Variations in infant and childhood vitamin D supplementation programmes across Europe and factors influencing adherence

Suma Uday; Ardita Kongjonaj; Magda Aguiar; Ted Tulchinsky; Wolfgang Högler

doi:10.1530/EC-17-0193

Variations in infant and childhood vitamin D supplementation programmes across Europe and factors influencing adherence

Endocr Connect. 2017 Nov;6(8):667-675. doi: 10.1530/EC-17-0193. Epub 2017 Sep 18.

Authors

Suma Uday¹, Ardita Kongjonaj², Magda Aguiar³, Ted Tulchinsky⁴, Wolfgang Högler^{5

6}

Affiliations

¹ Department of Endocrinology and DiabetesBirmingham Children's Hospital, Birmingham, UK.
² MEAL Specialist at Save the Children InternationalAlbania Country Office, Tirana, Albania.
³ Health Economics UnitUniversity of Birmingham, Birmingham, UK.
⁴ Braun School of Public Health and Community Medicineand Ashkelon College, Ashkelon, Israel.
⁵ Department of Endocrinology and DiabetesBirmingham Children's Hospital, Birmingham, UK wolfgang.hogler@nhs.net.
⁶ Institute of Metabolism and Systems ResearchUniversity of Birmingham, Birmingham, UK.

Abstract

Background: Nutritional rickets is a growing global public health concern despite existing prevention programmes and health policies. We aimed to compare infant and childhood vitamin D supplementation policies, implementation strategies and practices across Europe and explore factors influencing adherence.

Methods: European Society for Paediatric Endocrinology Bone and Growth Plate Working Group members and other specialists completed a questionnaire on country-specific vitamin D supplementation policy and child health care programmes, socioeconomic factors, policy implementation strategies and adherence. Factors influencing adherence were assessed using Kendall's tau-b correlation coefficient.

Results: Responses were received from 29 of 30 European countries (97%). Ninety-six per cent had national policies for infant vitamin D supplementation. Supplements are commenced on day 1-5 in 48% (14/29) of countries, day 6-21 in 48% (14/29); only the UK (1/29) starts supplements at 6 months. Duration of supplementation varied widely (6 months to lifelong in at-risk populations). Good (≥80% of infants), moderate (50-79%) and low adherence (<50%) to supplements was reported by 59% (17/29), 31% (9/29) and 10% (3/29) of countries, respectively. UK reported lowest adherence (5-20%). Factors significantly associated with good adherence were universal supplementation independent of feeding mode (P = 0.007), providing information at neonatal unit (NNU) discharge (P = 0.02), financial family support (P = 0.005); monitoring adherence at surveillance visits (P = 0.001) and the total number of factors adopted (P < 0.001).

Conclusions: Good adherence to supplementation is a multi-task operation that works best when parents are informed at birth, all babies are supplemented, and adherence monitoring is incorporated into child health surveillance visits. Implementation strategies matter for delivering efficient prevention policies.

Keywords: Europe; fortification; micronutrients; policy implementation; rickets; supplementation.