Maternal and Young Child Feeding, WASH and Child ......4.2 Infant and Young Child Feeding (IYCF) 19 4.2.2 IYCF Core Indicators 20 4.2.3 IYCF Optional Indicators 25 4.3 Child Health

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Maternal and Young Child Feeding, WASH and Child Protection KAP Survey Report: Jere, Konduga, Mafa, and MMC

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Table of Content

List of Acronyms 3

Executive Summary 5

1. Introduction 10

1.1 Background/Rationale 10

1.2 Aim and Specific Objectives 11

2. Methodology 12

2.1 Study location and Population 12

2.2 Core Indicators 13

2.3 Quantitative Approach 14

2.3.1 Sampling Design 14

4.0 Results and Discussion 18

4.1 Demographic Characteristics 18

4.2 Infant and Young Child Feeding (IYCF) 19

4.2.2 IYCF Core Indicators 20

4.2.3 IYCF Optional Indicators 25

4.3 Child Health 26

4.4 Mothers/Caretakers Knowledge of IYCF and Hygiene 29

4.5 Maternal Nutrition and Health 31

4.6 Maternal Hygiene 31

4.7 Water, Sanitation & Hygiene (WASH) 32

4.8 Child Protection 35

4.9 Covid-19 Awareness 37

Figure 8: Mode of Transmission of COVID-19 38

5. Conclusion 39

5.1 Recommendation 40

Annex 1-IYCF Results 44

Annex 2-Cluster Distribution 46

Annex 2-References 48

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List of Acronyms

AOGs Armed Organized Groups

CH Cadre Harmonizé

CJTF Civilian Joint Task Force

CNMs Community Nutrition Mobilizers

CP Child Protection

DTM Displacement Tracking Matrix

EBF Exclusive Breastfeeding

ENA Emergency Nutrition Assessment

EPI Expanded Programme on Immunization

FGD Focus Group Discussion

FGDs Focus Group Discussions

HH Household

HHs Households

IDIs In-Depth Interviews

IDP Internally Displaced Person

IDPs Internally Displaced Persons

IOM International Organization for Migration

IYCF Infant and Young Children Feeding

IYCF-E Infant and Young Children Feeding in Emergency

KAP Knowledge Attitude and Practice

KIIs Key Informants Interviews

LGA Local Government Area

LGAs Local Government Areas

MDD Minimum Dietary Diversity

MLoS Master List of Settlements

MMC Maiduguri Metropolitan Council

MNCH Maternal, Newborn and Child Health

MSG Mother Support Group

MTMSG Mother-to-Mother Support Group

NFSS Nutrition and Food Security Surveillance

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NGO Non-Government Organisation

NNHS National Nutrition and Health Survey

ODK Open Data Kit

OFDA Office of U.S. Foreign Disaster Assistance

ORS Oral Rehydration Solution

PHCs Primary Health Centres

SAM Severe Acute Malnutrition

SCI Save The Children International

SMART Standardized Monitoring and Assessment of Relief and Transitions

TSFP Targeted Supplementary Feeding Programme

UNICEF United Nations International Children's Emergency Fund

VAD Vitamin A Deficiency

VTS Vaccination Tracking System

WASH Water Sanitation and Hygiene

WHO World Health Organisation

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Executive Summary

Borno state is in northeast Nigeria with a geographic area of 57,799 km2 and a population of approximately

4.9 million. Since 2009 the state has been experiencing armed conflict which has led to displacement of

about 1 million people. Although the crisis is not at its 2012 peak, Borno state still has about 1,439,953

internally displaced persons (IOM DTM round 26) and at least 35% of the resident households in Borno

State have an IDP or returnee in household. In Borno state, as in overall Northern Nigeria, IYCF practices

were extremely poor prior to the conflict and the challenges to exclusive breastfeeding and optimal IYCF-

E practices faced due to displacement and strain from the conflict are significantly contributing to

malnutrition in children under two years. In addition to making treatment available for children under five

with SAM, there is an urgent need to prevent and reduce malnutrition through a multi-sectoral approach.

This approach includes improving IYCF practices, improving water quality, improving sanitation and

hygiene practices and ensuring that children are well protected and have access to various health, WASH,

nutrition and child protection services in target communities.

To better inform SCI interventions in Borno state, this assessment was conducted to understand the

prevailing Knowledge, Attitudes and Practices around Maternal Infant and Young Child Feeding, WASH

and Child Protection (CP) in communities, in four Local Government Areas (LGAs)—Jere, Konduga,

Magumeri and Kaga Local Government Areas (LGA).

The study employed a mixed-survey design, which included both quantitative and qualitative data

collection methods. For the quantitative component, cluster sampling design as recommended by CARE

IYCF guideline is used and the 10 primary IYCF indicators are the principal indicators of study. Other

maternal nutrition, WASH, Child Protection and Covid-19 indicators were included in the structure

qualitative tool administered using koBo. The qualitative data collection used paper questionnaires

administered through focus group discussions (FGDs) and key informant interviews (KIIs). A total of 2138

caregivers of children under 2 years from 3031 households were sampled for the quantitative data collection

while the qualitative component, 12 FGDs and 12 stakeholder interviews were conducted. Data collection

began on 18 July and ended on 26 July after 4 days of training plus piloting.

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Summary of Findings

The table 1 below presents a summary of key findings from the survey disaggregated by Local Government

Areas (LGAs). Some of the primary findings presented includes; Core IYCF indicators, hand washing

practices and MSG attendance. Please note that only the overall findings are representative as sampling for

IYCF was estimated to be representative ate the domain level (combining all 4 LGAs). Therefore,

disaggregated finding are merely indicative therefore should be interpreted with caution. See Annex 1 for

full results and disaggregation by gender.

Table 1: Summary of survey findings

Indicator LGAs (lower and upper bound)

Jere Konduga Mafa MMC Overall

Initiation to breastfeeding

(Birth) (0-23) (n=2127)

79.9% (77.0% - 82.6

%)

85.1%

(79.6% -

89.6%)

90.3%

(86.0%-

93.6%)

80.8%

(77.9% -

83.5%)

82% (80.3% - 83.7%)

Exclusive breastfeeding (0-5)

(n=348)

56.4% (47.6% -

64.8%)

63%

(48.6% -

75.9%)

67.3%

(54.2% -

78.5%)

76.7%

(68.8% -

83.7%)

66.1% (61.0% - 70.9%)

Continued Breastfeeding (12-

15) (n=424)

92.4% (88.0%-

95.6%)

86.1%

(72.2% -

94.5%)

88.4%

(76.4%-

95.4%)

89.4%

(83.9%-

93.4%)

90.3% (87.2%- 92.9%)

Introduction to Semi

Solid/Solid Food (6-8 ) (n=246) 69.5% (59.3%-

77.8%)

81.1%

(66.4% -

91.1%)

40%

(22.7% -

59.34%)

54%

(49.7% -

69.7%)

64.6% (58.5% - 70.4%)

Minimum Dietary Diversity (6-

23)(n=1779)

28.4% (21.8% -

36.4%)

25.6%

(14.0% -

42.8%)

33.7%

(21.1% -

50.8%)

22.1%

(16.2% -

29.5%)

26.4% (22.1% - 31.2%)

Minimum Meal Frequency (6-

23) (n=1779)

32.7% (29.4% -

36.2%)

33%

(26.3% -

40.1%)

32.7%

(26.5% -

39.3%)

33%

(29.5% -

36.6%)

32.8% (30.7% - 35.0%)

Minimum Acceptable Diet (6-

23)(n=1779)

15.9% (13.4% -

18.7%)

15.3%

(10.6% -

21.2%)

20%

(15.0% -

25.9%)

13.1%

(10.7% -

15.8%)

15.3% (13.7% - 17.0%)

Consumption of Iron (6-23 )

rich foods(n=1779) 6.2% (4.6% - 8.1%)

9.1%

(5.5% -

14.0%)

14.2%

(9.9% -

19.4%)

9.9%

(7.8% -

12.3%)

8.8% (7.5% - 10.2%)

Ever breastfed (0-23)(n=2127) 93.3% (91.5% -

94.9%)

87.8%

(83.1% -

91.6%)

91.2%

(87.2% -

94.2%)

92.9%

(91.0% -

94.6%)

92.3% (91.3% - 93.4%)

Continued Breastfeeding (20-

23) (n=460) 36.6% (30.2% -

43.3%)

17.9%

(7.2% -

34.8%)

40%

(27.8% -

53.2%)

24.%

(18.9% -

31.7%)

31.5% (27.3% - 35.8%)

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Minimum dietary diversity –

Women(n=1913) 32.50% 37.80% 39.40% 31.40% 34%

Caregiver who are member of

MSG that have at least 3

critical IYCF

knowledge (n=1913)

60.10% 65.22% 85.60% 69.23% 67.90%

Care givers that know critical

handwashing times (3-

5) (n=735)

70.20% 78.70% 89.36% 75.10% 75.30%

.

Overall results from this survey shows that the practice of exclusive breastfeeding in the survey area (66%)

is slightly higher than baseline (62.7%) conducted by SCI in the 2019 but significantly higher than NFSS

8 2019 estimate (45.3%). It is important to note that this survey and the baseline covered only SCI

programme areas while the NFSS covered the entire LGA, the EBF results however, indicates an

improvement in mothers breastfeeding practices. Earlier initiation to breastfeeding practice (82%) is

slightly higher than the baseline estimate (79.2%) but continued breastfeeding at 1-year practice is

significantly lower (90%) when compared to the baseline (99%). Introduction of solid, semi-solid or soft

food practice is in line with Nigeria National Nutrition and Health Survey. Overall, child breast feeding

indicators seem to be in line or showing better results than the baseline and other nutrition surveys, however,

breastfeeding practices is still poor as about 7% of assessed children were not breastfeed and SDG targets

for EBF has not been achieved. In line with the baseline, MMF, MMD and MAD results in the survey area

are really poor which according to FGDs is mainly caused by of lack of resources to buy nutritious food in

the right quantity. This poor food intake by children 0-23 months in the households signals a broader issues

of household food insecurity as a lot of households have been affected by the conflict which have disrupted

their means of livelihood. In general women in the survey area had a decent knowledge of IYCF but lack

of resources and cultural barriers continue to hinder full adoption of good IYCF practices. A large

proportion of women of reproductive age (15 - 49 years) did not consume the required 5 out of the 10 food

groups categories required to meet the minimum dietary diversity which has an effect on breastfeeding and

then the baby's health. The study also shows that mothers who are part of MSG have more robust IYCF

knowledge and are more able to practice them.

Most of the surveyed communities do have access to improved water but a lot still face problems of long

travel distance, queuing time and inadequate collection and storage containers. The majority of respondent

reported being aware of child protection and could identify a lot of child protection issues, however a lot of

the issues mentioned revolved around child’s needs and access to services and not so much on social and

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emotional related child issues this could be heavily influenced by social norms as some child protection

issues were described as “normal”. Communities in the survey area rely heavily on community mechanisms

for reporting and dealing with child protection issues. Communities seemed fairly knowledgeable on how

Covid-19 is spread and can be prevented, however, there is a need to improve personal hygiene and

handwashing practices in the community.

Recommendations

━ Because of the significantly high rate of children not breastfeed. It is critical that maternity facilities

and health centers supported by SCI are able to provide breastmilk for sick born, separated children

and children who have lost their mothers as a result of death during child birth or conflict.

━ As a result of Covid, MSG meetings and house to house visit are not as frequent as needed.

Mediums like radio, health facility and community leaders should be used in raising awareness of

child breastfeeding in the community. Also to be packaged in the sensitization message is the

awareness on breastfeeding from birth through two years’ age and why this is important for a child.

━ SCI should support the implementation of the ten steps to successful breastfeeding developed by

UNICEF and WHO in all supported health facilities if that is not already been done.

━ SCI should work to strengthen the link between health facilities and communities to ensure

continued support for breastfeeding and this should be continuously tracked and monitored to see

improvement in breastfeeding practices.

━ Since iron rich foods like liver, red meats, eggs and fish, are not widely available or affordable,

SCI support the distribution of fortified food to children and iron/folate supplement for pregnant

mothers.

━ A lot of women cannot afford a nutritious diet and struggle to meet their full dietary requirement

especially during pregnancy and breastfeeding so SCI can support these women through

conditional cash transfer programme for PLW, integrated with food diversification programme to

teach women how to utilize home yard/garden to provide nutritious food their family and a

behavioral change campaign around consumption of nutritious food.

