TY - JOUR T1 - A Review of Vitamin A Supplementation in South Sudan: Successes, Challenges, and Opportunities for the Way Forward JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-21-00660 VL - 10 IS - 3 SP - e2100660 AU - Nancy Jean Haselow AU - Vandana Joshi AU - Priscilla Nicholas Bayo AU - Jesca W. Murye AU - Sadick Nawal Shaban AU - Kiross Tefera Abebe AU - Ismail Kassim AU - Tesfatsion Shiweredo AU - Hari Vinathan AU - Chandrakala Pramod Jaiswal AU - Khamisa Ayoub Miluwa AU - Eric Alain Ategbo AU - Biram Ndiaye AU - Mohamed Ag Ayoya Y1 - 2022/06/29 UR - http://www.ghspjournal.org/content/10/3/e2100660.abstract N2 - Key FindingsUndernutrition and high under-5 mortality persist in South Sudan, with very low dietary intake of vitamin A and a high rate of infection considered to be the primary causes of vitamin A deficiency among young children.South Sudan's vitamin A supplementation (VAS) program has demonstrated success through campaign-style delivery with steady improvement from 2010 to the present.Continued political unrest, environmental factors, and health system infrastructure deficiencies contribute to low and uneven VAS coverage rates at different times and in different areas.Key ImplicationsProgram managers should consider developing a flexible, multifaceted delivery mechanism to ensure vitamin A supplementation and deworming (VASD) reach all children everywhere every 6 months.To support program managers in decision making, researchers should consider analyzing and using the Food Security and Nutrition Monitoring System data more fully to better target gaps in VASD coverage.Policy makers should consider how integrating VASD into community-based programming could strengthen the health system by extending it more fully into boma (villages) and take steps to build VASD into planning and budget cycles at all levels.Aim:To identify vitamin A supplementation (VAS) trends in South Sudan and provide insights to refocus VAS programming vis a vis polio eradication campaigns recently phased out while access to health care, land, food, and markets remain challenging.Method:Review of data from survey and coverage reports; review of policy and program documents; key informant responses; general literature search.Results:Vitamin A deficiency (VAD) is likely a severe public health problem among preschool-aged children in South Sudan based on a high under-5 mortality rate (96.2 deaths/1,000 live births) and high levels of undernutrition, infections, and food insecurity. Vitamin A capsules, with deworming tablets (VASD), have been delivered to preschool-aged children during national immunization days (NIDs) for the past decade. Although areas of South Sudan and certain populations continue to have low VAS coverage, when comparing national VAS coverage (reported in the last 6 months) between 2010 and August 2019, a large improvement is noted from 4% to 76%. In 2021, VAS coverage was more than 90% at the national level during 2 stand-alone distribution campaigns. Deworming coverage trends generally mimicked VAS coverage. VAS is provided to postpartum mothers who deliver at health facilities (approximately 12%–25%), but coverage data are not available.Conclusion:Twice-yearly VAS should remain a key lifesaving intervention to address VAD, but alternative delivery strategies will be needed. Conducting events, such as child health days, supported by promotional activities or community-based VASD distribution activities for the youngest children and those missed during campaigns, should be considered. For the long term, a hybrid approach targeting underserved areas with mass distribution events while integrating VASD into community-based programs such as quarterly screening for wasting should be tested further and gradually scaled up everywhere as this has the potential to sustainably reach all vulnerable children twice yearly. ER -