International Medical Corps (IMC Nigeria)
Borno State was a scene of violent conflict that caused an unprecedented movement of the population. The conflict left a significant number of people with limited access to any form of humanitarian assistance including nutrition. This resulted in “Extremely Critical” high rates of acute malnutrition which prompted the government of Nigeria through the Ministry of Health to declare a nutrition emergency in Borno state. The State nutrition response sector includes Community Management of Acute Malnutrition (CMAM) with both facilities-based and outreach Outpatient Therapeutic Feeding Programs (OTPs,) few inpatient care facilities were extremely capacities was stretched and there were limited Blanket Supplementary Feeding Programs (BSFP).
The GNC TST CMAM advisor was requested to Support the Borno State Department of Health, NGOs, and UN partners to strengthen and scale up the emergency nutrition response through CMAM technical capacity building, response coordination, and monitoring and evaluation of the program quality.
Save the Children
The protracted conflict in Northeast Nigeria increased population vulnerability to displacement, destruction & loss of livelihood, malnutrition, food insecurity, inadequate health services, and poor sanitation from 2009. Since the advent of the conflict, 60% of pre-existing health centers were damaged or destroyed in Borno, resulting in significantly reduced access to health and nutrition services. According to Nigeria's 2013 Demographic and Health Survey, the national rate of early initiation of breastfeeding (within 30 min according to Nigeria's recommendation) is 33% and the rates of exclusive breastfeeding (EBF was 17%, 13%, 15% and 17% respectively in 2003, 2008, 2011 and 2013) showing no improvement for the last decade. In 2016 the Infant and Young Child Feeding Technical Working Group (IYCF, TWG) developed the IYCF strategy and National Social and Behavioral Change Communication (SBCC) as well as 5 years operational plan to guide the implementation of IYCF programs.
The IYCF-E Technical Surge Adviser was requested to strengthen the delivery of the IYCF-E response through the provision of senior leadership, technical support and capacity building during both in-country and remote support to Emergency Nutrition Sector Group and non-governmental organisations implementing IYCF-E in Borno State, Nigeria.
Nigeria Coordination Centre (NCC)
According to Nigeria's 2013 Demographic and Health Survey, the national rate of early initiation of breastfeeding (within 30 min according to Nigeria's recommendation)was 33% and the rates of exclusive breastfeeding (EBF was 17%, 13%, 15% and 17% respectively in 2003, 2008, 2011 and 2013) showing no improvement for the last decade. Apart from the non-optimal breastfeeding practices, complementary feeding was also of concern in Nigeria. The percentage of children aged 6 to 23 months who consumed the minimum dietary diversity was 37% and this percentage dropped to 15.8 % for the age group 6-11 months. Accessibility to a minimum acceptable diet has been identified as one of the bottlenecks to adequate complementary feeding with only 17.5% and 12.5 % of children 6-23 and 6-11 months respectively having access to a minimum dietary diversity and a minimum meal frequency. Infant and Young Child Feeding Technical Working Group (IYCF, TWG) developed the IYCF strategy and National Social and Behavioral Change Communication (SBCC) as well as 5 five-year operational plan to guide the implementation of IYCF programs.
The IYCF-E Technical Surge Adviser was requested to strengthen the delivery of the IYCF-E response through the provision of senior leadership, technical support, and capacity building during both in-country and remote support to Emergency Nutrition Sector Group and non-governmental organizations implementing IYCF-E in Borno State, Nigeria.
Nigeria Coordination Centre (NCC)/ UNICEF
Borno State was a scene of violent conflict that caused an unprecedented movement of populations. The conflict left a significant number of people with limited access to food. The onset of the lean season has impacted the situation negatively leading to a large increase of people in need of immediate food assistance. This has resulted in high rates of global acute malnutrition which prompted the Government of Nigeria through the Ministry of Health to declare a nutrition emergency in Borno state. Critical levels of Severe Acute Malnutrition (SAM) had also been reported in some camps like Muna Garage and newly liberated areas. The host communities within Maiduguri have also reported high Global Acute Malnutrition (GAM) rates up to above 6.4% based on a surveillance survey (February- March 2017). As of March 2017, the Cadre Harmonise estimates that 3.9 million people in Borno State are in severity levels 3-5 (Acute food crisis to Famine), with 38,000 of these in level 5 (famine/human catastrophe).