━ Caregivers need to be encouraged and motivated to join MSG. This can be done through

sensitization campaigns using existing community structure (gate keepers), discussions with

mothers to understand barriers to participating in MSG and further incorporation of livelihood

activities into the MSG design Findings from the survey show a significant proportion of women

are not part of MSG, we therefore recommend a scale up of MSG so more women can have access.

━ Community child protection mechanisms need to be reinforced and realigned with the national

child protection laws as the majority of beneficiaries including some community leaders did not

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know national child protection laws. Further research is required to properly understand these

community systems and how it can be aligned to the national child protection response.

━ A significant proportion of respondents believed boys should be prioritized over girls in terms of

going to school, and children with disability don’t need to go to schools. This perception, coupled

with the fact that 27% of beneficiaries reported have difficulty with atleast one function (using

WGS), it is critical that SCI programmes are designed to include vulnerable groups (young girls

and disabled children) and there is a need for serious community sensitization around issues of

gender and disability.

━ From FGDs with fathers, a reoccurring theme was that fathers understood their role in the family

to be that of a provider and protector and nothing more. Because of this perception, father are not

getting very involved in their children’s nutrition. Therefore, a sustained scale up of child nutrition

and awareness campaigns specifically targeting fathers which could also be organized through the

community structure. We recommend bolstering the father support group programme.

━ In light of Covid-19, personal hygiene and handwashing messages should be increased. SCI staffs

should deliver hand washing and Covid-19 messages at every point of contact with beneficiaries

and the community. This should be implemented throughout all the stages of implementation and

by every staff in the organization.

━ Finally, SCI should consider a multi-sectoral approach that address all the sectoral needs of

children, mothers and households. Further research would be needed to fully understand the needs

of community in other to design an effective approach.

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1. Introduction

1.1 Background/Rationale

Since 2009, the Boko Haram driven crisis (herein, Armed Opposition Groups [AOGs]) has crippled north

eastern Nigeria, events from 2019 have led to an upsurge in the number of people that require humanitarian

assistance. From 2017 to 2019, the number of people in need of urgent assistance reduced from 8.5 million

to 7.1 million. Increased attacks by Non-State Armed Groups (NSAGs) against civilians, compounded by

the effects of climate change, natural hazards and disease outbreaks, exacerbated the needs of the population

already afflicted by more than ten years of protracted crisis. Millions of people have been plunged into

further vulnerability and 7.9 million are now in need of life-saving aid in 2020 – 800,000 more people than

in 2019[1].

Violations and abuse of international humanitarian and human rights law remain pervasive. Non-state

armed groups are increasingly setting up illegal checkpoints on main supply routes directly targeting

civilians. This condemnable practice has disastrous consequences for civilians and humanitarians,

hindering freedom of movement and heightening protection risks.

Save the Children has been working in Nigeria since 2001. The early focus was on getting children actively

involved in shaping the decisions that affect their lives. Today, SCI is working in 20 states focusing on

child survival, education and protecting children in both development and humanitarian contexts. The

humanitarian response started in 2014 with Save the Children among one of the first responders to the

conflict.

The ongoing conflict in the North East continues to increase population displacements, poor sanitation,

hygiene, poor access to safe water supplies, restrict income-generating opportunities, limit trade flows and

escalate food prices. As a result of the reduced food availability and access, local and IDP populations in

worst-affected areas of Borno, Yobe and Adamawa states continue to experience food gaps, in line with

crisis (IPC Phase 4) acute food insecurity, with an estimated 4.6M people in Phase 3-5 (Cadre Harmonizé

(CH) Analysis).

In Borno state, as in overall Northern Nigeria, IYCF practices were extremely poor prior to the conflict and

the challenges to exclusive breastfeeding and optimal IYCF-E practices faced due to displacement and

strain from the conflict are significantly contributing to malnutrition in children under two years. In addition

to making treatment available for children under five with SAM, there is an urgent need to prevent and

reduce malnutrition through a multi-sectoral approach. This approach includes improving IYCF practices,

improving water quality, improving sanitation and hygiene practices and ensuring that children are well

protected and have access to various services in target communities.

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To better inform SCI interventions in Borno state, this assessment was conducted to understand the

prevailing Knowledge, Attitudes and Practices around Maternal Infant and Young Child Feeding, WASH

and Child Protection (CP) in communities, in four Local Government Areas (LGAs)—Jere, Konduga,

Magumeri and Kaga Local Government Areas (LGA).

1.2 Aim and Specific Objectives

The general objectives of this survey is to determine knowledge, attitude and practice (KAP) of IYCF

practices, risks associated with practices pertaining to water, sanitation and child protection for children

and their families affected by conflict in targeted LGAs in Borno state, Nigeria.

━ Determine knowledge, attitudes and practices on Maternal Infant and Young Child nutrition in the

targeted LGAs

━ Identify key actors of change and/or influential community leaders and recommend approaches to

include them in programme designs.

━ Provide additional qualitative information on the choice of practices/ behaviours (through focus

group discussions, Key Informant Interview, transect walks etc)

━ Determine community knowledge and awareness on existing nutrition interventions.

━ Determine the attitude and practice of households on water treatment and storage

━ Determine the knowledge and awareness of households on diarrheal and other water borne diseases.

━ Determine the community knowledge on hand washing and hygiene practice

━ Determine the level of knowledge of parent and caregiver on child protection practices

━ Determine the knowledge of parents and caregivers on availability of services for children and

organizations that cater for children right within their community.

━ Recommend key simple, practical and achievable interventions that will address the identified

issues to ensure appropriate practices.

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2. Methodology

This survey adopted a combination of qualitative and quantitative approach. For the quantitative

component, a representative household survey powered by IYCF indicators was conducted and was

followed up by qualitative data collection; in depth interviews with traditional leaders, health facility in-

charge, lead mothers, lead fathers and local nutrition focal points. Focus group discussions were conducted

with caregivers of children, members of mother to mother support group (MTMSG), members of father to

father support groups and community nutrition mobilizers (CNMs).

2.1 Study location and Population

The survey was conducted in four targeted LGAs (Jere, Konduga, Mafa, & Maiduguri) in Borno State,

these are the locations where SCI OFDA or FFP funded interventions are being implemented. The survey

covered all accessible settlements in the targeted LGA. Based on the context of the humanitarian situation

in Borno, the population group considered for the household’s survey are the following;

━ Host community: This group of the population are either returnees or host communities.

Population estimates from the Polio Vaccination Tracking System (VTS) [2] were used to estimate

the population of this group.

━ Internal Displaced Persons (IDPs): This group of the population includes all aborigines and

settlers that are confined to defined IDPs camps or live in host communities. IDP population in the

survey area was obtained from IOM DTM [3].

Vaccination Tracking System population estimate is filtered through the Borno polio master list of

settlement (MLoS), the process generates a list of accessible settlements along with their respective

population estimates, combining this with IOM DTM data the population of the surveyed area is estimated

as follows;

Then the population of children aged 0-23 months living in the survey area is estimated by multiplying the

total population of the area by 0.08 (studies show that children aged 0-23 months are about 8% of the

population in the southern hemisphere. [4]

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2.2 Core Indicators Table 2: Primary Indicator for the Study

SN INDICATOR INDICATOR MEASURE

1 Inititiaon of breastfeeding (Birth)

Proportion of children 0-23 months who were put to the breast

within one hour.

2 Exclusive breastfeeding (< 6 months)

Proportion of infant 0-5 months of age who were fed exclusively

with breast milk in the past 24 hours prior to time of survey[1]

3

Introduction of solid, semi-solid or soft

foods (6-8 months)

Proportion of infants 6-8 months who received at least one solid,

semi-solid or soft foods in the 24 hours prior to time of survey

4

Continued breastfeeding up to 1 year and

2 years

Proportion of children 12-15 months old who are fed breast milk

in the past 24 hours prior to time of survey

Continued breastfeeding at 2 years of age (when children are

20-23 months)

5 Minimum dietary diversity

Proportion of children 6-23 months who received food from 4

or more of the 7 food groups in the past 24 hours prior to time

of survey[2]

6 Minimum meal frequency

Proportion of breastfed and non-breastfed children 6-23 months

of age who receive solid, semi-solid or soft foods the minimum

number of times or more, during the previous day[3].

7 Minimum acceptable diet

Proportion of children 6-23 months of age who had at least the

minimum dietary diversity and minimum meal frequency in the

past 24 hours prior to time of survey

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Consumption of iron-rich or iron-fortified

foods

Proportion of children 6-23 months old who receive an iron rich

or iron-fortified food that is specially designed for infants and

young children or that is fortified in the home

9 Bottle feeding

Proportion of children 6-23 months who were fed with a bottle

over the 24 hours prior to time of survey

10 IYCF knowledge

Percentage of caregivers of children under 2 years who take part

of support groups who are able to cite at least 3 IYCF best

practices

11 Minimum dietary diversity - Women

Percentage of reproductive age women (15-49) that consume at

least 5 out of the 10 food groups.

12 Water treatment and storage

community water treatment and storage knowledge attitude and

practice

13 Hand Washing hygiene Community hand washing hygiene practice

14 Child protection knowledge

Community and caregiver knowledge of child protection

knowledge

15 Awareness of child services Community awareness of child related services

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2.3 Quantitative Approach

2.3.1 Sampling Design

The survey adopted the WHO cluster sampling model [5] for vaccination which can be applied to a KAP survey

as recommended by ACF lessons learnt in KAP survey report [6]. Villages in the study area were considered as

primary sampling units and in order to estimate the effective sample size, an estimate of the percentage of

mothers practicing each of the IYCF indicators from a sector wide KAP protocol [7] for the study area is used.

Jere, Mafa, Konduga and Maiduguri are grouped into domain and using a 95% confidence interval, 5%. The

EBF indicator had the highest sample size estimate (492). In order to achieve representation for all sub age

groups within the 0-23 months cohort, CARE IYCF guide 2010 recommends multiplying the indicator with

the largest sample size (in this case exclusive breastfeeding under 6 months with 492) by 4. This ensures that

a representative sample was collected at all groups (0-5, 6-11, 12-17 and 18-23 months), therefore ensuring all

indicators were representative. The result of the multiplication was 1968 which means 1968 children between

0-23 months were sampled across all LGA. All 1968 children within the 4 age groups (0-5, 6-11, 12-17 and

18-23 months), were sampled in one household survey containing questions on all of the indicators

2.3.3 Household Selection

Using the demographic parameter of the survey area, the sample size for children between 0-23 months) was

to be reached in 3030 households (see table 3 below). 101 clusters were selected after putting into account a)

time of travel b) community entry and briefings c) time spent in filling a questionnaire and taking

anthropometric measurements and d) time required for household listing. Clusters were selected using

probability proportional to size method on ENA for SMART. Each cluster contained not more than 150-250

households (see SMART Manual), for settlement/villages/camps that have a higher population, segments of

the entire population were generated and one/more segments was randomly selected to represent the

cluster/clusters as required. See Annex 2 for cluster distribution.

Table 3: Quantitative sample size

LGA Children 0-23 months to sample

Number of

households to

Visit

Number of

clusters LGA

5 1968 3030 101 5

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“All persons who slept in the house the day before, shared the same meal and who recognize the authority of

a head of household” is the household definition adopted by this survey. Household listing was done in each

cluster then households were randomly selected in each cluster using a random number generating android

app. For settlements with more than 250HH that settlement was segmented. For mothers with more than one

child who are 0-23 months old, all children were administered the questionnaire. In a case of multiple births

(for example, twins and triplets), all age-eligible children in the family were interviewed

2.4 Qualitative Survey

Two types of qualitative data were collected in the survey area 1) in depth interviews (IDIs) with key

informants and 2) Focus group discussion (FGDs) with community stakeholders. IDIs and FGDs were

conducted in selected communities in all LGAs, one of each respondent group below were interviewed per

LGA bringing the total number of qualitative samples to 32. To better understand the role played by different

stakeholders, IDIs were conducted with traditional and religious leaders, health facility in-charge and lead

mothers,. One of this group was selected from each LGA, because of the homogeneity of population within

the LGA, similarity of needs and barriers and similarity of programme implementation within the LGAs. Also,

because of Covid-19 person to person contact needed to be minimised therefore sampling was rationalised.

