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Nigeria is a high burden country for stunting. Stunting reduction has been slow and characterized by unequal progress across the 36 states and federal capital territory of the country. This study aimed to assess the changes in prevalence of stunting and growth determinants from 2003 to 2018, identify factors that predicted the change in stunting, and project future stunting prevalence if these predicted determinants improve. Trend and linear decomposition analyses of growth outcomes and determinants were conducted using 2003, 2008, 2013, and 2018 Nigeria Demographic and Health Survey data. Pooled data included 57,507 children 0 to 59 months old. Findings show that stunting and severe stunting significantly reduced from 43 to 37% and 23% to 17%, respectively (p < 0.001), between 2003 and 2018. Disturbingly, height-for-age z-scores at birth significantly decreased, indicating risks of potential future stunting increase. Improvements in nine stunting determinants (maternal body mass index, maternal height, ≥ 4 antenatal care visits, health facility delivery, reduced child illnesses, asset index, maternal education, paternal education, and preceding birth interval) predicted stunting reductions in children 0–59 months. Few of these nine determinants improved in subpopulations with limited stunting progress. Intra-sectoral and multisectoral coordination were potentially inadequate; 12% of children had received all of three selected health sector interventions along a continuum of care and 6% had received all of six selected multisector interventions. Forward looking projections suggest that increased efforts to improve the nine predictors of stunting change can reduce under-five stunting in Nigeria to ≤ 27% in the short term.

Background: Renewed efforts by the Nigerian government to address malnutrition have led to nutrition actions by several sectors, including the agriculture sector. However, the success of these actions depends on the characteristics of the stakeholders involved, including their relationships and coordination. Objective: This article reports a 2015 study of nutrition-sensitive agricultural stakeholders in Nigeria that assessed what the stakeholders do, where they work and how they are organized to improve nutrition. The study provides a baseline for assessing progress and measuring stakeholder and coordination changes in the Nigerian nutrition-sensitive agriculture landscape. Methods: Semi-structured interviews (n = 17) and focus group discussions (n = 2) were held with federal, state, and local government level stakeholders; reviews of stakeholder program documents were also conducted. Results: The study identified 7 groups of nutrition-sensitive agriculture stakeholders and several coordination challenges. Political leadership, advocacy and provision of material and human resource support by nongovernmental organizations, and donor interest and funding have been vital for mobilizing nutrition-sensitive agriculture. Still, although stakeholders frequently highlighted that nutrition was an important consideration in their interventions, nutrition goals and activities and/or indicators to measure outcomes were not regularly communicated. Also, while coordination mechanisms existed, there appeared to be minimal actual cross-sectoral partnerships because of inadequate trust, competition, and conflicts over institutional turf and mandates. Conclusions: Needed enablers for improving nutrition-sensitive agriculture in Nigeria included improved stakeholder nutrition literacy, as well as enhanced stakeholder engagement facilitated by role definition, clarification, and consensus. Exploring different approaches to coordination may also be necessary.

Nigeria has an alarming prevalence of micronutrient deficiencies that has persisted over decades. National Micronutrient Deficiency Control (MNDC) guidelines describe several interventions to address the issue. This study identified and described currently implemented interventions, assessed coverage and coordination of the interventions, and considered the risk of overdosage and gaps. Methods included reviews of policy and program documents, key informant interviews, market, and pharmacy visits. The study found that an array of MNDC interventions were being implemented, including public health supplementation, mandatory fortification, point‐of‐use fortification, biofortification, promotion of dietary diversity, voluntary fortification, and ad hoc individual supplement use. Insufficient coordination existed for government, private, and civil society interventions within the health sector and between health and other sectors. Dosages of micronutrients supplied by different interventions were set independently of each other and target populations overlapped. Inadequate implementation of various interventions appeared to reduce the risk of excessive micronutrient intakes, but increased the risk of deficiencies. The risk of excessive intakes will likely increase with improved implementation and scale‐up. There is a need to develop effective coordination structures for MNDC in Nigeria that will critically examine the landscape, decide modalities for different interventions, and ensure that both deficiencies and risk of excessive intakes are minimized.

Suboptimal care is an important risk factor for undernutrition and disease. Such care includes inappropriate breastfeeding (BF) and child-feeding practices and inadequate immunization and supplementation. Over the past several years, Nigeria has increased the availability of health workers and health facilities. The use of health services has also increased. However, this has not led to an improvement in childcare practices, and certain practices that are mediated through behavior change communication, such as BF, have even declined. This article presents the result of a study that identified potential reasons for the decline in these childcare practices. The study was conducted in a primary health-care center (PHC) in South Eastern Nigeria. A key informant interview was held with the Chief Matron of the PHC. The delivery of nutrition and health information to mothers was observed over a 3-month period, and 107 women completed questionnaires to document their knowledge and practice of appropriate childcare practices. The findings from this study show that both health worker and maternal factors may contribute to less than optimal childcare practices. Health workers had received training in nutrition and health education, but their delivery of information was inconsistent and unstructured. Moreover, many mothers who regularly utilized the PHC services, and were aware of adequate childcare practices, were not adopting the practices. These results underscore the need to improve existing behavior change communication channels, as well as identify the barriers to the utilization of the information provided.

Key 2025 global nutrition targets are unlikely to be met at current rates of progress. Although actions necessary to reduce undernutrition are already mostly known, knowledge gaps remain about how to implement these actions in contextually appropriate ways, and at scales commensurate with the magnitude of the problem. This study describes the nutrition enabling environment in Nigeria, a country that contributes significantly to the global undernutrition burden, and identifies potential entry points for improving the enabling environment that could facilitate implementation and scale-up of essential intervention coverage. Study data were obtained from two sources: content analysis of 48 policies/strategies from agriculture, economic, education, environment, health, nutrition, and water/sanitation/hygiene sectors; and interviews at federal level (16) and in two states (Jigawa (10) and Kaduna (9) States). The study finds that aspects of the enabling environment improved between 2008 and 2019 and facilitated improvements in implementation of nutrition-specific and nutrition-sensitive interventions. Enabling environment components that improved included the framing of nutrition as a multisectoral issue, nutrition advocacy, political attention, evidence around intervention coverage, civil society involvement, and activity of nutrition champions. These factors have been especially important in creating and sustaining momentum for addressing malnutrition. While challenges remain in these aspects, greater challenges persist for factors needed to convert momentum into improvements in nutrition outcomes. Research and data that facilitate shared understanding of nutrition; improved multisectoral and vertical coordination; increased and improved delivery and operational capacity; and increased resource mobilization will be especially important for achieving future progress in nutrition in Nigeria.

Background: In response to calls to increase nutrition-sensitive agriculture (NSA), the Federal Ministry of Agriculture and Rural Development developed the Nigeria Agricultural Sector Food Security and Nutrition Strategy 2016-2025 (AFSNS). Capacity development activities to facilitate the AFSNS implementation subsequently commenced. Objective: This study analyzed the processes and outputs of initial capacity development efforts, examined findings from the analysis using existing literature, and identified critical next steps for nutrition capacity development in the Nigerian agriculture sector. Methods: The study reviewed documents including a proposal for nutrition training of agriculture sector actors, reports of meetings held among 6 resource persons who designed and/or delivered training, training reports, participants’ pre- and posttraining assessments, and participants’ training evaluation. Interviews were conducted with 2 resource persons involved in training design and delivery. Documents and interviews were coded and analyzed to identify emergent themes. Participants’ pre- and posttests results were compared using paired t test in Stata 12.0. Results: Knowledge and practice gaps were more extensive than had been anticipated. Training had some but limited effects on knowledge scores at the federal level. Modules addressing implementation practices had to be scaled down for participants to keep up with the learning pace. Existing literature indicates that such training would have been better planned as part of a broader sectoral nutrition workforce strategy, to facilitate greater tailoring of training to participants’ job roles. Conclusion: Effective AFSNS implementation requires developing and operationalizing a comprehensive short-, medium- and long-term Agriculture Sector Nutrition Capacity Development Strategy for Nigeria.

Background: Achieving meaningful malnutrition reductions in Nigeria and other high-burden countries requires sustained improvements in diets, mediated through nutrition-sensitive agriculture and food systems. Yet, the capacity to design, plan, implement, and monitor such nutrition-sensitive systems is very limited, including within agricultural extension services delivery. Understanding existing capacity of actors required to implement nutrition change is crucial for effective capacity development. Objective: This study assessed the nutrition capacity of agriculture extension agents (AEAs) in Nigeria and the capacity of their organizations and the institutions within which they operate. Methods: The study assessed 31 extension training materials for inclusion of recommendations for nutrition-sensitive agriculture. Structured interviews and focus group discussions were conducted with 23 extension agents and were coded and analyzed for major themes. Results: Training materials hardly included nutrition objectives and or nutrition-related services to be delivered. Some nutrition-related services were being delivered, including promotion of biofortified crops and nutrient-dense crops and animals, home gardening, food safety, and dietary diversification. However, these services were limited, and service delivery was unstructured, nonuniform, and inconsistent. Numbers of AEAs are quite inadequate while available AEAs had high workloads, are poorly motivated, and had limited funding, supervision, and logistics capacity to perform roles. Physical security was also a challenge for service delivery. Further, complementary activities in other sectors that were necessary for adequate delivery of nutrition-sensitive agriculture did not always exist. Conclusion: Extensive development of nutrition capacities of extension agents appears unlikely to achieve nutrition-related changes if limiting institutional and organizational capacity deficits are not addressed. Plain Language Title: Capacity of Agriculture Extension Agents in Nigeria to Deliver Nutrition Services. Plain Language Summary: Reducing the significant burden of malnutrition in Nigeria requires increased availability and consumption of foods that are nutritious and free from harmful substances. To produce such foods, farmers need adequate nutrition and food safety knowledge and skills. The production of such food will also need to support nutrition in other ways, including increased women’s empowerment. Extension agents traditionally support farmers to adopt new methods of food production and/or processing that support increased food yields. These agents can also be used to deliver services that will address nutrition if they have the necessary knowledge and skills. This study assessed the capacity of agriculture extension agents in Nigeria to deliver nutrition services, in order to determine how to increase their capacity to deliver these services. The results from the study are that the extension agents do not have sufficient knowledge and skills to deliver nutrition services, and that their organizations and the wider context in which they work do not have the capacity to enable them to deliver nutrition services effectively. For instance, the organizations do not have sufficient numbers of staff and do not provide current staff with adequate means of transportation to visit farmers. Insecurity is high and so extension agents are unable to visit farmers frequently because of the potential threats to their lives. The study concludes that effectively using extension agents to deliver nutrition services will require not just training of the extension agents but also improvements in organizational capacity and contextual factors.