Towards a More Evidence-Informed Intervention

By Hafsat Jaafar, Sunday James and Stephanie Okpere

While cost-effective interventions exist, utilization of nutrition services and maternal care remain drastically low.

The roots of poor nutrition and maternal health lie in human behavior. Improvements in nutrition and maternal health outcomes are not possible without broad widespread changes in the everyday behaviors of people and institutions that influence them. There is a significant lack of comprehensive understanding of the various structural and sociocultural issues that pose a challenge in boosting nutritional and maternal status in Nigeria. Exploring the complex network of intrapersonal and community factors influencing the utilization of these services will aid in the development of targeted interventions to support this population.

Stakeholders who attended the KAPs study validation workshop physically

Changing behaviors for nutrition and adolescent health requires a variety of approaches. -The lack of adeptness or understanding contributes to negative nutrition behaviors. People also practice certain behaviors when they believe them. Myths, misinterpretation, cultural practices, and other drawbacks including cost, location, and availability are major quagmires that can stand in the way of change or desired behaviors.

eHA-ANRIN consortium via the Accelerating Nutrition Results in Nigeria (project) in Kaduna state is providing basic nutrition, reproductive and adolescent health counseling services in 12 LGAs in Kaduna state. In addition to this, we are conducting a Knowledge, Attitudes, and Practices ((KAP) study around nutritional behavior and adolescent health amongst women and children under 5 years of age in Kaduna State. This formative study aims to develop a multidisciplinary and comprehensive approach that would positively influence nutritional and birth spacing behavior within our target groups.

The motivation for this approach is to allow for the evaluation of outcomes towards understanding how eHA-ANRIN can increase the utilization of quality, cost-effective nutritional services for the target group. Specifically, these insights will support the development of a behavior change communication strategy as well as the development of information, education, and communication (IEC) materials by the consortium partners.

A group photo of stakeholders after the session in Kaduna State.

Considering that behavior change approaches are essential to foundational cross-cutting change strategies for the achievement of program results. eHAANRiN hopes to use a balanced approach in its programming with supply and demand-side interventions. Efforts will be made to ensure the study is robust: key influencers of nutritional and reproductive health behaviors across the various segments of the state will be part of the study. We will also work very closely with our stakeholders; the Kaduna state government, all the relevant agencies, partners, implementers amongst others in the state to ensure that their insights are also captured. BUSARA, a member of the eHA - ANRIN consortium has strong experience delivering similar studies and currently leads the delivery.

Through this study, the consortium aims to; 

• increase access to nutrition and birth-spacing commodities and tailored counseling for the target population, particularly in hard-to-reach (HTR) areas

• generate demand for commodities and counseling by deploying behavioral science techniques; 

• and integrate a data-led approach to improve the delivery of essential products and services.

In the aftermath, the KAPs study plans to pinpoint the motivation, latitude, and challenges that influence the target group’s behavior, define behavior change objectives, and the mix of intervention and behavior change communication  products and campaigns to help our target group to live a healthy and fulfilled life.

Taking A Bite Out of Malnutrition

By Hafsat Jaafar

In less than a decade, the number of acutely malnourished children receiving treatment globally has quintupled: increasing from just over one million in 2011 to over 14 million in 2020. Nigeria has the second-highest number of under-five child undernutrition in the world, with about 2 million children suffering from severe acute malnutrition. A major challenge directly impeding child nutrition is the reduced access and utilization of maternal and youth-friendly sexual and reproductive health services. 

