In the northern states of Nigeria, there are twice as many children under five with severe malnutrition than there are in other parts of the country. Historically, health facilities in Nigeria have been under-resourced, and many health workers are not trained on how to identify cases of severe malnutrition. This makes it a challenge for children with malnutrition to get the care that they need.

Malnutrition, caused by lack of proper nutrition and not having enough to eat, can have devastating effects on children’s growth and development. Children who are malnourished are more likely to have a weak immune system, leading to a higher risk of getting sick with diseases like pneumonia and diarrhea, two of the leading causes of death for children in Sub-Saharan Africa. Adequate nutrition during early childhood is essential to ensure the growth, health, and development of every child to achieve their full potential.

One of the critical solutions to malnutrition? Ready to use therapeutic food (RUTF). It’s a calorie and nutrient dense shelf-stable product used to help underweight and malnourished children gain weight and recover from malnutrition. RUTF is the gold standard for treatment of severe malnutrition for children but sustaining this costly resource has long been a barrier to treating malnutrition in Nigeria.

The nutrient-dense peanut paste doesn’t need refrigeration, nor does it require mixing with potentially contaminated water and stays fresh for two years. RUTF is easy for parents or caretakers to administer and often comes in packets for six to eight week course treatments.

Due to the costs, of the 3.6 million children under five years old in Nigeria that are severely malnourished, less than 3% have access to the necessary RUTF treatment.

Since 2019, USAID’s Palladium-managed Integrated Health Program (IHP) has worked across four states in Nigeria, including Bauchi, Kebbi, Sokoto, and Ebonyi, the Federal Capitol Territory (FCT), and at the federal level to provide technical assistance to develop and implement national policy. In addition, the team provides nutrition programming and support at health care facilities to improve access to and quality of care, including the prevention and treatment of malnutrition.

Barriers to Treatment and a Promising Donation

In October 2023, IHP supported the Government of Nigeria to receive a donation from USAID of 60,000 cartons of RUTF seed stock to Sokoto, Kebbi, and Bauchi State governments.

As part of efforts to improve nutrition services in health facilities, USAID-IHP supported 78 primary health facilities across communities in Bauchi, Kebbi, and Sokoto states prepare their pharmacies and stores to store the RUTF commodities and equip them with basic equipment for measuring bodies, and data recording tools. IHP also supported 164 health providers with onsite training to improve their knowledge and hone their skills for the treatment of childhood malnutrition.

“Sustainable access is essential for addressing severe acute malnutrition, preventing long-term consequences, enabling community-based treatment, and responding effectively to humanitarian emergencies,” notes Abdulrasheed Aliyu, Integrated Primary Health Care Advisor for USAID Integrated Health Program.

Nigeria’s recent gains in expanding State Health Insurance and the facility-based Drug Revolving Fund will support a steady supply of RUTF at no cost for vulnerable children enrolled in State Health Insurance Schemes. The fund, which will also ensure a supply of quality medications, will be critical to prevent stockouts or shortages in public health facilities.

“Nigeria’s population is growing and the country is struggling to provide adequate food and nutrition security. RUTF is the answer but access needs to be sustainable,” adds Zainab Mohammed, Integrated Primary Health Care Advisor for USAID Integrated Health Program.

Treating the Underlying Causes

Beyond the team’s work preparing for USAID’s donation, IHP, in conjunction with the government and Nigeria and other partners, treated almost 110,000 children in Nigeria for severe acute malnutrition in just one year. Over three million children also received vitamin A supplementation with support from IHP in that time.

Across all four states and the FCT, IHP trains and mentors health care workers to deliver high-quality nutrition services, growth monitoring and promotion, effective nutrition counseling for caregivers, and treatment of underlying causes of malnutrition. IHP also supported the design of a picture-based recipe book on complementary feeding for infants and young children that features locally available, seasonal, and affordable foods.

In partnership with the Government of Nigeria, IHP strengthened Committees on Food and Nutrition at State and Local Government Areas in each IHP-supported state, which paved the way for additional resources to finance more nutrition initiatives and improve access to essential nutrition commodities across the country.

IHP’s stewardship to the States have contributed tremendously to the improvement of early and exclusive breastfeeding, growth monitoring and promotion, nutrition counseling, dietary diversity and increased meal frequency using locally available and affordable food, and iron and folic acid supplementation for pregnant women.

For Aliyu, IHP’s contribution to improving nutrition is the beginning of a long but hopeful journey. “A lot of progress has been made through these high impact interventions,” he says. “From building healthcare workers’ capacity to provide quality nutritional services, to improving data documentation and quality assurance for continuous improvement, the impact is real.”

USAID’s Integrated Health Program, Nigeria is funded by the United States Government and implemented by Palladium and has been working with the Nigerian government and non-government partners to improve health outcomes for women and children. For more information contact Marta Levitt (marta.levitt@ihp-nigeria.com or Ifeanyi Ume (ifeanyi.ume@ihp-nigeria.com).