BMJ nutrition, prevention & health · 2025
Socioeconomic inequalities in receiving vitamin A supplementation among children 6-59 months in South and Southeast Asia: a population-based study.
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Kundu Satyajit, Adnani Qorinah Estiningtyas Sakilah, Rahman Md Ashfikur, Chowdhury Syed Sharaf Ahmed, Dey Rakhi, Sharif Azaz Bin, Ahmed Faruk
Аннотация
INTRODUCTION: Vitamin A supplementation (VAS) is strongly recommended for children aged 6-59 months to reduce vitamin A deficiency and consequent morbidity and mortality. So, understanding country-specific and regional inequalities in VAS is crucial for targeting high-risk populations in the region. Therefore, we aimed to examine the socioeconomic inequalities in receiving VAS among children aged 6-59 months within and between 11 South and Southeast Asian countries.
METHODS: We used population-representative cross-sectional data from the demographic and health surveys conducted between 2003 and 2022 for 11 South and Southeast Asian countries (Afghanistan, Bangladesh, Cambodia, India, Indonesia, Maldives, Myanmar, Nepal, Pakistan, Philippines and Timor-Leste). We conducted an analysis using the slope index of inequality (SII) and relative index of inequality to measure absolute and relative inequalities in VAS coverage over time.
RESULTS: The prevalence of receiving VAS among children varied from 15.66% in India in 2006 to 87.52% in Nepal in 2006. In most countries, the coverage of VAS disproportionately affected the population with the poorest wealth status and no formal education. Meta-analysis revealed a similar pooled prevalence of receiving VAS in South Asia (66.27%) and Southeast Asia (66.33%). The highest wealth-driven inequality was observed in the Philippines in 2003 (SII 29.26, 95% CI 28.75, 29.76), followed by Indonesia in 2007 (SII 25.30, 95% CI 10.72, 39.88). The highest education-based inequality was manifested in Maldives in 2009 (SII -29.28, 95% CI -33.98, -24.59), followed by Timor-Leste in 2016 (SII 29.26, 95% CI 28.75, 29.76). Overall, most countries' absolute and relative measures of inequalities fluctuated over time.
CONCLUSION: Significant geographical and socioeconomic inequalities in receiving VAS persist in South and Southeast Asian countries, particularly among those with the lowest wealth and without formal education. Using only descriptive analysis limits causal interpretation, and future research should explore underlying drivers using multivariable or longitudinal approaches. VAS programmes should be better tailored to address equity gaps in high-risk groups.
METHODS: We used population-representative cross-sectional data from the demographic and health surveys conducted between 2003 and 2022 for 11 South and Southeast Asian countries (Afghanistan, Bangladesh, Cambodia, India, Indonesia, Maldives, Myanmar, Nepal, Pakistan, Philippines and Timor-Leste). We conducted an analysis using the slope index of inequality (SII) and relative index of inequality to measure absolute and relative inequalities in VAS coverage over time.
RESULTS: The prevalence of receiving VAS among children varied from 15.66% in India in 2006 to 87.52% in Nepal in 2006. In most countries, the coverage of VAS disproportionately affected the population with the poorest wealth status and no formal education. Meta-analysis revealed a similar pooled prevalence of receiving VAS in South Asia (66.27%) and Southeast Asia (66.33%). The highest wealth-driven inequality was observed in the Philippines in 2003 (SII 29.26, 95% CI 28.75, 29.76), followed by Indonesia in 2007 (SII 25.30, 95% CI 10.72, 39.88). The highest education-based inequality was manifested in Maldives in 2009 (SII -29.28, 95% CI -33.98, -24.59), followed by Timor-Leste in 2016 (SII 29.26, 95% CI 28.75, 29.76). Overall, most countries' absolute and relative measures of inequalities fluctuated over time.
CONCLUSION: Significant geographical and socioeconomic inequalities in receiving VAS persist in South and Southeast Asian countries, particularly among those with the lowest wealth and without formal education. Using only descriptive analysis limits causal interpretation, and future research should explore underlying drivers using multivariable or longitudinal approaches. VAS programmes should be better tailored to address equity gaps in high-risk groups.