Estimates Of Vitamin A Supplementation . - UNICEF DATA
Estimates of Vitamin ASupplementation Coveragein Preschool-age ChildrenMethods and processes for the UNICEF global databaseMETHODS AND PROCESSES FOR THE UNICEF GLOBAL DATABASEA
Estimates of Vitamin ASupplementation Coveragein Preschool-age ChildrenMethods and processes for the UNICEF global database
AcknowledgementsThis report was prepared by UNICEF’s Nutrition Section (Programme Division) andthe Data and Analytics section, Division of Data, Analytics, Planning and MonitoringContributorsJulia Krasevec, Erin Mclean, Jessica White, Andreas Hasman, Annette Imohe,Richard Kumapley, David Brown, Elizabeth Alden and Nita DalmiyaStrategic AdviceVíctor M. Aguayo, France Bégin, Mark Hereward, Chika HayashiEditorial supportNaomi Lindt (copy-editing), Nona Reuter (design)This report was made possible with the financial support of the Government ofCanada provided through Global Affairs Canada. United Nations Children’s Fund (UNICEF)March 2020Permission is required to reproduce any part of this publication. Permissions will befreely granted to educational or non-profit organizations.Please contact:UNICEFNutrition Section, Programme Division andData and Analytics, Division of Data, Analytics, Planning and Monitoring3 United Nations PlazaNew York, NY 10017, USAFor the latest data, please visit: deficiency/ Suggested citation:United Nations Children’s Fund, Estimates of Vitamin A Supplementation Coveragein Preschool-age Children: Methods and processes for the UNICEF global database,UNICEF, New York, 2020.Cover photo: UNICEF/Frank Dejongh
CONTENTS1. INTRODUCTION22. INDICATORS AND DATA SOURCES4A. Indicators of vitamin A supplementation coverage4Indicators from administrative data4Indicators from survey data4B. Administrative vitamin A supplementation coverage data:Sources and challenges6Sources of administrative data6Challenges of administrative data63. GLOBAL-LEVEL DATA COLLECTION, PROCESSING AND DISSEMINATION8A. Requesting data from countries8B. Reviewing data for completeness, quality and consistency9C. Calculating semester-wise coverage12D. Calculating annual two-dose vitamin A supplementation coverage13E. Final review13F. Dissemination134. CONCLUSION14References16Annex 1: UNICEF Vitamin A Supplementation Coverage Reporting FormMain Questions17Annex 2: Detailed review steps for completeness, quality and consistency19
1INTRODUCTIONVitamin A deficiency (VAD), for which the healthimplications are well described [1,2], remains apublic health problem in many low- and middleincome countries [3,4]. Though the globalprevalence of VAD in children under the age of 5years has declined from approximately 39 per centto 30 per cent over the past two decades, littleprogress has been achieved in South Asia and subSaharan Africa, where the deficiency still affects44 per cent and 48 per cent of children under 5years, respectively [2].First targeted by global initiatives such as the WorldSummit for Children (1990), VAD control continuesto be an important part of an intervention packageto reduce preventable deaths, a key SustainableDevelopment Goal. To thwart the public healthconsequences of deficiency, the World HealthOrganization (WHO) currently recommends thatperiodic, high-dose vitamin A supplements of100,000 international units (IU) be given to infantsaged 6–11 months and 200,000 IU to children aged12–59 months in high risk areas. Ideally, childrenreceive their first dose soon after they turn 6months and get subsequent doses every four tosix months until the last dose [6] is administeredbetween 54 and 59 months of age.As vitamin A supplementation (VAS) does notaddress the underlying causes of VAD and its effectis temporary, some countries are scaling up effortsto address dietary intake [5] and other underlyingcauses of poor vitamin A status, such as repeatedinfections due to poor hygiene. However, theseefforts have been insufficient to entirely eliminatethe need for supplementation [6,7]. Throughcollaborative efforts with partners, the UnitedNations Children’s Fund (UNICEF) plays a lead rolein supporting countries to reach children aged 6–59months with two appropriately spaced high-dosevitamin A supplements each year.d4ceapA ASemester 1Semester 2AAspace(July–December)uliolpro t e c tart(January–June) FTwo high-dosesupplements/yearfrom the age of6 months to59 monthsto 6 months apartnsSupplementation with high-dose vitamin A boosts immunity andprovides life-saving protection, but only when provided every four tosix months.apd4to 6 m o n t h sEstimating coverage for two semesters (semester 1 [January to June] andsemester 2 [July to September]) in a calendar year is required to generatean estimate of full protection.Figure 1: Vitamin A supplementation: two appropriately-spaced doses required each year2METHODS AND PROCESSES FOR THE UNICEF GLOBAL DATABASE
