A Mixed-Methods Exposé of Systemic Barriers and Enablers for Vitamin A and Deworming in Nigeria's Maternal Newborn and Child Health Week Programme

A Mixed-Methods Exposé of Systemic Barriers and Enablers for Vitamin A and Deworming in Nigeria's Maternal Newborn and Child Health Week Programme | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Mixed-Methods Exposé of Systemic Barriers and Enablers for Vitamin A and Deworming in Nigeria's Maternal Newborn and Child Health Week Programme Oluwaseun Ariyo, Edward Kutondo, Adegbenga Adedayo, Nemat Hajeebhoy, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7532150/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Vitamin A Deficiency (VAD) remains a severe public health issue in Nigeria, contributing to preventable childhood morbidity and mortality. The bi-annual Maternal, Newborn, and Child Health Week (MNCHW) is the primary platform for delivering high-dose Vitamin A Supplementation (VAS) and deworming to children aged 6–59 months. However, national coverage estimates are suspected to be inaccurate and mask significant subnational inequities. This study was designed to validate the reported coverage of the November-December 2024 MNCHW and investigate the systemic barriers and enablers influencing the delivery and uptake of VAS and deworming in Nigeria. Methods A cross-sectional mixed-methods post-event coverage survey (PECS) was conducted across six purposively selected states (Bayelsa, Enugu, Gombe, Katsina, Lagos, Niger). A two-stage cluster sampling design was employed, surveying 6,468 caregivers of eligible children using computer-assisted personal interviewing. Quantitative data were analysed for coverage, and bivariate analyses identified factors associated with uptake. Knowledge of vitamin A and Deworming was assessed using a 20-point scale and categorised as good (≥15), fair ( 8 – 14 ), and poor (< 8). Qualitative key informant interviews (n = 15) with national and state-level stakeholders were thematically analysed using the WHO Health Systems Building Blocks framework. Results Coverage for VAS was 71.1%, meeting the national 65% target, with wide state-level disparities (49.2% in Katsina to 84.0% in Enugu). Deworming coverage was lower at 52.7%. A significant dissonance was found between these verified coverages and administrative reports (87%) in assessed states, which calls for strengthening of routine data systems. Caregiver knowledge score was poor (67%), lack of awareness (36.5%) and health worker absenteeism (31.2%) were primary reasons for non-uptake. Qualitative findings identified critical systemic barriers, including delayed funding release, frequent stockouts of deworming tablets, weak health system, sociocultural resistance, and insecurity in hard-to-reach areas. Enablers included strong partner support, house-to-house delivery strategies, and community engagement. Conclusion While the MNCHW platform has achieved good coverage, significant gaps persist due to systemic and equity-related barriers. Reliance on donor-driven campaigns is unsustainable. To achieve universal coverage, Nigeria must address funding delays, commodity security, administrative data gaps, and knowledge gaps through improved planning, integrated service delivery, and strengthened community mobilization. Vitamin A Supplementation Deworming Coverage Equity Health Systems Nigeria MNCHW Post-Event Coverage Survey Figures Figure 1 Figure 2 Figure 3 Introduction Vitamin A Deficiency (VAD) remains a pernicious public health challenge in Nigeria with consequences on child survival, growth, and development. With one in three children aged 6–59 months affected, VAD contributes to preventable childhood blindness and increases risks of mortality by about 20% (FGoN/IITA 2024, NPC/ICF, 2019; Aghaji et al., 2019; Shekar et al., 2017). Vitamin A is important body immunity, cellular integrity, ocular health, good growth, and general health. Despite the importance of Vitamin A, 32 percent Nigerian children aged 6–59 months experience severe child food poverty, characterized by consumption of 0–2 food groups out of eight recommended food groups (UNICEF 2024). Inadequate dietary intake of Vitamin A can be attributed to a range of factors including poverty, limited nutrition education, geographical barriers to health services, and food insecurity. The World Health Organization recommends two consecutive high-dose of vitamin A supplements annually for under-five children in countries where VAD constitutes a public health menace such as Nigeria (UNICEF, 2007). Consequently, the Maternal, Newborn, and Child Health Week (MNCHW), a bi-annual campaign (May/June and November/December) to deliver high-dose vitamin A supplementation (VAS) and deworming to children 6–59 months, was institutionalized. However, national coverage aggregates conceal severe subnational inequities and systemic flaws. Factors such as delivery platform bottlenecks, data inaccuracies and commodities stockouts, among others have been reported to limit the effectiveness of MNCHW in terms of coverage and accessibility. Post-event coverage surveys (PECS) are indispensable for evaluating VAS programme performance, identifying coverage gaps, and addressing data inaccuracies from administrative tally sheets. In Nigeria, earlier post-event coverage survey has revealed disparities in verified coverage and administrative reporting, thereby suggesting data inaccuracies or possibly systemic overestimation (Helen Keller International, 2020). This finding reflects the significance of robust PECS to validate administrative data and design strategies to optimize coverage of of essential child health interventions. Therefore, this study leverages a mixed-methods PECS across six geopolitical zones to explore systemic barriers and validate Nigeria’s 2024 MNCHW coverage. By interrogating the dissonance between administrative data and ground truth, we aim to catalyze equity-driven strategies that ensure every child irrespective of geography, wealth, or maternal education receives these lifesaving interventions. Methodology Study Design and Setting This cross-sectional mixed-methods study evaluated coverage and implementation quality of Vitamin A supplementation (VAS) and deworming during Nigeria’s November–December 2024 Maternal, Newborn, and Child Health Week (MNCHW). Six states were purposively selected across Nigeria’s geopolitical zones (Bayelsa, Enugu, Gombe, Katsina, Lagos, Niger) using three criteria, namely UNICEF programme focus states, absence of prior coverage surveys, and zonal representation. Sampling Strategy and Sample Size A two-stage cluster sampling method was applied on the administrative areas where Vitamin A supplementation was implemented in November – December 2024 using WHO 2018 guidelines. In the first stage, 462 Enumeration Areas (EAs) were selected using probability proportional to size (PPS) from National Population Commission (NPC) frames and stratified by urban/rural residence. In the second stage, 14 households were randomly sampled per EA using a Random Number Generator app, and 77 Enumeration Areas were selected per state using the WHO sample size calculator. Eligibility inclusion criteria included household residency for the prior month (≥1 month) before the visit and presence of a child aged 6–59 months during MNCHW. Sample size calculation was based on anticipated VAS coverage of 80%, design effect (DE=2.503), intra-cluster correlation (ICC=0.167), a confidence interval of 5% (±5% precision), and non-response inflation (1.11) yielded 77 EAs/state. Following this, a total of 6468 caregivers of children 6-59 months (1,017 households from 77 EAs per state) participated in the study. Security-compromised EAs were substituted with pre-identified backups (10% reserve). Data Collection The target population for the quantitative data collection were the caregivers of children between 6 – 59 months. Quantitative data were collected using Android-tablet-based Computer-Assisted Personal Interviewing (CAPI) via SurveyCTO® (v2.80), including, 20-minutes caregivers survey (household/child questionnaires, coverage, sociodemographics, and knowledge of VAS and deworming). Enumeration area identification was guided by the GPS (OsmAND app®). Door-to-door enumeration was conducted for eligibility verification, and three revisit attempts were adopted for absent respondents. Qualitative data were collected using key informant interviews with the respective State Nutrition Officers and 15 national stakeholders including Director of Nutrition at Federal Ministry of Health and Social Welfare (FMoHSW), Director of Nutrition at National Primary Health Care Development Agency (NPHCDA), and relevant desk officers in UNICEF, Nutrition International (NI), Helen Keller International (HKI), and Vitamin Angels, among others. Each interview was facilitated by trained supervisors using semi-structured interview guide, lasted an average of 50 minutes each, audio-recorded, and transcribed verbatim. The survey guide used in this study was developed specifically for this research. The full English version of the survey instrument is available as a supplementary file [Supplementary File 1]. Data collection was preceded by a 3-day Training of Trainers (ToT) for a total of 30 supervisors and the state-level training for 155 data collectors. Each state team was comprised of five supervisors, 20 data collectors, one audio reviewer, and two transcribers. Data were collected between January 11 and February 2, 2025. The protocol included daily data synchronization to SurveyCTO server. Data quality assurance measures adopted included real-time GPS/audio auditing of 5% of interviews, totaling 420, weekly high frequency checks in Stata 17.0®, and supervisor-led spot checks (100% of teams). Data Analysis Creation of Indexes: Indexes were created for variables of interest, allowing for the synthesis of multiple indicators into comprehensive measures. The resulting indexes were then analysed using descriptive statistics. Wealth Index was derived from socio-economic variables such as housing characteristics (walls, roof, floor, cooking fuel, family size etc.) and non-productive assets such as tricycle, air conditioner, Tv, fridge etc. Variables with prevalence below 3-5% or higher than 95-97% were excluded from the analysis. All variables were then recoded as Improved “1”, not-improved “0” and availability of assets were coded as yes “1” and no “0”. A principal component analysis was performed and then wealth index was generated. The wealth index was categorized into 5 groups: lowest, second, middle, fourth and highest. The knowledge of the caregivers on vitamin A and Deworming was assessed using a 20-point scale comprising of eight questions with multiple responses. Every correct response scored “1 point” and incorrect responses were scored “0”. Knowledge of the caregiver was considered good when the score falls within 15-20 points, fair at 8-14 points, and poor with score less than 8 (<8). Quantitative data were analysed using Stata 17.0 (StataCorp LP). Coverage levels were determined for VAS, deworming, and complementary interventions with 95% confidence intervals. Bivariate analysis was conducted to explore relationships between variables using Chi-square tests and odds ratios, accompanied by 95% confidence intervals. This approach helped identify significant associations, such as factors influencing uptake of health services and any observed disparities in service coverage. Administrative and survey coverage validation was conducted using Bland-Altman plots. Qualitative data were analysed using framework-based thematic analysis. Barriers and promoters mapped to coverage gaps using WHO Health Systems Building Blocks framework. Ethics approval and consent to participate : This study was conducted in accordance with the principles of the Declaration of Helsinki. All methods were performed in accordance with relevant guidelines and regulations. The study protocol was approved by Nigeria’s National Health Research Ethics Committee (NHREC/01/01/2007-19/12/2024). Informed consent to participate was obtained from all the participants in the study. The datasets analysed during the current study are not publicly available due to privacy concerns contained in the participant consent agreements, but are available from the authors on reasonable request. Results Socio-demographic Characteristics Interviews were completed with 6,406 caregivers (99.0%) and the sociodemographic characteristics of the caregivers are presented in Table 1. Caregivers interviewed were largely female (91.7%) and 87.2% were biological mothers of index child with similar trend across the survey States. Findings showed that Fathers (5.5%) and others constituted 7.3% including grandmothers (3.0%) and aunts (1.4%). About 57 percent of the caregivers had secondary education or higher, 28.2% had no formal education and 14.4% had not more than primary education. Caregivers were largely self-employed (54.2%), especially in Lagos (81.6%), Enugu (61.7%), and Bayelsa (58.2%). Mean age of the caregivers was 31.5±8.7 years with highest mean in Lagos (34.7±8.7 years) and the lowest in Niger state (29.6±7.9 years). Household size was 6.1±3.2 with highest in Katsina state (8.3±4.6) and the lowest in Lagos state (4.8±1.6). About 79 percent of the caregivers had access to improved water sources with Lagos having the highest (97.3%) and Bayelsa the least (64.0%). About 21 percent of the caregivers used unimproved sanitation system with higher proportion in Katsina (35.4%), Gombe (34.5%), and Niger (24.3%). Overall, the caregivers were almost equally distributed across the five categories of wealth quintiles whereas wide disparities are observed across the state. Sampled caregivers in Gombe, Katsina and Niger were largely in the lower three wealth quintiles where in Lagos and Enugu, caregivers were largely in the top three wealth quintiles. Table 1 : Socio-demographic Characteristics of Respondents Bayelsa (n=1078) Enugu (n=1078) Gombe (n=1078) Katsina (n=1078) Lagos (n=1078) Niger (n=1078) Total (N=6468) Caregivers N(%) N(%) N(%) N(%) N(%) N(%) Gender Female 999(92.7) 1020(94.6) 990(91.8) 957(88.8) 1063(98.6) 900(83.5) 929(91.7) Male 79(7.3) 58(5.4) 88(8.2) 121(11.2) 15(1.4) 178(16.5) 539(8.3) Relationship with child Father 58(5.4) 43(4.0) 53(4.9) 83(7.7) 8(0.7) 110(10.2) 355(5.5) Mother 920(85.3) 959(89.0) 948(87.9) 906(84.1) 983(91.2) 922(85.5) 5638(87.2) Others 100(7.3) 76(7.0) 77(7.2) 89(8.2) 87(8.1) 46(4.3) 455(7.3) Age 30.8±8.1 32.8±8.3 30.5±8.6 30.9±9.5 34.7±8.7 29.6±7.9 31.5±8.7 Level of education No formal education 67(6.2) 10(0.9) 528(49.0) 642(59.6) 40(3.7) 538(49.9) 1825(28.2) Primary 176(16.3) 96(8.9) 168(15.6) 190(17.6) 116(10.8) 187(17.3) 933(14.4) Secondary or higher 865(77.5) 972(90.2) 382(35.5) 246(22.9) 913(85.4) 353(32.8) 3170(57.3) Employment status Unemployed 130 (12.1) 89 (8.3) 258(23.9) 273 (25.3) 59 (5.5) 274(25.4) 1083(16.7) Student 34 (3.2) 13 (1.2) 11 (1.0) 11 (1.0) 6 (0.6) 3 (0.3) 78 (1.2) Paid-employment 287 (26.8) 311 (28.9) 317(29.6) 337 (31.3) 133 (12.3) 419 (38.9) 1804 (27.9) Self-employed 627 (58.2) 665(61.7) 492(45.6) 457 (42.4) 880(81.6) 382(35.4) 3503(54.2) HH size 5.4±2.3 5.3±1.8 7.1±3.7 8.3±4.6 4.8±1.6 5.7±2.5 6.1±3.2 Had access to Improved water sources 683(64.0) 739(80.1) 818(76.6) 708(72.6) 1038(97.3) 896(83.6) 5063(79.0) Used Unimproved sanitation methods 72 (12.9) 118 (13.4) 330 (34.5) 350 (35.4) 31 (3.0) 198 (24.3) 1099 (20.9) Wealth Quintile Lowest 123(11.4) 30(2.8) 515(47.8) 507(47.0) 0(0.0) 119(11.0) 1294(20.0) Second 250(23.2) 138(12.8) 290(26.9) 296(27.5) 22(2.0) 289(26.8) 1285(19.9) Middle 258(23.9) 254(23.6) 189(17.5) 158(14.7) 89(8.3) 359(33.3) 1307(20.2) Fourth 258(23.9) 348(32.3) 61(5.7) 82(7.6) 331(30.7) 210(19.5) 1290(19.9) Highest 189(17.5) 308(28.6) 23(2.1) 35(3.2) 636(59.0) 101(9.4) 1292(20.0) Caregivers’ Knowledge of the Benefit of VAS, Deworming Services Information on awareness and knowledge of vitamin A supplementation and deworming among the caregivers is presented in Table 2. Overall, awareness of the VAS prior to implementation of the second round in 2024 was poor at only 45.5%. Niger state had the highest awareness among the caregivers at 67% while barely one in three caregivers was aware in Gombe (35.1%) and one in five caregivers in Katsina state (23.1%). Town announcers (35.5%), health workers (30.4%), and community/religious leaders (16.7%) were the major sources of information. Knowledge about vitamin A differs among the caregivers across the state. About 71 percent of the caregivers correctly identified Vitamin A capsule overall, however, only 41.9% of the sampled caregivers from Katsina state correctly identified the capsule. Only 42.0% knew VAS prevents night blindness and helps with vision, and only 31.6% of caregivers in Katsina and 32.1% in Bayelsa knew the importance of vitamin A in vision. About 42 percent of the caregivers knew age for VAS first dose, ranging from 36.5% in Bayelsa to 57.3% in Enugu; however, only 27.1% knew the age a child is no longer qualified for VAS, ranging from 12.9% in Gombe to 44.8% in Lagos. Likewise, only 30.0% knew the number of times VAS should be given per year. About 63 percent of the caregivers correctly identified deworming tablets, ranging from Katsina (47.9%) to Bayelsa (81.2%). Only 26 percent of the caregivers knew the first dose of deworming should be taken at 12 months/1 year, and this knowledge was particularly low in Katsina (10.9%), Gombe (15.1%), and Bayelsa (25.4%). Also, only 16.1% knew No of times a child should be given deworming tablets per year, particularly in Lagos (8.7%), Katsina (11.6%), and Bayelsa (15.6%). The knowledge of vitamin A supplementation and deworming among the caregivers is summarized in Figure 1. Caregivers with poor knowledge accounted for 67% overall, with a range of 57.5% in Enugu to 79.3% in Katsina. Table 2: Caregivers Awareness and Knowledge about VAS and Deworming Bayelsa (n=1078) Enugu (n=1078) Gombe (n=1078) Katsina (n=1078) Lagos (n=1078) Niger (n=1078) Total (N=6468) N(%) N(%) N(%) N(%) N(%) N(%) N(%) Awareness Awareness of VAS before implementation in NOV/DEC 2024 494(45.8) 464(43.0) 378(35.1) 249(23.1) 483(44.8) 722(67.0) 2940(45.5) Source of information Radio 21 (3.5) 26(3.0) 19(3.8) 5(1.3) 63(8.9) 37(3.2) 171(4.1) Television 4(0.7) 5((0.6) 7(1.4) 0(0.0) 12(1.7) 7(0.6) 35(0.8) Health workers 162(27.1) 191(21.8) 147(29.5) 125(33.5) 275(39.0) 381(32.7) 1281(30.4) Town announcers 330(55.2) 313(35.6) 142(28.5) 107(28.7) 169(23.9) 437(37.5) 1498(35.5) Member of HH 21(3.5) 35(4.0) 18(3.6) 27(7.2) 49(6.9) 30(2.6) 180(4.3) Community/religious leader 31(5.2) 224(25.5) 132(26.5) 92(24.7) 29(4.1) 198(17.0) 706(16.7) Poster 2(0.3) 16(1.8) 8(1.6) 1(0.3) 10(1.4) 13(1.1) 50(1.2) Neighbourhood 27(5.4) 67((7.6) 24(4.8) 13(3.5) 91(12.9) 60(5.2) 282(6.7) others 0(0.0) 1(0.1) 1(0.2) 3(0.8) 8(1.1) 1(0.1) 14(0.3) Knowledge Correctly identified Vit A. capsule 766(71.1) 948(87.9) 686(63.6) 452(41.9) 951(88.2) 803(74.5) 4606(71.2) Knew VAS prevents night blindness/ helps with vision 346(32.1) 611(56.7) 448(41.6) 341(31.6) 425(39.4) 544(50.5) 2715(42.0) Knew VAS protects against illnesses 92(8.5) 86(8.0) 118(10.9) 58(5.4) 173(16.0) 151(14.0) 678(10.5) Knew VAS improve children’s health 184(17.1) 278(25.8) 272(25.2) 145(13.5) 425(39.4) 242(22.4) 1546(23.9) Knew VAS reduce death risk 2(0.0) 1090.9) 8(0.7) 1(0.1) 12(1.1) 19(1.8) 52(0.8) Knew age of VAS first dose 394(36.5) 618(57.3) 364(33.8) 234(21.7) 585(54.3) 512(47.5) 2707(41.9) Knew age a child is no longer qualified for VAS 258(23.9) 349(32.4) 139(12.9) 193(17.9) 483(44.8) 330(30.6) 1752(27.1) Knew No of times VAS should be given per year 297(27.6) 443(41.1) 247(22.9) 181(16.8) 422(39.1) 351(30.6) 1941(30.0) Correctly identified deworming tablets 875(81.2) 785(72.8) 545(50.6) 516(47.9) 673(62.4) 696(64.6) 4090(63.2) Knew deworming tablets treat intestinal worms 719(66.7) 686(63.6) 435(40.4) 485(45.0) 540(50.1) 513(47.6) 3378(52.2) Knew deworming tablet could reduce stomach pain 68(6.3) 249(23.1) 185(17.2) 49(4.5) 133(12.