from the analysis. Living children aged 6–23 months living with their mother who consumed foods rich in vitamin A at least one food item among the seven food items (1) Have the child taken eggs in the last 24 hours?2) Have the child taken meat (beef, pork, lamb, chicken, etc.) in the last 24 hours? 3) Have the child taken a pumpkin, carrots, and squash (yellow or orange inside) in the last 24 hours? 4) Have the child taken any dark green leafy vegetables in the last 24 hours? 5) Have the child taken mangoes, papayas, and another vitamin A fruit in the last 24 hours? 6) Have the child was taken liver, heart, and other organs in the last 24 hours? 7) Have the child taken fish or shellfish in the last 24 hours?) at any time in the last 24 hours preceding the interview was declared good consumption of foods rich in vitamin A coded as “1”, whereas, no consumption of foods rich in vitamin A in the 24 hours preceding the interview was poor consumption coded as “0”. Based on known facts and literature the independent variables included in this was two types of variable that are individual-level and community-level variables. Community-level variables Country and residence. The individual-level variables are Age group, marital status, Educational status, literacy level, Occupational status, parity, children’s age in a month, family size and wealth index, breastfeeding status, and media exposure. The data was cleaned by STATA version 14.1 software. Sample weighting was done for further analysis. Since the outcome variable was binary two-level mixed-effects logistic regression analysis was employed. Sampling weight was applied as part of a complex survey design using the primary sampling unit, strata, and women’s weight (V005). The individual and community-level variables associated with good vitamin A consumption were checked independently in the bivariable multilevel logistic regression model and Variables that were statistically significant at a p-value of 0.2 in the bivariable multilevel mixed-effects logistic regression analysis were considered for the individual and community level model adjustments. A total of four models were fitted. The first was the null model with no exposure variables that were used to verify the variation in the community and give evidence to evaluate random effects at the level of community. The second model was the adjustment of the multiple variable models for individual variables and the third model was adjusted to consider factors at the community level. Whereas, in the fourth model, potential candidate variables from individual and community variables were adjusted to the outcome variable. Fixed effects were used to estimate the association between the probability of good vitamin A consumption explanatory variables at community and individual levels and have been expressed as an odds ratio with a 95% confidence interval. For measures of variation (random effects), the intracluster correlation coefficient (CCI), the proportional variation of community variance (VCP), and the median odds ratio (MOR) were used. The MOR is defined as the median of the odds ratio between the zone of greatest risk and the zone with the lowest risk when two zones are randomly selected. The purpose of the Median Odds Ratio (MOR) is to translate the area level variance in the widely used odds ratio (OR) scale that has a consistent and intuitive interpretation. It is computed by; MOR = exp[√(2×Va)×0.6745] [32] Where; VA is the area level variance, and 0.6745 is the 75th centile of the cumulative distribution function of the normal distribution with mean 0 and variance 1. See elsewhere for a more detailed explanation (24). Whereas the proportional change in variance is calculated as [33] Where; where VA = variance of the initial model, and VB = variance of the model with more terms.

Based on the provided information, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and resources on maternal health, including tips for good vitamin A consumption, nutrition advice, and access to healthcare services.

2. Telemedicine: Implement telemedicine services that allow pregnant women to consult with healthcare professionals remotely, reducing the need for travel and improving access to medical advice and support.

3. Community Health Workers: Train and deploy community health workers who can educate and support pregnant women in their communities, including providing information on good vitamin A consumption and connecting them to healthcare services.

4. Public Awareness Campaigns: Launch public awareness campaigns to educate the general population about the importance of good vitamin A consumption during pregnancy and the availability of healthcare services for maternal health.

5. Nutritional Supplements: Develop and distribute affordable and accessible nutritional supplements, such as vitamin A supplements, specifically targeted towards pregnant women in areas with limited access to diverse food sources.

6. Maternal Health Clinics: Establish dedicated maternal health clinics in underserved areas, equipped with trained healthcare professionals and necessary resources to provide comprehensive care, including nutrition counseling and support for good vitamin A consumption.

7. Partnerships with Local Organizations: Collaborate with local organizations, such as community-based groups and NGOs, to leverage their existing networks and resources to improve access to maternal health services and promote good vitamin A consumption.

8. Mobile Clinics: Set up mobile clinics that can reach remote and underserved areas, providing essential maternal health services, including nutrition counseling and supplementation, to pregnant women who may not have easy access to healthcare facilities.