Table 4: Qualitative sample size

Key Informant Interviews (KII) Number Focus Group Discussion (FGD) Number

Traditional and Religious leaders 4 Households including Mothers of under 2 years Children 4

Health facility In-charge 4 Households including Fathers of under 2 years Children 4

Lead Mother 4 Member of MTMSG 4

Total 16 Total 16

2.5 Field Data Collection

Field data collection ran concurrently across all 4 LGAs for a duration of 10 days. The survey teams were

assessed during the training and continually throughout the data collection period. Teams with consistent high-

quality data were retained, while any team found wanting as regards data quality, were dropped. Enumerator

training was conducted from 13 to 17th of July 2020. The training covered the following thematic areas;

overview of the survey and its objectives and introduction to KAP methods, Interview and general

communication skills, questionnaires simulation, sampling, estimation of age in months and validation using

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the calendar of local events, community entry and COVID-19 Awareness and Sensitization. Quantitative data

collection was conducted using ODK mobile data collection platform and data uploaded to/ downloaded from

a dedicated KoBo server. Data was cleaned daily and reviewed for daily briefings and quality checks (QC)

will be done. Following data collection, final data processing and cleaning was conducted.

2.6 Data management

Participants were asked for consent to participate and all information was handled with confidentiality and in

line with SCI’ data protection protocol. Data checking and validation for completeness and consistency was

carried out on a daily basis, based on the uploaded entries to KoBo Collect from phones. Data that was deemed

inconsistent were highlighted and shared with the relevant coordination team for rectification. Quality control

was ensured on a daily basis, with corrections being carried out immediately.

Quantitative data was processed and cleaned on excel and Following the completion of field data collection,

data was analysed using R version 3.6.2. while qualitative data was translated and analysed on Nvivo.

3.Ethical Considerations and Approval

3.1 Confidentiality

For all the study components (interview and FGD), no personal identifiers such as name, address, telephone

and hospital identification number were documented on the study tools. There is no way to link a specific

questionnaire to a specific respondent. During the Household survey, the respondent and the enumerators sort

a comfortable place or corner in the house to ensure privacy during the question and answer sessions. A high

level of confidentiality and security was strictly adhered to in handling the data from the study.

3.2 Informed Consent

Informed Consent was obtained from all respondents and FGD participants. Only respondents or participants

who voluntarily accepted to be part of the survey participated in the HH interview and FGD. For Only

participants 18 and above participated in this study.

3.3 COVID-19 Considerations

Enumerators Training

━ Facilitators and Enumerators used facemask all through

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━ Hand washing facility/ hand sanitizers were available

━ Venue of training was well ventilated and seats were arranged to maintain physical distance of at

least 2 metres

━ COVID-19 sensitization and awareness formed part of the enumerators training

During Data collection

━ Physical distance of at least 2 meters from respondent

━ All enumerators use facemask during data collection and are provided with hand sanitizers

━ FDGs participants limited to not more than 6 persons

━ Face mask were provided for all FGD participants and physical distancing maintained

━ 3 enumerators are transported per vehicle to ensure physical distancing

━ Data collection devices (i.e phones) are decontaminated daily (before and after field visits

3.4 Limitations

The following are thus the challenges and limitations of the survey;

━ Representativeness of the survey finding is limited to only accessible settlements and in

targeted locations, due to the current security challenges.

━ The study focuses on areas where SCI in implementing nutrition and child related

programmes so caution should be taken when adopting finding for other purposes or

generalizing across the entire area.

━ Results for IYCF indicators are representative at the domain level (Jere, Konduga, Mafa

and MMC). LGA level results are not representative but merely indicative so should be

interpreted with caution.

━ There is an inherent susceptibility for subjective biases and recall.

18

4.0 Results and Discussion

4.1 Demographic Characteristics

Table 5: Response Rate

Category Targeted Achieved Response Rate

LGAs 5 4 80%

Cluster 101 103 101%

5 LGAs (Jere, Konduga, Mafa, Magumeri and MMC) were targeted for this assessment with a total of

101 clusters. Due to the prevailing insecurity challenges around the Magumeri environs, the LGA was

dropped as part of this KAP assessment and its clusters were redistributed to the other 4 LGAs.

Table 6: Socio-Demographic Characteristics

Characteristics

Jere Konduga Mafa MMC

Overall(%)

(n=1990)

n=794

(Freq.%)

n=209

(Freq.%)

n=246

(Freq.%)

n=741

(Freq.%)

Gender of the Head of

Household

Female

Male

24.3%

75.7%

15.3%

84.7%

26%

74%

19.2%

80.8%

21.7%

78.3%

Highest form of education

achieved

koranic

none

secondary

primary

tertiary

51.3%

18%

13.6%

9.1%8.1%

60.3%

20.6%

9.6%

7.7%

1.9%

57%

11%

17%

10%

6%

55.5%

10.5%

16.5%

8.2%

9.3%

54.4%

14.6%

14.6%

8.7%

7.6%

HH_income

agriculture

aid_assistance

begging

casual_labor

hunting

no_income

other

petty_trade

Selling_charcoal

selling_fireword

31.4%

3.9%

0.1%

19.3%

0.9%

4.8%

12.5%

21.7%

2.3%

3.3%

47.9%

2.4%

0.5%

16.8%

3.8%

1.4%

9.1%

12%

2.4%

3.8%

17.1%

1.6%

0.0%

30.5%

0.4%

1.2%

18.7%

25.6%

3.3%

1.6%

16.7%

3.4%

0.4%

29.3%

0.1%

3.4%

11.9%

32.4%

0.8%

1.6%

25.9%

3.3%

0.3%

24.1%

0.9%

3.5%

12.7%

25.1%

1.9%

2.5%

Caregivers with Disability

No

Yes

72.9%

27.1%

71.3%

28.7%

67.5%

32.5%

75.0%

25.0%

72.9%

27.1%

Washington Group question sets on disability are used to identify respondents with disability.

19

Respondents report having “some difficulty”, “a lot of difficulty” or “cannot do it at all” when asked

whether they have difficulty performing basic universal activities (walking, seeing, hearing, cognition,

self-care and communication) are categories as disabled. From the analysis, 27.1% of caregivers

reported having some form of difficulty with certain universal activities/function.

Averagely the gender distribution of head of households is 78.3% males and 21.7% were females

(n=1990). The gender distribution ratio for heads of HH across the 4 LGAs follows the same pattern

of 7:3, this is consistent with the patriarchal nature of Northern Nigeria.

The highest form of education achieved by heads of HHs across the survey areas is Koranic education

at 54.4%, 14.6% had acquired secondary education and the same proportion (14.6%) do not have any

form of formal education. Konduga LGA recorded the highest proportion of persons with no any form

of formal education at 20.6%. More so the most common source of income for households are

Agricultural activities, petty trade and casual labor at 25.9%, 25.1% and 24.1% respectively.

4.2 Infant and Young Child Feeding (IYCF)

Poor Infant and Young Child Feeding (IYCF) practices can be detrimental to the health and nutritional

status of children, which consequently has a direct effect on their mental and physical development.

Breastfeeding also has an impact on the health status of mothers, the period of postpartum fertility and,

hence, the length of birth interval and the fertility levels [8]. Infants should be breastfed within one hour of

birth, exclusively breastfed (EBF) for the first six months of life and then continue to be breastfed at least

up to two years with age-appropriate, nutritionally adequate and safe complementary foods.

Table 7: Distribution of Children (0-36 Months)

Characteristics

Jere Konduga Mafa MMC Overall(%)

n=858

(Freq./%)

n=224

(Freq./%)

n=260

(Freq./%)

n=786

(Freq./%)

(n=2138)

(Freq./%)

Age

Distribution

for Children

(0-

23Months)

0-5 months

6-11 months

12-23 months

126(14.7%)

190(22.1%)

542(63.2%)

46(20.5%)

69(30.1%)

109(49%)

55(21.2%)

57(22%)

148(56.9%)

121(38.3%)

202(25%)

473(59.4%)

348(16.3%)

518(24.2%)

1272(59.5%)

Sex of Child

Female

Male

399(46.5%)

459(53.5%)

99(44.2%)

125(55.8%)

112(43.8%)

148(56.9%)

395(49.6%)

401(50.1%)

1005(47%)

1133(53%)

20

4.2.2 IYCF Core Indicators

Table 8: Early Initiation, Exclusive, Continued breastfeeding and Complementary Feeding

Early initiation of breastfeeding (0-23 Months)

LGAs

Indicators

Early Initiation of Breastfeeding (0-24)

Exclusive breastfeeding (0-5)

Continued Breastfeeding (12-15)

Introduction to Semi Solid/Solid Food (6-8 )

(n=2127) (n=348) (n=424) (n=246)

Jere 79.9% (77.0% - 82.6%) 56.4% (47.6% - 64.8%) 92.4% (88.0%- 95.6%) 69.5% (59.3%-77.8%)

Konduga 85.1% (79.6% - 89.6%) 63% (48.6% - 75.9%) 86.1% (72.2% - 94.5%) 81.1% (66.4% - 91.1%)

Mafa 90.3% (86.0%- 93.6%) 67.3% (54.2% - 78.5%) 88.4% (76.4%-95.4%) 40% (22.7% - 59.34%)

MMC 80.8% (77.9% - 83.5%) 76.7% (68.8% - 83.7%) 89.4% (83.9%-93.4%) 54% (49.7% - 69.7%)

Overall 82% (80.3% - 83.7%) 66.1% (61.0% - 70.9%)

90.3% (87.2%- 92.9%)

64.6% (58.5% - 70.4%)

According to WHO [9] “Provision of mother’s breast milk to infants within one hour of birth is referred to

as “early initiation of breastfeeding” and ensures that the infant receives the colostrum, or “first milk”,

which is rich in protective factors. Current evidence indicates that skin-to-skin contact between mother

and infant shortly after birth helps to initiate early breastfeeding and increases the likelihood of exclusive

breastfeeding for one to four months of life as well as the overall duration of breastfeeding. Infants placed

in early skin-to-skin contact with their mother also appear to interact more with their mothers and cry less”

Early initiation of breastfeeding enhances the release of oxytocin, this aids in the contraction of the uterus

(womb) and reduces risk of post-partum haemorrhage (blood loss of 500 ml or more within 24 hours after

birth) after birth in women. Additionally, the milk produced by the mother during the first 2-3 days of birth

(colostrums) contains large quantity antibodies and essential nutrients for newborns. Therefore, it is of

utmost importance to feed newborns with colostrum within the first hour of birth and that they continue to

be exclusively breastfed for 6 months.

Table 7 above shows that, across the 4 LGAs targeted for the survey, 82% of infants-initiated breastfeeding

within the first hour of life. (n=1964) of children (0-24 month). Comparatively, according to the Nutrition

& Food Security Surveillance (NFSS): Northeast Nigeria-emergence survey report, 2019[9] , the proportion

21

of mothers that initiated early breastfeeding (within one hour of birth) in MMC & Jere and Central Borno

domains is 53.7%(n=246) and 49.2% (n=240) respectively, while the proportion of mothers that initiated

breastfeeding within the first 24 hours of birth is 34.6% and 31.7% for the two domains respectively

Knowledge and Attitude

Table 9: Knowledge of Early Initiation of breastfeeding

Characteristics

Jere Konduga Mafa MMC

AVE.(%)

(n=1990)

n=794

(Freq.%)

n=209

(Freq.%)

n=246

(Freq.%)

n=741

(Freq.%)

What is the first food a

newborn baby should

receive?

Breast milk

Don't Know

Baby_milk

Water

Holy_water

Date_fruit

755(95.1%)

20(3.0%)

11(1.4%)

5(1.0%)

2(0.3%)

1(0.1%)

202(97.1%)

1(0.5%)

3(1.4%)

2(1.1%)

1(0.5%)

0(0.0%)

240(98.1%)

4(2.0%)

0(0.0%)

0(0.0%)

0(0.0%)

2(1.0%)

728(98.1%)

5(1.1%)

2(0.3%)

4(0.5%)

2(0.3%)

0(0.0%)

1925(96.7%)

30(1.5%)

16 (0.8%)

11(0.6%)

5(0.3%)

3(0.2%)

96.7% (n=1990) of mothers know that the first food a newborn baby should be given is breast milk, while

1.8% of them made reference to baby milk, date fruit, holy water and water and 1.5% said they don't know.

