A coverage survey using the Simplified Lot Quality Assurance Sampling Evaluation of Access or SLEAC methodology was carried out across 71 Local Government Areas (LGAs) implementing CMAM program in 11 states in the north of Nigeria. The survey was conducted in two Blocks: the West block and the East Block. The states of western block were Sokoto, Kebbi, Zamfara, Katsina, Kano and the states of the Eastern block were Gombe, Jigawa, Bauchi, Adamawa, Yobe and Borno.
The SLEAC used three-class classifier with 20% and 50% as the thresholds to determine low, moderate and high coverage classes (i.e. 20% or less, between 20% and 50% and greater than 50% respectively).
Of the 71 LGAs surveyed, more than half have moderate coverage (40 LGAs) but only 4 have high coverage. There were 27 LGAs with low coverage. At the state level, 8 of the 11 states surveyed had moderate coverage and only 3 states had low coverage. However, no state has achieved high coverage. Except for Adamawa and Kebbi state, coverage in all other states was heterogeneous. Overall coverage in the northern states of Nigeria was moderate with an estimate of 36.6% (95% CI: 32.3% – 40.9%).
The key barriers to service uptake and access for those children who were not in the program were: 1) no knowledge of malnutrition; 2) no knowledge of the program; 3) no knowledge of how the program works; 4) constraints and responsibilities of the mother; 5) service delivery problems; and 5) geographical access issues.
Based on the levels of coverage achieved and the barriers identified, the following actions are recommended to improve the coverage:
1) Strengthening of the program’s community mobilization strategy with a strong emphasis on raising community awareness regarding malnutrition, its causes and manifestations and available treatment through the program. Community mobilization should be aimed at the whole community including community leaders;
2) Strengthening the integration of CMAM into the activities of the health center (e.g. EPI, consultations, etc.);
3) Develop, trial and institutionalize alternative service delivery mechanisms which aim at increasing beneficiaries’ access to the program’s services with particular attention to those who live far from the health centers or the health posts providing the service. These alternative mechanisms may include mobile treatment centers which would cater for most distant villages or fortnightly follow-ups for beneficiaries who live far from treatment sites or who face significant opportunity costs related to the standard weekly follow-up visits;
4) Setting up the management of moderate acute malnutrition component of CMAM; and, 5) Perform a focused SQUEAC (Semi-Quantitative Evaluation of Access and Coverage) in a selection of the LGAs implementing CMAM which builds on the findings of the SLEAC particularly with regard to the spatial distribution of coverage in each of the LGA and within the states. This would entail more detailed mapping of the results of the SLEAC that would inform how improvements to the program can be implemented particularly in terms of positioning of new treatment sites (if deemed necessary) or alternative service delivery mechanisms mentioned in item 3 above