Background Vitamin A (VA) supplementation has been associated with reductions of all-cause child mortality. Child mortality amenable to VA, particularly related to infectious diseases, may be age dependent; hence, the beneficial effect of VA supplementation may differ between younger and older children. We aimed to estimate the all-cause child mortality disaggregated by younger and older than 2 years of age and estimate the contribution of VA supplementation in preventing child death in West and Central Africa. Methods Using the most recent (post-2010) cross-sectional Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we analysed child-level data (n=187 651) from 20 West and Central African countries. Age-specific (all-cause) mortality rates were estimated using survival analyses. Age-specific VA supplementation coverage was linked with the age-specific all-cause child mortality to estimate the contribution of the supplementation in averting child death. Results The cost per averted child death was also estimated using an average cost of US$1.2/child and VA supplementation coverage which ranged from 14% in Cote d’Ivoire to 81% in the Gambia. About 75% of the under-5 mortality occurred in the first 2 years of life. The share of excess (all-cause) mortality averted by VA supplementation was significantly higher in the first 2 years of life. A mean reduction of 7.1 deaths/1000 live births was estimated for children 6–23 months, compared to a reduction of 2.5 deaths/1000 live births for older children (24–59 months). The mean cost/averted child death for the 20 countries was 2.8 times lower for the 6–23 than the 24–59 months age group. Conclusion Prioritising VA supplementation for children in the first 2 years of life could be more cost-effective than when implemented among 6–59 months of age. Data are available on reasonable request. Data can be accessed from the DHS programme on request.

中文翻译：

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我们是否应该优先考虑 6-23 个月大的儿童补充维生素 A？西非和中非案例研究


背景维生素 A (VA) 补充剂与降低全因儿童死亡率有关。 VA 导致的儿童死亡率，特别是与传染病相关的儿童死亡率，可能与年龄有关；因此，补充 VA 的有益效果在年龄较小的儿童和年龄较大的儿童之间可能有所不同。我们的目的是估算按 2 岁以下和 2 岁以上儿童分类的全因儿童死亡率，并估算补充 VA 对预防西非和中非儿童死亡的贡献。方法 我们利用最新（2010 年后）的横断面人口和健康调查以及多指标类集调查，分析了来自 20 个西非和中非国家的儿童数据 (n=187 651)。使用生存分析估计特定年龄（全因）死亡率。将特定年龄的 VA 补充覆盖率与特定年龄的全因儿童死亡率联系起来，以估计补充对避免儿童死亡的贡献。结果 还使用每个儿童 1.2 美元的平均成本和 VA 补充覆盖率（科特迪瓦的 14% 到冈比亚的 81%）估算了每名避免儿童死亡的成本。大约 75% 的 5 岁以下儿童死亡率发生在生命的头 2 年内。在生命的头两年中，通过补充 VA 避免的超额（全因）死亡率比例显着更高。据估计，6-23 个月大的儿童每 1000 名活产婴儿死亡人数平均减少 7.1 人，而年龄较大的儿童（24-59 个月）则每 1000 名活产婴儿死亡人数平均减少 2.5 人。 20 个国家中 6-23 个月年龄组的平均成本/避免儿童死亡比 24-59 个月年龄组低 2.8 倍。 结论 优先为 2 岁以内的儿童补充 VA 可能比在 6-59 个月大时实施更具成本效益。可根据合理要求提供数据。可根据要求从 DHS 程序访问数据。