Coverage of vitamin A supplementation, deworming and immunisations: Associations with nutritional status among urban children younger than 5 years in Nelson Mandela Bay, Eastern Cape Province, South Africa
Article Sidebar
Main Article Content
Abstract
Background. Even though immunisation coverage is tracked through the district health system in South Africa (SA), limited information is available regarding interventions linked to the Expanded Programme on Immunisation (EPI) and the impact on the nutritional status of children <5 years of age.
Objectives. To describe coverage of immunisations, vitamin A supplementation and deworming among children <5 years old in an urban area of Nelson Mandela Bay, Eastern Cape Province, SA. A secondary objective was to investigate whether a history of missed immunisations, vitamin A supplementation or deworming was associated with wasting or stunting in children.
Methods. A descriptive study was conducted between September 2015 and February 2016, where cross-sectional anthropometrical data were collected from 1 513 children in 32 pre-schools, together with a retrospective analysis of the participants’ Road-to-Health/clinic cards to collect data on immunisation, vitamin A and deworming. Participants were categorised into 3-month age intervals to facilitate data analysis. Ethical approval was obtained from the Nelson Mandela University Research Ethics Committee (Human).
Results. Data of 1 496 children were included in the analysis. The prevalence of underweight was 2.5% (n=37), while 11.2% (n=167) were stunted and 1.1% (n=16) were wasted. There were associations between age category and delayed vitamin A supplementation (χ2=32.105; df=19; n=836; p=0.03) and deworming (χ2= 45.257; df=17; n=558; p<0.001), but there was no association between delayed vaccinations and age category. There were no significant differences in anthropometrical indicators for children with delayed vitamin A supplementation, deworming and vaccinations compared with children in this sample who were up to date regarding the relevant indicators. However, weight-for-age, height-for-age and weight-for-height z-scores and stunting risk were associated with low birthweight (LBW) (odds ratio (OR) 4.658; p<0.001).
Conclusion. Coverage of vitamin A supplementation and deworming but not immunisations was poorer among children in older age categories. A history of delayed vitamin A, deworming and vaccinations was not associated with the anthropometrical status of children. Children with LBW should be considered for more rigorous follow-up, as they are at higher risk of stunting.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJCH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
United Nations Children’s Fund, World Health Organization and World Bank. Stunting global and regional trends. 2020. https://www.who.int/data/gho/data/ indicators/indicator-details/GHO/stunting-prevalence (accessed 30 July 2020).
Raiten DJ, Bremer AA. Exploring the nutritional ecology of stunting: New approaches to an old problem. Nutrients 2020;12(2):371. https://doi.org/10.3390/ nu12020371
Black RE, Heidkamp R. Nestlé Nutr Inst Workshop Ser 2018;89:105-113. https:// doi.org/10.1159/000486496
Budge S, Parker AH, Hutchings PT, Garbutt C. Environmental enteric dysfunction and child stunting. Nutr Rev 2019;77(4):240-253. https://doi. org/10.1093/nutrit/nuy068
Liu J, Platts-Mills JA, Juma J, et al. Use of quantitative molecular diagnostic methods to identify causes of diarrhoea in children: A reanalysis of the GEMS case-control study. Lancet 2016;388(10051):1291-1301. https://doi.org/10.1016/ s0140-6736(16)31529-x
Muller I, Yap P, Steinman P, et al. Intestinal parasites, growth and physical fitness of schoolchildren in poor neighbourhoods of Port Elizabeth, South Africa: A cross-sectional survey. Parasit Vectors 2016;9(1):488. https://doi.org/10.1186/ s13071-016-1761-5
Wallace AS, Ryman TK, Dietz V. Experiences integrating delivery of maternal and child health services with children immunisation programs: Systematic review update. J Infect Dis 2012;205(S1):S6-S19. https://doi.org/10.1093/infdis/ jir778
Faye CM, Fonn S, Levin J. Factors associated with recovery from stunting among under-five children in two Nairobi informal settlements. PLoS ONE 2019;14(4):e0215488. https://doi.org/10.1371/journal.pone.0215488
Massyn N, Peer N, Padarath A, et al. District Health Barometer 2014/15. Durban: Health Systems Trust, 2015. https://www.health-e.org.za/wp-content/ uploads/2015/10/Complete_DHB_2014_15_linked.pdf (accessed 1 June 2016).
