There are a variety of ways to deliver high-dose vitamin A supplements to at-risk populations including restricting delivery to clinic settings for treatment purposes, integrating delivery with existing services such as immunization contacts or routine growth monitoring, or universal delivery, to attain the widest coverage of preschool children, through semi-annual campaigns that specifically promote vitamin A capsule distribution or that are combined with other national programs such as national immunization days or child-health weeks. Each delivery mode has advantages and disadvantages. Restricted delivery targets those most likely to be deficient in vitamin A and requires few additional resources (apart from the supplements); however it may result in poor coverage if those who are most at risk do not regularly access health clinics. 'Piggybacking' vitamin A distribution onto existing community services can be cost-effective but may also miss the children at greatest risk of vitamin A deficiency if their access to and use of these services is limited. Finally, universal distribution requires strong community mobilization and social marketing to attain coverage levels of at least 80%. Sustaining this coverage level every 4-6 months can be challenging, but there are numerous examples of countries where such levels have been sustained for at least 5-8 years.
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