#) 234(21.7) 918(14.2) Knew deworming tablets protect against illnesses 57(5.3) 25(2.3) 60(5.6) 9(0.8) 101(9.4) 69(6.4) 321(5.0) Knew deworming tablets protect against anaemia 3(0.3) 19(1.8) 21(1.9) 14(1.3) 19(1.8) 47(4.4) 123(1.9) Knew deworming tablets improve children’s health 123(11.4) 74(6.9) 108(10.0) 91(8.4) 197(18.3) 192(17.8) 775(12.0) Knew deworming tablets reduce death risk 2(0.2) 8(0.7) 2(0.2) 1(0.1) 8(0.7) 14(1.3) 35(0.5) Knew the first dose of deworming should be taken at 12 months/1 year 274(25.4) 389(36.1) 163(15.1) 118(10.9) 359(33.3) 348(32.3) 1651(25.5) Knew No of times a child should be given deworming tablets per year 168(15.6) 212(19.7) 176(16.3) 125(11.6) 94(8.7) 268(24.9) 1043(16.1) Coverage Rates of Vitamin A Supplementation and Deworming for Children In Table 3, 71 percent of the under 5 children received VAS and 53 percent of the index children received deworming tablets during the MNCHW held in November /December 2024 across the survey States. The VAS coverage was higher in Enugu (84.0%), Niger (79.3%), and Lagos (75.2%) but low in Katsina (49.2%). The overall coverage rate of VAS surpasses the expected 65% coverage rate in the National Multisectoral Plan of Action on Food and Nutrition, however, some states fall short of this target. At the State level, deworming uptake was more than 50 percent in Niger (64.1%), Bayelsa (63.4%), Enugu (58.3%), and Lagos state (50.3%). Almost 50 percent and 52.9% of the index children received VAS and deworming at home, respectively. Home administration of VAS was higher in Gombe (72.2%), Katsina (68.0%), and Niger (63.0%). Poor awareness (36.5%; 31.6%)) and health workers didn’t come (31.2%; 25.2%) constituted the major reasons for not receiving VAS and deworming, respectively. Table 3 : Coverage Rate of Vitamin A supplementation (U-5 children) and Deworming (12-59) Vitamin A Supplementation Deworming Bayelsa n=1419 Enugu n=1492 Gombe n=1619 Katsina n=1738 Lagos n=1279 Niger n=1564 Total N=9111 Bayelsa n=1419 Enugu n=1492 Gombe n=1619 Katsina n=1738 Lagos n=1279 Niger n=1564 Total N=9111 % % % % % % % % % % % % % % Gender of U5 Female 49.8 47.2 47.1 49.4 52.5 48.4 49.0 Male 50.2 52.8 52.9 50.6 47.5 51.6 51.0 Received intervention during Nov/Dec 2024 MNCHW 74.1 84.0 68.7 49.2 75.2 79.3 71.1 63.4 58.3 43.4 39.7 50.3 64.1 52.7 Administrative coverage Round I 53.0 103.0 104.0 96.0 104.0 97.0 22.0 33 100 39 9 89 26 13 Administrative coverage Round II 75 97 96 83 115 105 23 56 34 17 17 58 26 10 Location commodity was given Home 46.5 8.4 72.2 68.0 46.9 63.0 49.6 60.8 9.2 69.9 65.2 52.6 63.7 52.9 Health facility 33.6 46.8 25.8 23.4 36.5 29.8 33.2 25.6 45.7 28.1 26.5 27.4 28.3 30.5 School 7.7 31.7 0.2 1.0 11.1 1.0 9.4 3.2 31.5 0.1 1.4 14.3 0.7 8.6 Religious centres 4.1 9.9 0.4 0.4 2.5 0.6 3.2 2.8 8.0 0.3 0.0 1.4 0.4 2.3 Others 8.1 3.2 1.4 7.2 3.0 5.6 4.6 7.6 5.6 1.5 6.8 4.3 6.9 5.7 Reasons for non-uptake during NOV/DEC 2024 MNCHW Child was absent 26.1 11.4 7.4 8.3 16.5 30.6 14.3 15.2 5.6 4.2 7.8 10.3 27.0 10.4 Health workers didn’t come 23.3 12.7 39.0 41.1 19.5 23.1 31.2 18.0 6.5 40.0 39.7 9.4 15.1 25.2 Not aware 24.2 49.5 41.6 40.5 36.8 19.9 36.5 19.1 38.1 35.7 39.0 25.6 22.2 31.6 Child was ill 1.6 2.9 0.0 0.1 1.1 2.1 0.9 0.8 1.3 0.2 0.3 0.9 1.2 0.7 Refusal 4.6 3.9 0.8 0.7 7.7 2.1 2.5 3.3 3.7 0.7 0.4 6.6 0.8 2.2 Lack of products 2.8 1.0 2.2 0.4 2.2 1.8 1.5 3.3 5.6 3.2 2.1 5.7 3.3 3.6 Not of age 5.6 7.8 3.2 1.1 4.4 3.6 3.4 20.7 24.4 7.6 3.3 22.4 11.8 13.1 Others 4.3 4.4 0.6 0.7 6.6 3.6 2.5 14.2 12.9 7.5 7.0 10.1 15.1 10.3 Don’t know/do not remember 7.5 6.4 5.2 7.1 5.2 13.2 7.2 5.4 1.9 0.9 0.3 8.9 3.5 2.9 Barriers and Enablers of Vitamin A Supplementation and Deworming Coverage Barriers to Vitamin A and Deworming Services Feedback from various categories of stakeholders reflect implementation of Vitamin A supplementation and deworming interventions is affected by many preventable challenges as summarized in Figure 2. Barriers include funding delay which disrupts procurement and outreach, reduced efficiency, and postponed MNCH campaigns. Evidence shows funding gaps in the procurement of deworming tablets, which presently lacks structured international support. This funding gaps manifests in form of stockouts and low coverage of deworming coverage. Insufficient or untimely funds hinder procurement of supplies, health worker mobilization, and transportation coverage, ultimately lowering intervention reach and coverage rates. Another prominent barrier is the lack of commodities especially Albendazole. Frequent Albendazole shortages have been reported in many states including Gombe and Katsina, due to the absence of dedicated international funding, forcing states to procure supplies independently. This imbalance leads to incomplete interventions, where children receive Vitamin A but miss deworming, undermining the programmes' overall health impact. Nigeria's weak health system also hinders effective nutrition intervention delivery due to insufficient infrastructure, inadequate cold chain storage, staffing, and logistical support at primary healthcare facilities. Critical gaps like inadequate personnel, poor transportation networks, and unreliable cold chain storage further undermine program implementation and impact. “ One of the problems is that states are supposed to bring counterpart funding, and these funds are not released on time. …………….,; they are not released before the programme starts. This affects commodity availability, fueling vehicles, and mobilization of health workers .” – FMOH Stakeholder “ Delayed government release of funds is a major challenge. As partners, we complement the government’s efforts, but the delay in releasing state funds affects the timing of interventions. This sometimes results in postponing the MNCH campaign, which, in turn, affects social mobilization and caregiver participation.” - NI Programme Officer “ In terms of Vitamin A, I don’t think there is low coverage. But in terms of Albendazole (deworming), yes, coverage is very low not even up to 20% nationally. This is because there is no structured supply system for deworming tablets, making it difficult for states to ensure availability .” - Vitamin Angels “ The major challenge is the weakness within the health system. Many service delivery points have limited health workers compared to the demand for health services, making it difficult to provide quality nutrition interventions.” - UNICEF Nutrition Officer “Routine services remain weak, especially at the PHC level. We still see cases where facilities lack the proper logistics and infrastructure to store and distribute nutrition commodities effectively.” (KII FED NI Deputy Country Director 1222025) Poor social mobilization is another critical barrier and is occasioned by inadequate planning, funding, and political commitment which weaken outreach efforts, hinder caregiver engagement and reduce intervention coverage. Likewise, remote, conflict-affected, and geographically isolated regions, where logistical challenges, inadequate transportation, and insecurity hinder service delivery. Limited health infrastructure, poor road networks, high operational costs, and displacement of caregivers exacerbate low coverage, particularly in riverine areas in Bayelsa and Lagos, conflict zones like the Northeast/Northwest like Katsina and Niger, and mountainous terrains. Moreover, accurate data tracking for Vitamin A and deworming programmes in Nigeria is undermined by discrepancies between administrative reports (often inflated due to pressure to meet targets) and post-event coverage surveys (PECS), which reveal lower actual coverage rates. These gaps stem from a lack of standardized validation systems, reliance on outdated census data, and inconsistent data collection practices, skewing resource allocation and masking true coverage gaps. While PECS helps identify overreporting, its irregular implementation and states’ limited technical capacity hinder reliable validation nationwide. Poor coordination and funding sustainability characterized by fragmented efforts, leading to duplication of resources or gaps in coverage. Additionally, some states overly depend on partners for deworming tablets, which affects long-term sustainability. “The issue of mobilization is critical. In many communities, caregivers do not turn up for supplementation because they were not adequately informed. If sensitization efforts are not strong, turnout remains low, affecting coverage rates.” - Deputy Country Director “Some caregivers believe that deworming tablets cause infertility in children, which is not true. These misconceptions prevent some parents from allowing their children to receive the intervention.” - UNICEF Nutrition Officer “For the social mobilization team, the first rounds when we implemented it, there was that challenge of the people saying, the caregivers in the community saying they did not get information, that the town criers and the dialogue missing, that the money that was set aside for implementing the program was not enough.” - Bayelsa State KII “We have had cases where health workers were attacked while trying to reach conflict-affected communities. In such situations, we have to rely on alternative strategies such as working with local volunteers or integrating services into humanitarian aid programs.” - UNICEF Nutrition Officer “Additionally, the emergence of Internally Displaced Persons (IDP) camps and the migration of people from states like Kebbi and Kaduna add complexity to our planning efforts. Often, even after completing our micro-planning, we may face sudden demands for additional resources when we attempt to engage with communities” Niger state KII “Data validation processes are inconsistent across states. There needs to be a standardized approach to data quality assessment to ensure reliability.” - HKI VAS PM “We need a more rigorous data verification system. If the data is not accurate, then the planning for future interventions will be flawed, and resources may not be properly allocated.” - NI Deputy Country Director “Coordination among partners is improving, but we still need a stronger national platform where all stakeholders government, NGOs, and donors can align their efforts to prevent duplication and resource imbalances.” - KII FED HKI M & E Officer “We have been advocating for states to take ownership of deworming programs. Some states rely entirely on partners, which is not sustainable. The government must integrate deworming into routine budgets.” - NI Deputy Country Director Enablers of Vitamin A and Deworming Services Several factors contribute to successful Vitamin A supplementation and deworming service delivery, ranging from funding availability and community engagement to logistical efficiency (Figure 2). The timely release of funds, strong and coordinated partnerships, the use of trained personnel, and integrated service delivery impacted coverage rates. Coordinated partnerships among key stakeholders including federal agencies (NPHCDA), State actors and NGOs (UNICEF, Nutrition International) and others contributed to the success of vitamin A supplementation. This extends to training health workers, strengthening health systems, and integrating nutrition programmes with other health services. The government is responsible for policy formulation, planning, and funding, international partners such as UNICEF, Helen Keller International (HKI), Nutrition International (NI), and Vitamin Angels play a crucial role in providing financial and technical support, advocacy, and commodity supply. The adoption of MNCH Week Efficacy, a campaign-based approach, ensured rapid scale-up but lack sustainability compared to routine integration. Partner support is instrumental in ensuring the availability of Vitamin A capsules, which are provided free of charge through collaborations with organizations like UNICEF and Nutrition International. This strong donor/partner support is the key driver of near 100% VAS coverage in states like Gombe. Beyond commodity provision, development partners also contribute through advocacy efforts, urging the government to allocate more resources for nutrition programmes. Advocacy efforts have led to increased awareness and political commitment, but financial support from the government remains inconsistent, particularly for deworming programmes. The availability of Vitamin A supplements is relatively stable due to structured agreements with development partners, but deworming tablets still face major funding challenges. Limited partner initiative such as from Vitamin Angels have enhanced deworming coverage in some states and proactive leadership at the state level like in Kogi have led to prioritize procurement of deworming tablets, successful implementation and increased coverage. Strengthening collaboration between the government and partners is essential for improving coordination, ensuring timely release of funds, and addressing coverage gaps. Moving forward, increased government ownership and sustainable funding mechanisms will be key to the long-term success of these programmes. Furthermore, community engagement including the leveraging of public trust in traditional and religious leaders and the use of radio campaigns, media, and town announcers have enhanced mobilization and trust in Enugu and Katsina states. The use of house-to-house strategies in Gombe has proven successful to improve access in remote areas. Lastly, integration of nutrition services with routine health services such as immunization, antenatal care, family planning, malaria prevention and school health programmes offer a promising, cost-effective and sustainable strategy to improve accessibility and coverage. “ We, as Nutrition International, support all 36 states and the FCT with vitamin A supplement in partnership with UNICEF. We have a global memorandum of understanding with UNICEF, where we provide the in-kind donation of vitamin A supplementation to the government of Nigeria .” - NI Program Officer “ Partners provide support, but the government must take full ownership of these interventions. The long-term sustainability of Vitamin A and deworming interventions depends on how well the government integrates them into routine healthcare services .” - UNICEF Nutrition Officer “ The government is doing a lot to ensure nutrition commodities are available. One approach is the Child Nutrition Fund, a matching fund where if a state provides 250 million, the CNF matches it with another 250 million. Advocacy is ongoing to encourage states to participate .” - FMOH “ One, the use of CHIPS (Community Health Influencers, Promoters and Services) agents, house-to-house. Two, the health workers, like the social mobilization team, the state mobilization officer informed the social mobilization and the LGA to make sure that it is in order and availability of the vitamin A supplement .” Gombe State KII Opportunities for Improvement and Additional Resources for Enhancing Vitamin A and Deworming Services The effectiveness of Vitamin A supplementation and deworming programmes can be significantly enhanced with targeted improvements and additional resources. Some of the key areas identified by stakeholders that require attention to improve service delivery and ensure wider reach and impact are summarized in Figure 3. Identified opportunities included promoting Integrated Health Service Delivery which combines VAS and deworming initiatives with broader health campaigns such as immunization drives to streamline efforts, reduce costs, and improve coverage. “……………………. If we can do that, I think funding also should be given for, like all the SIAs, this is our initiative...we only target SIAs around other programmes to have mixed opportunities so that the mixed children will be grabbed ” Niger State KII Another window of opportunity is expanding social mobilization which is key to boosting participation. In rural and hard-to-reach areas, leveraging local networks like town announcers and trusted figures can bridge awareness gaps. Addressing cultural misconceptions and logistical barriers is critical for equitable coverage. “ The other area that will need improvement is the social mobilization activities...so that the women, the caregivers, you know, they will all come mass to assess these services ” Bayelsa State KII. “ That is why we say that, to increase coverage, we are using CHIPS agents. And we say that we should use routine services. We use routine services, and also the use of chief agents. And to sensitize the community, to use the structure that we have, like town announcement, mouth-to-mouth, tell somebody about this thing that is going to be happening, and we should start it early. Start doing that sensitization or awareness, one month prior to this implementation .” Gombe State KII Expanded Training and Capacity Building constitute another opportunity. Health workers, particularly community volunteers, require expanded training on supplementation protocols, monitoring tools (e.g., health cards), and communication strategies. Ongoing capacity-building programmes, coupled with supervision, ensure consistent service quality and accurate data reporting. “ It is essential to secure funding for training and oversight...providing proper training and orientation before the program begins, followed by ongoing monitoring ” Katsina State KII. Partnerships and advocacy can also be strengthened to source additional funding, technical support, and logistical resources. Advocacy targeting reluctant political leaders (e.g., local chairmen) is necessary to galvanize commitment and avoid bureaucratic bottlenecks. Coordinated partnerships also prevent duplication of efforts and enhance programme efficiency. “ Like these health facilities, it is important that they help sponsor training. Currently, we are not able to fund all the training ourselves. Therefore, their support during the training is crucial. During this training, participants should learn essential information that they can pass on to their communities and caregivers. ” Enugu State KII Dedicated funding, mobile health units, and community-based volunteers can be explored to extend coverage to children in conflict zones, remote terrains, and underserved regions. Proactive planning, such as pre-campaign mapping and flexible delivery models, is essential to reach displaced or nomadic populations. Robust monitoring systems, supported by technology and community feedback, enable real-time tracking of coverage and challenges. Regular post-event surveys validate administrative data, addressing overreporting and ensuring accountability. Transparent data sharing with stakeholders informs adaptive strategies and resource allocation. “ We need to pay close attention to the children in hard-to-reach areas. This will be very beneficial. With proper planning and funding dedicated to reaching these areas, we can identify many missed children who need Vitamin A. As I mentioned, coverage is primarily focused on accessible regions. If we allocate more support to reach hard-to-reach areas, we will significantly increase the number of children receiving Vitamin A, particularly in Katsina Town .” Katsina State KII “ That is why we say that, to increase coverage, we are using Community Health Influencers, Promoters and Services (CHIPS) agents. And we say that we should use routine services. We use routine services, and also the use of chief agents. And to sensitize the community, to use the structure that we have, like town announcement, mouth-to-mouth, tell somebody about this thing that is going to be happening, and we should start it early. Start doing that sensitization or awareness, one month prior to this implementation .” Gombe State KII Discussion The study shows that Vitamin A Supplementation (VAS) and deworming programmes have recorded improvement. However, critical gaps and opportunities exist with disparities in coverage, caregivers’ knowledge, and service delivery across region. The programmes still experience suboptimal coverage, regional disparities, and systemic inequities. Only one in two eligible children presently receive deworming tablets and about five in seven eligible children receive vitamin A supplementation. Successful implementation remains hinged on donor partnerships, and this explains the north-south variation in coverage. Though the overall VAS coverage reflects moderate progress, some states fall short of the 65% target set by Nigeria’s National Multisectoral Plan of Action on Food and Nutrition. The improvement in the VAS coverage can be largely attributed to donor support that ensured 100% capsule availability and leveraging the MNCH Week platform. In sub-Sahara Africa, media exposure, maternal awareness, mothers' education, and urban residency have been reported to increase the likelihood of uptake of VAS (Berde et al., 2019; Janmohamed et al., 2024). Strengthening the community mobilization and awareness of nutrition and health programmes remain important in enhancing uptake and improving on the coverage and this is largely reflected across selected states in this evaluation. Wondie et al (2025) emphasized the importance of increased community awareness about VAS, particularly targeting parents with low educational status and no antenatal and postnatal care through social media and community meetings in promoting increased coverage of VAS. Another key finding of this study is the predominance of poor knowledge of VAS and deworming among the caregivers. Poor caregiver knowledge in this study reflects systemic communication failures and this may be responsible for heavily reliance on health campaign strategy and low opt-in health services in these interventions. Efforts in the last few years have focused on strengthening health facility administration of VAS to promote health seeking behaviour among caregivers. Several studies have documented poor knowledge of vitamin A benefits among Nigerians and this has contributed to poor uptake of diverse interventions directed at improving vitamin A status of the population including VAS and biofortification of foods, among others (Ariyo et al., 2023; Adamu & Muhammad, 2016). This suggests that many caregivers do not fully appreciate the benefits of the services, and this calls for revisitation of strategy for nutrition education during nutrition service delivery. The high percentage of caregivers that indicated that health workers didn’t come in Katsina (41.1%) and Gombe (39.0%) reflects the reliance on home administration of VAS, and the need for consistency and compliance in programme delivery. Key barriers included poor caregiver awareness, health worker absenteeism, inconsistent commodity (albendazole) supply, weak political will, supply-chain failures, weak micro-planning, inadequate health worker training, and poor social mobilization. Qualitative data revealed stark regional disparities: northern states achieved higher VAS and deworming coverage due to robust donor partnerships and government commitment, whereas southern states faced logistical bottlenecks, delayed funding, and weak social mobilization. The barriers identified in this study largely aligns with pre-defined barriers typical about vitamin A supplementation programme in Africa including capsule stock-outs, poor healthcare worker attitude and service, inadequate health personnel, inadequate training of staff, lack of incentive for participants and staff, logistics issues transportation, fuel and food supplies, and poor monitoring and evaluation mechanisms (Ezezika et al., 2024). The national deworming coverage of 53% during the November/December 2024 MNCHW narrowly surpassed the 50% target set by Nigeria’s National Multisectoral Plan of Action on Food and Nutrition, and showcased significant disparities persist across states and regions. Only Niger, Bayelsa, Enugu, and Lagos met or exceeded the national benchmark (50.0%), underscoring uneven programme implementation. Home administration remains popular in northern states and largely relies on health and nutrition campaign which are very expensive and largely unsustainable, this calls for the need to strengthen health facility delivery and coverage of deworming services. Transitioning to routine supplementation requires addressing caregivers' health-seeking behaviors. About one in four of the index children received deworming tablets at any other time from January till February 2025, particularly in Bayelsa, Lagos, and Enugu. This suggests availability and accessibility to the deworming commodities beyond the MNCHW and this should be ensured across all the states. Interestingly, these deworming services were received at home (67.0%), this suggest that some other health campaigns are also leveraged to deliver deworming services beyond the MNCHW. The caregivers’ demonstration of poor knowledge of the benefits of deworming provides an insight to low uptake and suggest the needs to intensify efforts at health-educating the masses on the essentials of deworming. The low knowledge of deworming reflects a departure from the findings among caregivers in Rwanda where large proportion of the mothers demonstrated good knowledge of deworming (Rwamwejo et al., 2023). Scaling up access and uptake of deworming services is critical to achieving the World Health Organization’s Neglected Tropical Disease Roadmap towards eliminating select neglected tropical diseases (NTDs). Qualitative insights reveal systemic barriers, including reliance on donor-dependent campaigns for VAS, inconsistent deworming tablet procurement, insecurity and hard to reach areas, and regional inequities in governance and resource allocation; thereby reflecting the complex interplay of logistical, financial, and sociopolitical factors shaping child health outcomes in Nigeria. Earlier study in Nigeria have identified neighborhood socioeconomic disadvantage and geographic location as the community-level characteristics that determined receipt of VAS (Aremu et al 2010). This calls for the development of a context-specific strategy to adequate cater for children living in difficult terrains, hard to reach areas and areas where insecurity is high. The wide disparity between the administrative coverage and PECS coverage at the national level can be attributed to the focus on the six states and the likelihood that the states with high coverage are selected for the PECS. This suggests the need for intentional inclusion of states with low administrative coverage in subsequent PECS. Such intentional targeting may be helpful in unveiling bottlenecks in the promotion and delivery of nutrition services in such states. This mismatch raises questions about data accuracy and programme implementation. This observation can be attributed to under-projection of the target population, vaccinating children outside of the target age, and/or due to over-reporting by health workers in response to satisfy performance metrics or avoid repercussions, or underestimation in PECS (Sesay et al., 2015). The administrative-PECS discrepancy underscores systemic challenges in Nigeria’s health data ecosystem. Administrative coverage exceeding 100% is a red flag for data quality issues. Closing this gap requires addressing overreporting incentives, improving population estimates, and prioritizing equity in high-need states like Katsina and Lagos. The poor use of health services in selected states may be an indication of poor trust in the health services, availability of several barriers in accessing health facilities or discouragement from the use of health facilities following health workers attitude or non-availability of essential commodities. This shows poor use of health services particularly in Gombe, Katsina and Enugu. This calls for operational research to unravel the motivations, barriers and facilitators to the use of health facilities among the caregivers of infants and young children in these three States. Other issues such as distance to health centers, transportation costs, and insecurity (notably in Northern states like Katsina and Gombe), understaffed facilities and stockouts of essential medicines, and preference for traditional medicine demotivate caregivers and hinder access to health services (Ahinkorah et al., 2021). Nigeria’s north-south divide reflects systemic healthcare disparities. Northern states leverage donor-driven campaigns and culturally trusted CHVs to achieve higher coverage, mirroring Bangladesh’s success with community health models (Uddin et al., 2021). In contrast, southern states face urban fragmentation and governance gaps, leading to reliance on facility-based services; which underscores the need for context-specific strategies. Reliance on home-based administration and donor funding threatens programme sustainability. Stockouts and procurement challenges, highlight weak supply chains. Concurrent IFAS/MMS use in pregnancy contrary to WHO guidelines signals poor oversight. Administrative data overreporting, a systemic issue in low-resource settings, distorts resource allocation and masks true coverage gaps. Conclusion Despite moderate coverage, Nigeria’s VAS and deworming programmes face preventable barriers rooted in financing, health systems, and community engagement. Northern states demonstrate that strong partnerships and government commitment can mitigate challenges, but sustainable progress requires integrated service delivery, improved data systems, and decentralized funding. Policymakers must prioritize these areas to achieve universal coverage targets. Declarations Ethics approval and consent to participate: The study protocol was approved by Nigeria’s National Health Research Ethics Committee (NHREC/01/01/2007-19/12/2024). Written/verbal consent was obtained from all respondents. PII stored separately on encrypted servers (256-bit AES). Data ownership retained by UNICEF/Federal Government; destruction scheduled post-project. Consent for publication: Not applicable Availability of data and materials : Data ownership retained by UNICEF/Federal Government; destruction scheduled post-project. The datasets generated and/or analyzed during the current study are not publicly available due to privacy concerns but are available from the authors on reasonable request. Inquiries and data access requests should be directed to Edward Kutondo at [email protected] . Competing interests: The authors declare no conflict of interest. Funding: United Nations Children Fund Authors' contributions: All authors conceptualized the study and contributed in writing the manuscript. All authors have read and approved the manuscript. Acknowledgements: All the respondents and enumerators across the sampled states, Manawa Oghenevwede and Makinde Joseph for the support in data analysis Authors' information Oluwaseun Ariyo, Department of Human Nutrition and Dietetics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria, [email protected] Edward Kutondo, United Nations Children’s Fund, Nigeria Country Office, Abuja, Nigeria, [email protected] Adegbenga Adedayo, Hanovia Limited, Hanovia House, 8 Ahmed Musa Crescent, Jabi-Abuja, Nigeria, [email protected] Nemat Hajeebhoy, United Nations Children’s Fund, Nigeria Country Office, Abuja, Nigeria, [email protected] Adekola Durojaye, Hanovia Limited, Hanovia House, 8 Ahmed Musa Crescent, Jabi-Abuja, Nigeria, [email protected] Olabisi Kehinde Olorundare, Hanovia Limited, Hanovia House, 8 Ahmed Musa Crescent, Jabi-Abuja, Nigeria, [email protected] Tomilola Juliana Aladesanmi, Department of Human Nutrition and Dietetics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria, [email protected] Hashim Hassanu, Hanovia Limited, Hanovia House, 8 Ahmed Musa Crescent, Jabi-Abuja, Nigeria, [email protected] Angbala David, Hanovia Limited, Hanovia House, 8 Ahmed Musa Crescent, Jabi-Abuja, Nigeria, [email protected] Lawal Muhammad, Hanovia Limited, Hanovia House, 8 Ahmed Musa Crescent, Jabi-Abuja, Nigeria, [email protected] Prosper Dakurah, United Nations Children’s, Nigeria Country Office, Abuja, Nigeria, [email protected] Yadika Charles Shapu, United Nations Children’s Fund, Nigeria Country Office, Abuja, Nigeria, [email protected] Sam Obasi, National Primary Health Care Development Agency, Abuja, Nigeria, [email protected] References Adamu MD, Muhammad N. Assessment of vitamin A supplementation coverage and associated barriers in Sokoto State, Nigeria. Ann Niger Med. 2016;10(1):16. Aghaji AE, Duke R, Aghaji UCW. Inequitable coverage of vitamin A supplementation in Nigeria and implications for childhood blindness. BMC Public Health. 2019;19:282. https://doi.org/10.1186/s12889-019-6413-1 . Ahinkorah BO, Ameyaw EK, Seidu AA, Odusina EK, Keetile M, Yaya S. Examining barriers to healthcare access and utilization of antenatal care services: evidence from demographic health surveys in sub-Saharan Africa. BMC Health Serv Res. 2021;21:1–16. Aremu O, Lawoko S, Dalal K. Childhood vitamin A capsule supplementation coverage in Nigeria: a multilevel analysis of geographic and socioeconomic inequities. Sci World J. 2010;10:1901–14. 10.1100/tsw.2010.188 . PMID: 20890579; PMCID: PMC5763688. Ariyo O, Oladejo EO, Atojoko MA. Awareness, perception and constraints to consumption of pro-vitamin A cassava food among women of reproductive age in Ikire, Nigeria. Agro-Science. 2023;22(1):71–7. Berde AS, Bester P, Kruger IM. Coverage and factors associated with vitamin A supplementation among children aged 6–59 months in twenty-three sub-Saharan African countries. Public Health Nutr. 2019;22(10):1770–6. 10.1017/S1368980018004056 . Ezezika O, Quibrantar S, Okolie A, Ariyo O, Marson A. (2024). Barriers and facilitators to the implementation of vitamin A supplementation programs in Africa: A systematic review. Nutr Health, 02601060241294133. Federal Government of Nigeria (FGoN) and the International Institute of Tropical Agriculture (IITA). National Food Consumption and Micronutrient Survey 2021. Final Report. Abuja and Ibadan. Nigeria: FGoN and IITA; 2024. p. 550. Helen Keller International’s Protocol for Post-Campaign Coverage Survey of Vitamin A Supplementation and coupled services. (January 2024). Janmohamed A, Doledec D, Dissieka R, Jalloh UH, Juneja S, Beye M, Ndiaye F, Jumbe T, Baker MM. 2024. Vitamin A supplementation coverage and associated factors for children aged 6 to 59 months in integrated and campaign-based delivery systems in four sub-Saharan African countries. BMC Public Health , 24 (1), p.1189. National Population Commission (NPC) [Nigeria] and ICF. Nigeria Demographic and Health Survey 2018. Nigeria, and Rockville, Maryland, USA: NPC and ICF: Abuja; 2019. Rwamwejo F, Ndatinya GI, Mkata MI, Blauman A, Regnier D, Lackner SC. Assessing the knowledge, attitudes, practices, and perspectives of stakeholders of the deworming program in rural Rwanda. PLoS Negl Trop Dis. 2023;17(8):e0010759. Sesay FF, Hodges MH, Kamara HI, Turay M, Wolfe A, Samba TT, Koroma AS, Kamara W, Fall A, Mitula P, Conteh I. High coverage of vitamin A supplementation and measles vaccination during an integrated Maternal and Child Health Week in Sierra Leone. Int Health. 2015;7(1):26–31. Shekar M, Kakietek J, Eberwein JD, Walters D. An investment framework for nutrition: reaching the global targets for stunting, anemia, breastfeeding, and wasting. World Bank; 2017. Uddin ME, George J, Jahan S, Shams Z, Haque N, Perry HB. Learnings from a pilot study to strengthen primary health care services: the community-clinic-centered health service model in Barishal District, Bangladesh. Global Health: Sci Pract. 2021;9(Supplement 1):S179–89. United Nations Children’s Fund, Vitamin A, Supplementation. A Decade of Progress. 2007. http://www.unicef.org/publications/files/Vitamin_A_Supplementation.pdf (accessed on 20 August 2025). United Nations Children’s Fund, UNICEF. (2024). Child Food Poverty. Nutrition Deprivation in Early Childhood. Child Nutrition Report, 2024. UNICEF, New York, June 2024. Wondie WT, Zemariam AB, Gedefaw GD, Lakew G, Getachew E, Mengistie BA, Shibabaw AA, Chereka AA, Kitil GW, Yirsaw AN, Mekonnen GB. 2025. Vitamin A supplementation coverage and its associated factors among children 6–59 months of age in Ethiopia: a systematic review and meta-analysis. Frontiers in Public Health , 13 , p.1496931. Additional Declarations No competing interests reported. Supplementary Files PECSSURVEYQUESTIONNAIRE03102025.