HIV infection and malnutrition have relative consequence on child survival, to which WHO recommends routine nutrition assessment and nutrition intervention among children living with HIV to prevent and manage malnutrition. Internationally sourced Ready to use Therapeutic Foods are costly to produce and procure and not readily available thus producing RUTF from locally available materials along with other nutrition intervention plan is recommended. Previous studies and anecdotal data from ongoing Caritas OVC project has demonstrated positive effect of nutrition intervention using locally made RUTF among children generally, however, this effect needs to be assessed and justified among CLHIV. This study aims to assess nutrition status of CLHIV, identify malnourished children, provide nutrition intervention plan using locally made RUTF and evaluate effect, acceptability and feasibility of the nutrition intervention plan among children and households Finding from the study will support or refute finding from other studies showing effectiveness of locally made RUTF in Nigeria. It will also add to the body of knowledge and guide further translational research on nutrition intervention plans among CLHIV in Nigeria and related low income countries.

1. ConceptNote forCONI-Plan
1
Effect of Caritas OVC Nutrition Intervention Plan (CONI-Plan) among Children living with HIV in
Nigeria; the Abia State Experience
Amara Frances Chizoba. MPH, PhD
Caritas Nigeria.
camara@ccfng.org, camara.ccfng.org@gmail.com, +2347043216958
INTRODUCTION
Background
In 2020, an estimate of 1.7 million children aged less than 15 years of age were living with HIV
worldwide, with more than 90% of them in sub-Saharan Africa [1, 2]. In 2018, approximately 49
and 149 million under-five children were stunted and wasted, respectively, and more than 90%
lived in low and middle income countries [3]. Both under-nutrition and human immunodeficiency
virus (HIV) are highly prevalent, particularly in the sub-Saharan Africa like Nigeria [4, 5]. Due to
their lifelong infection, children living with HIV acquired perinatally are at high risk of co-
morbidities including malnutrition [6, 7]. Impaired nutritional status can also exacerbate their
immunodefciency and lead to advanced HIV status [8, 9].
Malnutrition in children under 5 years is pegged at Mid Upper Arm Circumference (MUAC) at red
line (<11cm) or at yellow line (11.5-12.5cm) and in children >5years with Body Mass Index (BMI)
of <18.5 kg/m2 or Weight-for-Height Z-score <-3SD) [2, 3]. MUAC is currently a quick and simple
way to determine whether or not a child is malnourished using a simple colored plastic tape (see
appendix 3). The tape measure is placed between the elbow. A measurement in the green zone
(12.5cm to 21cm) means the child is properly nourished; a measurement in the yellow zone
(11cm to 12.5cm) means that the child is at risk of malnutrition; a measurement in the red zone
(below 11cm) means that the child is acutely malnourished. On the other hand, the Body Mass
Index (BMI) is a popular indicator of undernutrition (see appendix 4). This is the weight of a
person in relation to their height, and is determined by dividing the body weight in kilograms by

2. ConceptNote forCONI-Plan
2
the body height (in meters) squared. A person with a Body Mass Index (BMI) of 18.5 and lower is
considered malnourished.
Among children with severe acute malnutrition, those infected with HIV have a threefold
increased riskof mortality compared to those not HIV-infected [10, 11]. Initiation of ARThas been
shown to have a positive impact on growth, with significantcatch-upgrowth during the first years
of ART, especially in children initiated early, before the age of two years old [12, 13]. However,
high rates of malnutrition are found in children receiving long-term ART, illustrating the need for
greater consideration of the nutrition component in pediatric HIV care [14, 15] if they must
survive.
HIV/AIDS, poverty, and food insecurity were the main causes of the high under-nutrition (also
interchangeably used as malnutrition) problems [16]. The burden further increases as studies
show that in a resource limited settings like Nigeria, more than one-third of under five children
mortality was due to under-nutrition every year [17]. In HIV infected children the risk of death
due to under-nutrition is three-times higher than non-HIV infected children [18]. The magnitude
of severe under-nutrition, hospitalization and death rates reaches as high as 20–50% among HIV
infected or exposed children in sub-Saharan Africa [19, 20]. Whereas other Studies have shown
that stunting, under-weight, and wasting were more prevalent among HIV infected children than
uninfected children [5, 21, 22, 23].
Therefore, the World Health Organization (WHO) recommends that children living with HIV
increase their energetic needs by 10% if asymptomatic, by 20–30% during symptomatic phases,
and by 50–100% in the case of severe acute malnutrition [24]. In fact, the World Health
Organization (WHO) recommends that children living with HIV increase energy intake and
maintain a balanced macronutrient distribution for optimal growth and nutrition [25, 26].
Irrespective, recommendation to increase nutrition uptake of children living with HIV stands out.
A recent systematic review revealed that vitamin A supplementation for HIV-infected infants and
children led to a 45% reduction in the risk of all-cause mortality and reduced the likelihood of all-
cause morbidity by 31% [27]. Along with micronutrient supplementation, sufficient dietary
diversity is considered a key to improving overall nutritional and health status of children living

