Nutritious Meal Plan Intervention for Vulnerable Mothers and Children, (NUMEPLAN) Project is a 16-month program that caters for the nutritious intake of Pregnant Mothers and infants who are malnourished or vulnerable to malnutrition in the under-served communities of Lagos State. The goal is to enable slums as well as Primary Health Centres (PHCs) to adopt and implement effective nutritional education programmes and affordable meal plans that help pregnant mothers/teenagers understand how nutrition is essential to maintain sound health at every stage of their pregnancy and for their babies after delivery. This article will highlight the specific problems associated with malnutrition that is the concern of the project, its strategic approaches, expected impact cum success evaluation and its replicability, scalability, and sustainability potentials.
Malnutrition is a universal problem that has many forms. It affects most of the world’s population at some point in their lifecycle, from infancy to old age. While anyone can experience malnutrition, people who are particularly vulnerable include young children, adolescent girls, pregnant and lactating women, older people, people who are ill or immuno-compromised, indigenous people and people in poverty. Collectively, malnutrition is responsible for more ill health than any other cause – good health is not possible without good nutrition. All forms of malnutrition are associated with various forms of ill health and higher levels of mortality. Undernutrition explains around 45% of deaths among children under the age of five, globally (Global Nutrition Report, 2018).
UNICEF statistics reports that 37% of children representing over 6million are malnourished, 43.6% of an estimated 40million Nigerian children under the age of 5 (from the estimated population of 197 million) are stunted, while 19.4% of children in South West Nigeria suffers same deficiency. The overview of National Nutritional Level shows that 80% of the world’s stunted children, live in 14 countries and Nigeria is the second largest contributor after India (Vanguard News Nigeria, 2018). Meanwhile, Multiple Indicator Cluster Survey, MICS, reports that the country is witnessing stagnant or worsening situations. The report shows a rise in the major indicators used to measure childhood malnutrition. It reveals that underweight prevalence (children too thin for their age) and stunting prevalence increases from 24.2% and 34.8% to 31.5% and 43.6%, during the year under review respectively. Nearly one million children under the age of 5 die in Nigeria every year, and the situation has made Nigeria one of the highest contributors of under-5 mortalities in the world (Vanguard News Nigeria, 2018).
In Nigeria, as stated in a study by Adinma et al (2017), under-nutrition in adolescent females aged 15–19 years has been variously reported to range between 23% and 57.8%, with more prevalence in the rural compared to the urban adolescents and this is attributable more to socio-economic factors and poor eating habits. Global evidence also shows that young girls bear a higher burden of maternal morbidity and mortality, with malnutrition as a key cause of morbidity in sub-Saharan Africa. Malnutrition in pregnancy has many adverse effects on child survival and long-term well-being, and in overall, economic productivity and national development, hence pregnancy represents an ideal time for health promotion activities. According to the Global Nutrition report, nutrition is one of the best drivers of development: it sparks a virtuous cycle of socioeconomic improvements, such as an increase in the capacity to learn and land a good job.
The Intervention and Strategic Approach
The NUMEPLAN Project seeks to improve the nutrition or food intake of pregnant mothers, teenage pregnant girls (TPGs) and infants affected by malnutrition with a wholesome approach that ensures that vulnerable mothers and children become physically fit by having sufficient intake of required nutrients and food necessary for optimal growth, function, and health. This intervention provides nutritious food items that can make the target beneficiaries break out of the cycle of malnutrition. The intervention works closely with Primary Healthcare Centres (PHCs) that are in the Local Government Areas of the under-served communities and ensures that they adopt and implement effective nutritional education programmes and affordable meal plans that can help pregnant mothers/teenagers understand how nutrition is essential to maintain sound health at every stage of their pregnancy and after the delivery of their babies. This includes equipping the PHCs with specific food vouchers for onward reference to the food bank for nutritious food collection needed for the pregnant teenagers/mothers to go through full-term pregnancy in sound health and have healthy babies. The Intervention utilizes the Lagos Food Bank volunteer network, with over 800 active health and nutrition volunteers on the database, to effectively implement the project in the selected communities, and develop curricula that help them and the community leaders effectively educate young girls on sex education to reduce the number of teenage pregnancy. They also coordinate the counselling and the enrolment of pregnant beneficiaries into the NUMEPLAN project.