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 11 Nov, 2025 Reviewers agreed at journal 04 Nov, 2025 Reviewers invited by journal 30 Oct, 2025 Editor assigned by journal 29 Oct, 2025 Editor invited by journal 05 Oct, 2025 Submission checks completed at journal 03 Oct, 2025 First submitted to journal 03 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7532150","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":542128660,"identity":"7d83eb93-d5ee-4ced-aa45-13c277ae22b5","order_by":0,"name":"Oluwaseun Ariyo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYFACxgYIzQ6iDSxI0cJzAKRFghTbJBLAJGGF/LMPt0l8+GOTuF3y+dUNPwokGPjbuxPwm30usU1yZlta4s7ZOWU3e4AOkzhzdgN+a84wtknzNhxO3HA7J+0GD1CLgUQufi3yIC08f/4nbrh5Ju3mH2K0GIC1sB1I3HCD/dhtomwxPMPYbDmzLdl4w5kcttsyBhI8BP0id4b94Y0Pf+xkNxw//uzmmz82cvztvQS8z8DAAo0LHgMwSUg5CDB/gNDsD4hRPQpGwSgYBSMQAADHzEq6SrBRoQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Ibadan","correspondingAuthor":true,"prefix":"","firstName":"Oluwaseun","middleName":"","lastName":"Ariyo","suffix":""},{"id":542128661,"identity":"cd3b5368-1182-45da-98d6-e3eab8c8d0ff","order_by":1,"name":"Edward Kutondo","email":"","orcid":"","institution":"United Nations Children's Fund, United States","correspondingAuthor":false,"prefix":"","firstName":"Edward","middleName":"","lastName":"Kutondo","suffix":""},{"id":542128662,"identity":"8bd46639-7fc1-4168-ab1f-d2a66ac4cdf0","order_by":2,"name":"Adegbenga Adedayo","email":"","orcid":"","institution":"Hanovia Limited","correspondingAuthor":false,"prefix":"","firstName":"Adegbenga","middleName":"","lastName":"Adedayo","suffix":""},{"id":542128663,"identity":"7bf61330-13e3-4782-9b43-3a06d260f4d7","order_by":3,"name":"Nemat Hajeebhoy","email":"","orcid":"","institution":"Hanovia Limited","correspondingAuthor":false,"prefix":"","firstName":"Nemat","middleName":"","lastName":"Hajeebhoy","suffix":""},{"id":542128664,"identity":"3b0a0b75-6d0b-4e84-80bb-8fc263f0716a","order_by":4,"name":"Adekola Durojaye","email":"","orcid":"","institution":"Hanovia Limited","correspondingAuthor":false,"prefix":"","firstName":"Adekola","middleName":"","lastName":"Durojaye","suffix":""},{"id":542128665,"identity":"80c7c205-01c0-4aba-9674-d73ac7b3b68c","order_by":5,"name":"Olabisi Kehinde Olorundare","email":"","orcid":"","institution":"Hanovia Limited","correspondingAuthor":false,"prefix":"","firstName":"Olabisi","middleName":"Kehinde","lastName":"Olorundare","suffix":""},{"id":542128666,"identity":"722cf3c8-5d5c-4e80-a526-6e936a1f6982","order_by":6,"name":"Tomilola Juliana Aladesanmi","email":"","orcid":"","institution":"University of Ibadan","correspondingAuthor":false,"prefix":"","firstName":"Tomilola","middleName":"Juliana","lastName":"Aladesanmi","suffix":""},{"id":542128667,"identity":"d8127c65-e779-4604-817a-e4eae1b1f678","order_by":7,"name":"Hashim Hassanu","email":"","orcid":"","institution":"Hanovia Limited","correspondingAuthor":false,"prefix":"","firstName":"Hashim","middleName":"","lastName":"Hassanu","suffix":""},{"id":542128668,"identity":"48f4649a-d8ce-4d62-a687-48804f976891","order_by":8,"name":"Angbala David","email":"","orcid":"","institution":"Hanovia Limited","correspondingAuthor":false,"prefix":"","firstName":"Angbala","middleName":"","lastName":"David","suffix":""},{"id":542128669,"identity":"f535117b-252c-4000-bd92-bc035ea39644","order_by":9,"name":"Lawal Muhammad","email":"","orcid":"","institution":"Hanovia Limited","correspondingAuthor":false,"prefix":"","firstName":"Lawal","middleName":"","lastName":"Muhammad","suffix":""},{"id":542128670,"identity":"4a8f2e46-f0b9-404f-b6c5-98ef40101c4d","order_by":10,"name":"Prosper Dakurah","email":"","orcid":"","institution":"United Nations Children's Fund, United States","correspondingAuthor":false,"prefix":"","firstName":"Prosper","middleName":"","lastName":"Dakurah","suffix":""},{"id":542128671,"identity":"ffbbc8ce-369f-4547-807e-2cdc60cdcb0a","order_by":11,"name":"Yadika Charles Shapu","email":"","orcid":"","institution":"United Nations Children's Fund, United States","correspondingAuthor":false,"prefix":"","firstName":"Yadika","middleName":"Charles","lastName":"Shapu","suffix":""},{"id":542128672,"identity":"f065a5dd-8e48-457d-b282-a9a8b0d283fc","order_by":12,"name":"Sam Obasi","email":"","orcid":"","institution":"National Primary Health Care Development Agency","correspondingAuthor":false,"prefix":"","firstName":"Sam","middleName":"","lastName":"Obasi","suffix":""}],"badges":[],"createdAt":"2025-09-04 05:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7532150/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7532150/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95662327,"identity":"588840ee-e014-47dc-b557-fafdc424d136","added_by":"auto","created_at":"2025-11-11 16:37:24","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":503734,"visible":true,"origin":"","legend":"","description":"","filename":"PECSSurveyManuscript103102025.docx","url":"https://assets-eu.researchsquare.com/files/rs-7532150/v1/f3650aca7c1f412856ac43b9.docx"},{"id":95661990,"identity":"39f3fe14-6888-4efb-9f70-c1009a35df40","added_by":"auto","created_at":"2025-11-11 16:37:03","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":14029,"visible":true,"origin":"","legend":"","description":"","filename":"654a7f8bed58489b839db81539e7ae9c.json","url":"https://assets-eu.researchsquare.com/files/rs-7532150/v1/7921a18f039be2e313b393f9.json"},{"id":95662334,"identity":"9a62537c-9746-47b6-8283-c6f58a1822e2","added_by":"auto","created_at":"2025-11-11 16:37:24","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":139412,"visible":true,"origin":"","legend":"","description":"","filename":"PECSSURVEYQUESTIONNAIRE03102025.docx","url":"https://assets-eu.researchsquare.com/files/rs-7532150/v1/d5b1d2ca685383e03a482442.docx"},{"id":95662168,"identity":"724f6535-92c4-4f66-b89d-370b6c8d8813","added_by":"auto","created_at":"2025-11-11 16:37:14","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":161933,"visible":true,"origin":"","legend":"","description":"","filename":"654a7f8bed58489b839db81539e7ae9c1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7532150/v1/d9181fd28b4c47bc3aeb8686.xml"},{"id":95662401,"identity":"483412fb-0dc5-4fe3-90c5-98f500dfcb81","added_by":"auto","created_at":"2025-11-11 16:37:30","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":64029,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7532150/v1/9982695eebed8368166b62f2.png"},{"id":95662103,"identity":"1ce35d49-6577-4c2d-b56e-4dacd007e22f","added_by":"auto","created_at":"2025-11-11 16:37:11","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":44051,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7532150/v1/593bcb62c437c0f1bcee8460.png"},{"id":95662321,"identity":"1c09bf92-0d3a-4d74-ab35-d49e1db0b968","added_by":"auto","created_at":"2025-11-11 16:37:23","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":155554,"visible":true,"origin":"","legend":"","description":"","filename":"654a7f8bed58489b839db81539e7ae9c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7532150/v1/6dcd883410910f6c70eb0668.xml"},{"id":95662149,"identity":"4e5bdc45-c9ed-4ce7-b3b1-9a2d0ab3a261","added_by":"auto","created_at":"2025-11-11 16:37:13","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":169099,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7532150/v1/0fca8974d56c12279e00b85b.html"},{"id":95662158,"identity":"f1dd1165-bf58-4277-8b40-af44fc209b4e","added_by":"auto","created_at":"2025-11-11 16:37:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":31380,"visible":true,"origin":"","legend":"\u003cp\u003eSummary of Knowledge score of VAS and Deworming\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7532150/v1/3f21c6078c2e4aa85aba2343.png"},{"id":95662389,"identity":"b45c6538-924b-4e12-8bc0-54db3c4bf255","added_by":"auto","created_at":"2025-11-11 16:37:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":225027,"visible":true,"origin":"","legend":"\u003cp\u003eInterconnected Barriers and Enablers of Vitamin A Supplementation \u0026amp; \u0026nbsp;Deworming Coverage\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7532150/v1/f642a5e30dc5934f65900a92.png"},{"id":95662175,"identity":"735917b8-5aaa-400d-807d-6f09326546b1","added_by":"auto","created_at":"2025-11-11 16:37:15","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":156299,"visible":true,"origin":"","legend":"\u003cp\u003eOpportunities for Improvement\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7532150/v1/b2d3e8499826eab5f33c8a47.png"},{"id":95663534,"identity":"b4f345d8-1a45-44a0-b387-6c367aab5c0f","added_by":"auto","created_at":"2025-11-11 16:39:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2161891,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7532150/v1/57b6c069-bd2d-47f7-920d-8896085e94cc.pdf"},{"id":95662068,"identity":"28100b0f-4ee0-4913-ba87-beced5cd3110","added_by":"auto","created_at":"2025-11-11 16:37:08","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":139412,"visible":true,"origin":"","legend":"","description":"","filename":"PECSSURVEYQUESTIONNAIRE03102025.docx","url":"https://assets-eu.researchsquare.com/files/rs-7532150/v1/ecb9378bcc459f2241947f2b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Mixed-Methods Exposé of Systemic Barriers and Enablers for Vitamin A and Deworming in Nigeria's Maternal Newborn and Child Health Week Programme","fulltext":[{"header":"Introduction","content":"\u003cp\u003eVitamin A Deficiency (VAD) remains a pernicious public health challenge in Nigeria with consequences on child survival, growth, and development. With one in three children aged 6\u0026ndash;59 months affected, VAD contributes to preventable childhood blindness and increases risks of mortality by about 20% (FGoN/IITA 2024, NPC/ICF, 2019; Aghaji et al., 2019; Shekar et al., 2017). Vitamin A is important body immunity, cellular integrity, ocular health, good growth, and general health. Despite the importance of Vitamin A, 32 percent Nigerian children aged 6\u0026ndash;59 months experience severe child food poverty, characterized by consumption of 0\u0026ndash;2 food groups out of eight recommended food groups (UNICEF 2024). Inadequate dietary intake of Vitamin A can be attributed to a range of factors including poverty, limited nutrition education, geographical barriers to health services, and food insecurity.\u003c/p\u003e\u003cp\u003eThe World Health Organization recommends two consecutive high-dose of vitamin A supplements annually for under-five children in countries where VAD constitutes a public health menace such as Nigeria (UNICEF, 2007). Consequently, the Maternal, Newborn, and Child Health Week (MNCHW), a bi-annual campaign (May/June and November/December) to deliver high-dose vitamin A supplementation (VAS) and deworming to children 6\u0026ndash;59 months, was institutionalized. However, national coverage aggregates conceal severe subnational inequities and systemic flaws. Factors such as delivery platform bottlenecks, data inaccuracies and commodities stockouts, among others have been reported to limit the effectiveness of MNCHW in terms of coverage and accessibility.\u003c/p\u003e\u003cp\u003ePost-event coverage surveys (PECS) are indispensable for evaluating VAS programme performance, identifying coverage gaps, and addressing data inaccuracies from administrative tally sheets. In Nigeria, earlier post-event coverage survey has revealed disparities in verified coverage and administrative reporting, thereby suggesting data inaccuracies or possibly systemic overestimation (Helen Keller International, 2020). This finding reflects the significance of robust PECS to validate administrative data and design strategies to optimize coverage of of essential child health interventions.\u003c/p\u003e\u003cp\u003eTherefore, this study leverages a mixed-methods PECS across six geopolitical zones to explore systemic barriers and validate Nigeria\u0026rsquo;s 2024 MNCHW coverage. By interrogating the dissonance between administrative data and ground truth, we aim to catalyze equity-driven strategies that ensure every child irrespective of geography, wealth, or maternal education receives these lifesaving interventions.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional mixed-methods study evaluated coverage and implementation quality of Vitamin A supplementation (VAS) and deworming during Nigeria\u0026rsquo;s November\u0026ndash;December 2024 Maternal, Newborn, and Child Health Week (MNCHW). Six states were purposively selected across Nigeria\u0026rsquo;s geopolitical zones (Bayelsa, Enugu, Gombe, Katsina, Lagos, Niger) using three criteria, namely UNICEF programme focus states, absence of prior coverage surveys, and zonal representation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling Strategy\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and Sample Size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA two-stage cluster sampling method was applied on the administrative areas where Vitamin A supplementation was implemented in November \u0026ndash; December 2024 using WHO 2018 guidelines. In the first stage, 462 Enumeration Areas (EAs) were selected using probability proportional to size (PPS) from National Population Commission (NPC) frames and stratified by urban/rural residence. In the second stage, 14 households were randomly sampled per EA using a Random Number Generator app, and 77 Enumeration Areas were selected per state using the WHO sample size calculator. Eligibility inclusion criteria included household residency for the prior month (\u0026ge;1 month) before the visit and presence of a child aged 6\u0026ndash;59 months during MNCHW.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSample size calculation\u003c/em\u003e was based on anticipated VAS coverage of 80%, design effect (DE=2.503), intra-cluster correlation (ICC=0.167), a confidence interval of 5% (\u0026plusmn;5% precision), and non-response inflation (1.11) yielded 77 EAs/state. Following this, a total of 6468 caregivers of children 6-59 months (1,017 households from 77 EAs per state) participated in the study. Security-compromised EAs were substituted with pre-identified backups (10% reserve).\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eThe target population for the quantitative data collection were the caregivers of children between 6 \u0026ndash; 59 months.\u0026nbsp;\u003cstrong\u003eQuantitative\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edata were collected using\u0026nbsp;\u003c/strong\u003eAndroid-tablet-based Computer-Assisted Personal Interviewing (CAPI) via SurveyCTO\u0026reg; (v2.80), including, 20-minutes caregivers survey (household/child questionnaires, coverage, sociodemographics, and knowledge of VAS and deworming). Enumeration area identification was guided by the GPS (OsmAND app\u0026reg;). Door-to-door enumeration was conducted for eligibility verification, and three revisit attempts were adopted for absent respondents.\u003c/p\u003e\n\u003cp\u003eQualitative data were collected using key informant interviews with the respective State Nutrition Officers and 15 national stakeholders including Director of Nutrition at Federal Ministry of Health and Social Welfare (FMoHSW), Director of Nutrition at National Primary Health Care Development Agency (NPHCDA), and relevant desk officers in UNICEF, Nutrition International (NI), Helen Keller International (HKI), and Vitamin Angels, among others. Each interview was facilitated by trained supervisors using semi-structured interview guide, lasted an average of 50 minutes each, audio-recorded, and transcribed verbatim.\u0026nbsp;The survey guide used in this study was developed specifically for this research. The full English version of the survey instrument is available as a supplementary file [Supplementary File 1].\u003c/p\u003e\n\u003cp\u003eData collection was preceded by a 3-day Training of Trainers (ToT) for a total of 30 supervisors and the state-level training for 155 data collectors. Each state team was comprised of five supervisors, 20 data collectors, one audio reviewer, and two transcribers. Data were collected between January 11 and February 2, 2025. The protocol included daily data synchronization to SurveyCTO server. Data quality assurance measures adopted included real-time GPS/audio auditing of 5% of interviews, totaling 420, weekly high frequency checks in Stata 17.0\u0026reg;, and supervisor-led spot checks (100% of teams).\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eCreation of Indexes: Indexes were created for variables of interest, allowing for the synthesis of multiple indicators into comprehensive measures. The resulting indexes were then analysed using descriptive statistics.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWealth Index was derived from socio-economic variables such as housing characteristics (walls, roof, floor, cooking fuel, family size etc.) and non-productive assets such as tricycle, air conditioner, Tv, fridge etc. Variables with prevalence below 3-5% or higher than 95-97% were excluded from the analysis. All variables were then recoded as Improved \u0026ldquo;1\u0026rdquo;, not-improved \u0026ldquo;0\u0026rdquo; and availability of assets were coded as yes \u0026ldquo;1\u0026rdquo; and no \u0026ldquo;0\u0026rdquo;. A principal component analysis was performed and then wealth index was generated. The wealth index was categorized into 5 groups: lowest, second, middle, fourth and highest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe knowledge of the caregivers on vitamin A and Deworming was assessed using a 20-point scale comprising of eight questions with multiple responses. Every correct response scored \u0026ldquo;1 point\u0026rdquo; and incorrect responses were scored \u0026ldquo;0\u0026rdquo;. Knowledge of the caregiver was considered good when the score falls within 15-20 points, fair at 8-14 points, and poor with score less than 8 (\u0026lt;8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative data\u0026nbsp;\u003c/strong\u003ewere analysed using Stata 17.0 (StataCorp LP). Coverage levels were determined for VAS, deworming, and complementary interventions with 95% confidence intervals. Bivariate analysis was conducted to explore relationships between variables using Chi-square tests and odds ratios, accompanied by 95% confidence intervals. This approach helped identify significant associations, such as factors influencing uptake of health services and any observed disparities in service coverage. Administrative and survey coverage validation was conducted using Bland-Altman plots. Qualitative data were analysed using framework-based thematic analysis.\u0026nbsp;Barriers and promoters mapped to coverage gaps using WHO Health Systems Building Blocks framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: This study was conducted in accordance with the principles of the Declaration of Helsinki. All methods were performed in accordance with relevant guidelines and regulations. The study protocol was approved by Nigeria\u0026rsquo;s National Health Research Ethics Committee (NHREC/01/01/2007-19/12/2024). Informed consent to participate was obtained from all the participants in the study. The datasets analysed during the current study are not publicly available due to privacy concerns contained in the participant consent agreements, but are available from the authors on reasonable request.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eSocio-demographic Characteristics\u003c/h2\u003e\n\u003cp\u003eInterviews were completed with 6,406 caregivers (99.0%) and the sociodemographic characteristics of the caregivers are presented in Table 1. Caregivers interviewed were largely female (91.7%) and 87.2% were biological mothers of index child with similar trend across the survey States. Findings showed that Fathers (5.5%) and others constituted 7.3% including grandmothers (3.0%) and aunts (1.4%). About 57 percent of the caregivers had secondary education or higher, 28.2% had no formal education and 14.4% had not more than primary education. Caregivers were largely self-employed (54.2%), especially in Lagos (81.6%), Enugu (61.7%), and Bayelsa (58.2%). Mean age of the caregivers was 31.5\u0026plusmn;8.7 years with highest mean in Lagos (34.7\u0026plusmn;8.7 years) and the lowest in Niger state (29.6\u0026plusmn;7.9 years). Household size was 6.1\u0026plusmn;3.2 with highest in Katsina state (8.3\u0026plusmn;4.6) and the lowest in Lagos state (4.8\u0026plusmn;1.6). About 79 percent of the caregivers had access to improved water sources with Lagos having the highest (97.3%) and Bayelsa the least (64.0%). About 21 percent of the caregivers used unimproved sanitation system with higher proportion in Katsina (35.4%), Gombe (34.5%), and Niger (24.3%). Overall, the caregivers were almost equally distributed across the five categories of wealth quintiles whereas wide disparities are observed across the state. Sampled caregivers in Gombe, Katsina and Niger were largely in the lower three wealth quintiles where in Lagos and Enugu, caregivers were largely in the top three wealth quintiles. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e: Socio-demographic Characteristics of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eRespondents\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"746\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eBayelsa\u003c/p\u003e\n \u003cp\u003e(n=1078)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eEnugu\u003c/p\u003e\n \u003cp\u003e(n=1078)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eGombe\u003c/p\u003e\n \u003cp\u003e(n=1078)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eKatsina\u003c/p\u003e\n \u003cp\u003e(n=1078)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eLagos\u003c/p\u003e\n \u003cp\u003e(n=1078)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eNiger\u003c/p\u003e\n \u003cp\u003e(n=1078)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(N=6468)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eCaregivers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eN(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eN(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eN(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eN(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eN(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eN(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e999(92.