3. ConceptNote forCONI-Plan
3
with HIV [28–30]. A number of recent studies have explored risk factors for undernutrition, using
dietary diversity score developed by the Food and Agriculture Organization [26, 31-36]. Dietary
diversity score, which consists of a simple count of food groups that an individual has consumed
over the preceding 24 hours, is considered aproxy for nutrient adequacy of the diet of individuals
[37]. Several studies in African countries have revealed that low dietary diversity was associated
with malnutrition, while consumption of an adequate variety of food can improve general
nutritional status [31, 25,26]. In order to plan an effective intervention program aimed at
improving feeding practices and dietary diversity of children living with HIV, it is crucial to
understand their current nutritional status and dietary intake [26].
Nutrition intervention differ by setting using locally available foods, however, the basics remains
the same. A typical nutrition intervention plan would include nutrition assessment, nutrition
counselling including food demonstration and fostering home gardening, food support including
use of Ready to Use Therapeutic food (RUTF), referral and support for clinical care and nutrition
monitoring.
To ensure proposer standardized nutrition assessment and monitoring is done in Nigeria, a
national nutritional assessment tool is used for nutrition assessment for children (see appendix
2) which assesses; nutrition indices and classifies child as malnourished or normal; food security;
dietary diversity and presence of factors affecting nutrition status especially among Children
living with HIV (CLHIV). The Nigeria nutrition intervention program also have recommended
locally available foods containing dietary requirements to meet nutrition and energy need of
children including CLHIV. This nutrition assessment tool is used before, during and after nutrition
intervention.
Furthermore, routine and need base nutrition intervention is provided which include counselling
on adequate nutrition, food demonstration on food preparation using local and seasonal
nutritious foods and support for home gardening to make available nutritious vegetables and
herbs.

4. ConceptNote forCONI-Plan
4
Referral and support for clinical intervention/care is also recommended in case of SAM more so
for CLHIV as Antiretroviral treatment (ART) and adherence to treatment must be maintained.
And in some cases, vitamin/mineral supplements as prescribed will be provided.
Food support with ready to use therapeutic food (RUTF) especially if locally sourced is an
important part of the intervention plan followed by routine nutrition monitoring.
RUTFs are semisolid products (which may include the ‘’TOM-BROWN’’ contents such as cereals,
legumes, sugar, peanut/groundnut butter, vegetable oil, vitamins, and minerals etc) developed
initially as a home-based follow-up treatment, usually made according to a standard, energy-rich
formula defined by the WHO [38, 39]. Treatment of SAM in children in clinics has not been
beneficial, especially in rural areas; hence the use of home-based therapies has been found to be
better [40]. Home-based treatment recommended by WHO can be either food prepared by a
caregiver (such as flour porridge or energy- and nutrient-dense locally available foods), or RUTF
provided by a clinic [40]. The WHO recommends the same therapeutic feeding approaches in
HIV-infected children using locally available food like cereals and legumes [41].
Ready-to-use therapeutic foods (RUTF) are energy-dense, micronutrient enhanced pastes used
in therapeutic feeding, which have greatly improved the recovery rate of children with severe
acute malnutrition (SAM) in sub-Saharan Africa [42-44]. Ready-to-use Therapeutic Food (RUTF)
can be used to treat 60-90% of children with SAM without medical complications without
admitting them to health facilities [45]. However, because majority of RTUF are internationally
sourced, it leads to high shipping costs, delays & donor fatigue, undermining its effectiveness in
combating malnutrition [42]. Therefore, sustainable treatment of SAM can be challenging in the
absence of locally produced RUTF [46]. to ensure sustainability of prevention and management
of malnutrition among children living with HIV, RUTFs can and should be made with local
ingredients for the following reasons; to fit local taste preferences; maintain steady supply of
nutrient dense meal to meet nutritional requirements; and be relatively available and affordable
as ingredients are sourced locally without shipping cost.
To demonstrate gains of RUTF using locallyavailableingredients, studies [38, 42] were conducted
in Bauchi and Kano on Formulation and Evaluation of Ready-To-Use Therapeutic Foods Using