In 2016, the United Nations (UN) declared the Decade of Action on Nutrition and stakeholders have made more efforts to contribute to Nutrition improvement globally.  The World Bank is taking a double-pronged approach to address malnutrition through the Accelerating Nutrition Results in Nigeria (ANRiN) project. ANRiN focuses on reaching pregnant women, adolescent girls, and children under the age of 5 years. The project aims to abate the surging rate of malnutrition through appropriate maternal care, counseling,  infant and young child feeding, healthy sanitation behaviors, prevention and, when necessary, appropriate treatment of diarrhea, and ensuring adequate intake of essential vitamins and minerals through food fortification and supplementation.

eHealth Africa as a lead consortium member has begun the implementation of the ANRiN project in 12 LGAs of Kaduna State; Kaduna South, Chikun, Kajuru, Kagarko, Jaba, Zangon Kataf, Jema’a, Sanga, Kaduna North, and Ikara. The eHA- ANRiN team delivers the Basic Package of Nutrition Services (BPNS) and Adolescent Health Services (AHS) to beneficiaries of the project. This includes; behavior change communication to improve infant and young child feeding behaviors, namely early and exclusive breastfeeding (0-6 months) and appropriate complementary feeding (6-23 months); micronutrient powders to children 6-23 months to improve the quality of food provided for complementary feeding; iron/folic acid supplementation for pregnant women with counseling to improve compliance; intermittent preventive treatment for malaria to pregnant women; zinc and ORS for treatment of diarrhea in children 6-59 months; vitamin A supplementation twice a year for children 6-59 months; deworming twice a year for children 12-59 months; and counseling and provision of commodities to married adolescents in Kaduna for increasing birth spacing.

Partnerships and Networks: Essential for achieving food security

By Chinedu Anarado

By 2030, the United Nations (UN), and its agency, the Food and Agriculture Organization (FAO) hope to have achieved Sustainable Development Goal 2—end extreme hunger in the world. As of 2017, an estimated 821 million people globally are facing extreme hunger. The bulk of this group lives in Sub-Saharan Africa, where 237 million people were undernourished. In Northeast Nigeria alone, 2019 saw an estimated 2.6 million people left severely food insecure due to the insurgency and conflict1.

Climate change, poor farming practices and the nonexistence of sustainable partnerships and support systems all contribute to the growing cases of low crop yield. Most farmers do not have access to the right kind of information, and where they have information, they lack sustainable support to implement them.

During the planting stage

Recognizing this, the UN identifies the need for governments and private actors around the world to ramp up investment through enhanced international partnerships, research and extension services, and technology. This will increase agricultural productivity in developing countries, thus strengthening nutrition and food security systems. 

Here is how eHealth Africa leveraged partnerships and existing structures to drive the introduction and adoption of the Farm Management Tool (FMT) among 25 farmers in Kano State.

• FMT started as Cornbot, a mobile application built in partnership with Dr. Cornelius Adewale, the Bullitt Environmental Dellow at Washington State University. The application was built to aid farmers to identify, detect, manage and control Fall Armyworm (FAW), a major pest of maize and 85 other plant species. It was an entry for the 2018 FAW Tech Prize jointly sponsored by Feed the Future, the United States Agency for International Development (USAID) and the Centre for Agriculture and Biosciences International (CABI). These platforms continue to provide financial support, expert knowledge, and interventions to local farmers around the world.

• Upon winning the Frontier Innovation Award, eHA and WSU utilized the prize money to build FMT. The project was implemented in a three-pathway approach consisting of a mobile application and a web-based dashboard to aggregate data, face to face training sessions and practical hand-holding sessions. To recruit the farmers, eHA and WSU partnered with the Kano State chapter of the National Agriculture Extension and Research Services (NAERLS) to hold a pre-implementation workshop for 40 smallholder farmers. The workshop gleaned useful information that helped the project team to understand the farmers’ current agricultural practices, challenges, and level of knowledge.

A local farmer watches a video about bio-pesticide production using Neem leaves

• After the workshop, 25 farmers were selected to participate in the study. They each earmarked 25 square meters of test farmland to test the efficacy of incorporating four Good Agricultural Practices (GAPs) put forward by FAO, on crop yield. eHA partnered with Gwarmai Consulting, a local consultancy company to provide handholding support to the farmers, from pre-planting to harvest. The farmers learned soil testing, pest scouting, weeding, plant spacing, fertilizer application, and ash application for soils with high alkaline content.

Farmers at the Pre-Implementation Workshop

The results were impressive. In comparison to the Kano State average Maize yield of 2,750 kg/hectare, test farms recorded a 116% increase. Test farms also had a 195% increase compared with the national average of 2,020 kg/hectare.

In addition, the farmers acknowledged the value of the new information and committed to imbibe them and share with other farmers within their networks. It is often said that information is power. However, the information will never produce the desired effect without platforms and networks to get it across to those who need it. The success of the Farm Management Tool is an example of how Nigeria can reverse food insecurity if the right partnerships and platforms are leveraged to get much-needed information and skills across to local farmers.

Expanding Cornbot to fight food insecurity

Chinedu Anarodo and Cornelius Adewale at the award ceremony

Last year, eHealth Africa’s CornBot Application was one of the finalists for the Fall Army Worm Tech Prize. The application received the Frontier Innovation Award for its ease of use and human-centric design. CornBot also received $50,000 in prize money. Six months later, CornBot’s, Chinedu Anarado and Cornelius Adewale share their progress and how they are using the prize money to expand CornBot so that the solution addresses more challenges in nutrition and food security.

Why did you develop CornBot?

One of eHA’s focus areas is Nutrition and Food Security Systems. Our goal with this program is to provide nutrition stakeholders at all levels of the value chain, with technological tools and data so that vulnerable populations in West Africa can have access to nutritious food.

When USAID called for innovations to address Fall Armyworm (FAW), a major pest that destroys various crops worth $2.4bn – $6bn annually, predisposing communities to food insecurity, we knew we had to respond. We partnered with the Washington State University (WSU) to design and build CornBot, a mobile application, that interacts with farmers in their local dialect and guides them through the process of detecting, preventing and treating FAW infestation on their farms. The application is synced to a dashboard to enable us and other stakeholders to easily aggregate data on FAW infestation and make informed decisions.

What scenario mapped the transition from CornBot to FMT?

After we received the Frontier Innovation Award and the prize money, we started thinking about what we could do to expand CornBot. During the field testing phase as well as during other field research carried out by WSU, we realized that smallholder farmers needed more than just a pest detection tool—they needed a platform where they could exchange and receive guidance and knowledge to increase their productivity. We then decided to invest the prize money in building a platform where farmers can gain additional information to enable them to yield as much as possible from their farms, in line with the Good Agricultural Practices (GAP) put forward by the Food and Agriculture Organization (FAO). So, CornBot went from an idea that helps in combating farm pests, to a platform for providing guidance on farming practices as a whole. For now, we call it the Farm Management Tool.

What do you hope to accomplish with the Farm Management Tool?

Farmers in Kano using Cornbot to identify FallArmy Worm

Overall, we want to improve the quality of livelihood among smallholder farmers and strengthen the resilience of communities against food insecurity. We know that by making small changes in their farming processes and decisions, and by adopting good agricultural practices, farmers can increase the crop yield from the same plot of land. They just do not know how to. Many of these farmers have been doing things the same way for years without ever knowing why. Our goal is to arm them with relevant information and ensure that they can produce more crops. If we can achieve this, it will be a huge success and it means that our solution is viable.  

What first steps have you taken?

We are currently working to build a mobile application. However, we held a workshop with 40 smallholder farmers in April to glean baseline data about their current agricultural practices, their level of knowledge, and current challenges, and to introduce them to our project and the concept of good agricultural practices. They have agreed to work with us for the pilot scheme and testing, as well as map out portions of their farmlands to test our concepts. We have also commenced field operations such as soil sample testing to understand the existing soil composition and what kinds of fertilizers will be needed.

The idea is to “hand-hold” the farmers throughout the planting season and see if there are significant differences from their previous outputs.

We are very excited about this platform and the possibilities that it presents for addressing food insecurity in communities across West Africa.