Community knowledge, attitudes, and preferences towards vitamin A supplementation in a semi-rural health zone, Kasai Oriental, Democratic Republic of the Congo: a mixed-methods study.

The vast majority of caregivers had low vitamin A knowledge scores in this semi-rural DRC community.

• 95.5% of respondents had relatively low knowledge scores (≤4)
• Survey included 420 caregivers of children under age 5 using multi-stage sampling
• Primary respondents were mothers/caregivers of children under 5 years old
• Negative binomial regression analysis was used to determine factors associated with vitamin A knowledge scores using Stata 17

Father's level of education was positively associated with caregiver knowledge about vitamin A supplementation.

• Adjusted incidence rate ratio (aIRR) = 1.35, 95% confidence interval [1.02–1.78]
• This association was statistically significant
• Knowledge was measured as a score in the quantitative survey among 420 caregivers
• The association was identified through negative binomial regression analysis

Receiving information from community health workers was positively associated with higher caregiver knowledge scores about vitamin A supplementation.

• Adjusted incidence rate ratio (aIRR) = 1.56, 95% confidence interval [1.08–2.23]
• This was statistically significant and represents a stronger association than father's education level
• Community health workers were identified as a key source of vitamin A supplementation information in the community
• This finding was consistent across both qualitative and quantitative components of the study

Community members held positive attitudes toward vitamin A supplementation despite low knowledge levels.

• Qualitative data included in-depth interviews with community leaders and focus-group discussions with parents (n = 79)
• Positive attitudes were identified through thematic analysis supported by NVivo 14
• Positive attitudes coexisted with low knowledge scores (≤4) in 95.5% of respondents
• A sequential mixed-methods approach was used to capture both attitudes and knowledge

Community members expressed equal preference for receiving vitamin A supplementation at health centres and at households.

• Administration at health centres and at households were equally denoted as the preferred approaches
• Preferences were identified through qualitative methods including focus-group discussions and in-depth interviews
• Participants included community leaders and parents (n = 79) in qualitative components
• This dual preference suggests community receptiveness to multiple delivery modalities

Strengthening community health worker competence and community interactions was identified as a key factor for successful vitamin A supplementation delivery.

• Community health workers played a key role in informing the community regarding vitamin A supplementation
• The study was conducted in a semi-rural Health Zone in Kasaï-Oriental province, DRC
• Improving community health worker capacity was identified as a lever to improve both knowledge and vitamin A coverage among children under 5
• Awareness was described as 'an important facilitatory factor in acceptance'