Trends and socioeconomic inequalities in receiving vitamin A supplementation among children aged 6-59 months in Bangladesh: analysis of nationwide cross-sectional data from 2004 to 2017.

Introduction: The coverage of vitamin A supplementation (VAS) is still short of the target set by the government to reach 90% coverage of VAS in Bangladesh. The present study aims to examine the socioeconomic and geographical inequalities in receiving VAS among children aged 6-59 months in Bangladesh from 2004 to 2017.

Methods: The Bangladesh Demographic and Health Surveys for the years 2004-2017 were accessed through the WHO's Health Equity Assessment Toolkit. Inequalities were explored from socioeconomic and geographical perspectives. Specifically, it considered wealth quintile and education as socioeconomic dimensions and place of residence as geographical dimensions. We calculated difference, population attributable fraction (PAF), population attributable risk (PAR) and ratio as summary measures and their associated 95% CIs to quantify and assess the extent of health disparities.

Results: The study revealed a fluctuating trend over the years in the prevalence of receiving VAS among children in Bangladesh. The prevalence shifted from 78.68% in 2004 to a low of 62.09% in 2011, subsequently increasing to 79.29% in 2017. The PAF in 2017 for the variable wealth was 4.61 (95% CI 2.38 to 6.85), highlighting the extent of the disparity that favoured wealthier individuals. The study also detected inequalities based on educational levels; in 2017, the difference measure of inequality was 9.24 (95% CI 3.69 to 14.79), indicating a notable advantage for children from the higher educated group. Children from urban areas were also observed to have a higher likelihood of receiving VAS compared with their rural counterparts.

Conclusion: This study identified a persistent regional inequality in receiving VAS in Bangladesh over time. These inequalities remained a concern, especially for children from poor wealth groups, low-educated families and rural regions. This understanding will inform the development of a comprehensive programme aimed at increasing the prevalence of VAS among all children in Bangladesh.