A rural community health volunteer writes a patient report on a 4-year-old during an outreach visit to the family’shome, Myanmar. UNICEF/UNI136052/DeanSince 2000, UNICEF has estimated VAS coveragein priority countriesi at national, regional and globallevels as part of organization-wide efforts tomonitor the situation of children worldwide. Thisincludes reporting on the estimated percentageof children aged 6–59 months receiving therecommended two doses, adequately spacedwithin each year (referred to throughout therest of this report as “annual two-dose VAScoverage”). These data are published in TheState of the World’s Children report and releasedannually on the UNICEF data website.ii Theregular collection and analysis of these data area key component of efforts to achieve universalVAS coverage. Tracking country-level progresstowards universal coverage facilitates programmemonitoring and planning through the identificationof countries with low coverage, identifying wherefocused attention and investment from UNICEFand partners may be required.This report describes the indicators, data,methods, assumptions and processes used toproduce the national semester-wise and annualtwo-dose VAS coverage estimates that UNICEFmaintains in the global database. Section 2describes VAS indicators and their data sources,section 3 outlines the type of data requested fromcountries and the review process for generatingestimates for the database, and section 4 outlineslimitations and conclusions. Additional detailsrelated to the review process for generating yearlyestimates described in section 3 are presented inAnnex 2.i The UNICEF Global VAS Coverage Database 2000–2017 includes 82 countries identified as “priority” for national VAS programming as of the year 2000.The list was based on a data-driven exercise undertaken in 2014, utilizing estimates of health and nutrition indicators around 2000, when VAS programmeswere typically initiated. The two main indicators considered in the exercise were (i) under-five mortality rate and (ii) VAD prevalence. Informed by thisanalysis, the set of countries for which semester-wise and annual two-dose VAS coverage estimates are reported on in the UNICEF global database has beenrestricted to these countries. This list was reduced to 64 priority countries as of the 2018 reporting year. Countries requiring only sub-national programmesare not included in the database. The lists of countries can be found at https://data.unicef.org/nutrition/vitamin-a . The UNICEF Global VAS CoverageDatabase 2000–2017 includes 82 countries identified as “priority” for national VAS programming as of the year 2000. The list was based on a data-drivenexercise undertaken in 2014, utilizing estimates of health and nutrition indicators around 2000, when VAS programmes were typically initiated. The twomain indicators considered in the exercise were (i) under-five mortality rate and (ii) VAD prevalence. Informed by this analysis, the set of countries for whichsemester-wise and annual two-dose VAS coverage estimates are reported on in the UNICEF global database has been restricted to these countries. This listwas reduced to 64 priority countries as of the 2018 reporting year. Countries requiring only sub-national programmes are not included in the database. Thelists of countries can be found at https://data.unicef.org/nutrition/vitamin-a .iiThe latest country-specific annual two-dose VAS coverage estimates are available at: https://data.unicef.org/nutrition/vitamin-a .METHODS AND PROCESSES FOR THE UNICEF GLOBAL DATABASE3
2INDICATORS AND DATA SOURCESVAS coverage indicators and sources of data arediscussed in this section. To determine whetherappropriately spaced vitamin A supplements weredelivered to children, VAS coverage data are ideallyreported in six-month intervals. Typically, VAScoverage data are reported for two periods within agiven calendar year, known as semesters: semester1 is January to June, and semester 2 is July toDecember.iiiA. Indicators of vitamin Asupplementation coverageThere are two main types of VAS coverage indicators:1) those that can be reported annually for eachsemester using data from administrative sourcesand 2) those that require a sample survey andare generally only sporadically available (and notnecessarily