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Validation of a roadmap for mainstreaming nutrition-sensitive interventions at state level in Nigeria.

ABSTRACT: BACKGROUND:National programs are often developed with little consideration to the sub-national local factors that might affect program success. These factors include political support, capacity for implementation of program and variation in malnutrition indices being tackled. State context factors are evident in the distribution of malnutrition (e.g. high prevalence or gap among Local Government Areas), in the implementation of nutrition-sensitive interventions (e.g. access to early childhood education) and in the political economic context (e.g. presence of external funding agencies). Context is shaped by the economy, population, religion, and poverty, which impact everyday lives. Considering these contexts, a roadmap was developed and validated. The aim of this paper is to report expert review and stakeholder validation to determine feasibility of the developed contextualised roadmap for two Nigerian states. METHODS:A validation tool was developed and reviewed using three experts. The content review occurred in two rounds to obtain recommendation and revisions of the developed roadmap and the validation tool. A pilot test of the roadmap and validation tool was done using two stakeholders in South Africa. The roadmap and the validation tool were then sent to the stakeholders and potential end-users in Nigeria using electronic media. Two research assistants were also engaged to deliver and collect hard copies to those who preferred it. RESULTS:Of the ten stakeholders invited, nine responded. All participants showed an adequate understanding of the roadmap as evidenced by the scores given. Responses regarding the translation of the roadmap to implementation varied. The majority (86,6%) either strongly agreed or agreed that the actions were translatable (43.0 and 43.6% respectively). CONCLUSIONS:The final roadmap comprises of actions that are appropriate for the state's context. It is recommended that stakeholders or end-users of any programme must be involved in the validation of such contextual programmes to improve chances of success.

SUBMITTER: Ezekannagha O

PROVIDER: S-EPMC7488070 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Validation of a roadmap for mainstreaming nutrition-sensitive interventions at state level in Nigeria.

Ezekannagha Oluchi O Drimie Scott S von Fintel Dieter D Maziya-Dixon Busie B Mbhenyane Xikombiso X

Nutrition journal 20200909 1

<h4>Background</h4>National programs are often developed with little consideration to the sub-national local factors that might affect program success. These factors include political support, capacity for implementation of program and variation in malnutrition indices being tackled. State context factors are evident in the distribution of malnutrition (e.g. high prevalence or gap among Local Government Areas), in the implementation of nutrition-sensitive interventions (e.g. access to early chil ...[more]

PMID: 32907577

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Project description:BACKGROUND:Interventions that work must be effectively delivered at scale to achieve population level benefits. Researchers must choose among a vast array of implementation frameworks (>?60) that guide design and evaluation of implementation and scale-up processes. Therefore, we sought to recommend conceptual frameworks that can be used to design, inform, and evaluate implementation of physical activity (PA) and nutrition interventions at different stages of the program life cycle. We also sought to recommend a minimum data set of implementation outcome and determinant variables (indicators) as well as measures and tools deemed most relevant for PA and nutrition researchers. METHODS:We adopted a five-round modified Delphi methodology. For rounds 1, 2, and 3 we administered online surveys to PA and nutrition implementation scientists to generate a rank order list of most commonly used; i) implementation and scale-up frameworks, ii) implementation indicators, and iii) implementation and scale-up measures and tools. Measures and tools were excluded after round 2 as input from participants was very limited. For rounds 4 and 5, we conducted two in-person meetings with an expert group to create a shortlist of implementation and scale-up frameworks, identify a minimum data set of indicators and to discuss application and relevance of frameworks and indicators to the field of PA and nutrition. RESULTS:The two most commonly referenced implementation frameworks were the Framework for Effective Implementation and the Consolidated Framework for Implementation Research. We provide the 25 most highly ranked implementation indicators reported by those who participated in rounds 1-3 of the survey. From these, the expert group created a recommended minimum data set of implementation determinants (n?=?10) and implementation outcomes (n?=?5) and reconciled differences in commonly used terms and definitions. CONCLUSIONS:Researchers are confronted with myriad options when conducting implementation and scale-up evaluations. Thus, we identified and prioritized a list of frameworks and a minimum data set of indicators that have potential to improve the quality and consistency of evaluating implementation and scale-up of PA and nutrition interventions. Advancing our science is predicated upon increased efforts to develop a common 'language' and adaptable measures and tools.

