Alive & Thrive Nigeria Phase 2 Baseline Household Survey

Alive & Thrive (A&T) is an initiative to save lives, prevent illness, and improve the health and wellbeing of mothers, children, and adolescents by using evidence-based approaches in collaboration with governments and other partners at the global, regional, national, and community levels. The initiative is managed by FHI Solutions and funded by the Bill & Melinda Gates Foundation. // A&T Nigeria has five key outcomes, all aimed to accelerate the scale of maternal, adolescent, infant, and young child nutrition (MAIYCN) interventions in Nigeria. These five outcomes are: • Outcome 1: Capacity of Government of Nigeria (GON) and key stakeholders to deliver MAIYCN services enhanced. • Outcome 2: MAIYCN policies and regulations operationalized at state level. • Outcome 3: MAIYCN services mainstreamed into all key service delivery platforms (antenatal care, postnatal care, child health services). • Outcome 4: Increased demand for MAIYCN services. • Outcome 5: Key learning agenda questions answered and local research capacity enhanced. // A&T is undertaking the following approaches to scale up MAIYCN interventions: 1) design a comprehensive package of MAIYCN interventions to reduce anemia, prevent low birth weight, promote early and exclusive breastfeeding, and reduce wasting and stunting; 2) support state government and local organizations to lead and sustain the delivery of MAIYCN interventions 3) work with community-based organizations to engage mothers, husbands/partners, influential family members, and religious and traditional leaders to increase demand for MAIYCN services. The initiative is also adapting and scaling mass media campaigns to new states, which now include messages on maternal nutrition. Mass media helps to create broad awareness of optimal nutrition practices for mothers and their children and complements other A&T interventions. The mass communication campaigns – “Start Strong” and “Zero Water” – reached more than 10 million families in 11 focus states in A&T Phase I, aiming to improve IYCF practices. // In its second phase of the intervention, A&T Nigeria will build on the successes and learning realized during the initiative’s first five years. From 2021-2026, A&T is scaling up maternal, adolescent, infant, and young child nutrition (MAIYCN) interventions coverage in seven focus states – Kaduna, Kano, Sokoto, Borno, Bauchi, Yobe and Lagos. The Alive & Thrive Nigeria Phase II project is a cross-sectional study involving mothers with young children and will collect baseline and endline data to assess changes in key maternal, adolescent, infant, and young child nutrition (MAIYCN) outcomes pre- and post- intervention implementation. // The data collected in the A&T Nigeria Phase II study will allow investigators to: • Assess changes in key MAIYCN behaviors. • Assess changes in MAIYCN service coverage. • Assess changes in MAIYCN knowledge among women and related community norms. • Assess changes in mothers’ perceptions of quality of MAIYCN services. Sample and sampling procedures: Two types of participants were enrolled in this research: mothers of children 0-5 months of age and mothers of children 6-23 months of age. Mothers of children 0 – 5 months provided information on early initiation of and exclusive breastfeeding practices; Mothers of children 6 – 23 months provided information on children’s dietary diversity. Both types of participants provided information on maternal nutrition. The study was conducted in a subset of local government areas (LGAs) in the seven states of Nigeria where Alive & Thrive works: Kaduna, Kano, Sokoto, Borno, Bauchi, Yobe and Lagos states. Three LGAs were randomly selected in each state, one from each senatorial district within the state, which generally reflects the range of ethnic, religious, and political groups. LGAs with active security situations or that are generally inaccessible were excluded from the list for selection. The A&T Nigeria team worked with state governments to classify LGAs in each state into mainly urban, rural, and semi-urban contexts The three LGAs per state were selected to achieve some representation of urban, rural, and semi-urban settings, depending on whether the senatorial districts in each of the states were more prominently of one type of settings, so not all states would have representation of all three settings (e.g. no rural LGAs were selected in Lagos). // A stratified, two-stage sampling design was implemented. Stratification: The sample selection was stratified by state and LGA so that independent samples are selected in each stratum and samples were allocated uniformly across stratum. We selected 5 PSUs and 10 eligible mothers in each target group for a total of 150 in each target group in each LGA in all states except for Lagos, where selected 10 PSUs and 5 eligible mothers per target group. The rationale to increase the number of PSUs in Lagos is that fertility rates are expected to be lower in Lagos and the number of eligible women is expected to be lower there. The sampling within each stratum followed basic principles of random selection with a 2-stage sampling strategy. // First stage: In the first stage, Primary Sampling Units (PSU) were selected with Probability Proportional to Size (PPS). The Measures of SIze (MOS) for PPS was based on the estimated population size from the last census, done in 2006 and provided by the National Population Commision (NPopC). // Second stage: Prior to sampling, a household listing operation was performed to identify all households that have an individual in the target group, a mother of a child aged 0-5 months and/or a mother of a child aged 6-23 months, who met all other eligibility requirements. Eligible respondents with a child aged 6-23 months were randomly selected within each PSU with simple random sampling method from the target group listing. Although there was a plan to use simple random sampling on both target groups, a census approach was performed for the target group of mothers of a child aged 0-5 months to provide an adequate sample for analysis. Sampling weights were calculated accordingly.