Development of a roadmap for mainstreaming nutrition-sensitive interventions in Anambra and Kebbi States, Nigeria

Ezekannagha, Oluchi (2019-04)

Thesis (PhD)--Stellenbosch University, 2019.

Thesis

ENGLISH SUMMARY : Malnutrition, though on a slight decline, has continued to be a problem in developing countries. The role of nutrition-sensitivity sectors as a linkage between immediate causes and basic causes of malnutrition has been increasingly recognised in recent years as positively associated with malnutrition reduction. Considering the accumulating evidence pointing to a strong relationship between malnutrition reduction and nutrition-sensitive sectors, including agriculture, education, water, sanitation and hygiene (WASH), and social protection, mainstreaming nutrition into these sectors has been widely discussed, designed and implemented in programmes and policies. Large-scale government programmes in nutrition-sensitive sectors are important elements of delivering nutrition-sensitive malnutrition-preventive benefits to the population. Mainstreaming nutrition into these cross-cutting sectors becomes imperative in the fight for malnutrition reduction. The Mainstreaming Nutrition Initiative Assessment (MNIA) is a framework developed for the assessment of mainstreaming nutrition (Menon et al, 2011), which measures the domains of epidemiology, operational and political commitment. However, there has been little attempt to explore its application in mainstreaming nutrition. The aim of the study was to develop a roadmap for mainstreaming nutrition-sensitivity in Anambra and Kebbi States, Nigeria. The study used a four-phased convergent parallel mixed methods design. In Phase 1, small area estimation methodology was employed to estimate local government prevalence of stunting in Nigeria. Phase 2 was carried out in two stages, first, a nutrition-sensitivity and potential checklist were used to determine the current nutrition-sensitivity and possible potential of programme execution in the various sectors in both states. Subsequently, a theory-based process evaluation that employed key informant interviews, document reviews, and site observations were used to determine the operational factors influencing the implementation of the programmes. In Phase 3, a political commitment rapid assessment test was administered in a workshop to explore the political realities regarding nutrition and nutrition-sensitivity in the states. In Phase 4, the data and information from the previous phases were employed to develop a roadmap for mainstreaming nutrition-sensitivity in both states, which was also validated by the stakeholders. Data were analysed using qualitative thematic analysis and MAXQDA software. LGA stunting prevalence estimations varied across the states. Kebbi State had high state average accompanied by very high LGA stunting estimates. Stunting prevalence in Kebbi State ranged from 54 percent to 67 percent. While in Anambra State, the stunting prevalence ranged from 17 percent to 25 percent, both states were in WHO category of medium to high stunting prevalence. The programmes assessed were averagely nutrition-sensitive but most of them had excellent potential to be highly nutrition-sensitive. The agricultural programmes have the best implementation while programmes in the WASH sector were the weakest in terms of implementation. The process evaluation showed that the programmes’ theory was validly nutrition-sensitive. The programmes had varied implementation dimensions, while the Agricultural Transformation Agenda Programme had a very high dose, the programmes reach was minimal. Programmes such as the Environmental Sanitation and Early Childhood Development Education has wide reach but lower dose and implementation. With regards to political commitment, while Kebbi had high expressed commitment, this was supported with the poor institutional commitment, unlike Anambra where strong institutional commitment existed but lacked financial support. From these findings, a roadmap for mainstreaming nutrition-sensitivity was developed and most stakeholders agreed that the roadmap was implementable and feasible. Future investigation is needed to replicate the study in other states. In addition, following-up Anambra and Kebbi states with the implementation of the roadmap may shed more light on the dynamics and role of the various domains in nutrition-sensitive mainstreaming.

