In Droum, in the Mirriah health district, many children grow up facing a double vulnerability. On one hand, malnutrition weakens their bodies. On the other hand, insufficient vaccination coverage exposes them to preventable diseases.
CThis reality is part of a worrying broader context. In Niger, 11.1% of children under five suffer from acute malnutrition, above the emergency threshold established by the WHO, and 30% to 40% are not fully vaccinated. In the Zinder region, the situation is even more critical, with nearly 18% of children affected by acute malnutrition and around 30% not vaccinated against measles.
Health teams are familiar with this vicious cycle: malnourished children are more likely to develop infections, and these illnesses in turn deteriorate their nutritional status. This spiral has serious consequences for the survival and development of the youngest children
It is within this context that OptiMAx steps in: a project seeking to address both challenges simultaneously through an innovative approach.
A simple approach changing habits
At the Droum Integrated Health Center, one of ten health facilities in the Mirriah district where ALIMA and BEFEN (Bien Etre de la Femme et de l’Enfant au Niger, Women’s and Children’s Well-Being in Niger) are implementing the OptiMAx project alongside the Ministry of Health, the change is visible from the early hours of the morning. Mothers arrive in large numbers, sometimes traveling long distances with their children.
In these rural areas, access to healthcare remains challenging: long distances to travel on foot, heavy daily responsibilities, other children to look after, and a lack of information. All these factors can delay or limit visits to health centers.
What is now encouraging many families to make the journey is a small 20-gram sachet. Distributed monthly, this small-quantity lipid-based nutrient supplement, known as SQ-LNS and or “Nutributter,” helps prevent malnutrition in children aged 6 to 23 months. But in practice, its impact goes beyond nutrition alone.
“OptiMAx was introduced to boost vaccination. Parents come to collect the SQ-LNS… and at the same time, their children get vaccinated.”
Ousmane Ahmad, project’s activities manager
In practice, each eligible child receives 28 sachets per month, enough for four weeks. This routine creates a regular touchpoint with the health center and encourages families to return, including those who previously did not come for vaccination. In this way, SQ-LNS acts as a gateway to more comprehensive monitoring of a child’s health.
A gateway to vaccination
At the health center, this dynamic is clear. Aïssata, who has come for her monthly visit, explains: “I came last month for the sachets. Today, I’m back to get more and to check his vaccination card.” Beside her, Mariama adds: “When the sachets run out, we come back…”
Like them, many mothers now return on a regular basis. These visits make it easier to check vaccination records and ensure that children who are not up to date can catch up. “When the sachets run out, the mothers come back. And that often coincides with the next vaccination appointment,” the project manager explains.
At the health center, children follow an integrated care pathway that includes nutritional screening, vaccination, and referral to appropriate services based on their needs.
Encouraging early results
The project is still in its implementation and analysis phase, but several trends are already emerging on the ground. Nearly 11,000 children are being monitored, including 9,000 enrolled in OptiMAx. Several hundred “zero-dose” children have been reached, including 240 in a single month. “We have seen ‘zero-dose’ children come to the health center, children who had never received any vaccination. Thanks to SQ-LNS, we were able to bring them into care,” the project manager notes.
Teams also observe increased attendance at health centers, very low dropout rates in the program, and visible improvement in the general health of monitored children. “Children receiving the SQ-LNS sachets show better overall health and positive nutritional progress.”
An integrated approach to be evaluated
In Mirriah, OptiMAx highlights a simple approach: using nutrition as an entry point to strengthen vaccination. Neither nutritional supplements nor vaccines are new. But combining them opens up an interesting path: a virtuous circle in which each intervention reinforces the other. In a context where malnutrition and under-immunization remain closely linked, this strategy appears promising. It is currently being evaluated through a cluster randomized controlled trial emulation, in order to better understand its effectiveness in highly vulnerable settings.
LThe final analyses will make it possible to measure its impact more precisely. But on the ground, one thing is already clear: a simple sachet is enough to bring mothers back and bring children closer to essential care.
This project is implemented with financial support from the Gates Foundation and Edesia Nutrition.