Project description:ObjectivesTo explore the role of individual-level and household-level characteristics for practice of nutrition-specific and nutrition-sensitive interventions.DesignSecondary data analysis (cross-sectional).SettingWest and Central Africa.ParticipantsData are from the Demographic and Health Surveys in the time period between 1986 and 2016. The final sample included between 116 325 and 272 238 observations depending on the outcome.Primary and secondary outcome measuresNutrition-specific and nutrition-sensitive interventions were identified based on the UNICEF Conceptual Framework for child undernutrition. These were early breastfeeding initiation, minimum dietary diversity, full age-appropriate immunisation, iodised salt usage, vitamin A supplementation, iron supplementation, deworming in children aged 1 to 5, clean cooking fuel, safe drinking water and improved sanitation. Explanatory variables include household, mother and child characteristics. Linear probability models were fitted for each outcome, both unadjusted as well as fully adjusted including primary sampling unit fixed effects.ResultsPrevalence of early breastfeeding initiation was 54.31% (95% CI: 53.22% to 55.41%), minimum dietary diversity 13.89% (95% CI: 13.19% to 14.59%), full age-appropriate immunisation 13.04% (95% CI: 12.49% to 13.59%), iodised salt usage 49.66% (95% CI: 46.79% to 52.53%), vitamin A supplementation 52.87% (95% CI: 51.41% to 54.33%), iron supplementation 10.73% (95% CI: 10.07% to 11.39%), deworming 31.33% (95% CI: 30.06% to 32.60%), clean cooking fuel usage 3.02% (95% CI: 2.66% to 3.38%), safe drinking water 57.85% (95% CI: 56.10% to 59.59%) and improved sanitation 42.49% (95% CI: 40.77% to 44.21%). There was a positive education and wealth gradient for the practices of all interventions except deworming. Higher birth order was positively associated with the practice of early breastfeeding initiation, minimum dietary diversity, vitamin A supplementation and negatively associated with full immunisation and improved sanitation.ConclusionsHousehold, maternal, and child-level characteristics explain practices of nutrition-specific and nutrition-sensitive interventions beyond intervention delivery at the regional level.

Project description:BackgroundAnnually, undernutrition contributes globally to 45% (3.1 million) of preventable deaths in children under 5. Effect following undernutrition i.e. physical growth & cognitive development etc. can be prevented during the first 1000 days also called window of opportunity. There is substantial evidence of positive nutrition outcomes resulting from integrating nutrition-specific interventions into nutrition specific program. However, there is paucity of knowledge on establishing and sustaining effective integration of nutrition intervention in fragile context. The objective of this review is to map and review the integration of nutrition-specific intervention to nutrition sensitive program and its impacts on nutrition outcomes.MethodsIn the study, we systematically searched the literature on integrated nutrition intervention into multi-sectoral programme in PUBMED, Google's Scholar, the Cochrane Library, World Health Organisation (WHO), United Nations Children's Fund (UNICEF), World Bank and trial registers from their inception until Oct 30, 2020 for up-to-date published and grey resources. We screened records, extracted data, and assessed risk of bias in duplicates. This study is registered with PROSPERO (CRD42020209730).ResultForty-four studies were included in this review, outlining the integration of nutrition-specific interventions among children 0-59 months with various existing programme. Most common integration platform in the study included integrated community case management and Integrated Management of Childhood Illness, Child Health Days, immunization, early child development, and cash transfers. Limited quantitative data were suggestive of some positive impact on nutrition and non-nutrition outcomes with a number of model of integration which varies according to the context and demands of the particular setting in which integration occurs.ConclusionOverall, existing evidence for nutrition sensitive and specific interventions is not robust and remains limited. It's worthwhile to note, for future studies/interventions should be based on the context key criteria like relevance, political support, effectiveness, feasibility, expected contribution to health system strengthening, local capacities, ease of integration and targeting for sustainability, cost effectiveness and financial availability.