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1020(94.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e990(91.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e957(88.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1063(98.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e900(83.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e929(91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e79(7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e58(5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e88(8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e121(11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e15(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e178(16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e539(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eRelationship with child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e58(5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e43(4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e53(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e83(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e8(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e110(10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e355(5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e920(85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e959(89.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e948(87.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e906(84.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e983(91.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e922(85.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e5638(87.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e100(7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e76(7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e77(7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e89(8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e87(8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e46(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e455(7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e30.8\u0026plusmn;8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e32.8\u0026plusmn;8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e30.5\u0026plusmn;8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e30.9\u0026plusmn;9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e34.7\u0026plusmn;8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e29.6\u0026plusmn;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e31.5\u0026plusmn;8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eLevel of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e67(6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e10(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e528(49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e642(59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e40(3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e538(49.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1825(28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003ePrimary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e176(16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e96(8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e168(15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e190(17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e116(10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e187(17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e933(14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eSecondary or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e865(77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e972(90.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e382(35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e246(22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e913(85.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e353(32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3170(57.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eEmployment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e130 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e89 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e258(23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e273 (25.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e59 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e274(25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1083(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e34 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e13 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e11 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e11 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e6 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e3 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e78 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003ePaid-employment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e287 (26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e311 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e317(29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e337 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e133 (12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;419 (38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp; 1804 (27.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e627 (58.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e665(61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e492(45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e457 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e880(81.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e382(35.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e3503(54.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eHH size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5.4\u0026plusmn;2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5.3\u0026plusmn;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e7.1\u0026plusmn;3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e8.3\u0026plusmn;4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4.8\u0026plusmn;1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e5.7\u0026plusmn;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e6.1\u0026plusmn;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eHad access to Improved water sources\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e683(64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e739(80.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e818(76.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e708(72.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1038(97.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e896(83.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e5063(79.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;Used Unimproved sanitation methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e72 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e118 (13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e330 (34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e350 (35.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e31 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e198 (24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1099 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eWealth Quintile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eLowest\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e123(11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e30(2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e515(47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e507(47.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e119(11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1294(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eSecond\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e250(23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e138(12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e290(26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e296(27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e22(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e289(26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1285(19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eMiddle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e258(23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e254(23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e189(17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e158(14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e89(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e359(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1307(20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eFourth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e258(23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e348(32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e61(5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e82(7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e331(30.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e210(19.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1290(19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003eHighest\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e189(17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e308(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e23(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e35(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e636(59.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e101(9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e1292(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCaregivers\u0026rsquo; Knowledge of the Benefit of VAS, Deworming Services\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformation on awareness and knowledge of vitamin A supplementation and deworming among the caregivers is presented in Table 2. Overall, awareness of the VAS prior to implementation of the second round in 2024 was poor at only 45.5%. Niger state had the highest awareness among the caregivers at 67% while barely one in three caregivers was aware in Gombe (35.1%) and one in five caregivers in Katsina state (23.1%). Town announcers (35.5%), health workers (30.4%), and community/religious leaders (16.7%) were the major sources of information. Knowledge about vitamin A differs among the caregivers across the state. About 71 percent of the caregivers correctly identified Vitamin A capsule overall, however, only 41.9% of the sampled caregivers from Katsina state correctly identified the capsule. \u0026nbsp;Only 42.0% knew VAS prevents night blindness and helps with vision, and only 31.6% of caregivers in Katsina and 32.1% in Bayelsa knew the importance of vitamin A in vision. About 42 percent of the caregivers knew age for VAS first dose, ranging from 36.5% in Bayelsa to 57.3% in Enugu; however, only 27.1% knew the age a child is no longer qualified for VAS, ranging from 12.9% in Gombe to 44.8% in Lagos. Likewise, only 30.0% knew the number of times VAS should be given per year.\u003c/p\u003e\n\u003cp\u003eAbout 63 percent of the caregivers correctly identified deworming tablets, ranging from Katsina (47.9%) to Bayelsa (81.2%). Only 26 percent of the caregivers knew the first dose of deworming should be taken at 12 months/1 year, and this knowledge was particularly low in Katsina (10.9%), Gombe (15.1%), and Bayelsa (25.4%). Also, only 16.1% knew No of times a child should be given deworming tablets per year, particularly in Lagos (8.7%), Katsina (11.6%), and Bayelsa (15.6%). The knowledge of vitamin A supplementation and deworming among the caregivers is summarized in Figure 1. Caregivers with poor knowledge accounted for 67% overall, with a range of 57.5% in Enugu to 79.3% in Katsina.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Caregivers Awareness and Knowledge about VAS\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and Deworming\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"973\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 383px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBayelsa\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=1078)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnugu\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=1078)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGombe\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=1078)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKatsina\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=1078)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLagos\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=1078)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNiger\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=1078)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=6468)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 383px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAwareness\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eAwareness of VAS\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ebefore implementation in NOV/DEC 2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e494(45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e464(43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e378(35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e249(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e483(44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e722(67.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2940(45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource of information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eRadio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e21 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e26(3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e19(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e5(1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e63(8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e37(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e171(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eTelevision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e4(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e5((0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e7(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e12(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e7(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e35(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eHealth workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e162(27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e191(21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e147(29.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e125(33.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e275(39.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e381(32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1281(30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eTown announcers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e330(55.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e313(35.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e142(28.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e107(28.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e169(23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e437(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1498(35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eMember of HH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e21(3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e35(4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e18(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e27(7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e49(6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e30(2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e180(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eCommunity/religious leader\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e31(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e224(25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e132(26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e92(24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e29(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e198(17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e706(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003ePoster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e2(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e16(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e8(1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e1(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e10(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e13(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e50(1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eNeighbourhood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e27(5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e67((7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e24(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e13(3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e91(12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e60(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e282(6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eothers \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e1(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e3(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e8(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e1(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e14(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eCorrectly identified Vit A. capsule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e766(71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e948(87.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e686(63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e452(41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e951(88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e803(74.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4606(71.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew VAS prevents night blindness/ helps with vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e346(32.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e611(56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e448(41.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e341(31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e425(39.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e544(50.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2715(42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew VAS protects against illnesses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e92(8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e86(8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e118(10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e58(5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e173(16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e151(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e678(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew VAS improve children\u0026rsquo;s health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e184(17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e278(25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e272(25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e145(13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e425(39.