MALNUTRITION AMONG CHILDREN UNDER FIVE: A CASE STUDY OF UNICEF-SUPPORTED NUTRITION STABILIZATION CENTRES

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Malnutrition among children under five years of age represents one of the most enduring public health challenges in Nigeria, contributing significantly to childhood morbidity, mortality, and long-term developmental impairment. Nigeria bears the second-highest burden of stunted children globally, with staggering regional disparities in prevalence: stunting ranges from 7.2% in Osun State to 61% in Kaduna State, while wasting varies from 1% in Ibadan to 29% in the Federal Capital Territory (Collins et al., 2024). These figures underscore not only the national magnitude of the problem but also the critical need for localised, evidence-driven interventions.

The United Nations Children's Fund (UNICEF) plays a pivotal role in addressing acute malnutrition through its support of Nutrition Stabilisation Centres (SCs) across northeast Nigeria, particularly in states severely affected by conflict and food insecurity such as Borno and Yobe. In 2024, UNICEF-supported facilities treated 963,916 children for severe acute malnutrition, surpassing the annual target of 835,177, with the Northeast accounting for 594,853 children treated partly attributable to floods in September 2024 and cholera and measles outbreaks in Maiduguri (UNICEF, 2024). These figures reflect the scale of the crisis and the indispensable role of stabilisation centres in child survival.

The characteristics and treatment outcomes of malnourished children in North-East Nigeria have been documented in a study of Médecins Sans Frontières (MSF) inpatient and ambulatory therapeutic feeding centres between 2019 and 2022, which found that over 25 million people in Nigeria could face food insecurity in 2023, representing a 47% increase from the 17 million at risk in the prior year, primarily driven by ongoing insecurity, protracted conflicts, and rising food prices (Kerac et al., 2024). This worsening food security landscape has direct implications for child nutritional status and the demand for stabilisation centre services.

A comprehensive scoping review of malnutrition disparities in Nigeria by Collins et al. (2024) identified contextual drivers of undernutrition including poverty, maternal education, infant and young child feeding practices, and access to health services. The review underscores the need for integrated, multi-sector responses that address both immediate clinical management and underlying structural determinants of child malnutrition.

1.2 Statement of the Problem

Despite significant investments by UNICEF and its partners in nutrition stabilisation centres across Nigeria, acute malnutrition among children under five continues to escalate, particularly in conflict-affected zones. In 2022, over 1.3 million children under five years of age in North-East Nigeria faced the threat of severe acute malnutrition, and this burden is compounded by recurring disease outbreaks, climate-induced food insecurity, and the continued displacement of populations (Aborode et al., 2025). UNICEF-supported stabilisation centres have expanded their capacity — for example, one such centre in Monguno grew from 14 to 60 beds since 2022 — yet patient demand consistently outpaces capacity (UNICEF, 2025).

The relationship between malnutrition, mortality, and treatment outcomes in these centres requires systematic investigation. Studies have documented high rates of defaulting from ambulatory therapeutic feeding programmes and elevated inpatient mortality in northeast Nigeria, yet the specific facility-level and patient-level factors associated with these outcomes remain insufficiently characterised in the context of UNICEF-supported stabilisation centres (Kerac et al., 2024). Furthermore, the scoping review by Collins et al. (2024) identifies a paucity of intervention studies that have evaluated the efficacy of stabilisation centre protocols across Nigeria's diverse epidemiological contexts.

1.3 Objectives of the Study

The main objective of this study is to assess the burden, clinical characteristics, and treatment outcomes of malnutrition among children under five years of age admitted to UNICEF-supported Nutrition Stabilisation Centres in northeast Nigeria.

The specific objectives are to:

1. determine the prevalence and clinical profiles of acute malnutrition among children under five admitted to UNICEF-supported stabilisation centres;
2. assess treatment outcomes, including recovery rates, defaulting, and case fatality rates, at the stabilisation centres;
3. identify patient-level and facility-level factors associated with treatment outcomes;
4. evaluate the adequacy of stabilisation centre services in meeting the nutritional needs of the target population; and

1.4 Research Questions

1. What is the prevalence and clinical profile of acute malnutrition among children under five admitted to UNICEF-supported stabilisation centres?
2. What are the treatment outcomes, including recovery, default, and case fatality rates, at these centres?
3. What patient-level and facility-level factors are associated with treatment outcomes?
4. Are stabilisation centre services adequate to meet the needs of the target population?

1.5 Research Hypotheses

H01: There is no significant association between the presence of co-morbidities and treatment outcomes among children under five admitted to UNICEF-supported stabilisation centres.

