Coverage of vitamin A supplementation among under-five children in India and its relationship with childhood mortality: insights from multiple rounds of a nationally representative survey from 2005-2006 to 2019-2021.

Abstract

We investigated the coverage of childhood vitamin A supplementation (VAS) across India from 2005-2006 to 2019-2021 and further explored how it related to childhood mortality. Data collected from mothers through standard questionnaires during the latest three rounds of the National Family Health Survey (2005-2006, 2015-2016 and 2019-2021) were used. Information on VAS in children aged 9-35 months was available from 2015-2016 to 2019-2021. Information on VAS among children aged 9-59 months was available from 2005-2006 to 2015-2016. Childhood VAS coverage was determined nationally and subnationally (viz. individual states, geography, socio-demographic index and developmental groups). Nearly 40 % eligible children aged 9-59 months and 30 % eligible children aged 9-35 months missed VAS during recent times. But improvements in VAS coverage were noticed over the years: from 18·6 % (2005-2006) to 60·5 % (2015-2016) among children aged 9-59 months and from 64·5 % (2015-2016) to 71·2 % (2019-2021) among children aged 9-35 months. There were coverage disparities, with Western India documenting the highest and Northeastern India documenting the lowest coverage values. During simple linear regression analysis, childhood mortality between 1 and 5 years of age varied inversely as a function of VAS coverage among children aged 9-59 months, with the association being less pronounced in 2015-2016 (β = -0·47) than in 2005-2006 (β = -0·40). However, this relationship disappeared when we accounted for potential confounders (viz. childhood immunisation and socio-economic factors) through multivariate analysis, suggesting that the role of VAS in promoting childhood survival may be limited during present times.