The policy environment for maternal nutrition in Taraba State, northeast Nigeria. Open Access
Yohanna, Cynthia Jemenso (2011)
Abstract
Background: The northeastern region of Nigeria has one of
the worst maternal mortality
ratios (MMR) in the world with malnutrition during pregnancy
identified as one of the
major underlying factors for the high MMR. An integrated set of
nutrition programs,
policies and strategies could reduce the incidence of maternal
malnutrition if effectively
implemented. It is essential that decision makers appreciate the
important role that
maternal malnutrition plays in influencing maternal child health
outcomes.
Objective: This study analyzes the policy environment in
which decision makers in
Taraba State plan, develop and implement maternal nutrition
policies and programs
Methods: Taraba State was chosen as the study area for this
policy review because of
relative paucity of information about the state. Four Local
Government Areas (LGAs) of
the 16 LGAs were selected to maximize diversity of opinions and
experience. Twenty-
six in-depth interviews with policy and decision makers on issues
pertaining to maternal
nutrition were analyzed for this study using the grounded theory
approach. Respondents
were selected from the State, LGAs, NGOs, Faith Based Organizations
(FBO) and
multilateral organizationsto identify existing maternal nutrition
policies and programs,reasons for
inconsistent uptake and potential delivery platforms.
Results: Maternal nutrition policies, disseminated primarily
from the federal level to the
state and LGA, are not used for action nor do they provide
benchmarks for the maternal
nutrition program implementation. Maternal nutrition programs have
low
coverage and utilization by the target population. Several critical
barriers to greater
coverage and uptake of maternal nutrition including low
prioritization by
decision makers, financial barriers at all levels and insufficient
personnel for program
and implementation constrained adequate coverage.
Discussion: A top down, non- decentralized approach to
maternal nutrition policy
formation exists in Nigeria. States, LGAs, NGOs and FBOs are rarely
involved in policy
decision. Using coverage and utilization of these programs as a
proxy to measure the
performance of a health system and impact of maternal nutrition
policies, it can be
inferred that Taraba State health systems and policy implementation
with regards to
maternal nutrition are not functioning effectively. Based on the
research findings,
recommendations and potential platforms for expanded delivery are
provided.
Table of Contents
Table of Contents
Acronyms
............................................................................................................................
1
CHAPTER 1: INTRODUCTION
.......................................................................................
3
Problem statement
...........................................................................................................
3
Purpose Statement
...........................................................................................................
4
Research Questions
.........................................................................................................
5
Specific Aims
..................................................................................................................
5
Significance
.....................................................................................................................
6
CHAPTER 2: LITERATURE REVIEW
............................................................................
7
Maternal nutrition and maternal
morbidity and mortality
............................................... 7
Causes of maternal malnutrition
.....................................................................................
8
Summary of current maternal nutrition
indicators in Nigeria .......................................
11
The Nigerian health system structures
..........................................................................
14
Policy environment in Nigeria
......................................................................................
18
Current policies and guidelines on
maternal nutrition
.................................................. 19
Interventions/
programs.................................................................................................
23
Conclusion
.....................................................................................................................
25
CHAPTER 3: METHODS
...............................................................................................
27
Study
objective..........................................................................................................
........ 27
Specific Aims
....................................................................................................................
27
Study setting
..................................................................................................................
27
Study design and population
.........................................................................................
31
Data collection
method..................................................................................................
32
Data collection
process..................................................................................................
32
Data analysis
.................................................................................................................
34
Data quality and study limitations
.................................................................................
36
CHAPTER 4: RESULTS
..................................................................................................
38
Existing maternal nutrition policies
and knowledge of the policies ...........................
38
Ongoing maternal nutrition programs
(activities)
.........................................................
41
Knowledge of the acceptability,
coverage and utilization of the of maternal nutrition
programs at the state, LGA and community level.
........................................................
44
Non-medical barriers to
implementation.......................................................................
51
Identifying barriers to accessing
maternal nutrition programs and interventions....... 57
Recommendations and potential
platforms for delivery of the maternal nutrition
policies and programs provided by the respondents.
.................................................... 60
CHAPTER 5: DISCUSSION
............................................................................................
62
Specific Aims
....................................................................................................................
62
Existing maternal nutrition policies
and knowledge of relevant policies and guidelines
at the state and LGA level
.............................................................................................
63
Respondents' perception of the
knowledge of coverage, acceptability and utilization of
the maternal nutrition programs from the perspective of the state
and LGA policy and
decision makers
.............................................................................................................
64
Barriers at the state, LGA and
community level to implementation and access of
maternal nutrition programs and interventions
.............................................................
66
Examining recommendations provided by
respondents ............................................
67
Recommendations and potential
platforms for delivery based on study findings. .......
68
CONCLUSION
.................................................................................................................
75
REFERENCES
.................................................................................................................
76
APPENDICES
..................................................................................................................
80
Appendix 1: In-depth interview guide
..........................................................................
80
Appendix 2: Map showing the GDP (PPP
per capita) of the states in Nigeria ............. 85
Appendix 3: Map showing the female
literacy levels of women 15-49 years of age by
state in Nigeria.
.............................................................................................................
86
Appendix 4: Ongoing nutrition
activities and their target groups.
................................ 87
List of Tables and Figures
Table 1:Nutrition indicators in Nigeria
.............................................................................
13
Table 2: Number of health workers
..................................................................................
17
Table 3: Maternal nutrition policies
..................................................................................
21
Table 4: Nutrition indicators by LGA
...............................................................................
31
Table 5: Ongoing maternal nutrition programs
................................................................
44
Table 6: Potential platforms for delivery
..........................................................................
72
Figure 1: Conceptual framework
......................................................................................
10
Figure 2: Map of regions and LGA boundaries in Taraba State
....................................... 30
Figure 3: Distribution of study participants
......................................................................
34
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