Nigeria Systematic Map to guide decision-making on the current landscape of research on World Health Assembly indicators in West Africa
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A new study by Transform Nutrition West Africa identifies the trends and gaps in research that cover the World Health Assembly indicators across West Africa. These are potentially valuable insights for nutrition decision makers in the region. This presentation is to be used as a freely accessible resource for decision-makers at all levels.
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Nigeria Systematic Map to guide decision-making on the current landscape of research on World Health Assembly indicators in West Africa
- 1. Nigeria International Food Policy Research Institute The Current Landscape of Research on World Health Assembly Indicators in West Africa: A Systematic Map to Guide Decision-Making
- 2. 2 The West Africa (WA) Region has been one of the slowest in reducing its many burdens of malnutrition. The World Health Assembly’s (WHA) 2025 nutrition targets were developed to track countries’ nutritional situations, and measure progress in reducing malnutrition. These indicators are therefore essential to guide decision making. Understanding the regional and in-country dynamics are an essential first step to highlight gaps and trends in evidence in the region. Introduction This study aimed to identify and catalogue peer-reviewed research on the WHA indicators in West Africa, and create a map of recent research evidence to inform decision-making for nutrition policies and programs in the region. Objective
- 3. Search terms were developed to capture evidence on the prevalence, drivers, programs (Randomized Controlled Trials), and policies relating to the WHA indicators. These include stunting, wasting and overweight in children under 5, low birth weight (LBW), exclusive breastfeeding (EBF) up to 6 months, and anemia in women of reproductive age (WRA) Data were extracted at abstract level. No quality appraisal of publications was undertaken A systematic approach was applied to literature searches, developing inclusion criteria, screening, coding, taxonomy, data extraction, and study synthesis The MEDLINE database was searched for research published on World Health Assembly (WHA) indicators from 2010 to April 2018 Methods
- 4. References identified through systematic search (n=6,630) References excluded (n=2,581) - Not WA region (n=130) - Not target population (n=172) - Disease specific/not nutrition related (n=1729) - Nutrition related but not WHA specific (n=337) - Additional program studies (n=75) - RCT Protocol (n=9) - Other (n=129) Duplicates removed (n=3,669) References retrieved after title and abstract screening (n=380) - Primary studies (n=359) - Reviews (n=21) References retrieved for title and abstract screening (n=2,961) References included in mapping (n=363) Primary Studies (n=340) Reviews (n=23) Excluded at extraction level (n=17) Flow chart of search approach
- 6. Analysis General characteristics Characteristics of WHA indicators Characteristics of focus of research Results
- 7. Number of publications per country 21 39 4 12 10 86 5 5 5 15 18 147 14 8 2 1 Benin Burkina Faso Cape Verde Cote d'Ivoire Gambia Ghana Guinea Guinea- Bassau Liberia Mali Niger Nigeria Senegal Sierre Leone Togo WA region 43% of publications identified through the search report on Nigeria 143 publications focus only on Nigeria and 4 publications are on multi- country studies that include Nigeria.