aligned with any semester). The UNICEFGlobal VAS Coverage Database relies on the first typeof indicator. While it could be possible to report onthe semester-wise indicators using sample surveys,resource constraints have prevented countries fromemploying surveys to estimate national VAS coveragefor each individual semester since 2000. In addition,surveys undertaken at this frequency would not be anadvisable use of resources to report on semesterwise VAS coverage.Indicators from administrative dataThe semester-specific numerator is the totalnumber of children that received an age-appropriatedoseiv of vitamin A through the mainv distributionmechanism in a given semester. Tally sheets and/or routine health system information reports ofthe number of children reached with vitamin Asupplements are aggregated from lower levels(e.g., health posts and districts) to the national level,where they are summed to determine the totalnumber of children aged 6–59 months reachedbetween January and June, as well as those reachedbetween July and December.These numerators are then divided by the estimatedtarget population of children in this age group in thecountry (for that specific year/semester/distributionmechanism) to estimate the percentage of eligiblechildren that received a vitamin A supplement ineach semester.In countries where multiple delivery mechanisms areutilized in a given semester, data on the number ofchildren reached (and their related target populations/denominators) are ideally reported separately foreach distribution mechanism. In such instances,efforts are made at the global level to account forpotential overlap of VAS numerators in any semesterby using a defined methodology to combine and/orseparate numerators and denominators for distinctdelivery mechanisms. Only data from the maindistribution mechanism are accepted for inclusion inthe global database. Further details on how the maindistribution mechanism is determined are provided insection 3 and Annex 2.Using coverage estimates from semesters 1 and 2,the annual two-dose VAS coverage is estimatedas the lower coverage of the two semesters.However, while annual two-dose coverage is themain indicator for monitoring VAS programmes atthe global level, it is not routinely used at the countrylevel; for programme management, individualsemester data for each distribution mechanismare recommended [8].The coverage indicators derived from administrativedata included in the global VAS database are: (i) VAScoverage of children aged 6–59 months through themain distribution mechanism in semester 1, (ii) VAScoverage of children aged 6–59 months throughthe main distribution mechanism in semester 2, and(iii) annual two-dose VAS coverage of children aged6–59 months for a calendar year (see Table 1 fordetails) [8].Indicators from survey dataTwo VAS coverage indicators are typically derivedfrom survey-based data: VAS coverage in the lastsix months and VAS coverage at a specific event.iii Semesters are based on six-month intervals to align with the WHO recommendation that children should receive one high-dose supplement every four tosix months.ivDefined as infants aged 6–11 months receiving a 100,000 IU dose of vitamin A and children aged 12–59 months receiving a 200,000 IU dose of vitamin A.vDefined as the mechanism that achieved the highest coverage in the semester.4METHODS AND PROCESSES FOR THE UNICEF GLOBAL DATABASE
Table 1: Coverage indicators derived from administrative data included in the UNICEF Global VAS Coverage DatabaseIndicatorIndicator definitionNumeratorSemester 1 VAScoverage (Januaryto Junevi)Percentage of children aged6–59 months estimated to havereceived an age-appropriatedose of vitamin A through themain distribution mechanism insemester 1Percentage of children aged6–59 months estimated to havereceived an age-appropriatedose of vitamin A through themain distribution mechanism insemester 2Percentage of children aged6–59 months estimated to havereceived twoviii age-appropriatedoses of vitamin A in eachsemester approximately sixmonths apart over the calendaryearNumber of children aged 6–59Total population ofmonths estimated to have received children aged 6–59an age-appropriate dose of vitamin monthsA through the main distributionmechanism in semester 1Semester 2 VAScoverage (July toDecember vii)Annual two-doseVAS coverageVAS coverage in “the last six months” (survey)VAS coverage in “the last six months” wasdeveloped in the late 1990s as VAS programmeswere being implemented on a larger scale. Thenumerator for this indicator is the number ofchildren