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e242(22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1546(23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew VAS reduce death risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e2(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e1090.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e8(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e1(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e12(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e19(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e52(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew age of VAS first dose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e394(36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e618(57.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e364(33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e234(21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e585(54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e512(47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2707(41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew age a child is no longer qualified for VAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e258(23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e349(32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e139(12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e193(17.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e483(44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e330(30.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1752(27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew No of times VAS should be given per year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e297(27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e443(41.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e247(22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e181(16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e422(39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e351(30.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1941(30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eCorrectly identified deworming tablets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e875(81.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e785(72.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e545(50.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e516(47.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e673(62.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e696(64.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e4090(63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew deworming tablets treat intestinal worms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e719(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e686(63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e435(40.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e485(45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e540(50.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e513(47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e3378(52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew deworming tablet could reduce stomach pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e68(6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e249(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e185(17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e49(4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e133(12.#)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e234(21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e918(14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew deworming tablets protect against illnesses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e57(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e25(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e60(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e9(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e101(9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e69(6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e321(5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew deworming tablets protect against anaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e3(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e19(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e21(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e14(1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e19(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e47(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e123(1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew deworming tablets improve children\u0026rsquo;s health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e123(11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e74(6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e108(10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e91(8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e197(18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e192(17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e775(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew deworming tablets reduce death risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e2(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e8(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e2(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e1(0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e8(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e14(1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e35(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew the first dose of deworming should be taken at 12 months/1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e274(25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e389(36.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e163(15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e118(10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e359(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e348(32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1651(25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 383px;\"\u003e\n \u003cp\u003eKnew No of times a child should be given deworming tablets per year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e168(15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e212(19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e176(16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e125(11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e94(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e268(24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1043(16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCoverage Rates of Vitamin A Supplementation and Deworming for Children\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Table 3, 71 percent of the under 5 children received VAS and 53 percent of the index children received deworming tablets during the MNCHW held in November /December 2024 across the survey States. The VAS coverage was higher in Enugu (84.0%), Niger (79.3%), and Lagos (75.2%) but low in Katsina (49.2%). The overall coverage rate of VAS surpasses the expected 65% coverage rate in the National Multisectoral Plan of Action on Food and Nutrition, however, some states fall short of this target. At the State level, deworming uptake was more than 50 percent in Niger (64.1%), Bayelsa (63.4%), Enugu (58.3%), and Lagos state (50.3%). Almost 50 percent and 52.9% of the index children received VAS and deworming at home, respectively. Home administration of VAS was higher in Gombe (72.2%), Katsina (68.0%), and Niger (63.0%). Poor awareness (36.5%; 31.6%)) and health workers didn\u0026rsquo;t come (31.2%; 25.2%) constituted the major reasons for not receiving VAS and deworming, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eCoverage Rate of Vitamin A supplementation (U-5 children) and\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eDeworming (12-59)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"1007\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 353px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVitamin A Supplementation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 401px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeworming\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003eBayelsa\u003c/p\u003e\n \u003cp\u003en=1419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eEnugu\u003c/p\u003e\n \u003cp\u003en=1492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eGombe\u003c/p\u003e\n \u003cp\u003en=1619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003eKatsina\u003c/p\u003e\n \u003cp\u003en=1738\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003eLagos\u003c/p\u003e\n \u003cp\u003en=1279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eNiger\u003c/p\u003e\n \u003cp\u003en=1564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003eN=9111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003eBayelsa\u003c/p\u003e\n \u003cp\u003en=1419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eEnugu\u003c/p\u003e\n \u003cp\u003en=1492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eGombe\u003c/p\u003e\n \u003cp\u003en=1619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003eKatsina\u003c/p\u003e\n \u003cp\u003en=1738\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003eLagos\u003c/p\u003e\n \u003cp\u003en=1279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003eNiger\u003c/p\u003e\n \u003cp\u003en=1564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003eN=9111\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender of U5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e49.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e47.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e47.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e49.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e48.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e49.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e50.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e52.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e52.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e50.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e51.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e51.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eReceived intervention during Nov/Dec 2024 MNCHW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e74.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e84.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e68.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e49.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e75.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e79.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e71.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e63.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e43.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e39.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e50.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e64.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e52.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eAdministrative coverage Round I\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e53.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e103.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e104.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e96.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e104.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e97.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eAdministrative coverage Round II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eLocation commodity\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;was given\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e46.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e72.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e68.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e46.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e63.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e49.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e60.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e69.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e65.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e52.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e63.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e52.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eHealth facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e33.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e46.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e25.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e36.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e29.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e33.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e25.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e45.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e26.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e28.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e30.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eSchool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e31.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eReligious centres\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eOthers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eReasons for non-uptake during NOV/DEC 2024 MNCHW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eChild was absent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e26.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e30.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e27.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e10.4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eHealth workers didn\u0026rsquo;t come\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e39.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e41.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e39.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e15.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e25.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eNot aware\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e24.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e49.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e41.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e40.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e19.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e36.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e38.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e35.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e39.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e25.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eChild was ill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eRefusal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eLack of products\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eNot of age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e24.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e22.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e13.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e12.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e15.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 202px;\"\u003e\n \u003cp\u003eDon\u0026rsquo;t know/do not remember\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eBarriers and Enablers of Vitamin A Supplementation and Deworming Coverage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBarriers to Vitamin A and Deworming Services\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFeedback from various categories of stakeholders reflect implementation of Vitamin A supplementation and deworming interventions is affected by many preventable challenges as summarized in Figure 2. Barriers include funding delay which disrupts procurement and outreach, reduced efficiency, and postponed MNCH campaigns. Evidence shows funding gaps in the procurement of deworming tablets, which presently lacks structured international support. This funding gaps manifests in form of stockouts and low coverage of deworming coverage. Insufficient or untimely funds hinder procurement of supplies, health worker mobilization, and transportation coverage, ultimately lowering intervention reach and coverage rates. Another prominent barrier is the lack of commodities especially Albendazole. \u0026nbsp;Frequent Albendazole shortages have been reported in many states including Gombe and Katsina, due to the absence of dedicated international funding, forcing states to procure supplies independently. This imbalance leads to incomplete interventions, where children receive Vitamin A but miss deworming, undermining the programmes\u0026apos; overall health impact.\u003c/p\u003e\n\u003cp\u003eNigeria\u0026apos;s weak health system also hinders effective nutrition intervention delivery due to insufficient infrastructure, inadequate cold chain storage, staffing, and logistical support at primary healthcare facilities. Critical gaps like inadequate personnel, poor transportation networks, and unreliable cold chain storage further undermine program implementation and impact.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eOne of the problems is that states are supposed to bring counterpart funding, and these funds are not released on time. \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.,; they are not released before the programme starts. This affects commodity availability, fueling vehicles, and mobilization of health workers\u003c/em\u003e.\u0026rdquo; \u0026ndash; FMOH Stakeholder\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eDelayed government release of funds is a major challenge. As partners, we complement the government\u0026rsquo;s efforts, but the delay in releasing state funds affects the timing of interventions. This sometimes results in postponing the MNCH campaign, which, in turn, affects social mobilization and caregiver participation.\u0026rdquo;\u003c/em\u003e - NI Programme Officer\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eIn terms of Vitamin A, I don\u0026rsquo;t think there is low coverage. But in terms of Albendazole (deworming), yes, coverage is very low not even up to 20% nationally. This is because there is no structured supply system for deworming tablets, making it difficult for states to ensure availability\u003c/em\u003e.\u0026rdquo; - Vitamin Angels\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eThe major challenge is the weakness within the health system. Many service delivery points have limited health workers compared to the demand for health services, making it difficult to provide quality nutrition interventions.\u0026rdquo;\u003c/em\u003e - UNICEF Nutrition Officer\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Routine services remain weak, especially at the PHC level. We still see cases where facilities lack the proper logistics and infrastructure to store and distribute nutrition commodities effectively.