COVID-19 concerns among caregivers and vitamin A supplementation coverage among children aged 6-59 months in four countries in Western sub-Saharan Africa

Objective:To assess child vitamin A supplementation (VAS) coverage in 2019 and 2020 and explore key factors, including COVID-19 concerns, that influenced VAS status in four sub-Saharan African countries. Design:Data from eight representative household surveys were used to assess VAS coverage. Multivariable logistic regression models examined the effect of rural/urban residence, child sex and age, caregiver education, COVID-19 concern and household wealth on VAS status. Setting:Nine (2019) and 12 (2020) districts in Burkina Faso, Cote d'Ivoire, Guinea and Mali. Participants:28 283 caregivers of children aged 6-59 months. Results:Between 2019 and 2020, VAS coverage increased in Burkina Faso (82 & BULL;2-93 & BULL;1 %), Cote d'Ivoire (90 & BULL;3-93 & BULL;3 %) and Mali (76 & BULL;1-79 & BULL;3 %) and decreased in Guinea (86 & BULL;0 % to 81 & BULL;7 %). Rural children had a higher likelihood of VAS uptake compared with urban children in Burkina Faso (adjusted OR (aOR) = 4 & BULL;22; 95 % CI: 3 & BULL;11, 5 & BULL;72), Cote d'Ivoire (aOR = 5 & BULL;19; 95 % CI: 3 & BULL;10, 8 & BULL;70) and Mali (aOR = 1 & BULL;41; 95 % CI: 1 & BULL;15, 1 & BULL;74). Children aged 12-59 months had a higher likelihood of VAS uptake compared with children aged 6-11 months in Cote d'Ivoire (aOR = 1 & BULL;67; 95 % CI: 1 & BULL;12, 2 & BULL;48) and Mali (aOR = 1 & BULL;74; 95 % CI: 1 & BULL;34, 2 & BULL;26). Moderate-to-high COVID-19 concern was associated with a lower likelihood of VAS uptake in Cote d'Ivoire (aOR = 0 & BULL;55; 95 % CI: 0 & BULL;37, 0 & BULL;80). Conclusion:The increase in VAS coverage from 2019 to 2020 suggests that COVID-19 concerns may not have limited VAS uptake in some African countries, though geographic inequities should be considered.