5. ConceptNote forCONI-Plan
5
Locally Available Ingredients in order to meet the recommended nutrient composition for RUTF
while achieving products that are culturally acceptableat a lower cost. The studies demonstrated
use of local cereals containing calories/carbohydrates (eg corn, millet), legumes containing
protein, fats and oil, vitamins and minerals (soya beans, groundnut) and addition of crayfish. By
sensory evaluation, the locally made RTFU had similar energy content (523 to 573 kcal) which are
comparable to the recommendation of 520-550 kcal by the WHO. The fat contents of 45.11g and
43.04g were within the recommendation of 45-60% for fat. And the protein contents of 21.7 -
24.11g were higher than the recommendation of 10-12% of energy. For an ingredient to be
described as local, a country has to have 500 metric tons or more of a given ingredient available,
[42, 47] and Nigeria’s current annual production of the above ingredients are way above the
recommended 500 metric tons [42, 48, 49]. Moreover, the children in the study showed
significant improvement in nutrition indices and physical attributes of malnutrition within weeks
of intervention. This published finding is therefore recommended for use to prevent and manage
malnutrition in children including CLHIV.
In addition to locally made RTFU, the benefit of Moringa as the herbal gold to combat malnutrition
especially in resource limited settings has been widely studied and reported [50-52]. For instance, the
West Africa representative of the Church World Service who used the Moringa tree as a base for a
nutritionprogramdemonstratedsignificantchange innutritiousstatusinchildrenfedwithmoringaleaf.
They Stated that “for a child aged 1-3, a 100 g serving of fresh cookedleaves wouldprovide all hisdaily
requirementsof calcium,about75% of his ironand half his proteinneeds,as well asimportantamounts
of potassium,Bvitamins,copperandall the essentialaminoacids.Aslittleas20 gof leaveswouldprovide
a child with all the vitaminsA and C he needs” [50]. Moringa (leaf and seeds) has been found to be
effective in prevention and management of malnutrition thus is also recommended for use to

6. ConceptNote forCONI-Plan
6
combat malnutrition and it is also encouraged to be planted as home gardening as it is easy to
Fig 1- Moringa-Nutrition tie illustration [51]
Despitethe challenges ofmalnutrition among CLHIV, WHO recommendation to increasenutrition
intake of CLHIV, evidence of positive effect of locally sourced RTFU on prevention and
management of malnutrition among children, the management of under-nutrition in children
living with HIV in the PEPFAR CDC HIV projects remains poorly addressed. The PEPFAR-CDC
funded program of Caritas Nigeria has the Orphans and Vulnerable Children (OVC) project
component saddled with responsibility of providing among other interventions, nutrition
intervention for children living with HIV (CLHIV) in Nigeria. Though studies in Nigeria has shown
that nutrition intervention with locally available foods are effective for malnourished children,
there is need for similarintervention to be applied and evaluated in the OVC-HIVprogram among
CLHIV.
We aimto provide and assess effectof Caritas OVC nutrition intervention plan (CONI-Plan)among
children living with HIV enrolled in the OVC project of Caritas Nigeria in order to provide new
knowledge and build on existing knowledge for implementation science.
Aim
Aim of the study is to assess effect of Caritas OVC Nutrition Intervention plan (CONI-Plan) using
locally made RUTF among CLHIV in Abia State Nigeria