AFRIKAANSE OPSOMMING : Wanvoeding, alhoewel daar ‘n effense afname gesien word, bly steeds 'n probleem in ontwikkelende lande. Verskeie staatsektore wat aktief is by die bewusmaking van voedingsgevoeligheid word as 'n skakel tussen die onmiddellike oorsake en basiese oorsake van wanvoeding erken. Hierdie rol hou positief verband met die vermindering van wanvoeding. Met die inagneming van verskeie bewyse wat dui op 'n sterk verhouding tussen wanvoedingvermindering en voedingsgevoelige sektore, insluitend landbou, opvoeding, water, sanitasie en higiëne, en sosiale beskerming, is die integrasie van voeding in hierdie sektore wyd bespreek, ontwerp en geïmplementeer in programme en beleide. Grootskaalse regerings programme in voedingsgevoelige sektore is belangrike elemente vir die lewering van voedingsgevoelige, wanvoeding-voorkomende voordele aan die bevolking. Die integrasie van voeding in hierdie sektore word noodsaaklik in die stryd teen wanvoeding. Die integrasie-voedingsinisiatief-assessering is 'n raamwerk wat ontwikkel is vir die assessering van integrasie voeding (Menon et al, 2011), wat die gebiede van epidemiologie, operasionele en politieke verbintenis meet. Daar is egter min pogings om die toepassing daarvan in die integrasie van voeding te ondersoek. Die doel van die studie was om 'n raamwerk te ontwikkel vir die integrasie van voedingsgevoeligheid in die Anambra en Kebbi state van Nigerië. Die gemengde metodes benadering is gebruik tydens die navorsings ontwerp. In Fase 1 is klein area beramingsmetodologie gebruik om die plaaslike regering se voorkoms van verdwerging in Nigerië te skat. Fase 2 is in twee fases uitgevoer. Eerstens is 'n voedingsgevoeligheid en potensiële voedingsgevoeligheid kontrolelys gebruik om die huidige voedingsgevoeligheid en die potensiaal van programuitvoering in die verskillende sektore in beide state te bepaal. Vervolgens is 'n teoriegebaseerde prosesevaluering gedoen, met die hulp van sleutel-informantonderhoude, dokumentresensies en besoeke, om die operasionele faktore wat die implementering van die programme beïnvloed, te bepaal. In Fase 3 is 'n politieke toewydings assesseringstoets toegepas om die politieke realiteite rakende voedings- en voedingsgevoeligheid in die state te ondersoek. In Fase 4 is die data en inligting van die vorige fases aangewend om 'n raamwerk te ontwikkel vir die integrasie van voedingsgevoeligheid in beide state, wat ook deur die belanghebbendes bekragtig is. Data is geanaliseer met behulp van kwalitatiewe tematiese analise en MAXQDA sagteware. Skattings van die voorkoms van verdwerging wissel tussen die state. Kebbi het 'n hoë staatsgemiddeld, vergesel met baie hoë plaaslike regerings area-ramings. Voorvalle van verdwerging in Kebbi wissel tussen 54 persent en 67 persent. In Anambra het die voorvalle tussen 17 en 25 persent gewissel. Albei lande was in die Wereld Gesondheid Organisasie se medium tot hoë kategorie van verdwerging voorkoms. Die beoordeelde programme was gemiddeld voedingsgevoelig, maar die meeste van hulle het uitstekende potensiaal om hoogs voedingsgevoelig te wees. Die landbouprogramme het die beste implementering getoon, terwyl programme in die WASH-sektor (water, sanitasie en higiëne) die swakste gevaar het in terme van implementering. Die prosesevaluering het getoon dat die programme teoreties voedingsgevoelig was. Die programme het uiteenlopende implementeringsdimensies gehad, terwyl die Program vir Landbou Transformasie Agenda 'n groot impak gehad het, was die omvang van die programme minimaal. Programme soos die Omgewings Sanitasie- en Vroeë kinderontwikkelings programme het wye omvang, maar laer impak en implementering getoon. Met betrekking tot politieke verbintenis het Kebbi groot betrokkenheid uitgespreek, maar is ondersteun deur swak institusionele toewyding. In Anambra was daar weer sterk institusionele toewyding, maar geen finansiële ondersteuning nie. Uit hierdie bevindings is 'n raamwerk vir die integrasie van voedingsgevoeligheid ontwikkel en die meeste belanghebbendes het ooreengekom dat die raamwerk implementeerbaar en haalbaar is. Verdere navorsing is nodig om die studie in ander lande te herhaal. Daarbenewens kan die opvolg van Anambra en Kebbi-state, na die implementering van die raamwerk, meer lig werp op die dinamika en rol van die verskillende sektore in voedingsgevoelige integrasie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105692
This item appears in the following collections: