In photos: Delivering vitamin A supplementation to hard-to-reach areas in Nigeria
Road access can be tricky in the northwestern state of Jigawa, Nigeria. When heavy rains flood dirt roads, boxes of vitamin A capsules are strapped to the back of motorbikes to safely reach their destination and ensure children under five receive their twice-annual dose during Maternal, Newborn and Child Health Weeks (MNCHW).
Posted on December 13, 2023
At the heart of Nutrition International’s work is our vitamin A supplementation (VAS) programming. Vitamin A is a critical micronutrient for children under the age of five. It aids in fighting off illnesses and infections, helps build immunity, safeguards against episodes of diarrhoea and protects against preventable death due to measles in populations at risk of vitamin A deficiency.
In Nigeria, Nutrition International partners with the National Primary Health Care Development Agency (NPHCDA), state primary healthcare development agencies, state ministries of health and UNICEF to deliver life-saving vitamin A to those who need it.
Maternal, Newborn and Child Health Weeks (MNCHW) are biannual events that provide an integrated package of health and nutrition services to communities. VAS is one of the critical offerings during the week. A twice-yearly dose of vitamin A for children between the ages of 6 to 59 months is a proven low-cost, high-impact intervention to reduce the impact of vitamin A deficiency.
Below, we visit a MNCHW in action in Kwanda town, Kiyawa Local Government Area (LGA) in Jigawa state, Nigeria, where health workers are delivering vitamin A supplementation to children under five. Follow the vitamin A as it reaches the rural hospital and meet the people helping to deliver this life-saving intervention.
Awal Abdullahi is a Community Health Extension Worker at the hospital facility in Kwanda town, Jigawa. In Jigawa, 48.1% of children under five are stunted and 22.1% are wasted, according to the National Demographic and Health Survey (NDHS, 2018). Managing the health affairs of the entire village as the MNCHW approaches, Awal picks up the vitamin A supplements from his local government’s office just outside of the village and brings it back to the hospital so he can distribute them to children under five at risk of vitamin A deficiency.
Hazardous roads surround the village of Kwanda town, making it a difficult location to deliver resources. Different seasons pose different challenges, as the dirt roads experience flooding and can become minor rivers. “Every time, especially during the rainy season, whenever it rains, we have to push our motorbikes until we reach the edge of the road then we can get on it and ride out,” Awal said.
MNCHW weeks happens twice a year, once in June and again in December, as a way to ensure children under the age of five receive essential health and nutrition services, including VAS, deworming, essential childhood vaccinations and screening for acute malnutrition. Above, a child’s mid to upper arm is being measured as an indicator for undernutrition and malnutrition.
“We are really having a lot of challenges in this area, but we are still persevering and going out because it is our job to do so.” – Awal Abdullahi, Community Health Extension Worker
Nutrition International provides support to MNCHWs, including the one in Kwanda town, through financial and technical assistance at the state level, as well as by providing a national supply of vitamin A capsules through the in-kind assistance program in partnership with UNICEF. We also provide operational support for VAS delivery at the national level and in the states of Kano, Kebbi, Katsina, Sokoto, Jigawa, Enugu and Cross River.
Nutrition International works with the national and state governments to ensure children receive supplementation at the right intervals through detailed planning. “A bottom-up approach means that at the lower level, the micro plan will be developed from the community ward level up to the Local Government Authority (LGA) level then up to the state level,” shared Junaidu Sani, VAS Program Officer, for Nutrition International in Nigeria. “All the children, most especially in the hard-to-reach areas, are also captured in this micro planning to ensure that all the eligible children in the settlement, both in the hard-to-reach areas and outside, are covered and are provided with vitamin A supplementation.”
Health workers, like Awal, distribute VAS at the local hospital in Kwanda town, where caregivers living nearby bring their children. Before the implementation of the MNCHW program, residents were forced to travel 40km to a hospital in a different community to receive supplemental care. “We are really having a lot of challenges in this area, but we are still persevering and going out because it is our job to do so,” said Awal.
Vitamin A deficiency remains a significant public health concern in more than half of all countries, particularly in sub-Saharan Africa. VAS reduces the risk of preventable child deaths by strengthening the immune systems of children under five suffering from vitamin A deficiency. Twice-yearly supplementation of children 6 to 59 months of age with vitamin A has been shown to contribute to a reduction of all-cause mortality of up to 24%. In addition to increasing children’s capacity to fight diseases like measles and diarrhoea, vitamin A also works to prevent blindness and hearing loss.
“A child that is well taken care of, who has good healthcare provision, is a child that will grow physically and mentally well,” explained Musa Mohammed Hadejia, the Deputy State Nutrition Officer at Jigawa State Primary Health Care Development Agency. “In order to ensure that our children grow physically and mentally well, we do all that it takes to give them the necessary supplements that will make them survive – supplements like vitamin A.”
Education plays a large role during MNCHW. With increased accessibility comes the need for increased knowledge surrounding nutrition. The hospital provides counselling for pregnant women and mothers so they can gain a better understanding of the necessary micronutrients that both themselves and their children should be consuming to remain healthy. These education sessions cover nutrition topics such as the importance of vitamin A supplementation, exclusive breastfeeding, HIV/AIDS, and handwashing.
Awal discusses the importance of vaccinations, breastfeeding and VAS, as well as encouraging community members to visit the hospital to receive treatment when needed. As a result of these education sessions, Awal has observed a reduction in preventable infections in the community he serves.
Fatima Nazifi brought both her children, four-year-old Hanan and seven-month-old Yasir, to receive their vitamin A doses during the week. Her eldest began receiving vitamin A as of six months old, and now her youngest is receiving it too. “I started taking them to get vitamin A after they turned six months old because of the benefits I heard it has,” said Fatima. She is grateful the hospital she lives near has a supply of vitamin A for her children and she does not need to travel far outside her village to receive healthcare for herself and her children.
“Since I started taking my children to get vitamin A, I have seen the positive effects. It protects them from infections,” shares Fatima. “Even with this road of ours that cars are not able to follow, they still bring us medications.”
While challenges still persist, members of the Kwanda town community can be assured they can safely receive VAS without having to travel, guaranteeing that children like Hanan and Yasir receive their bi-annual doses of vitamin A when needed.
Nutrition International has provided the global supply of vitamin A and supported national vitamin A programs for more than 30 years. Since 1998 we’ve delivered over 12 billion vitamin A capsules and every year supply sufficient capsules to meet 100% of unmet global need. We also help countries strengthen their health systems for delivering this critical intervention.