This indicates that a large proportion of mothers in the study area have good knowledge of early initiation

of breastfeeding, this corroborates findings from FGDs. FGDs participants in the Gonari community of

Konduga LGA all agreed that most women in the community put the child to breast immediately after the

child is born and this theme continued throughout the other FGDs. They said “it creates good attachment

of child to the mother”

Exclusive Breastfeeding (EBF) (0-5 Months)

Exclusive breastfeeding (EBF) refers to feeding infants with only breast milk and nothing else. Specifically

this connotes no other food or drink, not even water, except breast milk for the first 6 months of life, but

allows the infant to receive ORS, drops and syrups (vitamins, minerals and medicines). UNICEF and WHO

recommend that children be exclusively breastfed (no other liquid, solid food, or plain water) during the

first six months of life, since breast milk contains all the nutrients needed. Apart from being nutritionally

inadequate, substitutes – such as formula, other kinds of milk, and/or porridge – can be contaminated,

exposing infants to the risk of illness, thus increasing their risk of mortality. A total of 66.1% f mothers of

22

children 0-5 months reported exclusively breastfeeding their infants (table 8) across all LGAs. No

significant difference was observed between male and female children. The 2019 NFSS report, indicated

45.3% and 37.5% (n=64) of children 0-5 months were exclusively breastfed in MMC & Jere and Borno

Central domains respectively.

FGDs revealed that the reasons why some women do not exclusively breastfeed their babies is because of

lack of food for the mother which makes it hard to produce breast milk. Also, FGDs participants reported

that breast milk is perceived as inadequate so a child may become dehydrated due to hot weather. FGD

findings also indicated that psychological and physical stress due to displacement from their villages and

life in IDP camps with little or no source of livelihood interlaced with insecurity is also a contributing factor

to why some women don't practice exclusive breastfeeding.

Knowledge and Attitude

Table 10: Knowledge and Attitude of EBF

Characteristics

Jere Konduga Mafa MMC

Overal(%)

(n=1990)

n=794

(Freq.%)

n=209

(Freq.%)

n=246

(Freq.%)

n=741

(Freq.%)

Have you heard

about exclusive

breastfeeding?

Don't Know

No

Yes

20(3.0%)

91(11.5%)

683(86.0%)

0(0%)

17(8.1%)

192(92.1%)

7(3.1%)

11(4.5%)

228(93.1%)

14(2.1%)

35(5.0%)

692(93.4%)

41(2.1%)

154(8.0%)

1795(90.2%)

How long should a

baby receive

nothing more than

breastmilk?

3_months

6_months

more_6_months

59(7.4%)

628(79.1%)

107(13.5%)

12(6.0%)

165(79.1%)

32(15.3%)

11(4.5%)

221(90.0%)

14(6.1%)

38(5.1%)

645(87.0%)

58(8.0%)

120(6%)

1659(83.4%)

211(11.0%)

What are the

benefits for a baby

if he or she receives

only breastmilk

during the first six

months of life?

Don't Know

He/she grows healthily

Protection against obesity and chronic

Protection against other diseases.

Protection from diarrhoea and other infections

92(12.1%)

488(61.5%)

12(2.0%)

149(19.1)

53(7.1%)

7(3.4%)

149(71.3%)

4(2.0%)

44(21.1%)

52.4%)

17(7.0%)

160(65.0%)

1(0.4%)

39(16.1%)

29(12.1%)

54(7.3%)

506(68.3%)

6(1.0%)

136(18.4%)

395.3%)

170(9.0%)

1303(66.0%)

23(1.2%)

368(19.0%)

126(6.3%)

Analysis from the table 9 above indicates that 90.2% of mothers across the targeted LGAs for the

assessment confirmed they have heard of exclusive breastfeeding and 83.4% are aware of the duration for

exclusive breastfeeding. 66% of mothers are aware of the benefits of exclusive breastfeeding.

Across all the FGDs conducted, caregivers all agreed that breastfeeding a child is good because it helps the

child grow, improves child intelligence and prevents sickness. One FGDs participant said that exclusive

23

breastfeeding especially is good the child so that “Diseases a mother takes in through water would not affect

the child”

Continued Breastfeeding up to 2 years of age

Beside EBF until six months, optimal breastfeeding practices involve continued breastfeeding up to at least

24 months of age along with appropriate complementary feeding. Findings from this survey (table 4)

indicates that 90.3% (n=424) children still breastfed up to 1 year When disaggregated by LGA, the

proportion of children 12-15 month still being breastfed is at 92.4 %, 86.1%,88.4% and 89.4% in Jere,

Konduga, Mafa, and MMC respectively. From the NFSS report, continued breastfeeding for children 12-

15 months is 84.8% and 84.4% for MMC & Jere and the Borno Central domain respectively.

Knowledge and Attitude Table 11: Knowledge of Continued Breastfeeding

Characteristics

Jere Konduga Mafa MMC Overall (%)

(n=1990) n=794

(Freq.%)

n=209

(Freq.%)

n=246

(Freq.%)

n=741

(Freq.%)

Until what age is it

recommended that a

mother continues

breastfeeding?

12-23 months

24 & Above

6-11months

Don't know

Less than 6months

392(49.4%)

173(22.1%)

151(19.0%)

33(4.2%)

45(6.1%)

120(57.4%)

43(21.1%)

36(17.2%)

5(2.4%)

5(2.4%)

130(53.1%)

57(23.2%)

27(11.1%)

10(4.1%)

229.0%)

363(49.1%)

186(25.1)

98(13.2%)

14(2.1%)

8011.0%)

1005(51%)

459(23.1%)

312(16.0%)

62(3.1%)

152(8.0%)

51% (n=1990) of mothers and caregivers have knowledge on the duration for continued breastfeeding (12-

23 months) All FGDs participants across all of the FGDs conducted choose between 12-24 months as the

ideal age to stop breastfeeding a child. There are cultural and religious reasons around this choice as one of

the FGD participants says;

“In Islam we are supposed to breastfed until 21 months, while culturally is until 17 months, both are going

hand in hand but the difference is 4 months”

Minimum Dietary Diversity (MDD) (6-23 Months)

Dietary diversity refers to nutrient adequacy (basic nutrients needed in terms of macro and micro nutrients)

and to diet variety/balance, these are two of the main components of diet quality. For children aged 6 to 23

months, it means feeding on food from at least four out of the seven food groups. The cut-off at “at least 5

of the 8 food groups” is generally associated with better quality of diets.

Overall, as shown in table 12, 26% (n=1779) of children aged 6-23 months consumed 4 or more food

24

groups; Minimum dietary diversity is at 28.4%, 25.6%, 33.7% and 22.1% in Jere, Konduga, Mafa and

MMC. From the NFSS report MDD is at 8.8% and 4.2% for the MMC & Jere and the Borno central domain.

Minimum Meal Frequency (6-23 Months)

Minimum meal frequency is the proportion of breastfed and non-breastfed children aged 6 to 23 months

who received solid, semi-solid, soft foods or milk feeds the minimum number of times or more during the

previous day. These minimum feeding frequencies are based on the energy needs estimated from age-

specific total daily energy requirements. To be considered acceptable, breastfed infants aged 6-8 months

should be fed meals of complementary foods two to three times per day, with one to two snacks as desired;

breastfed children aged 9-23 months should be fed meals three to four times per day, with one to two snacks.

Non-breastfed children should be fed the seven food groups used to calculate this indicator are: grains, roots

and tubers; legumes and nuts; dairy products; flesh foods; eggs; vitamin A rich fruit and vegetables; other

fruits and vegetables [15]

The result from the survey is shown in table 12, only 26.4% (n=469) of children 6-23 months were fed the

recommended number of times during the 24 hours preceding the interview; disaggregated by LGAs is

28.4%, 25.6%, 33.7% and 22.1% for Jere, Konduga Mafa and MMC respectively. 3 out of 8 FDGs

participants

Minimum Acceptable Diet (6-23 Months)

Minimum acceptable diet indicator combines standards of dietary diversity and feeding frequency by

breastfeeding status for children 6-23 months of age. For breastfed children it means considering only those

children aged 6 to 23 months who have received both the minimum dietary diversity and the minimum meal

frequency in the last 24 hours.

Table 12 shows that overall, only 15.3% (n=272) of children aged 6-23 months (breastfed and non-

breastfed) received the minimum acceptable diet during the previous day, reflecting generally poor IYCF

practices.

Consumption of Iron-rich or Iron Fortified Foods (6-23 Months)

Micronutrient deficiency is a major contributor to childhood morbidity and mortality. Children can receive

micronutrients from foods, food fortification, and direct supplementation. Iron is essential for red blood cell

formation and cognitive development, and low iron intake can contribute to anaemia[1⁶]. Iron requirements

are greatest at age 6-23 months, when growth is extremely rapid. Findings from this survey (Table 12) show

that overall, 8.8% (n=1779) of children 6-23 months consumed iron rich food or iron fortified food in the

24 hours prior to the survey. Among the LGAs, the proportion of children 6 to 23 months who consumed

iron ranges from 14.2% in Mafa to 6.2% in Jere.

25

Table 12: Minimum dietary diversity, Minimum Meal Frequency, Minimum Acceptable Diet & Consumption of

Iron rich foods

LGAs

Indicators

Minimum Dietary Diversity (6-23)

Minimum Meal Frequency (6-23)

Minimum Acceptable Diet (6-23)

Consumption of Iron (6-23 )

(n=1779) (n=1779) (n=1779) (n=1779)

Jere 28.4% (21.8% - 36.4%) 32.7% (29.4% - 36.2%) 15.9% (13.4% - 18.7%) 6.2% (4.6% - 8.1%)

Konduga 25.6% (14.0% - 42.8%) 33% (26.3% -40.1%) 15.3% (10.6% - 21.2%) 9.1% (5.5% - 14.0%)

Mafa 33.7% (21.1% - 50.8%) 32.7% (26.5% - 39.3%) 20% (15.0% - 25.9%) 14.2% (9.9% - 19.4%)

MMC 22.1% (16.2% - 29.5%) 33% (29.5% - 36.6%) 13.1% (10.7% - 15.8%) 9.9% (7.8% - 12.3%)

Overall 26.4% (22.1% - 31.2%)

32.8% (30.7% - 35.0%)

15.3% (13.7% - 17.0%)

8.8% (7.5% - 10.2%)

4.2.3 IYCF Optional Indicators Table 13: Children ever breastfed, Continued BF at 2yrs

LGAs

Indicators

Children ever breastfed (0-23) Continued Breastfeeding (20-23 months(

(n=2127) (n=461)

Jere 93.3% (91.5% - 94.9%) 36.6% (30.2% - 43.3%)

Konduga 87.8% (83.1% - 91.6%) 17.9% (7.2% - 34.8%)

Mafa 91.2% (87.2% - 94.2%) 40% (27.8% - 53.2%)

MMC 92.9% (91.0% - 94.6%) 24.% (18.9% - 31.7%)

Overall 92.3% (91.3% - 93.4%) 31.5% (27.3% - 35.8%)

Children Ever Breastfed

This indicator refers to those infants, aged 0-23 months, who have been put to breast, even if only

once. The results show that the awareness and practice of breastfeeding is a common practice

within the surveyed LGAs, with 92.3% (n=2127) of children ever breastfed (table 13). NNHS

2018 survey report [10] children ever breastfed as 97% of in Borno and in the same year a UNICEF

report on breastfeeding[11] estimated this to be 95% of children in Nigeria. Although this surveys’

estimate is significantly lower than the NNHS and UNICEF estimates, it still falls within the lower

bound of the UNICEF estimate, further research is needed to validate this finding.

26

on bresa. Disaggregated data although not representative shows that the highest percentage of

children ever breastfed to be (93.3 %) in Jere and the lowest being Konduga (87.8%).

4.3 Child Health

Vitamin A Supplement Coverage

Improving the vitamin A status of deficient children through supplementation enhances their resistance to

disease and can reduce mortality from all causes by approximately 23 per cent. High supplementation

coverage is therefore critical, not only to eliminating vitamin A deficiency as a public-health problem, but

also as a central element of the child survival agenda [11].

Figure 1: Vita A supplementation by LGAs

In Africa, Vitamin A deficiency (VAD) alone is responsible for almost 6% of child deaths under the age of

5 years. survey results show that only about 54% of the children aged between 6 to 59 months received

Vitamin A supplement in the 6 months prior to the survey (N.B - caregivers where not asked to show

vaccination cards). This implies that about 45% of children in the 4 LGAs that did not receive the

supplement, may be growing up with VAD.

Deworming Treatment Coverage

Soil-transmitted helminth infections are among the most common infections in humans, caused by a group

of parasites commonly referred to as worms, including roundworms, whipworms and hookworms.

Preventive chemotherapy (deworming), using annual or biannual single-dose albendazole (400 mg) or

27

mebendazole (500 mg)b is recommended by WHO as a public health intervention for all young children

12–23 months of age, preschool children 1–4 years of age, and school-age children 5–12 years of age[12].

Figure 2: Deworming treatment coverage by LGA

Using the 6 months recall period, findings from this study presents the coverage of deworming treatment

at 42% (n=1272), while Mafa LGA has the highest deworming coverage Konduga LGA at 55.4% reported

the least coverage at 32.1%(N.B - caregivers where not asked to show vaccination cards).

