Nigeria has the third highest number of children suffering from SAM and stunting in the world, about 800,000 as estimated by UNICEF. To address this, UNICEF with support from Valid International, piloted CMAM in 2009. Results from the pilot demonstrated that CMAM was an appropriate approach in Nigeria and recommended expansion into other areas within the country. In response, SCF (UK) and ACF International launched pilot programmes in Katsina and Yobe states to identify how CMAM could be integrated most effectively and sustainably into health systems and communities. They implemented programmes independently but under a common, collaborative framework. Over 44,000 children were treated for SAM in these states in 2010.

Initial results in Yobe were encouraging with cure rates of around 70% and defaulter rates of 30%. The main problem areas were as service disruptions (mainly due to elections) and overcrowding in some sites where extremely high admissions led to long waiting time and poor services. Overcrowding was reduced in one site with the opening of outpatient treatment programme (OTP) sites in Potiskum LGA close by. There is also a need to strengthen the system for tracing absentees and defaulters as the approach is around sustainability. Increasing coverage by adding more OTP sites should improve the treatment of children with SAM by addressing overcrowding and this should substantially reduce defaulters and absenteeism.

Although some health staff at the two hospitals were trained on the inpatient management of SAM, Stabilization Centre (SC) services have really not been established due to lack of buy-in from the staff in the paediatric wards and from dieticians at the specialist hospital. From ACF’s perspective there has been little focus on supporting this component of the programme, with all the focus on the OTP services. One reason for the relative neglect of the SC services may be that no one was claiming ownership over SC services; in the past it was the MSF who supported SC nutrition activities in these hospitals and gave incentives.

ACF International have been implementing rapid assessments in Yobe State (ACF International 2011a, 2011b), collecting information about communities covered by the CMAM programme for the development of a comprehensive community mobilisation strategy.  The assessments identify main stakeholders, community organizations, health-seeking behaviours and identify contextual barriers to access, develop a mobilisation strategy and address possible solutions. Communities in the NW states will be receptive to CMAM in one major respect: there is a strong system based on village and ward heads who will encourage families to ensure children are taken to clinics. Women are allowed to leave compounds during the daytime for this purpose.

Note: This section is largely based on some unpublished reports from the agencies concerned.