Mobilizing and strengthening Civil

Society Organizations to scale up nutrition in

Nigeria: A Call for Action

by Dr. Philippa Momah

Network CoordinatorCivil Society Scaling Up Nutrition in

Nigeria (CS-SUNN)

…….Working together to attain a country where every citizen has food and nutrition is secured

Presentation outline…

• Introduction• The Crisis of Under-nutrition in

Nigeria• Stopping Child under-nutrition• Mobilizing Civil Society

Organizations to scale up Nutrition in Nigeria

• A call to action to PAPHNON

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Introduction ..(1) • Food is an important resource to human

development and survival.• Food security exists when all people, at all times,

have physical and economic access to sufficient safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life.

• Health implications of food insecurity include malnutrition, impaired mental development, diminished learning ability, increased prevalence of chronic diseases, morbidity and mortality.

• An adequate diet consists of all classes of food in the right proportion e.g. staple foods, legumes, animal source foods, fruits, vegetables, fats and oils .

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Introduction ..(2) • Nutrition is the process involved in taking in,

absorbing and utilizing nutrients for tissue growth, repairs and maintenance of body systems.

• Adequate nutrition is essential throughout the lifespan especially within the first 1000 days of life that begins with conception, through the mother’s pregnancy and up till the child is aged two years.

• Good nutritional practices such as exclusive breast feeding, complementary feeding, family dietary diversification and improved hygiene practices contribute towards the protection of the first 1000 days.

• The effects of poor nutrition during the 1,000 day window period are often irreversible. It can result in brain damage, poor growth and development problems .

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Introduction ..(3) • Malnutrition is a condition that occurs when people

consistently do not consume or absorb the right amounts and types of food and essential nutrients.

• Malnutrition among Nigeria’s children is a serious problem : each year about 1 million Nigerian children die before their 5th birthday and malnutrition contributes to nearly HALF of these deaths.

•  Dimensions of malnutrition in children:– Under-nutrition : Stunting, Wasting, and Micronutrient

deficiencies (Hidden Hunger);– Over-nutrition : Overweight / Obesity

• Nigeria has the highest burden of stunting in Africa, with over 11 million children less than 5 years old, stunted ( NDHS 2013).

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The Crisis of Under-nutrition in Nigeria…

Trends in Childhood under-nutrition(NDHS 2013): Stunting (short for their age):• Stunting reflects failure to receive adequate nutrition

over a long period of time (i.e. chronically malnourished)

Trends: The proportion of children who are stunted declined from 41 % in 2008 to 37 % in 2013.

Wasting (thin or acutely malnourished). • Wasting describes current nutritional status and

represents the failure to receive adequate nutrition in the period immediately preceding the survey.

Trends : Wasting has increased from 14% (2008) to 18% (2013), indicating recent nutritional deficiency among children in the country.

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The Crisis of Under-nutrition in Nigeria…Trends 2003 – 2013 (NDHS)

2003 2008 2013

Stunting 42% 41% 37%Wasting 11% 14% 18%Underweight

24% 23% 29%

EBF 17% 13% 17%

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The Crisis of Under-nutrition in Nigeria…Zonal Distribution (NDHS 2013):

NAT./ZONES STUNTING % WASTING %

NATIONAL 37 18

North Central 29 12

North East 42 20

North West 55 27

South South 18 11

South West 22 10

South East 16 12

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The Crisis of Under-nutrition in Nigeria: Trends in 10 states & FCT

S/No States

Height- for -age (stunted) in %

weight-for-height (wasted) in %

weight-for-age (under-weight) in %

1Anambra 18.4 17.3 14.12Akwa-Ibom 22.4 10.5 15.13FCT 20.6 13.8 12.64Kwara 27.1 6.5 13.85Adamawa 34.3 14.5 23.16Gombe 47.5 14.2 327Kebbi 60.6 18.1 398Sokoto 51.6 19.3 37.79Enugu 11.7 8.9 7.1

10Delta 14.9 17 15.411Lagos 17 11.3 12.9

Trends of GAM, Stunting, Underweight and MUAC<125mm by age in months , Nigeria 2014

Trends in under-nutrition in Nigeria by age – 1000 days

The Crisis of Under-nutrition in Nigeria…the Drivers of the burden..A. Immediate causes: • Inadequate dietary intake: NDHS 2013 states

that only 17% of babies (0 – 6 months) were exclusively breast fed & only 10% of children aged 6 – 23 months were fed appropriately.