7. ConceptNote forCONI-Plan
7
Objective
1. To assess nutrition status of CLHIV in Abia State
2. Evaluate effect of nutrition intervention among malnourished CLHIV
3. Assess acceptability and feasibility of locally made RUTF among households
Research questions
1. What is the nutrition status of CLHIV in Abia State?
2. Is nutrition intervention plan among malnourished CLHIV effective?
3. Is locally made RUTF acceptable and feasible among households
Hypothesis
1. Upto 50% of CLHIV are malnourished in Abia State
2. There is significant change among malnourished children who received Nutrition
intervention plan
3. Locally made RUTF are acceptable and feasible among households
Significance and justification of study
HIV infection and malnutrition have relative consequence on child survival, to which WHO
recommends routine nutrition assessment and nutrition intervention among children living with
HIV to prevent and managemalnutrition. Internationally sourced Ready to use Therapeutic Foods
are costly to produce and procure and not readily available thus producing RUTF from locally
available materials along with other nutrition intervention plan is recommended.
Previous studies and anecdotal data from ongoing Caritas OVC project has demonstrated positive
effect of nutrition intervention using locally made RUTF among children generally, however, this
effect needs to be assessed and justified among CLHIV.
This study aims to assess nutrition status of CLHIV, identify malnourished children, provide
nutrition intervention plan using locally made RUTF and evaluate effect, acceptability and
feasibility of the nutrition intervention plan among children and households

8. ConceptNote forCONI-Plan
8
Finding from the study will support or refute finding from other studies showing effectiveness of
locally made RUTF in Nigeria. It will also add to the body of knowledge and guide further
translational research on nutrition intervention plans among CLHIV in Nigeria and related low
income countries.

9. ConceptNote forCONI-Plan
9
METHODOLOGY
Study setting
Abia, one of the States in Nigeria with high incidence of HIV infection and malnutrition will be
used. Abia is also one of the States where HIV- OVC program of Caritas Nigeria, funded by
PEPFAR-CDC, is being implemented.
Study population
Study population will be children living with CLHIV, 0-17 years, receiving care in ART centers in
Abia State Nigeria
Inclusion criteria
1. CLHIV, 0-17 years receiving care in ART centers in Abia State Nigeria
2. CLHIV enrolled in OVC project of Abia State Nigeria
3. Intervention among CLHIV with reported indices and attributes of malnutrition
Exclusion criteria
1. CLHIV whose caregivers declined to be enrolled in OVC project
Study design
Sample size
According to National Data repository [53], Current data on active CLHIV 0-17 years in Abia State
is 1021. Using raosoft sample size calculation for quasi intervention study [54], with 1021
population, using 5% margin error at 95% confidence interval, and 50% response distribution,
the sample size n and margin error E are given by; X= Z(c/100)2r(100-r), n= N x/((N-1)E
2
+x), E=
Sqrt[(N - n)x/n(N-1)] resulting to 192 sample size to be studied.

10. ConceptNote forCONI-Plan
10
Sampling technique
Using simple random sampling technique, every CLHIV will selected and routinely assessed
quarterly. All CLHIV assessed with reported malnutrition indices will be included in study and
concurrently provided with nutrition intervention plan until minimum sample size of 192 is
reached.
Study Duration
Study duration will be a period of 18 months. From start of procurement of tools to training,
COPI-Plan implementation, monitoring and follow up, data collection and entry, data analysis
and presentation/publication. (See appendix 1 for GANTT chart)
Intervention approach
Intervention will be done using the nutrition Caritas OVC Nutrition intervention (CONI-Plan)
which include;
1. Work tools provision; Nutrition assessment form will be used to collect baseline and after
intervention data. Nutrition assessment tools (weighing scale, hytometer, MUAC) and job
aid and SOPs will be provided for the assessment and intervention
2. Training and Capacity building; Case managers will be trained to deliver nutrition
assessment and nutrition intervention plan, using nutrition assessment tools, forms, job
aids and standard operating procedures
3. Intervention plan;
a. Nutrition assessment
b. Nutrition intervention plan for malnourished
c. Sustainability plan
d. Monitoring and evaluation
4. Monitoring; Continuous technical assistance will be provided to Case managers by Care
and Support officers and the program managers