H02: There is no significant difference in treatment outcomes between inpatient and ambulatory therapeutic feeding programmes at UNICEF-supported stabilisation centres.

H03: Geographic accessibility does not significantly influence case fatality rates among children admitted to UNICEF-supported stabilisation centres.

1.6 Significance of the Study

The findings of this study hold significant implications for policy, programme planning, and clinical practice in nutrition service delivery in Nigeria. For UNICEF, the Federal and Borno State Ministries of Health, and humanitarian nutrition actors, the study offers evidence to inform the scaling, targeting, and quality improvement of stabilisation centre services. For the academic community, the study contributes original data on treatment outcomes in UNICEF-supported facilities, filling a critical gap identified in existing literature.

1.7 Scope and Limitations of the Study

This study focuses on children under five years admitted to UNICEF-supported Nutrition Stabilisation Centres in northeast Nigeria within a defined study period. The study examines clinical profiles, treatment outcomes, and associated factors. Limitations include: the potential for incomplete medical records in conflict-affected facilities; difficulty tracing children who have defaulted from ambulatory programmes; and variability in service delivery capacity across different stabilisation centre sites.

1.8 Definition of Terms

Malnutrition: A broad term encompassing deficiencies, excesses, or imbalances in a person's intake of energy and/or nutrients, including forms such as stunting (chronic malnutrition), wasting (acute malnutrition), and underweight.

Severe Acute Malnutrition (SAM): A life-threatening condition characterised by a very low weight-for-height ratio (below -3 z-scores), bilateral pitting oedema, or a mid-upper arm circumference below 115 mm.

Moderate Acute Malnutrition (MAM): A nutritional condition defined by a weight-for-height z-score between -3 and -2, or a mid-upper arm circumference between 115 and 125 mm, without bilateral pitting oedema.

Nutrition Stabilisation Centre (SC): An inpatient treatment facility that manages children with severe acute malnutrition complicated by medical complications such as anorexia, oedema, or infections, typically using F-75 and F-100 therapeutic milk formulas and Ready-to-Use Therapeutic Food (RUTF).

Ready-to-Use Therapeutic Food (RUTF): A nutrient-dense, ready-to-eat food specifically designed for the treatment of severe acute malnutrition, typically composed of peanut paste, milk powder, sugar, vegetable oil, and vitamin and mineral supplements.

Stunting: Low height-for-age (below -2 z-scores of the WHO Child Growth Standards median), reflecting chronic malnutrition and repeated exposure to inadequate nutrition and infection over time.

Wasting: Low weight-for-height (below -2 z-scores of the WHO Child Growth Standards median), indicating acute malnutrition typically resulting from recent insufficient food intake or disease.

Case Fatality Rate (CFR): The proportion of children admitted to a stabilisation centre with a given diagnosis who die as a result of that condition during the treatment period.

References

Aborode, A. T., Otorkpa, O. J., Abdullateef, A. O., Oluwaseun, O. S., Adegoye, G. A., Aondongu, N. J., Oyetunji, I. O., Akingbola, A., Scott, G. Y., Kolawole, B. O., & Komakech, J. J. (2025). Impact of climate change-induced flooding water related diseases and malnutrition in Borno State, Nigeria: A public health crisis. Environmental Health Insights, 19. https://doi.org/10.1177/11786302251321683

Collins, J., Poh, B. K., Jalaludin, M. Y., Michael, G., Adedeji, I., Oyenusi, E. E., Akor, B., Charles, N. C., Buthmanaban, V., & Muhardi, L. (2024). Exploring disparities in malnutrition among under-five children in Nigeria and potential solutions: A scoping review. Frontiers in Nutrition, 10, 1279130. https://doi.org/10.3389/fnut.2023.1279130

Kerac, M., Mwangome, M., McGrath, M., Frison, S., & Berkley, J. A. (2024). Characteristics and treatment outcomes of malnutrition among infants aged less than 6 months in North-East Nigeria (2019–2022). Maternal & Child Nutrition. https://pmc.ncbi.nlm.nih.gov/articles/PMC11574665/

UNICEF. (2024). Nigeria humanitarian situation report: December 2024. UNICEF.

UNICEF. (2025). Inside Monguno's only nutrition treatment centre for children. UNICEF Nigeria. https://www.unicef.org/nigeria/stories/inside-mongunos-only-nutrition-treatment-centre-children

World Health Organization (WHO). (2021). Malnutrition fact sheet. WHO. https://www.who.int/news-room/fact-sheets/detail/malnutrition