Changes in Micronutrient Intervention in Nigeria, 2003-2008, and Implications for Intervention Scale-up.

Objectives: Nigeria is third of 34 countries that contribute 90% of the global burden of stunting, and has the third highest numbers of wasted children. Prevailing evidence emphasizes the need for effective scale-up of interventions like micronutrient supplementation. This study assessed micronutrient interventions in Nigeria and how coverage has changed over time, in order to identify modifications that may be necessary to achieve such scale-up. Methods: Data from the 2003 and 2008 Nigeria Demographic and Health Surveys (NDHS) were used. Intervention access was estimated using information about skilled health-worker-to-client contact. Descriptive and chi-square statistics were obtained using complex survey design, in Stata 11.2. Results: From 2003 to 2008, prevalence of households with adequately iodized salt decreased from 97.1% to 52.9% (p<0.0001). Prevalence of children 6-59 months who received vitamin A supplements in the 6 months preceding the NDHS also decreased (34.1% to25.1%, p<0.0001), but women receiving vitamin A postpartum increased from 19.8% to 24.9% (p=0.004). For iron, there were no changes in prevalence of zero-supplementation during pregnancy (40.0% to 43.9%, p=0.13). Similarly, there were no improvements in prevalence of health-worker-to-client contact. Skilled antenatal care prevalence was 58.1% and 58.0% in2003 and 2008 respectively (p=0.96); skilled assistance at delivery was 35.5% and 39.5% (p=0.16); and 23.4% and 33.0% respectively (p<0.0001) of children 12-59 months had received zero vaccinations. Conclusions: There were lack of improvements in already low micronutrient intervention coverage, and poor services utilization among clients. Promoting health services utilization may help scale-up micronutrient interventions in Nigeria.

Constraints to Attending the Maternal, Newborn and Child Health Weeks in North West Nigeria.

Objectives: This study aimed to understand the barriers to MNCHW attendance in order to develop recommendations for strengthening its social mobilization activities. Methods: In the states of Jigawa and Zamfara in northern Nigeria, 19 in-depth interviews were conducted with government officials and community leaders; and 36 focus group discussions with women with a child under 5-years of age, their husbands, town criers, health workers, community volunteers, and religious leaders on MNCHW social mobilization and barriers to attendance. Content analysis was used to derive themes. Results: Awareness of MNCHW was low among the target beneficiaries. Even where programme awareness existed, there was little understanding of the nutrition and health benefits of VAS. Social mobilization focused solely on raising awareness about the dates and location of MNCHW, it did not promote its health benefits. MNCHW has also been overshadowed by the Immunization Plus Days (IPDs) which are conducted monthly. Other barriers to MNCHW attendance included inability to afford transportation costs, and distrust of government programmes. Conclusions: To increase attendance at MNCHW in northern Nigeria, social mobilization must first address the lack of understanding of the health benefits of the MNCHW programme.