11. ConceptNote forCONI-Plan
11
5. Data entry and Analysis;Care and support officers and Monitoring and Evaluation officers
will enter data into nutrition trackers and National OVC Management Information System
(NOMIS) data base
Caritas OVC Nutrition Intervention Plan (CONI-plan) package
1. Nutrition assessmentwillbe done among allCLHIV enrolled in OVC at leastonce aquarter
by trained case managers using nutrition assessment tools, forms and job aids provided,
and malnourished CLHIC identified for intervention. Nutrition status will be categorized
as malnutrition (MUAC in <11cm and in red or yellow 11.5-12.5cm and BMI <18).
2. Nutrition counselling will be done for all households of CLHIV on constitution of adequate
nutrition using standard job aids and on food demonstration
3. Referral and support of malnourished CLHIV for clinical intervention/care in ART centers
4. Provision of Food support including use of locally made Ready to Use Therapeutic food
(RUTF) done for malnourished CLHIV
5. Follow up nutrition monitoring, data entry, monitoring and evaluation
6. Sustainability plan of provision of support to start income generating activities and to
start home gardening including Moringa tree will be done for caregivers of malnourished
CLHIV
1] Nutrition assessment
To ensure proposer standardized nutrition assessment and monitoring is done in Nigeria, a
national nutritional assessment tool is used for nutrition assessment for children which assesses;
nutrition indices and classifies child as malnourished or normal; food security; dietary diversity
and presence of factors affecting nutrition status especially among Children living with HIV
(CLHIV). The Nigeria nutrition intervention program also have recommended locally available
foods containing dietary requirements to meet nutrition and energy need of children including
CLHIV. This nutrition assessment tool is used before, during and after nutrition intervention.

12. ConceptNote forCONI-Plan
12
2] Nutrition counselling
Routine and need base nutrition intervention is provided which include counselling on adequate
nutrition, food demonstration on food preparation using local and seasonal nutritious foods
3] Referral and support for clinical intervention/care
This is also recommended in case of SAM more so for CLHIV as Antiretroviral treatment (ART)
and adherence to treatment must be maintained. And in some cases, vitamin/mineral
supplements as prescribed will be provided.
4] Provision of food support and Locally made Ready to Use Therapeutic food
and Food support
Food support with locally made ready to use therapeutic food (RUTF) will be provided to
malnourished children
RTFU will include combination of;
a. Corn (pap to provide carbohydrate and high calories),
b. Soya beans flour (to provide protein and calories),
c. Groundnut paste (to provide protein, fats and oil and minerals)
d. Crayfish (to provide protein)
e. Dried Unripe plantain (to provide iron, minerals and vitamins)
f. Monringa leaf will be boiled and given to child as drink (known to be effective in
prevention and management of malnutrition)

13. ConceptNote forCONI-Plan
13
The 5 ingredients willbe provided to malnourished child in a 3 months’ meal plan in the following
proportions
Ingredient Quantity Nutritious content per 100g serving [50-55]
Corn 1 painter
(2KG)
Calories: 196 g
Energy 616 kcal
Energy 2541 kJ
Protein 34.5 g
Sugar 419.9 g
Fat 12.9 g
Fiber 240.4g
Soya beans ½ painter
(1KG)
Water 8.5 g
Energy 416 kcal
Energy 1741 kJ
Protein 36.5 g
Fat (total lipid) 19.9 g
Fatty acids, saturated 2.9 g
Fatty acids, mono-unsaturated 4.4 g
Fatty acids, poly-unsaturated 11.3 g
Carbohydrates 30.2 g
Fiber 9.3 g
Ash 4.9 g
Isoflavones 200 mg
Calcium, Ca 277 mg
Iron, Fe 15.7 mg
Magnesium, Mg 280 mg
Phosphorus, Mg 704 mg
Potassium, K 1797 mg
Sodium, Na 2.0 mg
Zinc, Zn 4.9 mg
Copper, Cu 1.7 mg
Manganese, Mn 2.52 mg
Selenium, Se 17.8 µg