The Nigeria Coordination Centre in partnership with UNICEF requested a CMAM advisor to provide technical support, training, strategic advice, and operational support for the implementation of inpatient management of SAM with medical complications.
A post-deployment webinar took place on 28th September 2017. The recording can be found here.
Nigeria Coordination Centre
The Boko Haram insurgency caused mass population displacement throughout Northeast Nigeria since 2012 when the government declared a state of emergency secondary to the conflict. According to the International Organization of Migration (IOM), there were 2,026,602 internal displaced persons (IDPs) spread across Borno, Adamawa, and Yobe states. The impact on freedom of movement, livelihoods, markets, and humanitarian access has resulted in a severe food security and nutrition emergency in Northeast Nigeria, Niger, Chad, and Northern Cameroon. A series of repeated surveys were organized with the primary objective of providing representative estimates for the prevalence of acute malnutrition among children (by both weight-for-height and MUAC), as well as mortality. Data from these surveys suggest that GAM trends were fluctuating based on seasonal variations as well as due to the volatility of the conflict. The humanitarian crisis in North-East Nigeria was protracted with threats of attacks by non-state armed groups and restrictions in movements continue to have negative impacts on trade, livelihoods and markets, leaving a substantial proportion of the civilian population relying on humanitarian assistance.
The GNC TST Assessment Adviser was requested in Nigeria to build the capacity of response stakeholders in the design, implementation, analysis and reporting of nutrition assessments with special emphasis on the validation process of any type of assessment that will be conducted by partners.
Nigeria Coordination Centre (NCC)
The escalation of political insurgency in Borno caused mass population displacement which left a significant number of people in a critical food crisis. According to October cadre Harmonisé 2020 (CH) analysis up to 5.1 million were at risk of food insecurity during the lean season. Global Acute Malnutrition (GAM) in Northeast Nigeria was at 10.7% in Borno, 7.5 % in Adamawa, and 13.6 % in Yobe. The survey results indicate that about 300,000 children suffering from Severe Acute Malnutrition (SAM) required urgent treatment and over half a million children were moderately malnourished. In addition to food insecurity, the WASH situation was worse and public interventions that prevent malnutrition such as deworming, and micronutrient supplementation were below 50% and 10% respectively. The survey also showed that fewer than 1 % of children 6-23 months old received the minimum acceptable diet and exclusive breastfeeding less than 50%.
UNICEF requested an IYCF-E technical advisor to support the implementation of IYCF-E intervention in Northeast Nigeria.
Northeast Nigeria states of Borno, Adamawa, and Yobe (BAY states) experienced a rapid deterioration in the nutrition situation classified as critical in several hotspots, Local Government Areas (LGAs). It was estimated that 1.4 million children under 5 years were acutely malnourished, including 316,753 severe acute malnutrition (SAM) cases. The trend analysis of admission data from nutrition facilities across the BAY states indicated that the number of SAM children admitted in 2022 in health facilities for the treatment of SAM with and without complications had increased by 47% and 15% respectively compared to the same period in 2021. This had been exacerbated by synergistic drivers including armed conflict, displacements to overcrowded camps and informal settlements with loss of livelihoods, assets, and critical support systems, disruptions of humanitarian assistance due to conflict, delayed funding and/or funding cuts, d) food insecurity and public health disease outbreaks among others.
Sector partners scaled up the treatment of SAM through integration into health facilities and outreach/mobile services reaching 100% of the sector's target inaccessible areas. However, only 26% of the MAM caseload was reached thus contributing to increased incidence of SAM, additional strain on health facilities, and increased risk of mortality. The Nutrition Sector, UNICEF, and WFP thus proposed a context-specific activation of Simplified Approaches (SA) in exceptional circumstances to deliver lifesaving treatment services in hard-to-reach areas and mitigate the effects of the delayed scale-up of services.