aged 6–59 months reported (by theircaregiver) to have received a dose of vitamin Aat some point in the six months preceding thesurvey interview, and the denominator is the totalnumber of children aged 6–59 months surveyed.Large household surveys such as Demographicand Health Surveys (DHS) and Multiple IndicatorCluster Surveys (MICS) also began reporting onthis indicator around that time. Data collection inDHS and MICS focused on interviewee recall ofreceiving a vitamin A supplement within “the lastsix months” and did not attempt to reference aspecific semester time period within a calendaryear. However, as this indicator is not aligned withthe semester-wise indicator definitions, it has notbeen included in the UNICEF global database sincethe early 2000s. For that reason, all estimatesderived from sources using the indicator for “thelast six months”, which were periodically used inthe global VAS database between 2000 and 2004,were removed from the database. This indicatorDenominatorNumber of children aged 6–59Total population ofmonths estimated to have received children aged 6–59an age-appropriate dose of vitamin monthsA through the main distributionmechanism in semester 2Number of children aged 6–59months estimated to have receivedan age-appropriate dose of vitaminA through the main distributionmechanism in the semester withthe lower coverage value for thecalendar yearTotal population ofchildren aged 6–59months used toestimate coveragefor the semesterwith the lowercoverage value forthe calendar yearis not among those currently recommended in theGAVA monitoring guidance [8]. In addition, mostlarge household surveys like DHS and MICS areonly conducted every three to five years, while thedatabase strives to have annual estimates for eachof two semesters.VAS coverage during a specific event (survey)The second VAS indicator from surveys refersto coverage at a specific event, which is alignedwith semester-wise estimates. This indicator istypically used in household surveys implementedvery soon after an event (e.g., within four to sixweeks of a polio supplementary immunizationactivity [SIA] or a Child Health Event) in order toassess VAS coverage and collect other informationrelated to the specific event. These estimatescan be compared with the semester-wise datafrom administrative estimates. This surveymethod and indicator are recommended withinthe latest GAVA monitoring guidance to validateadministrative coverage data from an event incertain situations [8], however, undertaking surveysevery six months to report on national semesterwise VAS coverage would not be an advisable useof resources.vi The majority of estimates for semester 1 in the database fall in the January to June period, but there have been limited exceptions when a semester 1distribution occurred in July (e.g., for 2015: S1 July 2015, S2 December 2015).vii The majority of estimates for semester 2 in the database fall in the July to December period, but there have been limited exceptions when a semester 2distribution occurred in January of the subsequent year (e.g., for 2015: S1 June 2015, S2 January 2016).viii As the numerator and denominator columns indicate, a numerator about the number of individual children that received two appropriately spaceddoses is not used to calculate this indicator due to lack of availability; to estimate annual two-dose VAS coverage, it is assumed that those children whoreceived a dose in the semester with the lower coverage also received one in the semester with the higher coverage.METHODS AND PROCESSES FOR THE UNICEF GLOBAL DATABASE5
The numerator for this indicator is the numberof children aged 6–59 months reported to havereceived a vitamin A supplement at the specificevent in question, either by verification of a healthcard or by recall, and the denominator is the totalnumber of children aged 6–59 months surveyed(see Table 2).Table 2: Indicator definitions for surveys assessing VAS coverage at a specific eventSurvey-specificindicatorIndicator definitionNumeratorDenominatorVAS coverage in thelast six monthsPercentage of children aged6–59 months who receiveda dose of vitamin A in the sixmonths preceding the surveyinterviewNumber of children aged6–59 months whose caregiver reported they receiveda dose of vitamin A in theprevious six monthsTotal number of childrenaged 6–59 monthssurveyedVAS coverage duringa specific eventPercentage of children aged6–59 months who received adose of vitamin A during thespecific event asked about inthe surveyNumber of children aged6–59 months whose caregiver reported they