14. ConceptNote forCONI-Plan
14
Vitamin C (ascorbic acid) 6.0 mg
Thiamin (vitamin B1) 0.874 mg
Riboflavin (vitamin B2) 0.87 mg
Niacin (vitamin B3) 1.62 mg
Panthotenic acid (vitamin B5) 0.79 mg
Vitamin B6 0.38 mg
Folic acid 375 µg
Vitamin B12 0.0 µg
Vitamin A 2.0 µg
Vitamin E 1.95 mg
Groundnut ½ painter
(1KG)
Energy 567 kcal
Carbohydrates 26.1 g
Protein 25.3 g
Fat 40.1 g
Fiber 3.1 g
Calcium 90 mg
Phosphorus 350 mg
Iron 3.5 mg
Minerals 2.4 g
Beta carotene 37 mcg
Niacin 19.9 mg
Folate (vitamin B9)) 20 mcg
Chilone 224 mg
Zinc 3.90 mg
Crayfish ¼ painter
(½ KG)
Energy 77 Kcal
Protein 15.97 g
Total Fat 0.95 g
Vitamins
Folates 37 μg
Niacin 2.208 mg
Pyridoxine 0.108 mg
Riboflavin 0.032 mg
Thiamin 0.070 mg
Vitamin-A 53 IU
Vitamin-C 1.2 mg
Vitamin-E 2.85 mg
Electrolytes

15. ConceptNote forCONI-Plan
15
Sodium 58 mg
Potassium 302 mg
Minerals
Calcium 27 mg
Iron 0.84 mg
Magnesium 27 mg
Phosphorus 256 mg
Zinc 1.30 mg
Omega-3 fatty acids (PUFA)
EPA (20:5 n-3) 0.104 g
DPA (22:5 n-3) 0.010 g
DHA (22:6 n-3) 0.038 g
Dried
Unripe
plantain
¼ painter
(½ KG)
Calories 220g
Iron 1.1mg
Carbohydrates 57 g
Fibre 4 g
Fat 0.5 g
Protein 2 g
Vitamin A 360 ug
Vitamin B6 0.44mg
Vitamin C 45 ug
Potassium 739 mg
Magnesium 66.2 mg
Zinc 0.3 mg

16. ConceptNote forCONI-Plan
16
Moringa Leafs/See
ds
Procedure for CONI-Plan RUTF preparation and serving;
1. Corn will be made into corn flour and stored in container
2. Soya beans will be made into soya beans flour
3. Groundnut will be fried and grounded into paste
4. Crayfish and unripe plantain will be grounded into paste
5. Nutrient-dense-combo (NDC) paste; of Soya beans flour, groundnut paste, crayfish and
plantain flour will be mixed together and stored in container
6. In one serving, using hot water, 5 tablespoons of corn flour will be made into pap-like
texture, and 2 table spoons of the nutrient dense combo paste will be added to the corn
meal and stair well
7. Combination will be given to child 3 times daily and on demand
8. This corn meal will be served along with available food being taken by the households
9. Moringa leaf will be boiled and served as drink to child thrice daily

17. ConceptNote forCONI-Plan
17
5] Follow up nutrition monitoring
Nutrition assessment and follow up of supported malnourished children will be done and
documented bi-weekly till child is treated of malnutrition. This will be done by responsible Case
managers and Care and support officers
6] Sustainability plan
Support will be provided for caregiver of the malnourished CLHIV to start up an income
generating activity (IGA) and support for home gardening to plant nutritious vegetables and
herbs especially moringa tree to meet the nutrition need of the child and household going
forward
Data Collection
1. Trained Case managers will collect data on nutrition indices using nutrition assessment
forms. Nutrition assessmenttools which are weighing scale,heightometer, MUAC and job
aid and SOPs will be provided for the assessment.
2. Nutrition assessmentforms willbe entered into nutrition registerin NOMIS (National OVC
Management Information System) by trained data clerk and MandE officers
3. Same form used to collect baseline data will be used in collecting the follow up and after
intervention data by case managers.
4. Data entry of baselineinformation of malnourished children will be entered into nutrition
tracker. And follow up indices of nutrition status of malnourished children receiving
intervention will also be tracked using nutrition tracker.
5. Thus, nutrition forms, nutrition register on NOMIS and nutrition tracker will be used for
data collection

18. ConceptNote forCONI-Plan
18
Data Analysis
1. Data will be analyzed using Excel and SPSS 21.
2. Simple demographic characteristics and variables will be analyzed and compared by age
and sex. Nutrition status will be compared against Household economic vulnerability
assessment score.
3. Nutrition tracker will be used to collect data on nutrition indices of child at baseline,
during and after nutrition plan intervention.
4. Z-score will be used to compare before and after intervention indices for significance
5. Significance of intervention within same cohort at before and after intervention will be
analyzed by chi square. Significance will be interpreted at p<0.5.
6. Data will be represented using tables, graphs and pictorials.

