# Bridging the vitamin A and deworming coverage gap among underserved populations in India through government and civil society organization partnerships

## TL;DR

This study shows how partnerships between the government and civil society organizations in India can improve vitamin A and deworming coverage, reducing child health issues.

## Contribution

The study evaluates the impact of government and CSO partnerships on vitamin A and deworming coverage in underserved populations in Nagaland, India.

## Key findings

- 77.2% of children received vitamin A supplementation in the past six months.
- Increasing VAS coverage by 22% through CSOs averted 25,017 diarrhea cases and 9 deaths in 2019.
- Lack of knowledge about benefits and lower preschool enrollment were barriers to VAS+D coverage.

## Abstract

Vitamin A deficiency (VAD) is a major public health problem in India, where approximately 62% of children under five have low retinol levels (< 70 µmol/L). This study aims to (1) evaluate vitamin A supplementation (VAS) and deworming (VAS + D) coverage in Nagaland state through government and civil society organization (CSO) partnerships, (2) examine socio-demographic barriers and facilitators to VAS + D coverage, (3) examine associations between socio-demographic characteristics and source of VAS coverage (i.e., government vs. CSOs), and (4) estimate the impact of VAS on health outcomes due to increased coverage through government and CSO partnerships.

A cross-sectional statewide coverage survey was conducted in Nagaland, India with 1,272 caregivers of children 6–59 months. Household socio-demographic data and VAS + D exposure variables were collected via quantitative survey. Univariate analyses were used to assess the associations between the independent and outcome variables; odds ratios were computed to measure the strength of the association at a significance level of < 0.05. The Lives Saved Tool (LiST) was used to estimate the impact of increased VAS coverage on child undernutrition, morbidity and mortality.

Most children (77.2%) received VAS in the past six months, with 28.1% receiving VAS in capsule form (provided primarily by CSOs) and 70.2% received VAS in syrup form (provided primarily by government). Total deworming coverage was 74.2%, with 43.5% receiving both VAS and deworming. Lower pre-school enrollment was a barrier to receiving VAS (47.4% not enrolled vs. 80.9% enrolled, p < 0.001). A barrier to receiving VAS + D was lack of knowledge of benefits (p < 0.001). Based on LiST modeling, increasing VAS coverage by 22% through CSOs resulted in an estimated 114 stunting cases averted, 25,017 diarrhea cases averted, and 9 lives saved in 2019 in Nagaland State.

Government and CSO partnerships can reduce disparities in VAS coverage and decrease under-five child morbidity and mortality.

The online version contains supplementary material available at 10.1186/s13690-024-01302-8.