- 8. Publications per year in focal countries 0 2 4 6 8 10 12 14 16 18 20 22 24 26 2010 2011 2012 2013 2014 2015 2016 2017 Nrofpublications Nigeria Ghana Burkina Faso Senegal
- 9. Publications reporting on Nigeria by study setting 50 9 2 3 3 53 22 3 2 0 10 20 30 40 50 60 Not specified National District Village Community Hospital Health facility Primary health care centre Other Nr of pubications
- 10. Publications reporting on Nigeria by study design 1% 27% 9% 2% 45% 10% 3% 3% Percent of publications per study design (n=147) Other Not specified Case-control Case series Cross-sectional Cohort RCT Review Hierarchy of evidence 67% 3%
- 11. Analysis General characteristics Characteristics of WHA indicators Characteristics of focus of research Results
- 12. Publications per indicator category grouping for four focal countries 16 24 23 5 21 18 20 5 7 33 61 2 1 4 7 2 8 20 50 3 9 13 20 4 0 20 40 60 80 100 120 140 160 180 200 Burkina Faso Ghana Nigeria Senegal U5 Stunting U5 Wasting LBW U5 Overweight Anaemia WRA EBF
- 13. Publications reporting on Nigeria per indicator category 12% 11% 72% 5% Breakdown of publications within U5NS (n=64) U5 Stunting U5 Wasting LBW U5 Overweight 44% 12% 25% 19% Percent of publications per indicator category (n=147) U5NS EBF Anaemia WRA More than 1 indicator
- 14. Analysis General characteristics Characteristics of WHA indicators Characteristics of focus of research Results
- 15. Publications reporting on Nigeria per indicator category and research focus 22 18 60 7 17 47 1 2 1 2 2 4 1 3 4 0 10 20 30 40 50 60 70 U5 Stunting U5 Wasting LBW U5 Overweight EBF Anaemia WRA Nrofpublications Policy Program Problem
- 16. Intervention description U5NS (n=1) EBF (n=2) Anaemia (n=1) Supplementation 1 1 Health promotions/ Peer counseling 0 2 0 Program studies by intervention type and outcome Nigeria’s programs 18 8 4 1 0 2 4 6 8 10 12 14 16 18 20 Burkina Faso Ghana Nigeria Senegal Nrofprogramstudies
- 17. Nigeria has the most amount of publications in the region (147 out of 340) The majority of studies report on under 5 nutritional status. Low birth weight is highly reported on, but very few report on under 5 overweight Most studies report on the prevalence or drivers of World Health Assembly indicators, with very few reporting on policy and programs. Key Messages
Editor's Notes
- Note: Only primary studies are included in the analysis (n=340) 23 reviews have been recorded for use at a later stage
- Note: Each bar in this graph includes publications that reports on one country only (eg. Nigeria), as well as publications that report on multiple countries (Burkina Faso and Nigeria and Ghana) We include all of these because we want to capture all evidence that incorporates that specific country (eg. Nigeria). This is why the total is greater than 340 (the number of publications included in this study) because they may be counted twice if it reports on more than 1 country. There are 17 publications that report on more than 1 country Key message: Nigeria had the greatest volume of publications (n=147)
- Note: This graph includes publications that report on one specific focal country only (eg Nigeria), as well as publications that report on multiple countries, that include the focal country (eg. Ghana, Burkina Faso and Nigeria). We include all of these because we want to capture all evidence that incorporates each focal country Key Messages: Over all the volume of publications in the focal countries has increased over time. Publications reporting on Nigeria have fluctuated over time, and peaked in 2013 (n=23).
- Note: This graph includes publications that report on Nigeria only, as well as publications that report in multiple countries, that include Nigeria (147 studies in total). We include all of these because we want to capture all evidence that incorporates Nigeria. Key message: Many publications do not report study setting at abstract level (n=50). Of those that do, the majority are conducted at the hospital (n=53) or health facility level (n=22). Other studies specified the geographic coverage of the study including national coverage (9 publications), village or community (3 publications each) and district coverage (2 publications).