receiveda dose of vitamin A duringthe specific eventTotal number of childrenaged 6–59 monthssurveyedB. Administrative vitamin Asupplementation coverage data:Sources and challengesacross the country during a specific event. Thisprocess is repeated for each event that takes placeduring the year.Sources of administrative dataAs the UNICEF Global VAS Coverage Databaseonly includes the semester-wise and annual twodose indicators based on administrative data, theremainder of this section focuses on administrativedata sources related to indicators described inTable 1. Administrative data are collected by trackingthe provision of commodities or services to endusers. These data are typically recorded into paperbased registers and/or electronic systems by theservice provider (e.g., health worker) at the point ofdistribution. Administrative reporting systems intendto capture each person that received the health andnutrition service of interest over a specified timeperiod.2. Health information system reports: Thesedocuments report on the total number of children inthe target age group given a vitamin A supplementthrough routine health system contacts – that is,the vitamin A doses delivered to children when theyvisit a fixed site health facility or during outreachservices from such a facility. For health informationsystem reports, the data are also aggregated upfrom local to central level together with informationon other routine health services, such as vaccines,essential drugs and/or other services deliveredduring a given time period.For VAS coverage, administrative data on thenumber of children aged 6–59 months given
2 METHODS AND PROCESSES FOR THE UNICEF GLOBA DATABASE A A A A Two high-dose supplements/year from the age of 6 months to 59 months s p a c e d s 4 t o 6 m n h a p r t s p a c e d 4 t o 6 m n t h s a r t F u l l e pro t c t i o n (January– June) (July– D Semester 1 Semester 2 1 INTRODUCTION Vitamin A deficiency (VAD), for which the health
vitamin D stores that are further depleted by the lack of vitamin D in maternal breastmilk. These children are at high risk of childhood rickets. Key aims of Vitamin D supplementation To ensure: 1. Maternal Vitamin D levels are replete to avoid neonatal rickets. 2. Vitamin D deficiency is reversed in a timely manner. 3.
Kaitlyn M. Schneider ! 2! The Effects of Vitamin D Supplementation on Bipolar Depression A Major Qualifying Project Report Submitted to the Faculty of . People obtain vitamin D from either food sources or through ultraviolet light, and this vitamin is then hydroxylated to 25-hydroxyl vitamin D (25 (OH)D) and is then measured in the serum. .
Konsumsi asam folat, vitamin B12 dan vitamin C pada ibu hamil tergolong masih rendah, sehingga konsumsi sumber vitamin perlu ditingkatkan untuk mencegah masalah selama kehamilan, seperti anemia, prematur, dan kematian ibu dan anak. Kata kunci: asam folat, ibu hamil, vitamin B12, vitamin C *Korespondensi: Telp: 628129192259, Surel: hardinsyah2010@gmail.com J. Gizi Pangan, Volume 12, Nomor 1 .
Milk Thistle Red Clover Rhodiola St. John’s Wort Soy Bean Tomato Tribulus Terrestris Willow Vitamin B1 Vitamin B2 Vitamin B6 Vitamin B12 Vitamin C Vitamin D3 Vitamin E MISCELLANEOUS Alpha Lipoic Acid Beta Carotene Caffeine Choline Bitartrate Chond. Sulphate Bovine Chond. Sulphate Porcine Ch
Normal vitamin D 36% 9% 55% Vitamin D deficiency* Severe vitamin D deficiency** Normal vitamin D Camargo CA, Jr., Ingham T, Wickens K, et al. Vitamin D status of newborns in New Zealand. Br J Nutr 2010;104:1051 -7. Grant CC, Wall CR, Crengle S, Scragg R. Vitamin D deficiency in early childhood Public Health Nutr. 2009;12(10):1893-1901
The effects of vitamin C supplementation on the incidence of common cold episodes have been extensively studied. Placebo-controlled studies have consistently shown that high doses of the vitamin alleviate the symptoms of the common cold (Hemila, 1992,1994, 1996a; Hemila & Herman, 1995). In contrast, the results of vitamin C supplementation on
25-OH Vitamin D levels* To determine vitamin D status * Only measure if patient is symptomatic and has risk factors for Vitamin D deficiency. Measurement, status and management (see Appendix 1 for flowchart) Vitamin D level Vitamin D status Health effect Management 30 nmol/L Defi
VITAMIN A This vitamin helps your body maintain healthy eyes and skin. VITAMIN C This vitamin helps the body heal cuts and wounds and maintain healthy gums. VITAMIN E This vitamin helps maintain healthy cells throughout your body. WATER Water makes up more than half of your body weight. Your