9. Health Education Programs: Implement targeted health education programs in schools, community centers, and other public spaces to raise awareness about the importance of good vitamin A consumption during pregnancy and provide practical tips for achieving it.

10. Policy and Advocacy: Advocate for policy changes and increased government investment in maternal health, including initiatives to improve access to nutritious foods and healthcare services for pregnant women.

These innovations aim to address the challenges of limited access to vitamin A-containing foods and healthcare interventions, ultimately improving maternal health outcomes in East African countries.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health is to focus on increasing good vitamin A consumption in East African countries. This can be achieved through the following strategies:

1. Health Education: Implement comprehensive health education programs that specifically target women of reproductive age and their families. These programs should emphasize the importance of consuming foods rich in vitamin A and provide information on the various food sources that contain this essential nutrient.

2. Mass Media Campaigns: Utilize mass media platforms such as television, radio, and social media to disseminate information about the benefits of vitamin A consumption during pregnancy and postpartum. These campaigns can raise awareness and educate a larger population about the importance of incorporating vitamin A-rich foods into their diets.

3. Economic Empowerment: Enhance the economic status of women in East African countries to improve their access to nutritious foods, including those rich in vitamin A. This can be achieved through initiatives that promote income-generating activities, entrepreneurship, and access to microfinance services.

4. Collaboration with Healthcare Providers: Strengthen collaboration between healthcare providers and community-based organizations to ensure that pregnant women and new mothers receive accurate information and support regarding vitamin A consumption. This can be done through training programs for healthcare professionals and the integration of nutrition counseling into routine antenatal and postnatal care.

By implementing these recommendations, it is expected that the access to maternal health will be improved by increasing good vitamin A consumption among women in East African countries.
AI Innovations Methodology
Based on the provided information, here are potential recommendations to improve access to maternal health:

1. Strengthen Health Education: Implement comprehensive health education programs that specifically focus on promoting good vitamin A consumption among women in East African countries. These programs should utilize mass media platforms to reach a wider audience and provide information on the importance of vitamin A, its food sources, and strategies to incorporate vitamin A-rich foods into daily diets.

2. Enhance Economic Status of Women: Address the economic barriers that hinder access to vitamin A-rich foods by implementing interventions that aim to improve the economic status of women in East African countries. This can be done through initiatives such as microfinance programs, vocational training, and income-generating activities that empower women economically and enable them to afford nutritious foods.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Baseline Data Collection: Collect baseline data on the current status of vitamin A consumption and access to maternal health services in the target East African countries. This can be done through surveys, interviews, and data analysis of existing health records.

2. Intervention Implementation: Implement the recommended interventions, such as health education programs and economic empowerment initiatives, in selected communities or regions within the East African countries. Ensure proper monitoring and evaluation mechanisms are in place to track the progress and effectiveness of the interventions.

3. Data Analysis: Analyze the data collected before and after the implementation of the interventions. Compare the baseline data with the post-intervention data to assess the impact of the recommendations on improving access to maternal health, specifically in terms of vitamin A consumption.

4. Statistical Modeling: Use statistical modeling techniques, such as multilevel logistic regression analysis, to determine the association between the implemented interventions and the likelihood of good vitamin A consumption. Adjust for relevant individual and community-level variables, as identified in the study.

5. Outcome Measures: Calculate outcome measures, such as adjusted odds ratios and their 95% confidence intervals, to quantify the strength of the association between the interventions and improved access to maternal health.

6. Variance Analysis: Assess the variation in outcomes at the community level using measures such as the intracluster correlation coefficient (CCI), proportional variation of community variance (VCP), and median odds ratio (MOR). These measures can help understand the impact of community-level factors on access to maternal health.

7. Interpretation and Recommendations: Interpret the findings of the data analysis and statistical modeling. Based on the results, provide recommendations for scaling up successful interventions and addressing any identified gaps or challenges in improving access to maternal health.

It is important to note that the methodology described above is a general framework and can be further customized based on the specific context and available resources in the East African countries.


Identifiers:
DOI: 10.1371/journal.pone.0281681
Research Areas:
Community Interventions, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
Burundi, Comoros, Ethiopia, Kenya, Madagascar, Malawi, Mozambique, Multi-Countries, Rwanda, Tanzania, Uganda, Zambia, Zimbabwe
Study Design:
Case-Control Study, Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Female
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