- This graph includes publications that were conducted only in Nigeria only, as well as publications that were conducted in multiple countries, that include Nigeria. We include all of these because we want to capture all evidence that incorporates Nigeria Key message: The majority (67%) of studies reporting on Nigeria are observational in design (cross-sectional, cohort, case-control, case-series) (n=98). Experimental studies (Randomized control trial (RCT)) only account only for 3% (n=4). The remaining are either not specified at abstract level or are of an alternative design Majority of studies are towards the bottom of the evidence pyramid in terms of evidence quality
- Note: Each bar in this graph includes publications that report on one specific focal country only (eg Nigeria), as well as publications that report on multiple countries, that include the focal country (eg. Ghana, Burkina Faso and Nigeria). We include all of these because we want to capture all evidence that incorporates each focal country Also, this graph includes publications reporting on one indicator category alone (Eg. EBF), as well as multi-indicator publications (eg. EBF and stunting). Therefore publications can be counted twice – Both in the EBF category and the stunting category. This is why the total for Senegal is higher than 147 (total number of publication reporting on Nigeria). Key messages: Most of the publications among the four focal countries report on stunting, wasting, LBW and Anaemia WRA. Compared to the rest of the focal countries Nigeria has more publications reporting on LBW (n=61), Anaemia WRA (n=50). In Nigeria: The majority of publications report on LBW (n=61), followed by Anaemia WRA (n=50), U5 stunting (n=23), U5 wasting and EBF (n=20 each) The least reported is U5 overweight (n=7)
- Note: These charts includes publications that report only on Nigeria only, as well as publications that report on multiple countries, that include Nigeria. We include all of these because we want to capture all evidence that incorporates Nigeria The left pie chart includes publications reporting on one indicator alone (Eg. EBF). Studies that report on more that one indicator have been brought together into the ‘more than 1 indicator’ category (n=28) The right side pie chart includes studies that report on single indicators only (eg. Stunting). Studies reporting on more than one indicator (eg. Stunting and wasting) have not been included here. U5NS (Under 5 nutritional status including stunting, wasting, LBW and overweight) Key message: Overall, the majority of publications report on U5NS. Within U5NS, the majority of publications report on LBW (n=61), followed by stunting (n=23) and wasting (n=20), and only 6% (n=7) reporting on overweight. The majority of publications report on U5NS (n=64), followed by Anaemia (n=37), and EBF (n=18). There are 28 publications that report in more than 1 indicator. Within U5SN, there is an uneven breakdown between studies. The majority of studies report on low birth weight (n=46) versus few on stunting (n=8) and wasting (n=7) and very few reporting on overweight (n=3)
- Note: These charts includes publications that report on Nigeria only, as well as publications that report on multiple countries, that include Nigeria. We include all of these because we want to capture all evidence that incorporates Nigeria Also, this graph includes publications reporting on one indicator category alone (Eg. EBF), as well as multi-indicator publications (eg. EBF and stunting). Therefore publications can be counted twice – Both in the EBF category and the stunting category. This is why the total for Nigeria is higher than 147 (total number of publications reporting on Nigeria). This graph includes publications reporting on one area of research only (eg. Policy) as well as multi-areas of research (eg. Policy and problem), therefore publications can be counted twice (when reporting for instance on two research areas, Problem and Program); and this is why the total number of publications on indicator category can be higher than the number of publications for that indicator category. Key messages: Across all indicator categories, the focus of research most reported is Problem (n=171) (this includes prevalence and drivers of indicators categories). This is followed by policy (n=16); and only four studies report on programs. There is a research gap between publications that report on problems compared to those that look at programs and policy. For U5 stunting, LBW and U5 overweight there are no programs at all, even through there is a high burden.
- Note: For each country, we included publications that report on that specific focal country only (eg Nigeria), as well as publications that report on multiple countries, that include the focal country (eg. Ghana, Burkina Faso and Nigeria). We include all of these because we want to capture all evidence that incorporates each focal country In the table we includes program studies reporting on one indicator category alone (Eg. EBF), as well as multi-indicator publications (eg. EBF and stunting). Therefore publications can be counted twice – Both in the EBF category and the U5NS category. This is why the total for Nigeria is higher than 4 (total number of publications reporting on programs). This table includes program studies reporting on one intervention only on related outcome (eg. Supplementation to address U5NS) as well as multi-interventions (eg. Supplementation and counseling to address U5NS), therefore program studies can be counted twice (when reporting for instance on more than one intervention type); and this is why the total number of program studies on intervention categories can be higher than the number of program studies for specific WHA indicators. Key messages: Nigeria has a very low number of program studies (RCTs) compared to the other focal countries (n=4), especially considering it has the most amount of publications in the region (147 out of 340 in the region).