19. ConceptNote forCONI-Plan
19
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APPENDIX 1- GANTT CHART
S/N Activities Duration
Month
1-3
Month 4-6 Month 7-9 Month
10-12
Month
12-18
1 Procurement of work tools X
2 Training and Capacity building;
Casemanagers and CBOCare and
support and MandE officers
X
3 Implementation of COPI-Plan,
Nutrition assessment
Nutrition intervention plan for
malnourished and
Sustainability plan
X X X X
4 Monitoring and feedback on
children under COPI-Plan
X X X X
5 Monitoring and Continuous
technical assistance provided to
Case managers by Care and
Support officers and the program
managers
X X X X X
6 Data entry into nutrition tracker
and NOMIS
X X X X X
7 Analysis, presentation and
publication
X

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26
Appendix 2- National Nutrition Assessment form
NUTRITION ASSESSMENT FORM
State: __________________ LGA: ________________ Community:
_________________
Date Assessment: _______________________ (Baseline Assessment Follow-up
Assessment (specify if 1st, 2nd, etc) ______)
(dd/mm/yyyy)
VC Unique ID
No._________/__________/_______/_______/_______
(State code / LGA code / Org code/ HH serial /VC serial No)
Child’s Name: ______________________________________________________ Sex:
________ Age: ________years _____ months
(Surname in block letters, first and middle name) (Enter
month if child is below 1 year)
Anthropometric
Weight: kg Height: cm
Fill only for children5 andover
BMI (refertochart):
Nutritional Status(refertotable):
Last Weight: kg on ____/ ____ / ____
Change inweight: gain
stationary (*if <12 years)
loss**
Fill only for children6 monthsto 4 years
Oedema: yes** no
MUAC: red**
yellow*
green
Obese* Mild malnutrition*
Overweight* Moderatemalnutrition
Normal Severe malnutrition**

27. ConceptNote forCONI-Plan
27
* indicates need for targeted counseling ** indicates need for IMMEDIATE REFERRAL
Service provider Name: ____________________Designation: _______________ Phone no:
______________Sign /Date: _______
Food Security& Diet
In the last30 days,wasthere evernofoodto eat inthe household?
In the last30 daysdidany householdmembergotosleephungry
because there wasn’tanyfood?
In the last30 days,didanyhouseholdmembergoa whole dayandnight
withouteatinganythingbecausethere wasnotenoughfood?
No Rarely Sometimes* Often*
Fill only for children over6 monthsto 18 years
How manytimesdidthe childeatyesterday?
Yes No*
Yes No*
Yes No*
Yesterday,didthe childeatanyvitaminA rich foods(forexample:mango,carrots,
papaya,red palmoil,zogali,ugu, cassava,liver,orkidney)?
Yesterday,didthe childeatanyIron-richfoods(forexample:liver,kidney,beans,
groundnut,ordark greenleavessuchasspinach,zogali,ugu,cassava)?
Yesterday,didthe childeatanyproteinfoods(forexample:meat,eggs,fish,beans,
groundnut, milk,cheese,soya,etc.)?
4 or more 3 2* 1* 0*
Fill only for children under 6 months ofage
Didthe childreceive anyfoodorliquidbesidesbreast milkinthe last24 hours? Yes No*
Doesthe householdhave soapandwaterto washdishesandutensils?
Doesthe householdhave soaporash for handwashing?
Do younormallywashyourhands withsoap/ashbefore cooking/eating?
Do younormallywashyourhands withsoap/ashafterthe toilet?
Yes No*
Yes No*
Yes No*
Yes No*
Hygiene
Clinical – Tick any recentillnessesconditionsthathave affectedchild’snutrition ANDREFER FOR MEDICAL
EVALUATION
HIV: Yes No
Diarrhea: Yes No
Nausea: Yes No
Difficultorpainful chewing/swallowing: Yes No
Vomiting: Yes No
Poorappetite: Yes No
Mouth sores: Yes No

28. ConceptNote forCONI-Plan
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Appendix 3- MUAC tape

29. ConceptNote forCONI-Plan
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Appendix 4- BMI Chart