Vitamin A supplementation coverage among children under five in Sierra Leone more than doubled from 26% in 2008 to 69% in 2019, according to Gram Research analysis of national health surveys. However, the country still falls short of the 80% target, with persistent gaps between wealthy and poor families, and between urban and rural areas. Wealthy families’ children were 9.3 percentage points more likely to receive supplements than poor families’ children in 2019, indicating that while overall progress is significant, vulnerable populations remain underserved.
Between 2008 and 2019, Sierra Leone nearly tripled the number of young children receiving life-saving vitamin A supplements, jumping from 26% to 69% coverage. Vitamin A prevents blindness, infections, and death in children under five. However, the country still falls short of its 80% goal, and gaps remain between rich and poor families, rural and urban areas, and different regions. According to Gram Research analysis, while the improvements are significant, targeted efforts are needed to reach the most vulnerable children and ensure every child gets this critical nutrient.
Key Statistics
A 2026 analysis of Sierra Leone’s national health surveys found that vitamin A supplementation coverage among children aged 6-59 months increased from 25.9% in 2008 to 69.1% in 2019, representing a 43 percentage point improvement over 11 years.
According to research reviewed by Gram analyzing three Sierra Leone Demographic and Health Surveys, the gap in vitamin A supplementation between children from wealthy households and poor households increased from 8.5 percentage points in 2008 to 9.3 percentage points in 2019, despite overall coverage improvements.
A 2026 study of vitamin A supplementation trends in Sierra Leone found that rural-urban inequality narrowed significantly, with the coverage gap decreasing from 4.9 percentage points in 2008 to 1.6 percentage points in 2019.
Research analyzing Sierra Leone’s vitamin A programs from 2008-2019 showed that inequality by maternal education declined substantially, with the coverage gap between children of educated and uneducated mothers shrinking from 11.1 percentage points to 4.9 percentage points.
The Quick Take
- What they studied: How many children in Sierra Leone received vitamin A supplements and whether coverage was fair across different groups (rich vs. poor, rural vs. urban, educated vs. uneducated parents)
- Who participated: Data from three national health surveys in Sierra Leone (2008, 2013, and 2019) covering children aged 6-59 months and their families across the entire country
- Key finding: Vitamin A supplementation coverage more than doubled from 26% in 2008 to 69% in 2019, but wealthy families and urban children were still more likely to receive supplements than poor families and rural children
- What it means for you: If you live in Sierra Leone or a similar country, vitamin A programs are reaching more children than ever, but if your family is poor or lives far from health centers, your child may still be missing out on this protection. Continued effort is needed to reach every child.
The Research Details
Researchers examined data from three large national health surveys conducted in Sierra Leone in 2008, 2013, and 2019. These surveys asked families whether their children aged 6-59 months had received vitamin A supplements in the past year. The researchers then looked at whether coverage was equal across different groups: children of different ages, families with different income levels, mothers with different education levels, children in rural versus urban areas, boys versus girls, and different regions of the country.
To measure fairness, they used special tools that compare coverage between groups. For example, they calculated the difference in coverage between rich and poor families, and between rural and urban areas. They also calculated what percentage of the gap could be closed if everyone received supplements at the same rate as the best-performing group.
This approach is like taking a snapshot of the country’s progress over time and checking whether the benefits are being shared equally or if some children are being left behind.
Understanding trends and fairness in vitamin A coverage is crucial because vitamin A deficiency remains a leading preventable cause of childhood blindness and increases the risk of serious infections and death. By tracking coverage over time and identifying which groups are being missed, health officials can design better programs to reach vulnerable children. This research shows whether progress is helping everyone equally or widening gaps between rich and poor.
This study uses data from official national health surveys, which are large, representative samples of the entire population. The surveys were conducted by trained professionals using standardized methods, making the data reliable. The researchers used established WHO tools to measure inequality, ensuring their methods are scientifically sound. However, the study relies on families’ recall of whether their children received supplements, which may not be perfectly accurate. The study does not specify the exact number of families surveyed in each year, though national surveys typically include thousands of households.
What the Results Show
Vitamin A supplementation coverage in Sierra Leone showed dramatic improvement over the 11-year period. In 2008, only about 1 in 4 children (25.9%) received vitamin A supplements. By 2019, nearly 7 in 10 children (69.1%) were covered—an increase of 43 percentage points. This represents substantial progress in a public health program.
However, important gaps remained between different groups. Children from wealthy families were more likely to receive supplements than children from poor families—a gap that actually grew slightly from 8.5 percentage points in 2008 to 9.3 percentage points in 2019. This means that as overall coverage improved, the advantage for wealthy families increased.
The good news came in other areas. The gap between children with educated mothers and uneducated mothers shrank significantly, from 11.1 percentage points to 4.9 percentage points. Rural-urban differences also narrowed substantially, from 4.9 percentage points to just 1.6 percentage points. Regional differences across the country decreased from 13.4 percentage points to 8.6 percentage points. There was virtually no difference between boys and girls throughout the entire period.
