ArticleGlobal health action2025
Implementation matters: program impact pathway analysis of four sectoral nutrition-sensitive interventions in Anambra and Kebbi states, Nigeria.
Article in Global health action, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundUndernutrition in early childhood can be reduced when large-scale, nutrition-sensitive programs are delivered with adequate dose, reach, fidelity, and recruitment.
objectivesThis study (i) investigates the implementation and impact pathways of four nutrition-sensitive programs in Kebbi and Anambra states, Nigeria: Early Childhood Development Education (ECCDE), Environmental Sanitation, Skills Acquisition, and Agricultural Transformation Support Program (ATASP-1) and (ii) identifies cross-sector factors that enable or hinder effective dose, reach, fidelity, and recruitment.
methodsThe study employs qualitative methods such as document reviews, in-depth interviews, and site observations to explore the complexity of program delivery and the contextual factors that influence its outcomes.
resultsAll four programs showed dose-reach-fidelity-recruitment gaps in varying degrees: irregular training and equipment delayed dose; rural and low-income communities were least reached; weak quality control cut fidelity; and recruitment seldom penetrated remote areas. Barriers across sectors included insufficient infrastructure, shortages of trained personnel, and bureaucratic funding delays. Programs with robust community engagement, active multi-stakeholder collaboration, timely resource flow, and short 'reviewandadapt' cycles (ATASP1 in both states; ECCDE in Anambra) overcame many shortfalls, whereas those lacking these features underperformed (Environmental Sanitation in Anambra; Skills Acquisition in Kebbi).
conclusionClosing Nigeria's nutrition-sensitive implementation gap demands a dual response: fix tangible barriers - staffing, infrastructure, and procurement - and institutionalize community-led planning and adaptive management to keep dose-reach-fidelity-recruitment on track. Doing so will improve program reach and quality and accelerate progress against child undernutrition.
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