The NDHS (2008) collected information on vitamin A supplementation. One in three urban children, compared with one in five rural children had received vitamin A supplements in six months preceding the survey. The intake of supplements was positively related to mother’s education level and household wealth. Regarding the Zones, the NW and NE, represented the lowest percentages of children who had taken Vitamin A supplements in the last 6 months at 13.9% and 18.6% respectively.

The five programme states Smart Surveys found that in the four time periods of the surveys, the highest coverage of vitamin A supplementation was in Katsina state on three occasions and the lowest in Yobe on two occasions. The variations were: between 93% in Katsina and 52% in Yobe in July 2010, between 97.3% in Kebbi and 13.7% in Yobe in December 2010, between 62% in Katsina and 38% in Jigawa in July/August 2011, and between 80% in Katsina and 26% in Kebbi in February 2012.

Many HIV and AIDS-related programmes included nutritional supplements in their programming. In Benue, where HIV prevalence is very high, there are a number of programmes providing RUTF; the Ministry of Health facilitated its distribution to moderately/severely malnourished under-five children and lactating mothers, and vitamin A supplements are given to children 6-59 months every six months. Iron folate for pregnant women and de-worming of children 12-59 months are also available in the state (Holmes, 2011). In Edo, the Girls‘ Power Initiative offers nutritional services to infants as well as carrying out de-worming exercises every three months. Community volunteers are trained to help mobilize participants to access these services. Similarly, WEO provides nutritional support to vulnerable households, distributing food items such as rice, groundnut oil and beans (Holmes 2011).

The only supplementation programme uncovered by the literature review in Nigeria was for vitamin A supplementation. Efforts to control vitamin A deficiency started in 1996 in response to high infant and under-five mortality rates. The Nutrition Division of the Federal Ministry of Health (FMOH), the National Primary Health Care Development Agency (NPHCDA), and UNICEF jointly developed a work plan in 1996 to eliminate vitamin A deficiency. In 1999, UNICEF, WHO, DFID, USAID, the National Programme on Immunization and the FMOH developed a broader framework to link vitamin A distribution to polio eradication. The National Program on Immunization, created by the federal government in July 1996, is responsible for formulating policy and coordinating all immunization activities in the country. Hence it was easy to integrate vitamin A supplementation into immunization activities despite the fact that such integration was not part of the National Programme on Immunization’s mandate.

The National Planning Commission through the National Committee on Food and Nutrition (NCFN) coordinates all nutrition activities in the country. The NCFN addresses micronutrient deficiency through the multi-stakeholder MNDC subcommittee, which was set up by NCFN in the Nutrition Division of the FMOH. At inception, the NPHCDA was the government agency designated to coordinate and implement vitamin A and mineral supplementation in the country.

The National Immunization Days (NIDs) and its state variants, Subnational Immunization Days (SNIDs), used to eradicate polio, have been major vehicles for the distribution of vitamin A capsules to eligible children. The country first integrated large-scale vitamin A supplementation into NIDs in 2000. This integration has since been elevated to two rounds a year because it is seen as the best way to provide vitamin A to the target groups in Nigeria.

Other agencies also assist the government in the distribution of vitamin A through Child Health Weeks in some states. Vitamin A supplementation is usually given twice a year in this way. The Child Health Weeks are often integrated with other interventions, such as growth promotion, deworming, ITNs, immunizations, and other micronutrient programs. This mechanism is currently in use by the Food Basket Foundation International and UNICEF with support from MI (based on information on the HKI study on Vitamin A coverage which included the Northern States).

The following strengths of vitamin A supplementation have been noted (Akinyele, 2009):

• The National Food and Nutrition Policy is in place and provides a reference point for vitamin A supplementation.
• NIDs are a low cost means of delivering vitamin A supplements at least once a year and are implemented in all 774 LGAs areas of the country through home delivery.
• Trained vaccinators also visit the markets, places of worship, and day care centres for young children and each round lasts from 3-7 days.
• The health system is decentralized along the three tiers of government. Policymakers have developed an intermediate PHC structure at the ward level to serve as a bridge between the LGA and village levels. This intermediate structure replaces the district level in 200 out of the 774 LGAs nationwide.
• Human resources for vitamin A supplementation are available at all levels: (i) NPHCDA at the national level and six zonal offices; (ii) the state directorate of Primary Health Centre (PHC) at the state level; (iii) the PHC department at the LGA level; and (iv) health workers in the health facilities at the ward and community levels.
• The private sector (both profit and nonprofit) has been an important delivery channel.
• The main vitamin A supplementation partners provide a local model of partnership for improved coverage and impact.
• Frequent meetings of the nutrition partners have been beneficial.
• The use of other vehicles and avenues such as CDTI and Child Health Weeks has increased coverage.
• Guidelines are important to implementation. These include guidelines on training in vitamin A supplementation in PHC facilities (NPHCDA), training during National Immunization Days (BASICS II), and management of diseases (CDTI) (NPHCDA 2010).

Weaknesses of the vitamin A supplementation program are (Akinyele, 2009):

• The National Food and Nutrition policy proposes MNDC emphasizing food fortification and dietary diversification but makes no mention of the role of vitamin A supplementation to address vitamin A deficiency and improve child survival.
• Vitamin A supplementation has no permanent home nor effective coordination and implementing mechanisms.
• There is inconsistency in the denominator population used in the estimation of vitamin A supplementation coverage.
• There is no provision for vitamin A supplementation in emergency situations.
• There is a lack of consensus in Nigeria on the best strategies for sustaining vitamin A supplementation.
• The policy leadership for vitamin A supplementation needs to be strengthened.
• There are no clear roles and accountabilities among governmental partners.
• The private sector (profit/ nonprofit), though recognized as an important delivery channel, has not being integrated into the vitamin A supplementation system.
• The system’s capacity to deliver is low because financial resources (including salaries) do not reach the local levels.
• There has been inadequate attention paid to pre-service training on micronutrient deficiency control in general and vitamin A deficiency control in particular.
• There is no clear understanding of the roles and accountabilities of stakeholders, especially at the national level among NCFN, the Nutrition Division of FMOH and the NPHCDA. Hence the government provides poor technical coordination of the program.
• Poor logistics and weak supervision due to insufficient resources have lead to delays in distributing capsules.
• There has been inadequate monitoring, supervision, and coordination of activities to ensure that nationally, vitamin A supplementation is administered uniformly at the same time to the target population.