When researchers looked at how many children could benefit if everyone received supplements at the same rate as the best-performing groups, they found that closing the gap by household wealth could prevent about 6.6 cases of vitamin A deficiency per 100 children. Regional disparities could account for 3.5 cases per 100 children. These numbers show that while progress has been made, significant opportunity remains to protect more children by reaching disadvantaged populations.
This research builds on previous studies showing that vitamin A supplementation programs work best when they’re part of organized, well-funded health systems. Sierra Leone’s progress from 26% to 69% coverage is encouraging compared to some countries but still lags behind global best practices. The WHO recommends 80% coverage as a minimum target to prevent vitamin A deficiency in populations. Sierra Leone’s 69% coverage in 2019 shows the country is close but hasn’t yet reached this goal. The persistent gap between wealthy and poor families mirrors patterns seen in other developing countries, suggesting that reaching the poorest populations requires special, targeted efforts.
The study relies on families remembering whether their children received vitamin A supplements, which may lead to underestimation or overestimation of actual coverage. The research doesn’t explain why some groups have better coverage than others—it only documents that differences exist. The study doesn’t include information about the quality of supplements or whether children actually received the correct dose. Additionally, the exact number of families surveyed in each year is not provided, though national surveys typically include thousands of households. Finally, the study only covers data through 2019, so more recent trends during the COVID-19 pandemic are not included.
The Bottom Line
Strong evidence supports continued investment in vitamin A supplementation programs in Sierra Leone and similar countries. Programs should specifically target poor families and remote rural areas to close remaining gaps. Health workers should receive better training and resources to reach all children. Community education programs should help parents understand why vitamin A is important. These recommendations are based on clear evidence of what works and what gaps remain.
Parents and caregivers of children under five in Sierra Leone and similar countries should care about this research, as it shows whether their children are likely to receive this life-saving nutrient. Health officials and program managers should use these findings to redesign programs to reach poor and rural families. International health organizations should consider this research when allocating resources. Policymakers should recognize that while progress is real, sustained commitment and funding are needed to reach the 80% target.
Vitamin A supplementation provides immediate protection against infections and vision problems, with benefits appearing within weeks to months of starting supplementation. However, closing the coverage gaps identified in this research will require sustained effort over several years. If targeted programs are implemented now, significant improvements in coverage for poor and rural families could be achieved within 2-3 years, but maintaining these gains requires ongoing commitment.
Frequently Asked Questions
Why is vitamin A supplementation important for young children?
Vitamin A prevents blindness, reduces severe infections, and decreases mortality risk in children under five. Deficiency is a leading preventable cause of childhood blindness in developing countries. Regular supplementation strengthens immune function and protects vision development during critical growth years.
How much has vitamin A coverage improved in Sierra Leone?
Coverage nearly tripled from 26% in 2008 to 69% in 2019. This means about 7 in 10 children now receive supplements, compared to only 1 in 4 eleven years earlier. However, the country still aims for 80% coverage to ensure maximum protection.
Which children in Sierra Leone are less likely to receive vitamin A supplements?
Children from poor families, those living in remote rural areas, and those with less-educated mothers are less likely to receive supplements. While rural-urban gaps have narrowed, economic inequality has actually increased slightly, meaning wealthy families’ advantage has grown despite overall improvements.
What needs to happen to reach every child with vitamin A supplements?
Programs must specifically target poor families and remote areas with better health infrastructure and services. Community education about vitamin A’s importance, improved health worker training, and sustained government funding are essential. Removing barriers like transportation and cost would help reach the most vulnerable children.
Is vitamin A supplementation safe for all children?
Vitamin A supplementation at recommended doses is safe and effective for children aged 6-59 months. Health professionals determine appropriate dosing based on age. Supplementation is especially important in areas where vitamin A deficiency is common, like Sierra Leone.
Want to Apply This Research?
- Track whether your child received vitamin A supplements at each health visit. Record the date, dose, and location where the supplement was given. This creates a personal record you can share with health providers and helps ensure your child doesn’t miss doses.
- Set reminders for vitamin A supplementation campaigns in your area. Many programs distribute supplements during specific months or at health clinics. Use the app to find the nearest health center offering supplements and plan a visit. Share information with other parents about where and when supplements are available.
- Over 12 months, track how many times your child received vitamin A supplements (goal: at least 2 times per year for children 6-59 months). Monitor your child’s eye health and frequency of infections as indirect indicators of vitamin A status. Compare your family’s access to supplements with other families in your community to identify barriers and solutions.
This research describes trends in vitamin A supplementation coverage in Sierra Leone and identifies gaps in access. It does not provide medical advice for individual children. Parents and caregivers should consult with their healthcare provider about whether vitamin A supplementation is appropriate for their child, proper dosing, and timing. Vitamin A supplementation should only be given as recommended by qualified health professionals. This article is for informational purposes and should not replace professional medical guidance. If you have concerns about your child’s nutrition or health, speak with a doctor or qualified health worker.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.