Measles Vaccination Coverage

Measles is a highly contagious viral respiratory tract infection known to be an important cause of death and

acute malnutrition among young children particularly in emergency contexts wherein 1 to 5 percent of

children with measles may die from complications of the disease [13].

Measles vaccination is one of the immunizations provided as part of the Nigerian Expanded Programme on

Immunization (EPI), a program initiated in 1979. A child is considered adequately immunized against

measles after receiving only one dose of vaccine (around 9 months of age). Currently, a second dose of

measles vaccination has been introduced in Nigeria with implementation staggered and expected to cover

the whole country by the end 2020.

Figure 3: Meals coverage by LGA

28

Mothers/caregivers of children above 9 months of age were asked to present vaccination cards to

enumerators to confirm measles vaccination status of the child, measles is refered to in the local Hausa

languge as “cutar kyanda”. If the child had no vaccination card, the respondents were asked to recall if the

vaccine was given to the child. Overall, measles vaccination coverage among children 12-59 months as

determined by observation of vaccination card or maternal recall was 85.1% (1544).

Diarrhea

Mothers (or caregiver) were asked whether any of their children under five had an illness at any time during

the preceding two weeks. 49.9% (n=2137) of respondents reported their children had an illness within the

recall period, the distribution across LGAs is thus 49.3%, 48.2%, 48.5% and 51.5% in Jere, Konduga, Mafa

and MMC respectively. 69.1%(n=1066) of respondents reported diarrhea as the ailment that the children

suffered from (Fig 4). Mafa recorded the highest prevalence of diarrhea at 77% while Jere recorded the

lowest prevalence at 67.5%. 36.2% of respondents indicated they sought treatment for their children that

suffered from diarrhea at a hospital, 24.9%,11.7% and 6.3% from Pharmacy/Dispensary, PHCs and

community health workers respectively. 55.3% of the mothers/caregivers indicated they sort treatment

immediately, 31.9% within 48 hours and 12.8% after 48 hours.

Figure 4: Diarrhea prevalence

29

4.4 Mothers/Caretakers Knowledge of IYCF and Hygiene

30

Figure 5: caregivers IYCF knowledge (MSG vs none MSG members) by LGAs

Questions in table 15 below were asked to caregivers to further uncover other attitudes and practices

towards feeding their child(ren). Overall, a majority of caregivers reported cleaning utensils before

feeding a child (98%), washing the child’s hands before feeding them (97%) and covering the child's

food after cooking (97%). It is interesting to see that 32% of caregivers force their children to eat and

15% do not reheat leftover meals before feeding their child(ren).

Table 15: IYCF Hygiene

Question Respon

se

LGA

Jere Konduga Mafa MMC Overall

Do you clean utensils before feeding a child? i.e Child (ren)

under 24 months

no 3.15% 0.96% 0.81% 2.43% 2.40%

yes 96.73% 99.04% 99.19% 97.57% 97.60%

Do you wash the hands of children before feeding?

no 3.27% 0.48% 0.81% 3.24% 2.70%

yes 96.35% 99.52% 99.19% 96.76% 97.20%

Do you cover your child’s food after cooking?

no 2.64% 0.48% 3.25% 3.10% 2.70%

yes 97.23% 99.52% 96.75% 96.90% 97.30%

Do you reheat leftover food before serving your child?

no 17.51% 25.36% 10.57% 9.58% 14.50%

yes 81.74% 74.64% 89.43% 90.42% 85.20%

31

Do you force your child(ren) to eat?

no 68.14% 76.56% 58.13% 69.64% 68.30%

yes 31.49% 23.44% 41.87% 30.23% 31.50%

Do you support your child while they are eating (like talking

to them)?

no 23.30% 28.71% 16.26% 19.16% 21.50%

yes 76.32% 71.29% 83.74% 80.84% 78.40%

4.5 Maternal Nutrition and Health

Maternal nutrition focuses on women as mothers, on their nutritional status as it relates to the

bearing and nurturing of children. Overall only 17% of women surveyed were enrolled in a State

or NGO funded nutrition program i.e targeted supplementary feeding programme (TSFP), the

disaggregated results are similar across all 4 LGAs. Women of reproductive age (15 - 49 years)

were asked to list all of the food items they ate in the previous day and their responses were placed

within the 10-food group category to assess the proportion of women that met the minimum dietary

diversity (MDD-W) in the survey area. The results showed that overall, only 34% (667) of assessed

women met MDD criteria of consuming 5 or more food groups in the previous day or night and

there were no significant difference between LGAs; Jere 32% (258), Konduga 38% (79), Mafa

39% (97) and Maiduguri 32% (233).

4.6 Maternal Hygiene

96% of surveyed women reported washing hands with a cleaning agent the last time they washed

their hands and of this proportion, 86% used soap while 6% ash this result is consistent across the

4 assessed LGAs. Enumerators asked women who reported using soap if they could see the soap

and overall, only 19% of women could not provide the soap, the result is slightly higher in

Konduga 23% and Mafa 25%.

32

Figure 6: caregivers knowledge on critical handwashing times by LGAs

Knowledge of 3-5 critical hand washing times was high amongst caregivers, however, Jere LGA had the

lowest proportion 70%. Overall, the most practiced hand washing was ‘before eating’ 87%, ‘after

defecating’ 79%, ‘before preparing food’ 68%, ‘before feeding child’ 60% and ‘after cleaning a baby’s

bottom’ 51%.

Caregivers were asked where they went to the last time they defecated and an overwhelming majority 83.5%

used a latrine while 12% reported digging a hole to defecate, 3% reported open defecation and a very small

proportion (0.2%) reported defecating in a river.

4.7 Water, Sanitation & Hygiene (WASH)

Access to water supply and sanitation facilities has considerable health and economic importance to both

households and individuals. Lack of access to safe drinking water and inadequate disposal of human excreta

are associated with a range of diseases, including diarrhea, schistosomiasis and intestinal helminths [16]

33

4.7.1 Water

Table 16: Water Indicators

Characteristics

Jere Konduga Mafa MMC AVE.(%)

(n=1990)

n=794

(Freq.%)

n=209

(Freq.%)

n=246

(Freq.%)

n=741

(Freq.%)

What is the main

source of water

used by your

household for

drinking?

borehole

bottled_sachet

handpump

open_rainwater

open_well

piped_dwelling

protected_spring

public_tap

sealed_well

spring

surface_water

water_truck

water_vendor

495(62.3%

0(0.0%)

76(10.1%)

0(0.0%)

14(2.1%)

9(1.1%)

1(0.1%)

50(6.3%)

26(3.3%)

0(0.0%)

1(0.1%)

4(1.0%)

118(15.1%)

155(74.2%)

0(0.0%)

19(9.1%)

0(0.0%)

4(2.0%)

0(0.0%)

0(0.0%)

10(5.1%)

0(0.0%)

1(0.5%)

8(4.0%)

0(0.0%)

12(6.0%)

151(61.4%)

8(3.3%)

6(2.4%)

0(0.0%)

0(0.0%)

1(0.4%)

0(0.0%)

8(3.3%)

0(0.0%)

0(0.0%)

0(0.0%)

0(0.0%)

72(29.3%)

444(60.0%)

1(0.1%)

46(6.2%)

1(0.1%)

8(1.1)

5(1.1%)

0(0.0%)

15(2.2%)

38(5.1%)

0(0.0%)

1(0.1%)

32(4.3%)

150(20.2%)

1245(63.0%)

9(1.0%)

147(7.4%)

1(0.1%)

26(1.3%)

15(1.0%)

1(0.1%)

83(4.2%)

64(3.2%)

1(0.1%)

10(1.0%)

36(1.8%)

352(18.0%)

Does your

household treat

water to make it

safer to drink?

N0

Yes

483(61.0%)

311(39.2)

158(76.0%)

51(24.4%)

139(57.0%)

107(44.0%)

464(63.0%)

277(37.4%)

1244(63.0%)

746(38.0%)

How do you treat

the water?

aquatabs_tablets

boil

disinfection_product

dnk

expose_sunlight

filter_it

liquid_clorine

powder_clorine

stand_settle

watermaker

51(18.0%)

3(1.0%)

7(2.4%)

1(0.3%)

12(4.1%)

114(39.2%)

26(9.0%)

13(4.5%)

63(22.1%)

1(0.3%)

0(0.0%)

1(2.0%)

1(2.0%)

0(0.0%)

11(22.5%)

4(8.2%)

8(16.3%)

0(0.0%)

2449.1%)

0(0.0%)

1716.1%)

8(7.5%)

22.1%)

0(0.0%)

4(4.0%)

52(49.0%)

6(6.0%)

0(0.0%)

17(16.1%)

1(1.0%)

39(15.3%)

21(8.2%)

4(2.1%)

1(0.4%)

9(4.0%)

98(38.4%)

25(10.0%)

11(4.3%)

46(18.0%)

1(0.4%)

107(15.2%)

33(5.0%)

14(2.0%)

2(0.3%)

36(5.1%)

268(38.2)

65(9.3%)

24(3.4%)

150(21.4%)

3(0.4%)

Access to Improved Water Source

Access to an improved water source refers to the percentage of the population using improved drinking

water source. The improved drinking water source includes piped water on premises (piped household water

connection located inside the user’s dwelling, plot or yard), and other improved drinking water sources

34

(public taps on standpipes, tube wells or boreholes, protected dug wells, protected springs, and rainwater

collection)

Overall, 97.6% (n=1990) of HHs within the LGAs of this study have access to improved water sources for

drinking and HHs chores. This finding meets the global WHO standard (emergency) for access to improved

water sources, which is pegged at ≥ 70[18]. This finding is also in pari passu with that of REACH, which

reported about 75% [19] of surveyed households with access to improved water sources.

Treatment of Drinking Water

39% of HHs reported, they treat their drinking water while 61% of the HHs reported `no treatment`. The

use of Filter is the most common medium of water treatment cited by 39.2%%, followed by Sand settle

cited by 22.1% , 18% reported the use of aquatabs tablets, 9% cited liquid chlorine, and 4,5% powder

chlorine.

Challenges in Accessing Water point

Table 17: Access to Water points

Characteristics

Jere Konduga Mafa MMC

AVE.(%)

(n=1990)

n=794

(Freq.%)

n=209

(Freq.%)

n=246

(Freq.%)

n=741

(Freq.%)

What are

the

problems

your

household

has with

collecting

water?

No problem

Long distance to water point

Long queue time at water point

Water Point is not safe in general (insecurity, harassment, physical violence,

kidnapping)

Water point is not safe for women (risk of sexual harassment or attack)

Waterpoint is not safe due to presence of explosive hazards

Water point is too expensive

Water point is dirty

Water point is not easy to operate

Water is not functional/needs fixing

Water point gives bad quality water

Other

No response

Don’t know

412(52.1%)

179(23.0%)

246(31.1%)

4(1.0%)

3(0.4%)

20 (3%)

60(8.1%)

24(3.0%)

39(5.0%)

14(2.1%)

10(1.3%)

6(1.1%)

6(1.1%)

6(1.1%)

97(46.4%)

68(33.0%)

79(38.0%)

8(4.0%)

1(0.5%)

1(0.5%)

13(6.2%)

6(3.1%)

1(0.5%)

16(8.1%)

0(0.0%)

0(0.0%)

1(0.5%)

0(0.0%)

103(42.1%)

87(35.4%)

100(41.1%)

2(1.0%)

1(0.4%)

1(0.4%)

26(11.1%)

1(0.4%)

4(2.0%)

4(2.0%)

6(2.4%)

6(2.4%)

0(0.0%)

2(0.81%)

377(51.1%)

200(27.1%)

215(29.0%)

9(1.2%)

2(0.3%)

5(1.1%)

51(7.1%)

18(2.4%)

10(1.4%)

33(4.5%)

7(1.0%)

6(1.0%)

1(0.1%)

4(1.0%)

989(50.0%)

534(27.0%)

640(32.2%)

23(1.2%)

7(0.4%)

9(1.0%)

150(8.0%)

49(2.5%)

54(3.1%)

67(3.4%)

23(1,2%)

18(1.0%)

8(0.4%)

12(1.0%)

How long

does it take

to collect

water from

your main

water

source,

including

traveling

back and

forth and

15-30 Minutes

1-2 Hours

30 Minutes-1hour

Don't Know

Greater than 2 hours

Less than 15 Minutes

No Travel

other

190(24.2%)

56(7.1%)

96(2.2%)

8(1.0%)

20(3.1%)

297(38.1%)

113(14.4%)

4(1.0%)

40(19.3%)

14(7.1%)

32(15.5%)

1(0.5%)

7(3.4%)

100(48.3%)

13(6.3%)

0(0.0%)

56(23.3%)

12(5.0%)

41(17.1%)

11(5.1%)

13(5.4%)

84(35.0%)

21(9.0%)

2(1.0%)

186(25.4%)

41(6.0%)

71(10.0%)

18(2.5%)

23(3.2%)

252(34.5%)

137(19.0%)

3(0.4%)

472(24.1%)

123(6.3%)

240(12.2%)

38(2.0%)

63(3.2%)

733(37.4%)

284(15.0%)

9(1.0%)

35

queuing

time?

