Mahdi Garba and Safiya Shuaibu Isa (Lead writers)
Every Wednesday for the past four years, Abdulrahman Hannatu, a trained community health worker with the Masaki nutrition programme, wakes up at exactly 5:45 a.m., gets dressed, and prepares for the day’s nutrition class near the Danmasara community ward head’s residence.
During the weekly class, Hannatu and her assistant teach mothers how to detect signs of malnutrition in children, prepare nutritious meals, and administer Ready-to-use therapeutic food (RUTF). “We emphasise the importance of nutritious meals. We tell them RUTF is only temporary, but healthy food will always be there,” she explained.
Children with Severe Acute Malnutrition (SAM) are immediately referred to Outpatient Therapeutic Centres (OTP) across 15 Local Government Areas (LGAs) of Jigawa State for treatment, where they are monitored for five weeks before discharge. According to the United Nations Children Fund (UNICEF), malnutrition is a direct or underlying cause of 45% of all deaths among children. Nigeria currently has the second-highest rate of stunted children globally, with 32% of under-fives affected. In Jigawa alone, 64% of children are stunted, 9.6% wasted, and 81.9% anaemic.
In 2020, the National Multisectoral Plan of Action for Food and Nutrition (NMPFAN) recognised that malnutrition has multifaceted causes that require comprehensive solutions across various sectors.
This operational plan is structured around six key result areas as outlined in the National Policy on Food and Nutrition.
Its primary focus was on improving the health and nutrition of infants, young children, and mothers while strengthening community-based management of acute malnutrition, enhancing household hygiene to reduce infections, promoting exclusive breastfeeding, and encouraging appropriate complementary feeding practices. A critical component of this strategy is the Community-based Management of Acute Malnutrition (CMAM), which aims to treat SAM in children ages 6 to 59 months without the need for hospitalisation, provided they do not have complications.
CMAM emphasises early detection, outpatient treatment, and community-based care, thereby improving access and outcomes for malnourished children. In Jigawa, the State’s Primary Healthcare Development Agency (JSPHCDA) introduced Masaki- a CMAM programme in 2018, piloting it in select communities within Jahun LGA.
A community-based nutrition response
Magaji Uba Ahmed, Deputy Director of Nutrition Services at the JSPHCDA and State Focal Person for the Masaki Programme, explained that when they discovered that Jigawa had been experiencing incessant cases of severe and moderate acute malnutrition, they returned to the drawing board to find a lasting solution to the problem.
The success of the pilot led to an expansion to all 27 LGAs in the state. Today, the Masaki programme operates across Jigawa with a network of 300 Masaki centres, significantly enhancing the local response to malnutrition. “We appreciate how the health workers treat us and our children,” said 44-year-old Hajara Muhammad, whose child recovered from malnutrition after attending the Masaki sessions.
Nazifi Ado, a medical lab technician at PHC Kudai and the local Outpatient Therapeutic (OTP) Centres, explained that children aged 6 to 59 months are eligible, but those under 4KG are advised to gain weight through nutritious meals like groundnut pudding before qualifying for RUTF. Children are only discharged once their Middle Upper Arm Circumference (MUAC) reaches 12.5CM. “When we began, we saw at least 150 children weekly. Now it’s down to between 30 and 50,” Ado shared, crediting improved awareness and compliance.
Collaboration, education and empowerment
When the agency started the programme, it was the sole funder , without any partner support. The money they had could not fund the programme. Over time, support came from the UNICEF, Action Against Hunger (ACF) and CARE International. Members of the Jigawa State House of Assembly also started financially supporting the programme as part of constituency activities.
UNICEF also introduced a socioeconomic empowerment component. Mothers receive crop seedlings such as orange and moringa, that they can cultivate and sell for a profit. They also receive chickens to rear, thus creating sustainable food security at the household level.
Since the programme’s inception, cases of malnutrition in Jigawa have dropped from 74,000 in 2010 to just 2,000 in 2024, according to the nutrition department at the JSPHCDA. In 2024, the government allocated ₦1 billion, with ₦500 million in donor counterpart funding, to procure RUTF, reflecting a strong commitment. According to Ahmed, “there are now villages that have gotten rid of malnutrition as a result of the Masaki programme. If you go to these communities and ask, they will show you children who were malnourished but are now fine.”
The agency’s management also added targeted sensitisation sessions to empower women in rural areas, which experience the highest rates of malnutrition. This initiative involves health workers educating mothers about malnutrition, covering its causes, classifications, how to identify it, and the actions they can take to support their malnourished children.
Ahmed noted that the feedback they received suggests the programme has been impactful. He explained that, unlike in the past when cases of child malnutrition were attributed to evil spirits and taken to prayer houses, people are now beginning to seek proper care.
“Now, with the knowledge they have, they understand that malnutrition comes as a result of insufficient [nutritious] food. Now, if they have these problems, they go to the hospital because they know it is purely a medical problem and not associated with an evil spirit.”
Lack of community support
Despite the progress made, Ahmed raised concerns about the limited sense of community ownership. Many sessions are still held in open spaces due to inadequate local infrastructure. Recruiting volunteer community support members has been challenging, as some leaders appointed their relatives who expected financial incentives, leading to low commitment levels.
“In each centre, there are supposed to be 10 to 11 people to support the sessions. Sometimes only 2 or 3 will be dedicated, while the remaining ones would say even if they attend, there is no payment.”
He added that despite the resource mobilisation and sensitisation that have been done in the communities, the ownership is low.
Ahmed explained that the Masaki programme is structured for community members to donate food each week for demonstrations. However, only a few communities contribute, while many others point to financial hardship as a barrier.
He explained that when communities do not contribute food items, agency funds meant for protein and logistics are often used to cover the entire meal preparation in some centres.
Nonetheless, unlike donor-dependent programmes, Masaki thrives on state funding to ensure long-term impact, prompting the UNICEF to recommend it for nationwide scale-up to address the incessant malnutrition situation across Nigeria.