\u0026rdquo; (KII FED NI Deputy Country Director 1222025)\u003c/p\u003e\n\u003cp\u003ePoor social mobilization is another critical barrier and is occasioned by inadequate planning, funding, and political commitment which weaken outreach efforts, hinder caregiver engagement and reduce intervention coverage. Likewise, remote, conflict-affected, and geographically isolated regions, where logistical challenges, inadequate transportation, and insecurity hinder service delivery. Limited health infrastructure, poor road networks, high operational costs, and displacement of caregivers exacerbate low coverage, particularly in riverine areas in Bayelsa and Lagos, conflict zones like the Northeast/Northwest like Katsina and Niger, and mountainous terrains.\u003c/p\u003e\n\u003cp\u003eMoreover, accurate data tracking for Vitamin A and deworming programmes in Nigeria is undermined by discrepancies between administrative reports (often inflated due to pressure to meet targets) and post-event coverage surveys (PECS), which reveal lower actual coverage rates. These gaps stem from a lack of standardized validation systems, reliance on outdated census data, and inconsistent data collection practices, skewing resource allocation and masking true coverage gaps. While PECS helps identify overreporting, its irregular implementation and states\u0026rsquo; limited technical capacity hinder reliable validation nationwide. Poor coordination and funding sustainability characterized by fragmented efforts, leading to duplication of resources or gaps in coverage. Additionally, some states overly depend on partners for deworming tablets, which affects long-term sustainability.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The issue of mobilization is critical. In many communities, caregivers do not turn up for supplementation because they were not adequately informed. If sensitization efforts are not strong, turnout remains low, affecting coverage rates.\u0026rdquo; - Deputy Country Director\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Some caregivers believe that deworming tablets cause infertility in children, which is not true. These misconceptions prevent some parents from allowing their children to receive the intervention.\u0026rdquo; - UNICEF Nutrition Officer\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;For the social mobilization team, the first rounds when we implemented it, there was that challenge of the people saying, the caregivers in the community saying they did not get information, that the town criers and the dialogue missing, that the money that was set aside for implementing the program was not enough.\u0026rdquo; - Bayelsa State KII\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We have had cases where health workers were attacked while trying to reach conflict-affected communities. In such situations, we have to rely on alternative strategies such as working with local volunteers or integrating services into humanitarian aid programs.\u0026rdquo; - \u0026nbsp;UNICEF Nutrition Officer\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Additionally, the emergence of Internally Displaced Persons (IDP) camps and the migration of people from states like Kebbi and Kaduna add complexity to our planning efforts. Often, even after completing our micro-planning, we may face sudden demands for additional resources when we attempt to engage with communities\u0026rdquo; Niger state KII\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Data validation processes are inconsistent across states. There needs to be a standardized approach to data quality assessment to ensure reliability.\u0026rdquo; - HKI VAS PM\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We need a more rigorous data verification system. If the data is not accurate, then the planning for future interventions will be flawed, and resources may not be properly allocated.\u0026rdquo; - NI Deputy Country Director\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Coordination among partners is improving, but we still need a stronger national platform where all stakeholders government, NGOs, and donors can align their efforts to prevent duplication and resource imbalances.\u0026rdquo; - KII FED HKI M \u0026amp; E Officer\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We have been advocating for states to take ownership of deworming programs. Some states rely entirely on partners, which is not sustainable. The government must integrate deworming into routine budgets.\u0026rdquo; - NI Deputy Country Director\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEnablers of Vitamin A and Deworming Services\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral factors contribute to successful Vitamin A supplementation and deworming service delivery, ranging from funding availability and community engagement to logistical efficiency (Figure 2). The timely release of funds, strong and coordinated partnerships, the use of trained personnel, and integrated service delivery impacted coverage rates. Coordinated partnerships among key stakeholders including federal agencies (NPHCDA), State actors and NGOs (UNICEF, Nutrition International) and others contributed to the success of vitamin A supplementation. This extends to training health workers, strengthening health systems, and integrating nutrition programmes with other health services. The government is responsible for policy formulation, planning, and funding, international partners such as UNICEF, Helen Keller International (HKI), Nutrition International (NI), and Vitamin Angels play a crucial role in providing financial and technical support, advocacy, and commodity supply.\u003c/p\u003e\n\u003cp\u003eThe adoption of MNCH Week Efficacy, a campaign-based approach, ensured rapid scale-up but lack sustainability compared to routine integration. Partner support is instrumental in ensuring the availability of Vitamin A capsules, which are provided free of charge through collaborations with organizations like UNICEF and Nutrition International. This strong donor/partner support is the key driver of near 100% VAS coverage in states like Gombe. Beyond commodity provision, development partners also contribute through advocacy efforts, urging the government to allocate more resources for nutrition programmes. Advocacy efforts have led to increased awareness and political commitment, but financial support from the government remains inconsistent, particularly for deworming programmes. The availability of Vitamin A supplements is relatively stable due to structured agreements with development partners, but deworming tablets still face major funding challenges. Limited partner initiative such as from Vitamin Angels have enhanced deworming coverage in some states and proactive leadership at the state level like in Kogi have led to prioritize procurement of deworming tablets, successful implementation and increased coverage. \u0026nbsp;Strengthening collaboration between the government and partners is essential for improving coordination, ensuring timely release of funds, and addressing coverage gaps. Moving forward, increased government ownership and sustainable funding mechanisms will be key to the long-term success of these programmes.\u003c/p\u003e\n\u003cp\u003eFurthermore, community engagement including the leveraging of public trust in traditional and religious leaders and the use of radio campaigns, media, and town announcers have enhanced mobilization and trust in Enugu and Katsina states. The use of house-to-house strategies in Gombe has proven successful to improve access in remote areas. Lastly, integration of nutrition services with routine health services such as immunization, antenatal care, family planning, malaria prevention and school health programmes offer a promising, cost-effective and sustainable strategy to improve accessibility and coverage. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eWe, as Nutrition International, support all 36 states and the FCT with vitamin A supplement in partnership with UNICEF. We have a global memorandum of understanding with UNICEF, where we provide the in-kind donation of vitamin A supplementation to the government of Nigeria\u003c/em\u003e.\u0026rdquo; - NI Program Officer\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003ePartners provide support, but the government must take full ownership of these interventions. The long-term sustainability of Vitamin A and deworming interventions depends on how well the government integrates them into routine healthcare services\u003c/em\u003e.\u0026rdquo; - UNICEF Nutrition Officer\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eThe government is doing a lot to ensure nutrition commodities are available. One approach is the Child Nutrition Fund, a matching fund where if a state provides 250 million, the CNF matches it with another 250 million. Advocacy is ongoing to encourage states to participate\u003c/em\u003e.\u0026rdquo; - FMOH\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eOne, the use of CHIPS (Community Health Influencers, Promoters and Services) agents, house-to-house. Two, the health workers, like the social mobilization team, the state mobilization officer informed the social mobilization and the LGA to make sure that it is in order and availability of the vitamin A supplement\u003c/em\u003e.\u0026rdquo; Gombe State KII\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOpportunities for Improvement and Additional Resources for Enhancing Vitamin A and Deworming Services\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe effectiveness of Vitamin A supplementation and deworming programmes can be significantly enhanced with targeted improvements and additional resources. Some of the key areas identified by stakeholders that require attention to improve service delivery and ensure wider reach and impact are summarized in Figure 3. Identified opportunities included promoting Integrated Health Service Delivery which combines VAS and deworming initiatives with broader health campaigns such as immunization drives to streamline efforts, reduce costs, and improve coverage.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u003cem\u003eIf we can do that, I think funding also should be given for, like all the SIAs, this is our initiative...we only target SIAs around other programmes to have mixed opportunities so that the mixed children will be grabbed\u003c/em\u003e\u0026rdquo; Niger State KII\u003c/p\u003e\n\u003cp\u003eAnother window of opportunity is expanding social mobilization which is key to boosting participation. In rural and hard-to-reach areas, leveraging local networks like town announcers and trusted figures can bridge awareness gaps. Addressing cultural misconceptions and logistical barriers is critical for equitable coverage.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eThe other area that will need improvement is the social mobilization activities...so that the women, the caregivers, you know, they will all come mass to assess these services\u003c/em\u003e\u0026rdquo; Bayelsa State KII.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eThat is why we say that, to increase coverage, we are using CHIPS agents. And we say that we should use routine services. We use routine services, and also the use of chief agents. And to sensitize the community, to use the structure that we have, like town announcement, mouth-to-mouth, tell somebody about this thing that is going to be happening, and we should start it early. Start doing that sensitization or awareness, one month prior to this implementation\u003c/em\u003e.\u0026rdquo; Gombe State KII\u003c/p\u003e\n\u003cp\u003eExpanded Training and Capacity Building constitute another opportunity. Health workers, particularly community volunteers, require expanded training on supplementation protocols, monitoring tools (e.g., health cards), and communication strategies. Ongoing capacity-building programmes, coupled with supervision, ensure consistent service quality and accurate data reporting.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eIt is essential to secure funding for training and oversight...providing proper training and orientation before the program begins, followed by ongoing monitoring\u003c/em\u003e\u0026rdquo; Katsina State KII.\u003c/p\u003e\n\u003cp\u003ePartnerships and advocacy can also be strengthened to source additional funding, technical support, and logistical resources. Advocacy targeting reluctant political leaders (e.g., local chairmen) is necessary to galvanize commitment and avoid bureaucratic bottlenecks. Coordinated partnerships also prevent duplication of efforts and enhance programme efficiency.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eLike these health facilities, it is important that they help sponsor training. Currently, we are not able to fund all the training ourselves. Therefore, their support during the training is crucial. During this training, participants should learn essential information that they can pass on to their communities and caregivers.\u003c/em\u003e\u0026rdquo; Enugu State KII\u003c/p\u003e\n\u003cp\u003eDedicated funding, mobile health units, and community-based volunteers can be explored to extend coverage to children in conflict zones, remote terrains, and underserved regions. Proactive planning, such as pre-campaign mapping and flexible delivery models, is essential to reach displaced or nomadic populations. Robust monitoring systems, supported by technology and community feedback, enable real-time tracking of coverage and challenges. Regular post-event surveys validate administrative data, addressing overreporting and ensuring accountability. Transparent data sharing with stakeholders informs adaptive strategies and resource allocation.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eWe need to pay close attention to the children in hard-to-reach areas. This will be very beneficial. With proper planning and funding dedicated to reaching these areas, we can identify many missed children who need Vitamin A. As I mentioned, coverage is primarily focused on accessible regions. If we allocate more support to reach hard-to-reach areas, we will significantly increase the number of children receiving Vitamin A, particularly in Katsina Town\u003c/em\u003e.\u0026rdquo; Katsina State KII\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eThat is why we say that, to increase coverage, we are using Community Health Influencers, Promoters and Services (CHIPS) agents. And we say that we should use routine services. We use routine services, and also the use of chief agents. And to sensitize the community, to use the structure that we have, like town announcement, mouth-to-mouth, tell somebody about this thing that is going to be happening, and we should start it early. Start doing that sensitization or awareness, one month prior to this implementation\u003c/em\u003e.\u0026rdquo; Gombe State KII\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study shows that Vitamin A Supplementation (VAS) and deworming programmes have recorded improvement. However, critical gaps and opportunities exist with disparities in coverage, caregivers\u0026rsquo; knowledge, and service delivery across region. \u0026nbsp;The programmes still experience suboptimal coverage, regional disparities, and systemic inequities. Only one in two eligible children presently receive deworming tablets and about five in seven eligible children receive vitamin A supplementation. Successful implementation remains hinged on donor partnerships, and this explains the north-south variation in coverage. Though the overall VAS coverage reflects moderate progress, some states fall short of the 65% target set by Nigeria\u0026rsquo;s National Multisectoral Plan of Action on Food and Nutrition. The improvement in the VAS coverage can be largely attributed to donor support that ensured 100% capsule availability and leveraging the MNCH Week platform.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn sub-Sahara Africa, media exposure, maternal awareness, mothers\u0026apos; education, and urban residency have been reported to increase the likelihood of uptake of VAS (Berde et al., 2019; Janmohamed et al., 2024). Strengthening the community mobilization and awareness of nutrition and health programmes remain important in enhancing uptake and improving on the coverage and this is largely reflected across selected states in this evaluation. Wondie et al (2025) emphasized the importance of increased community awareness about VAS, particularly targeting parents with low educational status and no antenatal and postnatal care through social media and community meetings in promoting increased coverage of VAS. Another key finding of this study is the predominance of poor knowledge of VAS and deworming among the caregivers. Poor caregiver knowledge in this study reflects systemic communication failures and this may be responsible for heavily reliance on health campaign strategy and low opt-in health services in these interventions. Efforts in the last few years have focused on strengthening health facility administration of VAS to promote health seeking behaviour among caregivers. Several studies have documented poor knowledge of vitamin A benefits among Nigerians and this has contributed to poor uptake of diverse interventions directed at improving vitamin A status of the population including VAS and biofortification of foods, among others (Ariyo et al., 2023; Adamu \u0026amp; Muhammad, 2016). This suggests that many caregivers do not fully appreciate the benefits of the services, and this calls for revisitation of strategy for nutrition education during nutrition service delivery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe high percentage of caregivers that indicated that health workers didn\u0026rsquo;t come in Katsina (41.1%) and Gombe (39.0%) reflects the reliance on home administration of VAS, and the need for consistency and compliance in programme delivery. Key barriers included poor caregiver awareness, health worker absenteeism, inconsistent commodity (albendazole) supply, weak political will, supply-chain failures, weak micro-planning, inadequate health worker training, and poor social mobilization. Qualitative data revealed stark regional disparities: northern states achieved higher VAS and deworming coverage due to robust donor partnerships and government commitment, whereas southern states faced logistical bottlenecks, delayed funding, and weak social mobilization. The barriers identified in this study largely aligns with pre-defined barriers typical about vitamin A supplementation programme in Africa including capsule stock-outs, poor healthcare worker attitude and service, inadequate health personnel, inadequate training of staff, lack of incentive for participants and staff, logistics issues transportation, fuel and food supplies, and poor monitoring and evaluation mechanisms (Ezezika et al., 2024).\u003c/p\u003e\n\u003cp\u003eThe national deworming coverage of 53% during the November/December 2024 MNCHW narrowly surpassed the 50% target set by Nigeria\u0026rsquo;s National Multisectoral Plan of Action on Food and Nutrition, and showcased significant disparities persist across states and regions. Only Niger, Bayelsa, Enugu, and Lagos met or exceeded the national benchmark (50.0%), underscoring uneven programme implementation. Home administration remains popular in northern states and largely relies on health and nutrition campaign which are very expensive and largely unsustainable, this calls for the need to strengthen health facility delivery and coverage of deworming services. Transitioning to routine supplementation requires addressing caregivers\u0026apos; health-seeking behaviors. About one in four of the index children received deworming tablets at any other time from January till February 2025, particularly in Bayelsa, Lagos, and Enugu. This suggests availability and accessibility to the deworming commodities beyond the MNCHW and this should be ensured across all the states. Interestingly, these deworming services were received at home (67.0%), this suggest that some other health campaigns are also leveraged to deliver deworming services beyond the MNCHW. The caregivers\u0026rsquo; demonstration of poor knowledge of the benefits of deworming provides an insight to low uptake and suggest the needs to intensify efforts at health-educating the masses on the essentials of deworming. The low knowledge of deworming reflects a departure from the findings among caregivers in Rwanda where large proportion of the mothers demonstrated good knowledge of deworming (Rwamwejo et al., 2023). Scaling up access and uptake of deworming services is critical to achieving the World Health Organization\u0026rsquo;s Neglected Tropical Disease Roadmap towards eliminating select neglected tropical diseases (NTDs).\u003c/p\u003e\n\u003cp\u003eQualitative insights reveal systemic barriers, including reliance on donor-dependent campaigns for VAS, inconsistent deworming tablet procurement, insecurity and hard to reach areas, and regional inequities in governance and resource allocation; thereby reflecting the complex interplay of logistical, financial, and sociopolitical factors shaping child health outcomes in Nigeria. Earlier study in Nigeria have identified neighborhood socioeconomic disadvantage and geographic location as the community-level characteristics that determined receipt of VAS (Aremu et al 2010). This calls for the development of a context-specific strategy to adequate cater for children living in difficult terrains, hard to reach areas and areas where insecurity is high. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe wide disparity between the administrative coverage and PECS coverage at the national level can be attributed to the focus on the six states and the likelihood that the states with high coverage are selected for the PECS. This suggests the need for intentional inclusion of states with low administrative coverage in subsequent PECS. Such intentional targeting may be helpful in unveiling bottlenecks in the promotion and delivery of nutrition services in such states. This mismatch raises questions about data accuracy and programme implementation. This observation can be attributed to under-projection of the target population, vaccinating children outside of the target age, and/or due to over-reporting by health workers in response to satisfy performance metrics or avoid repercussions, or underestimation in PECS (Sesay et al., 2015). The administrative-PECS discrepancy underscores systemic challenges in Nigeria\u0026rsquo;s health data ecosystem. Administrative coverage exceeding 100% is a red flag for data quality issues. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClosing this gap requires addressing overreporting incentives, improving population estimates, and prioritizing equity in high-need states like Katsina and Lagos. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe poor use of health services in selected states may be an indication of poor trust in the health services, availability of several barriers in accessing health facilities or discouragement from the use of health facilities following health workers attitude or non-availability of essential commodities. This shows poor use of health services particularly in Gombe, Katsina and Enugu. This calls for operational research to unravel the motivations, barriers and facilitators to the use of health facilities among the caregivers of infants and young children in these three States. Other issues such as distance to health centers, transportation costs, and insecurity (notably in Northern states like Katsina and Gombe), understaffed facilities and stockouts of essential medicines, and preference for traditional medicine demotivate caregivers and hinder access to health services (Ahinkorah et al., 2021).\u003c/p\u003e\n\u003cp\u003eNigeria\u0026rsquo;s north-south divide reflects systemic healthcare disparities. Northern states leverage donor-driven campaigns and culturally trusted CHVs to achieve higher coverage, mirroring Bangladesh\u0026rsquo;s success with community health models (Uddin et al., 2021). In contrast, southern states face urban fragmentation and governance gaps, leading to reliance on facility-based services; which underscores the need for context-specific strategies. Reliance on home-based administration and donor funding threatens programme sustainability. Stockouts and procurement challenges, highlight weak supply chains. Concurrent IFAS/MMS use in pregnancy contrary to WHO guidelines signals poor oversight. Administrative data overreporting, a systemic issue in low-resource settings, distorts resource allocation and masks true coverage gaps.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDespite moderate coverage, Nigeria’s VAS and deworming programmes face preventable barriers rooted in financing, health systems, and community engagement. Northern states demonstrate that strong partnerships and government commitment can mitigate challenges, but sustainable progress requires integrated service delivery, improved data systems, and decentralized funding. Policymakers must prioritize these areas to achieve universal coverage targets.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: The study protocol was approved by Nigeria\u0026rsquo;s National Health Research Ethics Committee (NHREC/01/01/2007-19/12/2024). Written/verbal consent was obtained from all respondents. PII stored separately on encrypted servers (256-bit AES). Data ownership retained by UNICEF/Federal Government; destruction scheduled post-project.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e:\u0026nbsp;Data ownership retained by UNICEF/Federal Government; destruction scheduled post-project.\u0026nbsp;The datasets generated and/or analyzed during the current study are not publicly available due to privacy concerns\u0026nbsp;but are available from the authors on reasonable request. Inquiries and data access requests should be directed to Edward Kutondo at\u0026nbsp;[email protected].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003eFunding: United Nations Children Fund\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: All authors conceptualized the study and contributed in writing the manuscript. All authors have read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: All the respondents and enumerators across the sampled states, Manawa Oghenevwede and Makinde Joseph for the support in data analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eOluwaseun Ariyo, \u003cstrong\u003eDepartment of Human Nutrition and Dietetics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria,\u0026nbsp;\u003c/strong\[email protected]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEdward Kutondo, United Nations Children\u0026rsquo;s Fund, Nigeria Country Office, Abuja, Nigeria,\u0026nbsp;\u003c/strong\[email protected]\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAdegbenga Adedayo, Hanovia Limited,\u0026nbsp;\u003c/strong\u003eHanovia House, 8 Ahmed Musa Crescent, Jabi-Abuja, Nigeria, [email protected]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eNemat Hajeebhoy, United Nations Children\u0026rsquo;s Fund, Nigeria Country Office, Abuja, Nigeria,\u0026nbsp;\u003c/strong\[email protected]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAdekola Durojaye, Hanovia Limited,\u0026nbsp;\u003c/strong\u003eHanovia House, 8 Ahmed Musa Crescent, Jabi-Abuja, Nigeria, [email protected]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eOlabisi Kehinde Olorundare, Hanovia Limited,\u0026nbsp;\u003c/strong\u003eHanovia House, 8 Ahmed Musa Crescent, Jabi-Abuja, Nigeria, \u003cstrong\u003e\u0026nbsp;\u003c/strong\[email protected]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eTomilola Juliana Aladesanmi, Department of Human Nutrition and Dietetics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria,\u0026nbsp;\u003c/strong\[email protected]\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHashim Hassanu, Hanovia Limited,\u0026nbsp;\u003c/strong\u003eHanovia House, 8 Ahmed Musa Crescent, Jabi-Abuja, Nigeria, [email protected]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAngbala David, Hanovia Limited,\u0026nbsp;\u003c/strong\u003eHanovia House, 8 Ahmed Musa Crescent, Jabi-Abuja, Nigeria, [email protected]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLawal Muhammad, Hanovia Limited,\u0026nbsp;\u003c/strong\u003eHanovia House, 8 Ahmed Musa Crescent, Jabi-Abuja, Nigeria, [email protected]\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eProsper Dakurah, United Nations Children\u0026rsquo;s, Nigeria Country Office, Abuja, Nigeria,\u0026nbsp;\u003c/strong\[email protected]\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eYadika Charles Shapu, United Nations Children\u0026rsquo;s Fund, Nigeria Country Office, Abuja, Nigeria,\u0026nbsp;\u003c/strong\[email protected]\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSam Obasi,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNational Primary Health Care Development Agency, Abuja, Nigeria,\u0026nbsp;\u003c/strong\[email protected]\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdamu MD, Muhammad N. Assessment of vitamin A supplementation coverage and associated barriers in Sokoto State, Nigeria. Ann Niger Med. 2016;10(1):16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAghaji AE, Duke R, Aghaji UCW. Inequitable coverage of vitamin A supplementation in Nigeria and implications for childhood blindness. BMC Public Health. 2019;19:282. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-019-6413-1\u003c/span\u003e\u003cspan address=\"10.1186/s12889-019-6413-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhinkorah BO, Ameyaw EK, Seidu AA, Odusina EK, Keetile M, Yaya S. Examining barriers to healthcare access and utilization of antenatal care services: evidence from demographic health surveys in sub-Saharan Africa. BMC Health Serv Res. 2021;21:1\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAremu O, Lawoko S, Dalal K. Childhood vitamin A capsule supplementation coverage in Nigeria: a multilevel analysis of geographic and socioeconomic inequities. Sci World J. 2010;10:1901\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1100/tsw.2010.188\u003c/span\u003e\u003cspan address=\"10.1100/tsw.2010.188\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 20890579; PMCID: PMC5763688.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAriyo O, Oladejo EO, Atojoko MA. Awareness, perception and constraints to consumption of pro-vitamin A cassava food among women of reproductive age in Ikire, Nigeria. Agro-Science. 2023;22(1):71\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBerde AS, Bester P, Kruger IM. Coverage and factors associated with vitamin A supplementation among children aged 6\u0026ndash;59 months in twenty-three sub-Saharan African countries. Public Health Nutr. 2019;22(10):1770\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1017/S1368980018004056\u003c/span\u003e\u003cspan address=\"10.1017/S1368980018004056\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEzezika O, Quibrantar S, Okolie A, Ariyo O, Marson A. (2024). Barriers and facilitators to the implementation of vitamin A supplementation programs in Africa: A systematic review. Nutr Health, 02601060241294133.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFederal Government of Nigeria (FGoN) and the International Institute of Tropical Agriculture (IITA). National Food Consumption and Micronutrient Survey 2021. Final Report. Abuja and Ibadan. Nigeria: FGoN and IITA; 2024. p. 550.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHelen Keller International\u0026rsquo;s Protocol for Post-Campaign Coverage Survey of Vitamin A Supplementation and coupled services. (January 2024).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJanmohamed A, Doledec D, Dissieka R, Jalloh UH, Juneja S, Beye M, Ndiaye F, Jumbe T, Baker MM. 2024. Vitamin A supplementation coverage and associated factors for children aged 6 to 59 months in integrated and campaign-based delivery systems in four sub-Saharan African countries. \u003cem\u003eBMC Public Health\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e(1), p.1189.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Population Commission (NPC) [Nigeria] and ICF. Nigeria Demographic and Health Survey 2018. Nigeria, and Rockville, Maryland, USA: NPC and ICF: Abuja; 2019.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRwamwejo F, Ndatinya GI, Mkata MI, Blauman A, Regnier D, Lackner SC. Assessing the knowledge, attitudes, practices, and perspectives of stakeholders of the deworming program in rural Rwanda. PLoS Negl Trop Dis. 2023;17(8):e0010759.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSesay FF, Hodges MH, Kamara HI, Turay M, Wolfe A, Samba TT, Koroma AS, Kamara W, Fall A, Mitula P, Conteh I. High coverage of vitamin A supplementation and measles vaccination during an integrated Maternal and Child Health Week in Sierra Leone. Int Health. 2015;7(1):26\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShekar M, Kakietek J, Eberwein JD, Walters D. An investment framework for nutrition: reaching the global targets for stunting, anemia, breastfeeding, and wasting. World Bank; 2017.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUddin ME, George J, Jahan S, Shams Z, Haque N, Perry HB. Learnings from a pilot study to strengthen primary health care services: the community-clinic-centered health service model in Barishal District, Bangladesh. Global Health: Sci Pract. 2021;9(Supplement 1):S179\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUnited Nations Children\u0026rsquo;s Fund, Vitamin A, Supplementation. A Decade of Progress. 2007. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.unicef.org/publications/files/Vitamin_A_Supplementation.pdf\u003c/span\u003e\u003cspan address=\"http://www.unicef.org/publications/files/Vitamin_A_Supplementation.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (accessed on 20 August 2025).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUnited Nations Children\u0026rsquo;s Fund, UNICEF. (2024). Child Food Poverty. Nutrition Deprivation in Early Childhood. Child Nutrition Report, 2024. UNICEF, New York, June 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWondie WT, Zemariam AB, Gedefaw GD, Lakew G, Getachew E, Mengistie BA, Shibabaw AA, Chereka AA, Kitil GW, Yirsaw AN, Mekonnen GB. 2025. Vitamin A supplementation coverage and its associated factors among children 6\u0026ndash;59 months of age in Ethiopia: a systematic review and meta-analysis. \u003cem\u003eFrontiers in Public Health\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, p.1496931.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Vitamin A Supplementation, Deworming, Coverage, Equity, Health Systems, Nigeria, MNCHW, Post-Event Coverage Survey","lastPublishedDoi":"10.21203/rs.3.rs-7532150/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7532150/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eVitamin A Deficiency (VAD) remains a severe public health issue in Nigeria, contributing to preventable childhood morbidity and mortality. The bi-annual Maternal, Newborn, and Child Health Week (MNCHW) is the primary platform for delivering high-dose Vitamin A Supplementation (VAS) and deworming to children aged 6\u0026ndash;59 months. However, national coverage estimates are suspected to be inaccurate and mask significant subnational inequities. This study was designed to validate the reported coverage of the November-December 2024 MNCHW and investigate the systemic barriers and enablers influencing the delivery and uptake of VAS and deworming in Nigeria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional mixed-methods post-event coverage survey (PECS) was conducted across six purposively selected states (Bayelsa, Enugu, Gombe, Katsina, Lagos, Niger). A two-stage cluster sampling design was employed, surveying 6,468 caregivers of eligible children using computer-assisted personal interviewing. Quantitative data were analysed for coverage, and bivariate analyses identified factors associated with uptake. Knowledge of vitamin A and Deworming was assessed using a 20-point scale and categorised as good (\u0026ge;15), fair (\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), and poor (\u0026lt;\u0026thinsp;8). Qualitative key informant interviews (n\u0026thinsp;=\u0026thinsp;15) with national and state-level stakeholders were thematically analysed using the WHO Health Systems Building Blocks framework.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eCoverage for VAS was 71.1%, meeting the national 65% target, with wide state-level disparities (49.2% in Katsina to 84.0% in Enugu). Deworming coverage was lower at 52.7%. A significant dissonance was found between these verified coverages and administrative reports (87%) in assessed states, which calls for strengthening of routine data systems. Caregiver knowledge score was poor (67%), lack of awareness (36.5%) and health worker absenteeism (31.2%) were primary reasons for non-uptake. Qualitative findings identified critical systemic barriers, including delayed funding release, frequent stockouts of deworming tablets, weak health system, sociocultural resistance, and insecurity in hard-to-reach areas. Enablers included strong partner support, house-to-house delivery strategies, and community engagement.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eWhile the MNCHW platform has achieved good coverage, significant gaps persist due to systemic and equity-related barriers. Reliance on donor-driven campaigns is unsustainable. To achieve universal coverage, Nigeria must address funding delays, commodity security, administrative data gaps, and knowledge gaps through improved planning, integrated service delivery, and strengthened community mobilization.\u003c/p\u003e","manuscriptTitle":"A Mixed-Methods Exposé of Systemic Barriers and Enablers for Vitamin A and Deworming in Nigeria's Maternal Newborn and Child Health Week Programme","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 16:21:25","doi":"10.21203/rs.3.rs-7532150/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"25250992608058726137816893748429230460","date":"2025-11-11T09:07:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318930099165295158754041412928720808602","date":"2025-11-04T09:11:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-30T08:54:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-29T17:08:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-06T03:53:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-03T20:40:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-10-03T20:30:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3b480084-1645-44be-bf75-9b0940d13ce4","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-11T16:21:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 16:21:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7532150","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7532150","identity":"rs-7532150","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}