50% (n=1990) of respondents cited they do not face any challenge or face any problem in accessing water

for household use. 32.2% cited Long queue time at water point, and 27% cited Long distance to water point

as challenges in accessing water.

Moreso, 37.4% of respondents reported it takes them less than 15 minutes to access water, 24.1% within

15-30 minutes, 15% need not travel to access water, and 12.2% have to travel 30 minutes to 1 hour to access

water for household use.

4.8 Child Protection Save the Children defines child protection as measures and structures to prevent and respond to abuse,

neglect, exploitation and violence affecting children. Child protection means safeguarding children from

harm which includes violence, abuse, exploitation and neglect. 79% of respondents reported knowing about

child protection issues in their community and when asked to list some of the situations that put children in

danger in their community, basic needs not met (67%) and No access to school or to health care (29%) were

the most frequently mentioned (see table 18 below), also there was no significant difference across LGAs.

Table 18: Child Protection Issues

Child Protection Issues Percentage

Basic needs not met (food, shelter, clothing) 67%

No access to school or to health care 29%

Domestic violence 9%

Children living in the streets 8%

Harmful child labour 8%

Peer Pressure 8%

Abuse and exploitation of children 6%

Abandonment by parent or guardian 4%

Teenage pregnancy 3%

Corporal Discipline 2%

Drugs or liquor 2%

36

Giving children to other people 2%

Unsafe migration (e.g., child goes away to work) 1%

Child Soldiers 1%

Less than a third of the overall sampled household (29%) did not know of any law in Nigeria about care

and safety of children. 41% of households reported having a place in the community where children can go

if they are abused (physical, sexual, psychological etc) or if they run away from home. An overwhelming

87% reported that the community leader's house was that place, followed by social worker and NGO (19%)

and a community members house (14%).

Overall, 73% of respondents said they do report when they see or hear of children experiencing abuse at

home or in the community and 25% would confront the perpetrators, 14% would comfort the child while

8% would not report

Table 19: Report of Child Protection Issues

Jere Konduga Mafa MMC Average

Report 69% 81% 82% 73% 73%

Confront the perpetrator 25% 18% 28% 26% 25%

Comfort the child 15% 7% 18% 14% 14%

Keep quiet/do nothing 10% 6% 10% 7% 8%

Of the proportion of household that do report cases of child abuse, 70% report to bulama (community

leader) and 12% family member. Other reporting channels mentioned by respondents include

Police/Army/CJTF (8%) and NGO staff (4%). For the 10% of respondent that do not report cases of child

abuse, the main reasons for their silence include; dont know where to report (64%), fear of retaliation (14%),

none of my business (13%) and no action is likely to be taken (11%). 57% of respondents heard about

NGO/Government agencies providing child services in their community.

There is accumulating evidence that community perception of what constitutes child protection plays an

important role in communities’ response and action in cases of child abuse. Respondents were provided

with a list of comments regarding perception of what constitutes a protection issue and asked whether they

agree or disagree (Table 19).

Table 20; Child protection KAP

Question Agree Disagree

It is justified to beat children for discipline and correction 55% 45%

Children with disabilities or special needs should not go to school 30% 69%

Girls under 18 years should be given out to marriage 30% 69%

37

Girls should be forced to marry partners chosen for them by their parents or

families 8% 92%

It is sometimes justified for parents to send children to hawk on the streets 18% 81%

Boys should be sent to school in preference to girls 19% 79%

From the table 20 above it is clear that most respondents (55%) approve of beating children for discipline

and correction. Although most respondents (92%) did not agree that a girl should be forced into marriage,

30% of respondents agreed that a girl under the age of 18 should be given out to marriage. In terms of

education, 19% of respondents think boys should be sent to school in preference of girls and a worrying

30% of respondents feel children with disabilities or special needs should not go to school. FGDs

participants say marriage of girls under 18 is common and once parents feel a girl is ready, they can give

her out to marriage notwithstanding her age.

4.9 Covid-19 Awareness

Respondents awareness on covid-19 risks and mitigation to protect their household and communities. When

respondents were asked if they knew of any measures to prevent themselves and those around them from

getting sick from Coronavirus, the majority (80%) of respondents reported constant hand washing, and

keeping a safe distance from others (66%). disaggregation of the data showed no significant difference

between LGAs.

Figure 7: Awareness on covid-19 risks and mitigation

Respondents were asked if they know how covid-19 is spread and as in figure below 71% of respondents

reported direct contact with infected people, 50% reported droplets from infected people and touching

38

contaminated objects or surfaces (43%). It's worth noting that 13% of respondents did not know how Covid-

19 is transmitted. In case they become sick with covid type symptoms, 67% of respondents said they would

go to a hospital while 20% would call health authorities. Went asked about their source of information on

covid 86% said they got information from the radio while 20% and 19% received corona information from

family members and friends respectively.

Figure 8: Mode of Transmission of COVID-19

39

5. Conclusion Good maternal nutrition can help ensure children are healthy from birth and when women are informed,

empowered and supported to breastfeed, the benefits extend beyond their children, to themselves and to

society as a whole. Overall results from this survey shows that the practice of exclusive breastfeeding in

the survey area (66%) is slightly higher than baseline (62.7%) conducted by SCI in the 2019 but

significantly higher than NFSS 8 2019 estimate (45.3%). It is important to note that this survey and the

baseline covered only SCI programme areas while the NFSS covered the entire LGA, the EBF results

however, indicates an improvement in mothers breastfeeding practices. Earlier initiation to breastfeeding

practice (82%) is slightly higher than the baseline estimate (79.2%) but continued breastfeeding at 1-year

practice is significantly lower (90%) when compared to the baseline (99%). Introduction of solid, semi-

solid or soft food practice is in line with Nigeria National Nutrition and Health Survey. Overall, child breast

feeding indicators seem to be in line or showing better results than the baseline and other nutrition surveys,

however, breastfeeding practices is still poor as about 7% of assessed children were not breastfeed and SDG

targets for EBF has not been achieved.

Malnutrition remains the leading cause of poor health, wasting and stunting in children, even less visible is

hidden hunger which is as a result of deficiencies in vitamins and other essential nutrients. In line with the

baseline, MMF, MMD and MAD results in the survey area are really poor which according to FGDs is

mainly caused by of lack of resources to buy nutritious food in the right quantity. This poor food intake by

children 0-23 months in the households signals a broader issues of household food insecurity as a lot of

households have been affected by the conflict which have disrupted their means of livelihood. To buttress

this, a large proportion of women of reproductive age women (15 - 49 years) did not consume the required

5 out of the 10 food groups categories required to meet the minimum dietary diversity which means women

are physically unable to exclusively breastfeed on continue breastfeeding their children for long.

The survey shows a significant difference in general IYCF knowledge between caregivers who are part of

MSG and mothers who are not, as mothers who are part of MSG have more robust IYCF knowledge and

are more able to practice them. Most of the surveyed communities do have access to improved water but a

lot still face problems of long distance and queuing time. FGDs participants complained of not having

adequate containers for collecting and storing water. And although most caregivers reported using latrine,

40

a small proportion still continue to practice open defecation (defecating in bushes and rivers) and most

caregivers know about the critical hand washing times and handwashing with soap.

The majority of respondent reported being aware of child protection and could identify child protection

issues, however a lot of the issues mentioned revolved around child’s needs and access to services and not

a lot of social and emotional related child issues were mentioned, this maybe because of cultural norms as

some of this issues were seen as normal (child beating, early marriage etc). A high proportion of

respondents said they do report cases of child abuse to community leaders and identify the community

leaders house as the safe haven for children suffering abuse in the community. This implies a heavy reliance

on community structure to deal with child protection cases and the fact that only a few respondents know

about any laws that protect the right of children further enhance the reliance and use of community

mechanism and authority in dealing with child protection issues as most community members may not be

aware of other referral channels.

Finally, the communities seem to have fairly good knowledge on how Covid-19 is spread and can be

prevented. The main source of covid-19 information in the community is mainly from the radio and then

from family and friends in that order.

5.1 Recommendation

━ The fact that ever breastfeeding rates are low, suggests that women are not being provided with

sufficient information and support. This are areas that requires urgent attention. It is important that

increase awareness of the important of child breastfeeding is bolstered. Because of the current

Covid pandemic, MSG meetings and house to house visit are not as frequent. Mediums like radio,

health facility and community leaders to should be used in raising awareness of child breastfeeding.

It is also critical that maternity facilities are able to provide breastmilk for sick born, separated

children and children who have lost their mothers as a result of death during child birth or conflict.

━ Also to be packaged in the sensitization message above is the awareness on breastfeeding from

birth through two years’ age and why this is important for a child.

━ SCI should support the implementation of the ten steps to successful breastfeeding developed by

UNICEF and WHO in all supported health facilities

━ SCI should also work to strengthen the link between health facilities and communities to ensure

continued support for breastfeeding and this should be continues tracked and monitored to see

improvement in breastfeeding practices.

━ Since iron rich foods like liver, red meats, eggs and fish, are not widely available or affordable,

SCI support the distribution of fortified food to children and iron/folate supplement for pregnant

mothers.

41

━ Although a lot of women cannot afford a nutritious diet and struggle to meet their full dietary

requirement especially during pregnancy and breastfeeding, SCI can support these women through

conditional cash transfer programme for PLW integrated with food diversification programme to

teach women how to utilize home yard/garden to provide nutritious food the family and a

behavioral change campaign around consumption of nutritious food.

━ It is evident from the survey that women who were part of an MSG had significantly better IYCF

knowledge which has the potential to better the nutrition and health outcome of the child.

Community sensitization on the benefits of being part of MSG needs to be improved. Caregivers

need to be encouraged and motivated to join MSG. This can be done through sensitization

campaigns using existing community structure (gate keepers), discussions with mothers to

understand barriers to participating in MSG and further incorporation of livelihood activities into

the MSG design. Consideration should also be given to house to house visits by MSG volunteers

in areas where MSG are currently not very active.

━ From the survey it is clear that the communities rely heavily on community mechanism to deal with

child protection issues, this creates both a problem and an opportunity as on the one hand heavy

reliance on community mechanism may mean that lots of child protection issues would continue

undedicated because of cultural norms but on the other hand it creates an opportunity to design and

implement a thoroughly community led child protection strategy. Community child protection

mechanisms need to be reinforced and realigned with the national child protection laws. Further

research is required to properly understand these community systems and how it can be aligned to

the national child protection response.

━ A significant proportion of the surveyed community think children with disability should not go to

school and that it is preferable to send a boy rather than a girl to school. This community perception

hinders the achievement of gender and disability inclusive education. This perception, coupled with

the fact that 27% of beneficiaries reported have difficulty with atleast one function (using WGS),

it is critical that SCI programmes are designed to include vulnerable groups (young girls and

disabled children) and there is a need for serious community sensitization around issues of gender

and disability.

━ From FGDs with fathers, a reoccurring theme was that fathers understood their role in the family

to be that of a provider and protector and nothing more. Because of this perception, father are not

getting very involved in their children’s nutrition. Therefore, a sustained scale up of child nutrition

and awareness campaigns specifically targeting fathers which could also be organized through the

community structure. We recommend bolstering the father support group programme.

42

━ There is a need to increase awareness on hand washing, the danger of drinking water from unsafe

water sources and open defecation which are the root causes of many diarrheal and water-borne

diseases. In light of Covid, these personal hygiene messages are even more critical. SCI staffs

should deliver hand washing and Covid-19 messages at every point of contact with beneficiaries

and the community. This should be implemented throughout all the stages of implementation and

by every staff in the organization.

━ Community child protection mechanisms need to be reinforced and realigned with the national

child protection laws as the majority of beneficiaries including some community leaders did not

know national child protection laws. Further research is required to properly understand these

community systems and how it can be aligned to the national child protection response.

━ Finally, SCI should consider a multi-sectoral approach that address all the sectoral needs of

children, mothers and households. Further research would be needed to fully understand the needs

of community in other to design an effective approach.

43

━

44

Annex 1-IYCF Results

Count

Column

N %

95.0%

Lower

CL for

Column

95.0%

Upper

CL for

Column Count

Column

N %

95.0%

Lower

CL for

Column

95.0%

Upper

CL for

Column Count

Column

N %

95.0%

Lower

CL for

Column

95.0%

Upper

CL for

Column Count

Column

N %

95.0%

Lower

CL for

Column

95.0%

Upper

CL for

Column Count

Column

N %

95.0%

Lower

CL for

Column

95.0%

Upper

CL for

Column

immediat

e637 79.9% 77.0% 82.6% 166 85.1% 79.6% 89.6% 214 90.3% 86.0% 93.6% 594 80.8% 77.9% 83.5% 1611 82.0% 80.3% 83.7%

after_first

_hr_first_

24_hr

115 14.4% 12.1% 17.0% 21 10.8% 7.0% 15.7% 14 5.9% 3.4% 9.5% 105 14.3% 11.9% 17.0% 255 13.0% 11.6% 14.5%

after_24_

hrs

35 4.4% 3.1% 6.0% 7 3.6% 1.6% 6.9% 8 3.4% 1.6% 6.3% 32 4.4% 3.1% 6.0% 82 4.2% 3.4% 5.1%

no_respo

nse

10 1.3% 0.6% 2.2% 1 0.5% 0.1% 2.4% 1 0.4% 0.0% 2.0% 4 0.5% 0.2% 1.3% 16 0.8% 0.5% 1.3%

no 659 91.0% 88.8% 92.9% 163 93.1% 88.7% 96.2% 188 91.7% 87.3% 94.9% 625 93.3% 91.2% 95.0% 1635 92.2% 90.8% 93.3%

yes 64 8.8% 6.9% 11.1% 12 6.9% 3.8% 11.3% 16 7.8% 4.7% 12.1% 43 6.4% 4.7% 8.5% 135 7.6% 6.4% 8.9%

no_respo

nse

1 0.1% 0.0% 0.6% 1 0.1% 0.0% 0.7% 2 0.1% 0.0% 0.4%

don't_kno

w1 0.5% 0.1% 2.3% 1 0.1% 0.0% 0.7% 2 0.1% 0.0% 0.4%

no 783 91.7% 89.7% 93.4% 193 86.9% 82.0% 90.9% 223 85.8% 81.1% 89.6% 698 88.2% 85.9% 90.3% 1897 89.2% 87.8% 90.5%

yes 71 8.3% 6.6% 10.3% 29 13.1% 9.1% 18.0% 37 14.2% 10.4% 18.9% 93 11.8% 9.7% 14.1% 230 10.8% 9.5% 12.2%

no 57 6.7% 5.1% 8.5% 27 12.2% 8.4% 16.9% 23 8.8% 5.8% 12.8% 56 7.1% 5.4% 9.0% 163 7.7% 6.6% 8.9%

yes 797 93.3% 91.5% 94.9% 195 87.8% 83.1% 91.6% 237 91.2% 87.2% 94.2% 735 92.9% 91.0% 94.6% 1964 92.3% 91.1% 93.4%

no 14 7.6% 4.4% 12.0% 5 13.9% 5.5% 27.8% 5 11.6% 4.6% 23.6% 17 10.6% 6.6% 16.1% 41 9.7% 7.1% 12.8%

yes 171 92.4% 88.0% 95.6% 31 86.1% 72.2% 94.5% 38 88.4% 76.4% 95.4% 143 89.4% 83.9% 93.4% 383 90.3% 87.2% 92.9%

no 130 63.4% 56.7% 69.8% 23 82.1% 65.2% 92.8% 33 60.0% 46.8% 72.2% 130 75.1% 68.3% 81.1% 316 68.5% 64.2% 72.7%

yes 75 36.6% 30.2% 43.3% 5 17.9% 7.2% 34.8% 22 40.0% 27.8% 53.2% 43 24.9% 18.9% 31.7% 145 31.5% 27.3% 35.8%

no 29 30.9% 22.2% 40.7% 7 18.9% 8.9% 33.6% 15 60.0% 40.6% 77.3% 36 40.0% 30.3% 50.3% 87 35.4% 29.6% 41.5%

yes 65 69.1% 59.3% 77.8% 30 81.1% 66.4% 91.1% 10 40.0% 22.7% 59.4% 54 60.0% 49.7% 69.7% 159 64.6% 58.5% 70.4%

0 72 9.9% 7.9% 12.2% 15 8.5% 5.1% 13.3% 28 13.7% 9.5% 18.9% 97 14.5% 12.0% 17.3% 212 11.9% 10.5% 13.5%

1 178 24.5% 21.4% 27.7% 52 29.5% 23.2% 36.6% 42 20.5% 15.4% 26.4% 187 27.9% 24.6% 31.4% 459 25.8% 23.8% 27.9%

2 165 22.7% 19.7% 25.8% 36 20.5% 15.0% 26.9% 34 16.6% 12.0% 22.1% 137 20.4% 17.5% 23.6% 372 20.9% 19.1% 22.8%

3 106 14.6% 12.1% 17.3% 28 15.9% 11.1% 21.8% 32 15.6% 11.1% 21.0% 101 15.1% 12.5% 17.9% 267 15.0% 13.4% 16.7%

4 82 11.26% 9.12% 13.71% 14.00 7.95% 4.63% 12.64% 25.00 12.20% 8.25% 17.20% 68.00 10.15% 8.03% 12.61% 189.00 10.62% 9.26% 12.12%

5 57 7.83% 6.04% 9.95% 14.00 7.95% 4.63% 12.64% 23.00 11.22% 7.45% 16.08% 33.00 4.93% 3.48% 6.76% 127.00 7.14% 6.01% 8.41%

6 34 4.67% 3.31% 6.39% 9.00 5.11% 2.56% 9.12% 12.00 5.85% 3.24% 9.70% 33.00 4.93% 3.48% 6.76% 88.00 4.95% 4.01% 6.03%

7 34 4.67% 3.31% 6.39% 8.00 4.55% 2.17% 8.39% 9.00 4.39% 2.19% 7.86% 14.00 2.09% 1.20% 3.39% 65.00 3.65% 2.86% 4.60%

MMD 207 28.4% 21.8% 36.4% 45 25.6% 14.0% 42.8% 69.00 33.7% 21.1% 50.8% 148.00 22.1% 16.2% 29.5% 469.00 26.4% 22.1% 31.2%

no 490 67.3% 63.8% 70.6% 118 67.0% 59.9% 73.7% 138 67.3% 60.7% 73.5% 449 67.0% 63.4% 70.5% 1195 67.2% 65.0% 69.3%

yes 238 32.7% 29.4% 36.2% 58 33.0% 26.3% 40.1% 67 32.7% 26.5% 39.3% 221 33.0% 29.5% 36.6% 584 32.8% 30.7% 35.0%

no 612 84.1% 81.3% 86.6% 149 84.7% 78.8% 89.4% 164 80.0% 74.1% 85.0% 582 86.9% 84.2% 89.3% 1507 84.7% 83.0% 86.3%

yes 116 15.9% 13.4% 18.7% 27 15.3% 10.6% 21.2% 41 20.0% 15.0% 25.9% 88 13.1% 10.7% 15.8% 272 15.3% 13.7% 17.0%

no 683 93.8% 91.9% 95.4% 160 90.9% 86.0% 94.5% 176 85.9% 80.6% 90.1% 604 90.1% 87.7% 92.2% 1623 91.2% 89.8% 92.5%

yes 45 6.2% 4.6% 8.1% 16 9.1% 5.5% 14.0% 29 14.1% 9.9% 19.4% 66 9.9% 7.8% 12.3% 156 8.8% 7.5% 10.2%

Continued

Breastfeeding

(20-23)Introduction to

Semi Solid/Solid

Food (6-8 )

Minimum

Dietary

Diversity

Minimum Meal

Frequency

Minimum

Acceptable Diet

Consumption of

Iron

overall

Initiation to

breastfeeding

Bottle feeding

Eclusive

breasfeeding

Ever breastfed

Continued

Breastfeeding

(12-15)

lga

jere konduga mafa mmc

45

Count

Colum

n N %

95.0%

Lower

CL for

Colum

n N %

95.0%

Upper

CL for

Colum

n N % Count

Colum

n N %

95.0%

Lower

CL for

Colum

n N %

95.0%

Upper

CL for

Colum

n N % Count

Colum

n N %

95.0%

Lower

CL for

Colum

n N %

95.0%

Upper

CL for

Colum

n N % Count

Colum

n N %

95.0%

Lower

CL for

Colum

n N %

95.0%

Upper

CL for

Colum

n N % Count

Colum

n N %

95.0%

Lower

CL for

Colum

n N %

95.0%

Upper

CL for

Colum

n N % Count

Colum

n N %

95.0%

Lower

CL for

Colum

n N %

95.0%

Upper

CL for

Colum

n N % Count

Colum

n N %

95.0%

Lower

CL for

Colum

n N %

95.0%

Upper

CL for

Colum

n N % Count

Colum

n N %

95.0%

Lower

CL for

Colum

n N %

95.0%

Upper

CL for

Colum

n N %

yes 306 82.0% 77.9% 85.7% 331 78.1% 73.9% 81.8% 81 91.0% 83.8% 95.7% 85 80.2% 71.8% 86.9% 89 89.9% 82.8% 94.7% 125 90.6% 84.9% 94.6% 298 81.4% 77.2% 85.1% 296 80.2% 75.9% 84.0%

2 43 11.5% 8.6% 15.1% 72 17.0% 13.6% 20.8% 5 5.6% 2.2% 11.9% 16 15.1% 9.3% 22.8% 7 7.1% 3.2% 13.4% 7 5.1% 2.3% 9.7% 52 14.2% 10.9% 18.1% 53 14.4% 11.1% 18.2%

3 17 4.6% 2.8% 7.0% 18 4.2% 2.6% 6.5% 3 3.4% 1.0% 8.7% 4 3.8% 1.3% 8.7% 3 3.0% 0.9% 7.9% 5 3.6% 1.4% 7.8% 15 4.1% 2.4% 6.5% 17 4.6% 2.8% 7.1%

dont't_know 7 1.9% 0.8% 3.6% 3 0.7% 0.2% 1.9% 1 0.9% 0.1% 4.3% 1 0.7% 0.1% 3.3% 1 0.3% 0.0% 1.3% 3 0.8% 0.2% 2.2%

no 303 90.4% 87.0% 93.2% 356 91.5% 88.4% 94.0% 73 97.3% 91.7% 99.4% 90 90.0% 83.0% 94.7% 84 90.3% 83.1% 95.1% 104 92.9% 87.0% 96.6% 312 95.7% 93.1% 97.5% 313 91.0% 87.6% 93.7%

yes 31 9.3% 6.5% 12.7% 33 8.5% 6.0% 11.6% 2 2.7% 0.6% 8.3% 10 10.0% 5.3% 17.0% 8 8.6% 4.2% 15.6% 8 7.1% 3.4% 13.0% 14 4.3% 2.5% 6.9% 29 8.4% 5.8% 11.7%

dont't_know 1 0.3% 0.0% 1.4% 1 0.3% 0.0% 1.4%

no_response 1 1.1% 0.1% 4.9% 1 0.3% 0.0% 1.4%

no 358 90.2% 87.0% 92.8% 425 93.0% 90.4% 95.1% 84 85.7% 77.8% 91.6% 109 87.9% 81.3% 92.8% 100 89.3% 82.6% 94.0% 123 83.1% 76.5% 88.5% 338 86.0% 82.3% 89.2% 360 90.5% 87.3% 93.0%

yes 39 9.8% 7.2% 13.0% 32 7.0% 4.9% 9.6% 14 14.3% 8.4% 22.2% 15 12.1% 7.2% 18.7% 12 10.7% 6.0% 17.4% 25 16.9% 11.5% 23.5% 55 14.0% 10.8% 17.7% 38 9.5% 7.0% 12.7%

no 24 6.0% 4.0% 8.7% 33 7.2% 5.1% 9.9% 9 9.2% 4.6% 16.1% 18 14.5% 9.2% 21.5% 13 11.6% 6.7% 18.5% 10 6.8% 3.5% 11.7% 27 6.9% 4.7% 9.7% 29 7.3% 5.0% 10.2%

