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Background
Northeast Nigeria states of Borno, Adamawa and Yobe (BAY states) experience a seasonal trend of acute malnutrition with a peak during the lean season. The state-level prevalence of acute malnutrition has remained static over the past 5 years – Borno (12.3%), Adamawa (7.2%) and Yobe (10.6%) according to the Nutrition and Food Security Surveillance (NFSS) Round 12 conducted in August 2022. The nutrition situation is classified as critical in several hotspot Local Government Areas (LGAs). In 2023, it was projected that 2 million children under 5 years would be acutely malnourished, including 697,000 severe acute malnutrition (SAM) cases.
Trend analysis of admission data from nutrition facilities across the BAY states indicated that the number of SAM children admitted during 2022 in health facilities for the treatment of SAM with and without complications on average increased by 52 per cent and 6 per cent respectively compared to 2021. Similarly, moderate acute malnutrition (MAM) admissions increased more than twofold compared to 2021. Borno state has the worst trends of SAM admissions among the BAY states exacerbated by synergistic drivers including, a) disruptions of humanitarian assistance due to the protracted conflict, delayed funding and/or funding cuts, b) outbreaks of communicable diseases (measles and cholera), c) food shortages and spikes in food prices, d) Internally Displaced Persons (IDPs) relocations to areas with limited humanitarian assistance, e) inaccessibility, f) low coverage of preventive services, etc. During 2022, sector partners scaled up the treatment of SAM through integration into health facilities and outreach/mobile services reaching 92 per cent of the sector target in accessible areas. However, only 33 per cent of MAM caseload were reached thus contributing to increased incidence of SAM, additional strain on health facilities and increased risk of mortality.
The State Ministry of Health (SMoH), State Primary Health Care Development Agency (SPHCDA), Nutrition Sector partners, UNICEF and WFP have therefore proposed a context-specific activation of Simplified Approaches (SAs) in exceptional circumstances to deliver lifesaving treatment services in hard-to-reach areas and mitigate the effects of the delayed scale-up of services. These will contribute to increase in nutrition services coverage and mitigate implementation challenges faced such as pipeline breaks, limited supervision, unavailability of health personnel, limited capacity, and limited accessibility to existing health facilities and other exceptional circumstances as agreed upon by the nutrition sector. Simplified Approaches are a set of modifications to the existing national and global protocols for the treatment of acute malnutrition designed to improve effectiveness, quality, coverage and reduce the cost of caring for children with uncomplicated acute malnutrition in exceptional circumstances.