By Misbahu el-Hamza (Twitter: @misbahuelhamza)
Zurfa’a Hamza, 25, is a Community Health Worker (CHW) living in Yalwa, a densely populated community in Dala Local Government Area (LGA) of Kano State. At 9am, on 22 September, Hamza was set to visit Zara’u Ibrahim and Fatima Hashim while donning a white hijab and grabbing a bag that contained a smartphone, a pen and register, and medical supplies. Ibrahim, 33, is a mother of nine and is pregnant with her tenth child, while Hashim, 25, is a lactating mother with her third child. Since August 2021, Hamza has been visiting these women in their respective homes once a month, during weekdays, to monitor and counsel them on ways they can improve their nutritional status. Hamza is one of the 172 CHWs in Kano State involved in the Accelerating Nutrition Results in Nigeria (ANRiN) Project.
The World Bank and the Federal Government of Nigeria launched the ANRiN program in 12 States across Nigeria (Abia, Akwa Ibom, Gombe, Kaduna, Kano, Kogi, Kwara, Nasarawa, Niger, Oyo, and the Plateau States). The beneficiary States were chosen based on their nutritional rankings from several surveys, including the 2018 National Demographic Health Survey (NDHS), according to Dr. Ishaya Madaki, ANRiN Project Director in Kano State.
The Institute of Human Virology Nigeria (IHVN) and the Clinton Health Access Initiative (CHAI) are the organizations implementing the ANRiN project in Kano in collaboration with the State Government. IHVN began implementing the program in nine LGAs (Kano Municipal, Tarauni, Kumbotso, Bunkure, Wudil, Dala, Nassarawa, Gwale, and Fagge) in August 2021. In all the nine LGAs, IHVN selected a community-based organization (CBO) with a proven record of similar community programs and years of experience working with other international organizations. The program is carried out in Dala LGA by a CBO known as Taimako Community Health Grassroot Empowerment Foundation (TCHGEF) which has procured 27 CHWs from neighborhood PHCs and reassigned them to particular housing clusters in the LGA.
According to Dr. Madaki, the ANRiN program in the State seeks to address chronic malnutrition in young children under five, pregnant women, and nursing mothers, as well as reduce maternal and child mortality.
During their house visits, the CHWs use a mobile app provided by the IHVN to capture the biodata of beneficiaries, which is then sent instantly to the IHVN’s database. They would later enter the record manually into their register. Newly registered beneficiaries will be given a card, indicating when next the CHW will be coming again. Using a paint, the CHW will number the house upon leaving, indicating that the household has been enrolled.
Hamza counsels Hashim on breastfeeding her 3-months-old infant and maintaining hygiene practices like frequently changing and washing her brassieres. With a smile, Hashim stated that, “this is the first time I am trying the six months of exclusive breastfeeding, and I am observing significant changes in this baby compared to my previous two births, which I didn’t.” Pregnant women like Ibrahim, on the other hand, receive nutritional supplements: vitamin A, iron and folic acid (IFA) and preventive treatment for malaria. Additionally, local nutritious food consumption is more acceptable to expectant and nursing mothers. Ibrahim said the CHW never openly advocated child spacing to her, “but I know that if I practice exclusive breastfeeding, there is a good chance I will rest for some time before having another pregnancy.”
Hamza, however, said that for most of the beneficiaries she visits, it could be problematic for a couple if the wife insists on eating eggs and liver when she’s pregnant. “I, therefore, recommend pregnant women to frequently eat beans, spinach, lettuce, oranges, and to use palm oil often in their meals.” She said these aren’t expensive but are rich in nutritional supplements.
Based on the 2018 survey, Kano State has poor average baby feeding practices, low nutritional diversity, meal frequency, and an acceptable diet for children aged 6–23 months. It further reported that 56.9 percent of children under the age of five in the state are moderately stunted, 29.7 percent are moderately underweight, and 72.9 percent of children between the ages of 6 and 59 months are anemic.
There is a strong connection between maternal malnutrition and infants’ lower birth weights, neurological conditions, stunted physical development, mental impairment, and subpar academic performance. Adequate nutrition is crucial during the preconception period, pregnancy, and lactation to ensure the health of the mother, fetus, and infant.
Khadija Lawan Shuaibu, 32, is another CHW under the TCHGEF working in Gobirawa, a distance of 10km from Yalwa. Gobirawa is said to be the most densely populated area in Dala LGA. Shuaibu has a slogan which she is known by in Gobirawa. “Women’s and children’s health is our aspiration,” she would say in Hausa upon entering a house. “This is how we establish a happy interaction with women during our first visits or revisits,” she said. Within the first 12 months of the project, Shuaibu said she attended to more than 1,000 pregnant women, lactating mothers, and children in her cluster.
There are different services for three groups of children between 6 and 59 months old; infants from 0 to 6 months receive “zero services.” Three services; vitamin A, zinc/ORS, and micronutrient powder are administered to children 6–12 months old. In addition to the three services for 6–12-month-olds, there’s a deworming drug for 12- to 23-month-old children. The last group, aged 24–59 months, receives Vitamin A, a deworming drug, and zinc/ORS only.
One of Shuaibu’s clients, Sumayya Alhassan, 25, is a mother of six and is now pregnant with her seventh child. She said the program benefited her and her 2-year-old daughter, Aisha, and 4-year-old twin.
“I have started exclusive breastfeeding as a result of this program. My daughter and her twin brothers are now healthier than my other children.” She is now more informed, she said. “I feel learned enough to start advocating for exclusive breastfeeding, proper hygiene, and a balanced diet for pregnant, lactating mothers, and under-five children in my community.”
All the three beneficiaries interviewed said their husbands neither denied using the supplements given to them and their children nor stopped them from discussing with the CHWs who visit them once a month. But that’s not the situation throughout the nine LGAs.
The beginning of the program was met with mistrust toward the CHWs. “People thought we came with polio vaccines, and in some areas, some people even attacked our staff and stole their smartphones,” recounts Dr. Madaki. Rumors began circulating in some areas, “alleging that we were giving family planning pills to stop women from getting pregnant. But we never relent. We doubled our efforts on community sensitization and engaged more community leaders. Eventually, those who agreed to welcome us began noticing the benefits of our intervention, and they started testifying to fellow community members that our drugs worked. And that was when we had a positive turnaround.”
Sumayya Alhassan said although they are grateful for the counseling and provision of iron and folic acid (IFA) when they are pregnant, she believes that improving the financial status of women will strengthen the impact of the ANRiN program. “If we can get a small token to support us, we can buy the necessary food that will provide us with adequate nutrition.” In addition to educating girls and women of childbearing age about iron-rich foods, efforts must be intensified to alleviate poverty.
This story was produced in partnership with Nigeria Health Watch through the Solutions Journalism Network, a nonprofit organisation dedicated to rigorous and compelling reporting about responses to social problems.