Factors associated with coverage of vitamin a supplementation among Bangladeshi children: mixed modelling approach

Abstract

Background: Vitamin A deficiency (VAD) is a prominent and widespread public health problem in developing countries, including Bangladesh. About 2% of all deaths among under-five children are attributable to VAD. Evidence-based information is required to understand the influential factors to increase vitamin A supplementation (VAS) coverage and reduce VAD. We investigated the potential factors affecting VAS coverage and its significant predictors among Bangladeshi children aged 6 to 59 months using the VAS clustered data extracted from the latest Bangladesh Demographic and Health Survey 2014. Methods: Data were analysed using mixed logistic regression (MLR) modelling approach in the generalised linear mixed model framework. The MLR model performs better than logistic regression for analysing the clustered data because of its minimum Akaike information criterion value. The likelihood ratio test showed that the variance component was significant. Therefore, the clustering effect among children was inevitable to use. Results: VAS coverage among under-five children was 63.6%, which is not optimal and below the WHO’s recommendation and the country’s target of 90%. Children aged 25 to 36 months (AOR = 2.07, 95% CI: 1.711 to 2.513), who had higher educated mothers (AOR = 1.37, p = 0.033, 95% CI: 1.026–1.820) and fathers (AOR = 1.32, p = 0.027, 95% CI: 1.032–1.683), whose mothers had media exposure (AOR = 1.22, p = 0.006, 95% CI: 1.059–1.408) and NGO membership (AOR = 1.24, p = 0.002, 95% CI: 1.089–1.422) were more likely to consume VAS. Conclusion: The relevant authorities should create proactive awareness programs for highly vulnerable local communities, specifically targeted to educate the children’s mothers about the necessity and benefits of childhood nutrition.