Understanding facilitators and barriers to vitamin A supplementation uptake among children under five in the Kasaï-Oriental province, Democratic Republic of the Congo: a qualitative study.

Background: Vitamin A deficiency (VAD) is a major public health problem in sub-Saharan Africa. Vitamin A supplementation (VAS) - the main strategy used to combat VAD - does not have optimal coverage in the Democratic Republic of the Congo, and several disparities exist between provinces, particularly in the health zones of Kasaï-Oriental province. Over two decades since the implementation of the VAS, no evaluation has been carried out to improve this strategy compared to other countries. This study aimed to identify the facilitators and barriers of the VAS campaigns conducted in Kasaï-Oriental province, aiming to enhance the overall comprehension of implementation challenges and opportunities in similar low-resource environments.

Methods: A qualitative exploratory approach was used, involving stakeholders at national, provincial, health zone, and community levels. It comprised key informant interviews, in-depth interviews, and focus groups. Inductive thematic analysis was carried out, supported by NVivo 14 software.

Results: Several factors were recognised as facilitators of VAS, including heightened awareness of its benefits, the communication strategies employed during campaigns, and the properties of vitamin A supplements. Conversely, this strategy was impeded at the community level by certain beliefs, lack of motivation of healthcare providers, and insufficient vitamin A capsules.

Conclusion: This study identified facilitators and barriers to VAS affecting the current VAS programme. Interventions will need to address barriers related to the health system and the community level by increasingly involving relevant stakeholders in VAS implementation.