For enrolment of beneficiaries into the NUMEPLAN project, some tests are conducted for reference purpose, such as; the calculation and measurement of the Body Mass Index (BMI) as a function of the ratio of body weight to the square of height with Weighing Scale and Stadiometer, Blood pressure with the Sphygmomanometer, Random Blood Sugar (RBS) level with the Glucometer, Blood haemoglobin level with the Haemoglobinometer, and Urinalysis assay using the Urine Multistix. After the test, any children (0-10) or pregnant teenagers/mothers that are malnourished and are not able to get the required nutrients during pregnancy and breastfeeding of the babies are enrolled in the project and are catered for accordingly and adequately.
Expected Impacts and Evaluation Plan
The expected impacts of the project are as follow:
- Pregnant teenagers in the selected beneficiary communities have a yearlong supply of required food and basic needs.
- The girls are healthy all through the year, successfully nursing their infants to full term, achieving the baby friendly nutrition (breastfeeding conveniently for at least 6 months).
- The girls are empowered through skill acquisition programmes such as baking, tailoring, hair-dressing, etc. to be able to provide for their babies.
- Appropriate nutrition education/affordable meal plans provided by trained health care providers in the PHCs.
- Lagos Food Bank serving as a frontline agency providing the needed nutritious meal model that can be replicated across the board in vulnerable communities in Lagos State and other regions of Nigeria.
To measure impact, the project team members and volunteer dieticians/nutritionists will often carry out a pre-test-post-test analysis method of evaluation on the nutritional level of the selected beneficiaries and their infants in order to measure what progress has been made during the pregnancy cycle and after delivery. Pre and post testing is an assessment method that examines the change in the condition (malnutrition level) of a thing (beneficiary) before and after something (an intervention) is done to address the condition. The basic premise behind the pre-test–post-test method involves obtaining a pre-test measure of the nutrition level prior to administering some treatment, followed by a post-test on the same measure after treatment occurs.
We will also go a step further in evaluating the impact of the project by using a participatory approach which operates by asking each volunteer physician, dietician/nutritionist assigned to selected beneficiaries to complete an evaluation questionnaire so that we can continue to find ways to improve as we scale on the project. This approach directly allows the participation of the beneficiaries in the assessment of what affects them and our volunteers in the evaluation of their contribution to the solution.
Replicability, Scalability, and Sustainability
The model adopted for the project allows it to be replicated in other communities in Lagos State after the successful execution which can be expanded from the pilot stage of just one community to include 2 more communities at the same time. This project has kicked-off in January 2019 and our plan is to scale from 5000 beneficiaries in one community to 15,000 beneficiaries in 2 additional communities by 2020. Regarding the sustainability of this project, the parent body saddled with the implementation of this Project is Lagos Food Bank. Lagos Food Bank has successfully carried out several feeding and nutritional programs in over 86 slums and 300 communities with the support of local donors who have keyed into the zero hunger campaign of Lagos Food Bank. In other words, our financials reveals that we have the strength to pilot the project with or without grant funding as we have been able to establish our presence in the hearts of our donors who make daily, weekly and monthly financial commitment towards our hunger relief efforts.
Malnutrition is the underlying cause of death for at least 3.1 million children, accounting for 45% of all deaths among children under the age of five and stunting growth among a further 165 million globally. Lagos Food Bank is committed to solving the problem of malnutrition and hunger in the underserved ` communities in Lagos Nigeria and has successfully impacted 86 rural communities with the help of over 4000 registered volunteers. The NUMEPLAN Project at hand seeks a wholesome approach to improved nutrition that helps mothers and children become physically fit by having sufficient intake of required nutrients and food necessary for optimal growth, function, and health. The main objectives of the project are to increase access to affordable meal and food security through our food bank facilities; increase community involvement in health and nutrition education activities; and strengthening the capacity of Primary Healthcare Centres within the slums to provide, manage and monitor affordable meal plans.
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