• Infectious diseases e.g. diarrhea, malaria.B. Underlying causes: Food insecurity, poor

child and maternal care; poor access to health services; unhealthy environment; Emergencies.

C. Basic causes: Poverty; Population ; failure in governance; gender inequality.

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Table 1: Drivers of Malnutrition: Magnitude of the problem in Nigeria

Cause Indicator National

Sources Im

med

iate C

ause

s Inadequate

dietary intake Exclusive Breastfeeding of children until 6 months of age (%)

17 NDHS 2013

Prevalence of Diarrhoea

Percentage of children under age 5 who had diarrhoea in the two weeks preceding the survey

10.2 NDHS 2013

Prevalence of Malaria

Percentage of children under age 5 with a fever during the two weeks preceding the survey

12.5 NDHS 2013

Unde

rlyin

g Cau

ses

Food Security Households in poorest wealth quintiles with poor or borderline food consumption (%)

29 IFPRI 2013

Global Hunger Index Score Rank (2013) 15 GHI 2013 Health & Sanitation

Women 15-49 years with problems accessing health care (%)

53.3 NDHS 2013

Household access to an improved water source (%) 60.6 NDHS 2013

Household access to improved sanitation (%) 30.1 NDHS 2013

Care and Feeding Practices

Exclusive Breastfeeding of children until 6 months of age (%)

17 NDHS 2013

Timely initiation of breastfeeding percent (within the first hour)

33.2 NDHS 2013

Compliance to recommended infant and young child feeding practices

10% NDHS 2013

Education Females that completed primary school or higher (%) 62.2 NDHS 2013

Basic

Caus

es Population Total Fertility Rate (%) 5.5 NDHS 2013

Gender Women’s intra-household decision-making power (%) 31.3 NDHS 2013

Poverty Population living under the national poverty line (%) 54.7 UNDP 2013

normal wasted stunted

If not addressed, malnutrition is

transmitted from generation to generation.

However, the implementation of key Nutrition interventions

by Government and Non-state Actors at all

levels will enable Nigeria break this

vicious cycle and stop the Crisis!!...

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Stopping Child under nutrition(1)Government’s Role: • Nigeria joined the Scaling Up Nutrition (SUN)

Initiative in November, 2011. SUN is a global movement which is led by governments and comprises of civil societies, business, donors and UN organizations in a world-wide effort to reduce hunger and malnutrition.

• Developed the National Strategic Action Plan for Nutrition ( NSPAN, 2014- 2019) , for implementation at all levels.

Goal of the NSPAN: Improve the nutritional status of Nigerians, with a particular focus on vulnerable groups especially women of reproductive age and children under five years of age.

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NSPAN Targets….

• To reduce the number of under-five children who are stunted by 20% by 2018

• To reduce low birth weight by 15% by 2018• To ensure no increase in childhood overweight by

2018• To reduce and maintain childhood wasting to less

than 10% by 2018• To reduce anaemia in women of reproductive age

by 50% by 2018• To increase exclusive breastfeeding rates in the

first six months to at least 50% by 2018

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Estimated unit costsCost of key nutrition interventions –

World Bank 2014 – Basis for: MOH national strategic plan of action for nutrition 2014-2019

Intervention Cost per child (units vary)

Promotion of Breastfeeding, appropriate complementary feeding, handwashing

US$ 5 per participant / year

Vitamin A supplements US$ 0.44 per child through MNCHW

Micronutrient powders US$ 3.60 (6-24 months)Deworming US$ 0.44 per child through

MNCHWIron-folic acid supplements for pregnant women

US$ 1,79 per pregnancy MNCHWUS$ 2.00 per pregnancy Community

Iron fortification of staple foods US$ 0.20 per person / year

Salt iodisation US$ 0.05 per person / year

Stopping Child under-nutrition..(2)

1. Exclusive Breast Feeding: support early initiation of breastfeeding within 30 minutes after birth and exclusive breastfeeding for the first six months of life of the baby:– An estimated 13% of child deaths could be averted if

90% of mothers exclusively breastfed their infants for first 6 months;

2. Complementary feeding: Give children the right quantity and variety of foods from 6 months of age with continued breastfeeds until 2 years;– If 90% mothers provided adequate and timely

complementary feeding for 6 to 24 months olds, additional 6% of child deaths could be prevented.

•  …….Working together to attain a country where every citizen has food and nutrition is secured

Stopping Child Under nutrition…(3)

3. Nutrition education:

• Provide parents & caregivers with information and support on EBF, care & feeding practices for young children.

• Babies must be fed very frequently and on demand because of the small stomach size. Key:- 1 oz = 30 ml; 1 cup = 240 ml

Stopping Child under-nutrition..(4)4. Food Security:Ensure mothers and their children have access to essential vitamins, minerals, and nutrients.

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The Government has taken major steps, so what are the roles of Non- state Actors?...

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Mobilizing Civil Societies to scale up Nutrition in Nigeria….(1)

• Civil Society Scaling Up Nutrition in Nigeria (CS-SUNN )is a non-governmental, non-profit making coalition, made up of organizations with a shared vision to transform Nigeria into a country where every citizen has food and nutrition is secured.

• CS-SUNN was launched on August 7, 2014. • Membership is multi- sectoral including

human rights, agriculture, health, community development, education, water, sanitation, planning and financing.

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Mobilizing Civil Societies to scale up Nutrition in Nigeria….

(2)CS-SUNN objectives are to:• Engage state and non-state actors for nutrition action;• Mobilize and strengthen CSOs in Nigeria to scale-up

nutrition through advocacy and public awareness;• Support existing policy, legal and budgetary frameworks

to be more accountable to meet the nutritional needs of Nigerians , with focus on maternal and child nutrition;

• Enhance experience sharing and learning between and within organizations , nationally and globally.

CS-SUNN has mobilized CSOs in 10 states and Federal Capital Territory (FCT) to establish Volunteer Local Working Groups for nutrition advocacy.

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Mobilizing Civil Societies to scale up Nutrition in Nigeria….(3)Key roles:• Create awareness on the crisis of malnutrition;• Advocate for the domestication of the National

Strategic Plan of Action for Nutrition (NSPAN, 2014 -2019) with focus on maternal and child nutrition at the state & LGAs;

• Organize the communities to identify their nutrition priorities / “asks” to be presented to the relevant decision makers;

• Mobilize stakeholders, interest groups and citizens to participate in budget work;

• Advocate for a culture of accountability.

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Mobilizing Civil Societies to scale up Nutrition in Nigeria….(4)Key roles:• Mobilize communities to participate in Community

maternal nutrition and IYCF services implementation.

• Monitor nutrition services delivery ; share reports and circulate relevant information to stakeholders including community groups and the media;

• Organize public dialogue meetings for the members of the community to interact with local leaders, discuss key issues that affect them, and to demand action from the decision makers;

• Use data for advocacy: e.g. Maternal, Newborn & Child Health Week (MNCHW) data provides evidence to equity gaps, coverage and accountability for services provision.…….Working together to attain a country where every citizen has food and nutrition is secured

Mobilizing Civil Societies to scale up Nutrition in Nigeria….(5)

CS-SUNN ASKs to Government..• Domesticate the National Strategic Plan of

Action for Nutrition (NSPAN, 2014 -2019) with focus on maternal and child nutrition;

• Allocate Budget with timely release of funds to implement nutrition interventions that target Adolescents, mothers and young children;

• Extend maternity leave to 6 months for working mothers, to protect Exclusive Breast Feeding;

• Provide maternal nutrition and IYCF services, through Health Facilities and Community based structures.

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1. Utilize extensive network to :• Promote Exclusive Breast Feeding;• Advocate for the provision of

Community maternal nutrition and IYCF services;

• Provide sustained community nutrition education.

2. Partner with CS-SUNN, so that together we can make a difference and contribute to stopping child under-nutrition in Nigeria .

CS-SUNN Call to Action to PAPHNON:

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.

THANK YOU…

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Acknowledgements..

• CS-SUNN Coalition Members• SUN MPTF Team• UNICEF Nigeria Country Office Nutrition

Team

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