Measuring the coverage of Helen Keller Intl’s Vitamin A Supplementation Program in Kilifi County, Kenya

Decision-maker’s challenge

Vitamin A Deficiency (VAD) significantly contributes to morbidity and mortality of children under five, especially in developing countries. In Kenya, the prevalence of VAD is estimated at 17.4%. Improving the Vitamin A status of deficient children through supplementation enhances their resistance to disease. Soil-Transmitted Helminth Infections (parasitic worms) affect up to 40% of children aged 12-59 months, often affecting their nutritional status.To help combat VAD and parasitic worms in Kenya, Vitamin A Supplementation (VAS) and Deworming are delivered to children through three different approaches:  (i) routine service delivery at health facilities, (ii) integration in Malezi Bora (Helen Keller International VAS program), and (iii) through Community Health Units (CHUs) and early childhood development (ECD) centres. Helen Keller collaborates with the Ministry of Health to support Vitamin A Supplementation (VAS) delivery and deworming programming across 25 counties. 

In July 2023, Helen Keller International and IDinsight carried out a post-event coverage survey (PECS) in Kilifi County to measure VAS and deworming coverage rates over the first six months of 2023, with a focus on the coverage during the June Malezi Bora VAS and Deworming event.

The collaboration with IDinsight had two primary goals:

1. Measuring coverage rates for VAS and deworming programs in Kilifi to inform future program targeting; and 
2. Testing enhancements in the quality and cost-effectiveness of coverage surveys.

Impact opportunity

DataDelta supported Helen Keller International’s VAS program to improve targeting and cost effectiveness by providing representative data on coverage of and access to Vitamin A supplements and deworming interventions. Our work would also test out enhancements in data quality systems to ensure accuracy of coverage surveys informing programmatic distribution points for VAS and Deworming. The survey provided Kilifi County with insights into residents’ access to health services, knowledge, attitudes, and health-seeking behavior. 

Our approach

Measurement

IDinsight conducted a representative quantitative cross-sectional household study for 1000 households to assess post-intervention coverage of vitamin A supplementation and deworming children 6-59 months old and 12-59 months old, respectively, by interviewing their mothers/caregivers. Additionally, the survey assessed the health-seeking behaviour of caregivers, breastfeeding practices, access to antenatal care services and child nutritional health. An exploratory, nonrepresentative quantitative study consisting of individual interviews with actors implementing VAS activities in the field (healthcare extension workers and CHPs) in parallel with the abovementioned main household study. We designed the parallel survey to complement the cross-sectional household study to determine the training and services offered by CHPs and health workers. We used a convenience sample for this study based on the health workers and CHPs available to support the study during data collection.

DataDelta

The DataDelta team deployed SurveyStream, our custom-built survey management software to conduct data quality checks, manage audio audit assignments, and monitor survey progress. SurveyStream was key to ensuring field teams received daily feedback on their data quality and productivity. SurveyStream data quality checks guided the supervisors spot checks and back check efforts throughout the survey. We also deployed a hyper-local enumeration team based in Kilifi County ensuring efficient execution and cost savings in logistics. 

The results

The survey was successful in gathering representative data for 14% of Kilifi’s population (203,000 children), based on a sample of 1,000 households across 7 sub-counties. Captured the voices and lived experiences of primary caregivers (mostly women) raising children between 6 – 59 months old in Kilifi County. 

Impact

As a result of these findings, Helen Keller Intl adopted the following changes to their survey execution and administration process:

1. Using PowerBI dashboards to monitor survey data quality
2. Monitoring enumerator productivity and performance at every stage of the survey process
3. Using independent enumerators to conduct household listings before coverage surveys to ensure accurate results

Kilifi County is using the results of our survey to design a routinized Vitamin A Supplementation program outside of campaigns run by Helen Keller Intl. Read more about our work with Helen Keller Intl in Kilifi in our recent policy brief on Access to Health Services: Kilifi County Case Study.