The policy environment for maternal nutrition in Taraba State, northeast Nigeria. Público

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

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health
Palabra Clave	Maternal nutrition Northeast Nigeria Policy environment
Committee Chair / Thesis Advisor	McFarland, Deborah A, Emory University
Committee Members	Girard, Amy Webb, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.) National or regional non-profit organization (e.g., American Cancer Society)

Última modificación

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	The policy environment for maternal nutrition in Taraba State, northeast Nigeria. ()	2018-08-28 11:25:25 -0400	Press to Select an action Download

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions