Unveiling Disparities and Missed Opportunities in Vitamin A Supplementation Among Children Under Five in Ethiopia.

Vitamin A supplementation (VAS) is an effective and low-cost strategy for improving vitamin A status and reducing childhood morbidity and mortality. Ethiopia started nationwide biannual VAS in 2006, but routine VAS coverage consistently remained low, necessitating the use of multiple delivery approaches. This study aimed to determine coverage, existing disparities, and missed opportunities for VAS among children under 5 years of age in Ethiopia. We used the data from Ethiopia's Food and Nutrition Strategy baseline survey, a cross-sectional study conducted between 2021 and 2023. This analysis included a subsample of 8580 children aged 6-59 months. Nationally, routine VAS coverage was 21%, with significant inequalities reflected by the slope inequality index (SII) and concentration index (CIX). A significantly higher VAS coverage was observed among the wealthiest households (SII; CIX: 30.2, 23.0), urban residents (32.3, 13.7), and agrarians (23.7, 6.1) than their counterparts (p < 0.001). VAS coverage was also higher among children from households where the head had attained above secondary education compared to those with no formal education (36% vs. 14%). About 39% of 9-15-month-old children received measles but not VAS, illustrating a missed opportunity as the two interventions are delivered in integration. Such missed opportunities disproportionately affected rural residents, revealing multiple deprivations. The VAS program has faced recent challenges, marked by inequitable coverage and weak service integration. To enhance coverage, equity, and program resilience, it is essential to expand access, tailor delivery approaches, and leverage diverse service contact points.