Project description:BackgroundHealth systems need to be evaluated to ascertain if they are meeting their objectives. There is an increased interest in health system responsiveness (HSR) as a means to appraise health systems. This becomes vital as we put people at the centre of integrated health systems and put a premium on their rights and perspectives. Thus, this study assessed the levels, distribution and factors associated with HSR in Oyo State.MethodsThe study was a cross-sectional study with 717 adults, who had used an out-patient health facility in the preceding 12 months, interviewed using a semi-structured, interviewer-administered questionnaire. HSR was measured on a multi-domain and multi-item (7 domains and 20 items) 5-point Likert scale that was developed by the WHO to measure HSR globally. Summary scores were computed for level, distribution and the most important domains of HSR. Determinants of poor HSR were determined using binomial logistic regression. The level of statistical significance was set at 5%.ResultsThe overall level of HSR was 47%. The highest-rated domains were confidentiality (72%), dignity (64%) and choice (60%), while the least rated were prompt attention (43%) and communication (52%). The overall distribution of HSR was 0.228 (range of 0 to 1) with the domains of prompt attention (0.595) and choice (0.506) being the most unequally distributed. The most important domains were communication, prompt attention and dignity. The least important domains were choice and confidentiality. The factors associated with poor HSR (overall) were no formal education, (OR = 2.81; 95% CI: 1.35-5.86), primary education as the highest level of education (OR = 2.19; 95% CI: 1.28-3.75), poor socioeconomic class (OR = 1.86; 95% CI: 1.23-2.80), using a government-owned facility (OR = 1.56; 95% CI: 1.11-2.19) and not using the usual health facility (OR = 1.69; 95% CI: 1.13-2.53).ConclusionsThe overall level of HSR in Oyo State was low with the domains of prompt attention, communication and autonomy being the least rated domains. Therefore, concerted efforts should be targeted at improving HSR as this will improve wellbeing, health system utilization, and the overall health system.

Project description:BackgroundNutrition outcomes among young children in Nigeria are among the worse globally. Mother's limited knowledge about food choices, feeding, and health care seeking practices contributes significantly to negative nutrition outcomes for children in most developing countries. Much less is known about the relationship between mother's nutrition-related knowledge and child nutritional outcomes in rural Nigeria. This paper investigates therefore: (i) the association of mother's nutrition-related knowledge with nutrition outcomes of young children living in rural Nigeria, where access to education is limited, and (ii) whether mother's education has a complementary effect on such knowledge in producing positive child nutrition outcomes in such settings.MethodsUsing the Demographic and Health Survey data for Nigeria, we employ both descriptive and regression analyses approaches in analyzing the study's objectives. In particular, we apply ordinary least square (OLS) to investigate the association of mother's nutrition-related knowledge with child HAZ and WHZ while controlling for maternal, child, household and regional characteristics. An index was constructed for mother's nutrition-related knowledge using information on dietary practices, disease treatment and prevention, child immunization, and family planning.ResultsWe found that mother's knowledge is independently and positively associated with HAZ and WHZ scores in young children. Higher levels of mother's education, typically above primary, have a significant, positive association with child HAZ and WHZ scores. We argue that mother's knowledge of health and nutrition may substitute for education in reducing undernutrition in young children among populations with limited access to formal education. However, the present level of mother's education in rural Nigeria appears insufficient to reinforce knowledge in producing better nutrition outcomes for children.ConclusionsThis study suggests promotion of out-of-school (informal) education, such as adult literacy and numeracy classes where women without formal education can gain health and nutrition knowledge, and practices that could enhance child nutrition outcomes in Nigeria.

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Validation of a roadmap for mainstreaming nutrition-sensitive interventions at state level in Nigeria.

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Validation of a roadmap for mainstreaming nutrition-sensitive interventions at state level in Nigeria.

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