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There has been a dramatic shift in food systems, and the consumption of commercially processed and packaged foods has grown globally, including among older infants and young children. Many of these products are ultraprocessed and contain additives, with concerning implications for the health and nutrition of children.

Background: Vitamin A supplementation (VAS) among children 6 to 59 months of age reduces vitamin A deficiency (VAD)-related mortality. Child health days (CHDs) only reach an estimated 16.7% of children at exactly 6 months, leaving uncovered children at risk of VAD-related mortality; similarly, VAS provided at 9 months of age with measles-containing vaccine leaves infants unprotected for 3 months.Objective: Using data from sub-Saharan Africa, we estimated the mortality benefits and safety of providing VAS at age 6 months, compared to delivery through CHDs and at 9 months.Methods: We modeled VAS-preventable mortality benefits at 6 months as a function of published VAS effect sizes, intervention coverage, and proportion of infant deaths occurring between 6 and 11 months. To evaluate safety, we modeled the effect of different VAS coverage scenarios on maximum hepatic vitamin A concentrations (HVACs).Results: VAS linked to a 6-month visit could reduce infant mortality by an additional 1.95 (95% confidence interval [CI]: 1.38-2.52) and 1.63 (95% CI: 1.15-2.11) percentage points compared to VAS through CHDs and at 9 months, respectively. The HVAC models indicate that VAS at 6 months is safe even in the presence of a second VAS dose 1 month later and other food-based vitamin A control strategies.Conclusion: Advancing the first VAS dose to 6 months should be considered in settings where VAS is currently given first at 9 months. A 6-month VAS dose should also be considered in settings where VAS is delivered through CHDs. VAS delivery at 6 months could also serve as a platform to deliver other high-impact interventions.

Twice-yearly child health weeks are an effective way of reaching children with essential child survival services in developing countries. In Kenya, child health weeks, or Malezi Bora, were restructured in 2007 from an outreach-based delivery structure to a health facility-based delivery structure to reduce delivery costs and increase sustainability of the events. Administrative data from 2007 to 2011 have demonstrated a decrease in coverage of Malezi Boraservices to targeted children. A post-event coverage (PEC) survey was conducted after the May 2012 Malezi Borato validate coverage of vitamin A supplementation (VAS) and deworming and to inform program strategy. Nine hundred caregivers with children aged 6–59months were interviewed using a randomized, 30×30 cluster design. For each cluster, one facility-based health worker and one community-based health worker were also interviewed. Coverage of VAS was 31.0% among children aged 6–59months and coverage of deworming was 19.6% among children aged 12–59months.Coverage of VAS was significantly higher for children aged 6–11months (45.7%, n=116) than for children aged 12–59months (28.8%, n=772) (p<0.01). Eighty-five percent (51/60) of health workers reported that Malezi Borawas implemented in their area while 23.6% of primary caregivers reported that Malezi Boraoccurred in their area. The results of this PEC survey indicate that the existing Malezi Boraprogrammatic structure needs to be reviewed and reformed to meet WHO guidelines of 80% coverage with VAS.

Twice-yearly child health weeks are an effective way of reaching children with essential child survival services in developing countries. In Kenya, child health weeks, or Malezi Bora, were restructured in 2007 from an outreach-based delivery structure to a health facility-based delivery structure to reduce delivery costs and increase sustainability of the events. Administrative data from 2007 to 2011 have demonstrated a decrease in coverage of Malezi Boraservices to targeted children. A post-event coverage (PEC) survey was conducted after the May 2012 Malezi Borato validate coverage of vitamin A supplementation (VAS) and deworming and to inform program strategy. Nine hundred caregivers with children aged 6– 59 months were interviewed using a randomized, 30 × 30 cluster design. For each cluster, one facility-based health worker and one community-based health worker were also interviewed. Coverage of VAS was 31.0% among children aged 6– 59 months and coverage of deworming was 19.6% among children aged 12– 59 months. Coverage of VAS was significantly higher for children aged 6–11 months (45.7%, n= 116) than for children aged 12–59 months (28.8%, n= 772) (p< 0.01). Eighty-five percent (51/60) of health workers reported that Malezi Borawas implemented in their area while 23.6% of primary caregivers reported that Malezi Boraoccurred in their area. The results of this PEC survey indicate that the existing Malezi Boraprogrammatic structure needs to be reviewed and reformed to meet WHO guidelines of 80% coverage with VAS.