Concurrent coverage and determinants of vitamin A supplementation and deworming among children aged 12-59 months in 15 Sub-Saharan African countries.

The pooled co-coverage of vitamin A supplementation and deworming among children aged 12-59 months was 44.0% across 15 Sub-Saharan African countries.

• Co-coverage was 44.0% (95% CI: 43.4–44.6%) despite individual coverage of 57.1% for each intervention separately.
• Approximately 13% of children received either vitamin A or deworming as a single intervention.
• Nearly 30% of children received neither intervention.
• The sample included 107,725 children aged 12–59 months from DHS data across 15 countries.
• This pooled co-coverage is far below the WHO 80% target.

Co-coverage varied widely across countries, ranging from 10.3% in Sierra Leone to 84.7% in Rwanda.

• Lowest co-coverage was observed in Sierra Leone (10.3%) and Gabon (13.2%).
• Moderate co-coverage was seen in Burkina Faso (28.6%), Côte d'Ivoire (31.0%), Mozambique (44.0%), and Tanzania (44.7%).
• Highest co-coverage was in Lesotho (58.4%) and Rwanda (84.7%).
• VAS coverage alone was lowest in Gabon (15.7%) and Sierra Leone (16.5%) and highest in Rwanda (89.1%) and Lesotho (73.6%).
• Deworming alone was lowest in Sierra Leone (30.3%) and Burkina Faso (36.7%) and highest in Rwanda (89.4%) and Lesotho (62.4%).

Between-country differences accounted for approximately 21.6% of the variance in concurrent coverage, as measured by the intraclass correlation coefficient.

• The intraclass correlation coefficient (ICC) was approximately 21.6%.
• This indicates substantial clustering of co-coverage outcomes at the country level.
• A mixed-effects logistic regression model was used to account for survey design and clustering.

Children aged 24–47 months had higher odds of receiving both interventions concurrently compared to other age groups.

• Children aged 24–47 months had AOR = 1.07 for co-coverage.
• Age was included as an individual-level determinant in the multilevel model.
• Variables with p < 0.20 or deemed theoretically relevant were included; significance threshold was p < 0.05 with 95% CI.

Full immunization status was positively associated with co-coverage of vitamin A supplementation and deworming.

• Fully immunized children had AOR = 1.41 for concurrent coverage.
• This suggests integration with immunization platforms may facilitate co-delivery of VAS and deworming.

Maternal characteristics including older age, education, antenatal care attendance, and media exposure were positively associated with co-coverage.

• AORs for older, educated mothers who attended antenatal care ranged from 1.14 to 1.59.
• Media exposure was associated with AOR = 1.13 for co-coverage.
• These factors operated at the individual and household levels in the multilevel model.

Household wealth was positively associated with concurrent receipt of both interventions.

• AORs for household wealth ranged from 1.27 to 1.64 across wealth quintiles.
• Wealthier households had consistently higher likelihood of co-coverage.

Urban residence was negatively associated with co-coverage of vitamin A supplementation and deworming.

• Urban residence was associated with AOR = 0.84, indicating lower odds of co-coverage compared to rural residence.
• This finding suggests that campaign-based delivery may reach rural areas more effectively than urban areas.

At the country level, Rwanda, Mauritania, and Lesotho had the highest odds of co-coverage compared to Burkina Faso, while Gabon and Sierra Leone had the lowest.

• Compared with Burkina Faso as reference, Rwanda had AOR = 20.05, Mauritania AOR = 4.30, and Lesotho AOR = 3.92.
• Gabon had AOR = 0.36 and Sierra Leone had AOR = 0.22 compared to Burkina Faso.
• These represent inter-country disparities in integrated child health coverage.