The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #54938

Yoonjoung Choi¹, David M. Bishai, MD, MPH, PhD², and Kenneth Hill². (1) Population and Family Health Sciences, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, 410-955-7156, ychoi@jhsph.edu, (2) Department of Population and Family Health Sciences, Johns Hopkins School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205

Background: The efficacy of Vitamin A supplementation in child survival has been well demonstrated. However, the effectiveness of a vitamin A supplementation program at the population level has been rarely examined. Understanding how well real world programs reach disadvantaged children can help improve the design of Vitamin A supplementation initiatives. The primary purpose of the study is to explore differentials in vitamin A receipt by socioeconomic status, using data from the Philippines.

Methods: Factors associated with vitamin A receipt during the last 6 months were examined using the Philippines Demographic and Health Surveys conducted in 1993 and 1998. A total of 6,970 and 6,118 children between 12 to 59 months of age were included in 1993 and 1998, respectively. Logistic regression was used to identify associations between the outcome and household socioeconomic variables.

Findings: National level vitamin A supplementation coverage increased from 27 % in 1993 to 79 % in 1998. However, children whose mothers did not complete primary education and children in poor households were less likely to receive supplementation persistently in both surveys. Especially, the adjusted odds of vitamin A receipt by poor households relative to middle households declined from 0.75 (95% CI: 0.61 - 0.87) in 1993 to 0.52 (95% CI: 0.42 - 0.63) in 1998, resulting in increased health inequity.

Interpretation: The Philippines vitamin A program was not uniformly successful at reaching the most vulnerable children. Approaches targeting the vulnerable households or approaches not requiring mothers to travel to distribution centers may be more promising.

Learning Objectives:

• 3. Recognize high program coverage does not necessarily mean elimination of health inequity.
  6. Identify barriers in utilizing health care services.
  9. Discuss alternate approaches to reach disadvantaged children.

Keywords: International Health, Child Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.