Trends and inequalities in vitamin A supplementation coverage among children aged 6-59 months in Sierra Leone: 2008-2019.

BACKGROUND: Vitamin A deficiency is a major public health concern among young children and is associated with an increased risk of infections, vision impairment, and mortality. We examined the trends and inequalities in vitamin A supplementation coverage among children aged 6-59 months in Sierra Leone between 2008 and 2019. METHODS: We analyzed data from the 2008, 2013, and 2019 Sierra Leone Demographic and Health Surveys (SLDHS). Inequalities in Vitamin A supplementation were assessed across age, household economic status, maternal education, place of residence, sex of child, and subnational region. The World Health Organization Health Equity Assessment Toolkit (WHO HEAT) software was used to calculate simple measures of inequality; difference (D) and ratio (R), and complex measures; population attributable risk (PAR) and population attributable fraction (PAF). RESULTS: The national vitamin A supplementation coverage among children aged 6-59 months increased from 25.9% in 2008 to 69.1% in 2019. Age-inequality narrowed, with D changing from - 2.6 percentage points in 2008 to - 0.4 percentage points in 2019. PAF and PAR remained were zero throughout the study period. Economic status disparity increased slightly, with D rising from 8.5 percentage points in 2008 to 9.3 percentage points in 2019 and PAR increasing from 6.1 to 6.6. Inequality by maternal education declined, with D decreasing from 11.1 to 4.9 percentage points and PAR declining from 9.2 to 3.4. Rural-urban inequality also narrowed: D decreased from 4.9 to 1.6 percentage points , while PAR declined from 3.6 to 1.0. Inequality by sex of the child remained minimal, with D changing from 0.2 percentage points in 2008 to - 1.0% percentage points in 2019. Both PAF and PAR were zero. Regional disparity decreased, with D declining from 13.4 to 8.6 percentage points and PAR from 8.0 to 3.5. CONCLUSION: Vitamin A supplementation coverage among children 6-59 months in Sierra Leone improved substantially between 2008 and 2019. However, coverage remained below the 80% national target, inequalities persisted across socioeconomic and demographic groups, particularly by household economic status and subnational region. Sustained and targeted interventions are needed to reach disadvantage populations, strengthen health infrastructure and service delivery in remote areas, improve caregiver education, and ensure sustainable funding and political commitment to child- health programmes.