yes 373 94.0% 91.3% 96.0% 424 92.8% 90.1% 94.9% 89 90.8% 83.9% 95.4% 106 85.5% 78.5% 90.8% 99 88.4% 81.5% 93.3% 138 93.2% 88.3% 96.5% 366 93.1% 90.3% 95.3% 369 92.7% 89.8% 95.0%

no 7 8.2% 3.8% 15.5% 7 7.0% 3.2% 13.3% 2 14.3% 3.1% 38.5% 3 13.6% 4.0% 32.1% 3 14.3% 4.2% 33.4% 2 9.1% 1.9% 26.1% 7 9.3% 4.3% 17.5% 10 11.8% 6.2% 19.9%

yes 78 91.8% 84.5% 96.2% 93 93.0% 86.7% 96.8% 12 85.7% 61.5% 96.9% 19 86.4% 67.9% 96.0% 18 85.7% 66.6% 95.8% 20 90.9% 73.9% 98.1% 68 90.7% 82.5% 95.7% 75 88.2% 80.1% 93.8%

no 51 58.6% 48.1% 68.5% 79 66.9% 58.1% 74.9% 12 92.3% 69.3% 99.2% 11 73.3% 48.3% 90.3% 12 60.0% 38.4% 78.9% 21 60.0% 43.5% 74.9% 59 73.8% 63.4% 82.4% 71 76.3% 67.0% 84.1%

yes 36 41.4% 31.5% 51.9% 39 33.1% 25.1% 41.9% 1 7.7% 0.8% 30.7% 4 26.7% 9.7% 51.7% 8 40.0% 21.1% 61.6% 14 40.0% 25.1% 56.5% 21 26.3% 17.6% 36.6% 22 23.7% 15.9% 33.0%

no 15 27.8% 17.2% 40.7% 14 35.0% 21.7% 50.4% 3 16.7% 4.9% 38.1% 4 21.1% 7.6% 42.6% 7 58.3% 31.2% 82.0% 8 61.5% 35.0% 83.5% 14 33.3% 20.6% 48.3% 22 45.8% 32.3% 59.8%

yes 39 72.2% 59.3% 82.8% 26 65.0% 49.6% 78.3% 15 83.3% 61.9% 95.1% 15 78.9% 57.4% 92.4% 5 41.7% 18.0% 68.8% 5 38.5% 16.5% 65.0% 28 66.7% 51.7% 79.4% 26 54.2% 40.2% 67.7%

0 35 10.4% 7.5% 14.0% 37 9.5% 6.9% 12.7% 8 10.7% 5.2% 19.1% 7 6.9% 3.2% 13.1% 15 16.1% 9.7% 24.6% 13 11.6% 6.7% 18.5% 47 14.4% 10.9% 18.5% 50 14.5% 11.1% 18.6%

1 95 28.2% 23.6% 33.2% 83 21.2% 17.4% 25.5% 19 25.3% 16.6% 36.0% 33 32.7% 24.1% 42.2% 21 22.6% 15.0% 31.8% 21 18.8% 12.4% 26.7% 97 29.8% 25.0% 34.9% 90 26.2% 21.7% 31.0%

2 68 20.2% 16.2% 24.7% 97 24.8% 20.7% 29.3% 18 24.0% 15.4% 34.5% 18 17.8% 11.3% 26.1% 20 21.5% 14.1% 30.6% 14 12.5% 7.3% 19.6% 70 21.5% 17.3% 26.2% 67 19.5% 15.6% 23.9%

3 50 14.8% 11.3% 18.9% 56 14.3% 11.1% 18.1% 9 12.0% 6.1% 20.8% 19 18.8% 12.1% 27.3% 10 10.8% 5.7% 18.2% 22 19.6% 13.1% 27.7% 54 16.6% 12.8% 20.9% 47 13.7% 10.3% 17.6%

4 39 11.6% 8.5% 15.3% 43 11.0% 8.2% 14.4% 7 9.3% 4.3% 17.5% 7 6.9% 3.2% 13.1% 10 10.8% 5.7% 18.2% 15 13.4% 8.0% 20.6% 29 8.9% 6.2% 12.4% 39 11.3% 8.3% 15.0%

5 26 7.7% 5.2% 10.9% 31 7.9% 5.6% 10.9% 7 9.3% 4.3% 17.5% 7 6.9% 3.2% 13.1% 11 11.8% 6.4% 19.5% 12 10.7% 6.0% 17.4% 12 3.7% 2.0% 6.1% 21 6.1% 3.9% 9.0%

6 16 4.7% 2.9% 7.4% 18 4.6% 2.9% 7.0% 4 5.3% 1.8% 12.2% 5 5.0% 1.9% 10.5% 3 3.2% 0.9% 8.4% 9 8.0% 4.1% 14.2% 12 3.7% 2.0% 6.1% 21 6.1% 3.9% 9.0%

7 8 2.4% 1.1% 4.4% 26 6.6% 4.5% 9.4% 3 4.0% 1.1% 10.3% 5 5.0% 1.9% 10.5% 3 3.2% 0.9% 8.4% 6 5.4% 2.3% 10.7% 5 1.5% 0.6% 3.3% 9 2.6% 1.3% 4.7%

no 236 70.0% 65.0% 74.7% 254 65.0% 60.1% 69.6% 52 69.3% 58.3% 78.9% 66 65.3% 55.7% 74.1% 69 74.2% 64.7% 82.3% 69 61.6% 52.4% 70.2% 216 66.3% 61.0% 71.2% 233 67.7% 62.7% 72.5%

yes 101 30.0% 25.3% 35.0% 137 35.0% 30.4% 39.9% 23 30.7% 21.1% 41.7% 35 34.7% 25.9% 44.3% 24 25.8% 17.7% 35.3% 43 38.4% 29.8% 47.6% 110 33.7% 28.8% 39.0% 111 32.3% 27.5% 37.3%

no 290 86.1% 82.1% 89.4% 322 82.4% 78.3% 85.9% 64 85.3% 76.1% 91.9% 85 84.2% 76.1% 90.3% 79 84.9% 76.7% 91.1% 85 75.9% 67.4% 83.1% 296 90.8% 87.3% 93.6% 286 83.1% 78.9% 86.8%

yes 47 13.9% 10.6% 17.9% 69 17.6% 14.1% 21.7% 11 14.7% 8.1% 23.9% 16 15.8% 9.7% 23.9% 14 15.1% 8.9% 23.3% 27 24.1% 16.9% 32.6% 30 9.2% 6.4% 12.7% 58 16.9% 13.2% 21.1%

no 319 94.7% 91.9% 96.7% 364 93.1% 90.3% 95.3% 68 90.7% 82.5% 95.7% 92 91.1% 84.4% 95.5% 86 92.5% 85.8% 96.6% 90 80.4% 72.3% 86.9% 298 91.4% 88.0% 94.1% 306 89.0% 85.3% 91.9%

yes 18 5.3% 3.3% 8.1% 27 6.9% 4.7% 9.7% 7 9.3% 4.3% 17.5% 9 8.9% 4.5% 15.6% 7 7.5% 3.4% 14.2% 22 19.6% 13.1% 27.7% 28 8.6% 5.9% 12.0% 38 11.0% 8.1% 14.7%

Minimum

Meal

Frequenc

Minimum

Acceptabl

e Diet

Consump

tion of

Iron

Ever

breastfed

Continue

d

Breastfee

Continue

d

Breastfee

Introducti

on to

Semi

Minimum

Dietary

Diversity

Initiation

to

breastfee

ding

Bottle

feeding

Eclusive

breasfee

ding

female male female male female male female male

lga

jere konduga mafa mmc

46

Annex 2-Cluster Distribution

Lga Ward Kanguri Household Population Sampled Clusters

Jere Dusuman Bashetti 580 1

Jere Dusuman BOSAP Quarters 121 2

Jere Dusuman Musari 527 3

Jere Galtimari Mulai Bulabulin 82 4

Jere Galtimari Mulai Quarters 680 5,6

Jere Gongulong Bulabulin 851 7,8

Jere Gongulong Gongulong Bulamari Aliye 202 9

Jere Gongulong Gumsumeri 292 10

Jere Gongulong Modu Ajiri 555 11

Jere Gongulong Modu Ajiri Gana 196 12

Jere Khaddamari Basheti 293 13

Jere Old maiduguri Gwazari 320 99

Jere Old maiduguri El-yakub 410 RC

Jere Old maiduguri Fariah block 741 RC,14

Jere Dala Lawanti Dala Kafe 183 15

Jere Dusuman Muna Ethiopia 330 16

Jere Dusuman Musari 986 17,18

Jere Mashamari Kantigoma 257 19

Jere Mashamari Goni Kachallari 1,112 20,21,22,96,97

Jere Galtimari Bulabulin Kusheri 60 23

Jere Galtimari Molai Juddumri 297 24

Jere Galtimari Molai Kura 266 25

Jere Galtimari Molai Quarters 870 RC,26

47

Jere Galtimari Molai Shuwari 2,279 27,28,29,30,31,32

Jere Galtimari Polo gwarri 2,364 33,34,35,36,37,38

Jere Mairi Mairi Kuwait 600 39

Jere Mairi Dalori 931 40,41

Jere Mairi Chabbal 530 42,43

Jere Mairi Dangalti (Usmanti) 620 44

Konduga Dalori Amarwa Bulamari 335 45

Konduga Dalori Amarwa Goniri 331 46

Konduga Dalori Kalari Abdule 268 47

Magumeri Ardoram Chingowa 86 48

Konduga Zarmari Gremari 500 49

Konduga Zarmari Shiwari bypass 500 50

Konduga Konduga Central Kiji Malari 62 51

Konduga Konduga Central Kofan Ruwa 543 52

Konduga Konduga Central Mandadari - 2 550 53,98,

Konduga Konduga Central Yandadari Gana 121 54

Konduga Konduga Central Sabon Gari 1 750 55,56,

Konduga Konduga Central Sabon Gari 2 328 57

Konduga Konduga Central Mainari 226 58

Mafa Tamsumgandua Kaleri 750 61,RC, 94, 95

Mafa Tamsumgandua Malakylari 1845 62,63,64,65

MMC Shehuri North Kawar Maila 890 66,67

MMC Shehuri North Gangamari 1300 68,69,70

MMC Bolori II Musari Dubai 430 RC

MMC Bolori II Bolori II 650 71,72

MMC Bolori II Bolori 3 731 73,74

MMC Bolori II Bolori 8 802 75,RC

MMC Bolori II Bulabulin Bolibe 442 76

MMC Bolori II Low Cost block 1130 77,78

48

MMC Bolori I Sabon Gari 641 79,80

MMC Bolori I Garba Buzu 641 81

MMC Maisandari Bintu Suga 400 82

MMC Maisandari Mudosullumri 244 RC

MMC Maisandari Bulabulin Extension 1,878 83,84,85,86

MMC Maisandari Mega 226 87

MMC Maisandari Kabanti 544 RC

MMC Maisandari Dala Dayeri 224 88

MMC Maisandari Dala Shuwari 421 89

MMC Bulabulin Bulabulin 1,964 90,91,92,93,RC

Annex 2-References

1. https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/docum

ents/files/ocha_nga_humanitarian_response_plan_march2020.pdf

2. http://vts.eocng.org/population/LGA?s=&l=&gender=MF&from=0&to=100

3. https://displacement.iom.int/

4. CARE IYCF Guildline https://www.ennonline.net/attachments/987/final-iycf-guide-iycf-

practices.pdf

5. http://www.who.int/immunization/monitoring_surveillance/Vaccination_coverage_cluster_su

rvey_with_annexes.pdf

49

6. https://www.actionagainsthunger.org/sites/default/files/publications/Conducting_KAP_surve

ys_A_learning_document_based_on_KAP_failures_01.2013.pdf

7. Knowledge Attitude and Practice (KAP) on IYCF-E, WASH and Child Protection interventions in

the Humanitarian Response in Borno State. Save the CHildren May 2019

8. Nigeria Demographic and Health Survey (NDHS) 2013

9. https://www.who.int/elena/titles/early_breastfeeding/en/#:~:text=Provision%20of%20mot

her's%20breast%20milk,is%20rich%20in%20protective%20factors.

10. https://fscluster.org/sites/default/files/documents/nfss_round_8_final_report_november_201

9.pdf

11. https://www.unicef.org/nigeria/media/2181/file/Nigeria-NNHS-2018.pdf

12. https://www.who.int/nutrition/topics/vad/en/

13. http://www10.who.int/entity/elena/titles/deworming/en/

14. World Health Organization (WHO). 2007. WHO Fact sheet N°286: Measles. Available at:

http://www.who.int/mediacentre/factsheets/fs286/en/