A community campaign‐based vitamin A supplementation (VAS) program is better than a clinic‐based program in reaching vulnerable children in Tanzania

In 2000, Tanzania moved from a clinic‐based VAS approach to a community campaign‐ based approach. Large household surveys conducted in 4 districts in 1999 and again in 2002 permitted us to examine the performance of these 2 approaches in reaching children who were at risk for vitamin A deficiency. Using multivariate logistic regression, we found that participation of all children rose from 8.1% to 50.4%, a 6.2‐fold increase (p<0.01) in the campaign‐based VAS compared to the clinic‐based VAS program. The community‐based VAS program was even more effective in reaching children who were likely to be vulnerable to deficiency based on social indicators of risk. For example, the participation of children whose mothers had no formal education rose from 2.7% to 46.7%, a 17.3‐fold increase (p<0.01). The difference in the magnitude of the increase (6.2‐ compared to 17.3‐fold) indicates that the vulnerable benefited preferentially. This improvement in participation and targeting in the campaign‐based VAS program cannot be attributed to secular trends, as the use of clinic‐based health services for children did not change during this period. Thus the campaign based VAS program not only improved coverage, but it also improved targeting of the most vulnerable children.