Nyarko MJ. Management of the nutritional care of children under five years old by nurses in the Nelson Mandela Bay Health District. MA thesis. Pretoria: University of South Africa, 2014.
McLaren S, Steenkamp L, Feeley A, et al. Food insecurity, social welfare and low birth weight: Implications for childhood malnutrition in an urban Eastern Cape township. S Afr J Child Health 2018;12(3):95-99. https://doi.org/10.7196/ SAJCH.2018.v12i3.1468
Centers for Disease Control. National Health and Nutrition Examination Survey Anthropometry Procedures Manual. 2007. https://www.cdc.gov/nchs/data/ nhanes/nhanes_07_08/manual_an.pdf(accessed 22 January 2020).
World Health Organization. Software for assessing growth and development of the world’s children. 2006. http://www.who.int/childgrowth/software/ WHOantho2005_PC_Manual.pdf (accessed 27 June 2017).
World Health Organization. WHO multicentre growth reference study group: WHO child growth standards: Length/height for age, weight for age, weight for length, weight for height and body mass index for age: Methods and development. 2006. https://apps.who.int/iris/handle/10665/43413 (accessed 2 November 2022).
IBM Corporation. IBM SPSS Statistics for Windows, version 26.0. Armonk, NY: IBM Corp., 2017.
Comley V, Nkwanyana N, Coutsoudis A. Immunisation and vitamin A capsule coverage in a semi-urban area of KwaZulu-Natal Province, South Africa. S Afr J Child Health 2015;9(4):108-111. https://doi.org/10.7196/SAJCH.2015.v9i4.925
World Health Organization. Guideline: Vitamin A Supplementation in Infants and Children 6 - 59 Months of Age. Geneva: WHO, 2011.
Gall S, Muller I, Walter C, et al. Associations between selective attention and soil-transmitted helminth infections, socio-economic status and physical fitness in disadvantaged children in Port Elizabeth, South Africa: An observational study. PLoS Neg Trop Dis 2017;11(5):e0005573. https://doi.org/org/10.1371/journal. pntd.0005573
Fink G, Rockers PC. Childhood growth, schooling, and cognitive development: Further evidence from the young lives study. Am J Clin Nutr 2014;100(1):182- 188. https://doi.org/10.3945/ajcn.113.080960
Taylor-Robinson DC, Maavan N, Donegan S, et al. Public health deworming programmes for soil-transmitted helminths in children living in endemic areas. Cochrane Database Syst Rev 2019;9:CD000371. https://doi. org/10.1002/14651858.cd000371.pub7
Welch VA, Ghogomu E, Hossain A, et al. Mass deworming to improve developmental health and wellbeing of children in low-income and middle-income countries: A systematic review and network meta-analysis. Lancet Glob Health 2017;5(1):e40-e50. https://doi.org/10.1016/s2214-109x(16)30242-x
Strunz EC, Addiss DG, Stocks ME, et al. Water, sanitation, hygiene and soil-transmitted helminth infection: A systematic review and meta-analysis. PLoS Med 2014;11(3):e1001620. https://doi.org/10.1371/journal.pmed.1001620
National Department of Health, South Africa.Government Notice No. R2003. Regulations relating to the fortification of certain foodstuffs. Section 15(1) of the Foodstuffs, Cosmetics and Disinfectants Act No. 54 of 1972.
Faber M, van Jaarsveld PJ, Kunneke E, et al. Vitamin A and anthropometric status of South African preschool children from four areas with known distinct eating patterns. Nutrition 2015;31(1):64-71. https://doi.org/10.1016/j.nut.2014.04.024
Singh A, Upadhyay AK, Kumar K. Birth size, stunting and recovery from stunting in Andhra Pradesh, India: Evidence from the young lives study. Matern Child Health J 2017;21:492-508. https://doi.org/10.1007/s10995-016-2132-8