i Key Findings i The Federal Republic of Nigeria National Food Consumption and Micronutrient Survey 2021 Key Findings January 2024 The Federal Republic of Nigeria National Food Consumption and Micronutrient Survey 2021 Key Findings January 2024 Key Findings Published by the Federal Government of Nigeria through the Federal Ministry of Health and Social Welfare, Federal Ministry of Agriculture and Food Security, and Federal Ministry of Budget and Economic Planning in collaboration with the International Institute of Tropical Agriculture (IITA) Ibadan, Nigeria. ISBN 978-978-131-424-7 Recommended citation: Federal Government of Nigeria (FGoN) and the International Institute of Tropical Agriculture (IITA). 2024. National Food Consumption and Micronutrient Survey 2021. Key Findings. Abuja and Ibadan, Nigeria: FGoN and IITA. 73 pp. Printed in Nigeria. Key Findings Key Findings Federal Ministry of Health and Social Welfare v Key Findings Contents Key Messages ....................................................................................................................1 National Food Consumption and Micronutrient Survey (NFCMS) 2021 Key Findings .......2 Objectives ..............................................................................................................2 Household in-sample key findings ......................................................................................5 Key Findings for Dietary Intake ..........................................................................................7 Key Findings: Characteristics of respondents ...................................................................7 Key findings on macronutrient intakes for women and children .........................................7 Key findings on micronutrient intakes for women and children ........................................11 Calcium ................................................................................................................13 Iron .....................................................................................................................13 Zinc ......................................................................................................................13 Vitamin A ..............................................................................................................14 Vitamin C .............................................................................................................14 Vitamin B1 (Thiamine) .........................................................................................15 Vitamin B2 (Riboflavin) ........................................................................................15 Vitamin B9 (Folate) ..............................................................................................16 Vitamin B12 (Cobalamin) .....................................................................................16 Key Findings on Infant and Young Child Feeding ............................................................17 Key findings on the nutrient density of the complementary diet of children aged 6-23 months.............................................................................................................19 Biofortification Coverage ..................................................................................................21 Fortification coverage and intake of Fortifiable food vehicles ...........................................23 Fortification status of household food samples ................................................................26 Diet Quality ......................................................................................................................27 Key Findings for Anthropometry .......................................................................................28 Adolescent girls (aged 10-14 years) ....................................................................29 Women of Reproductive Age (WRA, aged 15-49 years) .....................................30 Coverage of national interventions to improve micronutrient status. ................................31 Intervention coverage among children aged 6-59 months. ................................31 Intervention coverage among adolescent girls (aged 10-14 years) ....................32 Intervention coverage among women of reproductive aged, 15-49 years ...........34 Intervention coverage among pregnant women (aged, 15-49 years) ..................36 Self-reported morbidity .....................................................................................................39 Self-reported morbidity among adolescent girls (aged 10-14 years). ..................41 Self-reported morbidity among women of reproductive age (aged 15- 49 years) .....42 Self-reported morbidity among pregnant women (aged 15-49 years) .................43 Malaria: ...............................................................................................................46 H. pylori ..............................................................................................................46 Helminths ............................................................................................................47 Haemoglobin genotype.....................................................................................................47 Inflammation ........................................................................................................48 Anaemia ..............................................................................................................50 Iodine ..................................................................................................................58 Key Drivers of Anaemia ....................................................................................................60 Key factors associated with multiple forms of malnutrition. .............................................62 Recommendations for Nutrition Policy in Nigeria ............................................................63 NFCMS Collaborating Institutions ....................................................................................69 1 Key Findings Key Messages • The results show a low coverage of key nutrition interventions. To improve overall nutritional status and maternal and child health, key nutrition interventions and services need to be better implemented across populations. A better understanding of implementation science is needed to address implementation bottlenecks to improve programme coverage, quality, and impact of nutrition interventions. • Dietary diversity is still too low to ensure an adequate supply of micronutrients in women. Innovations in the food system are needed to incentivize the production and consumption of nutrient-rich foods in addition to the familiar staples. • The contribution of animal protein is low and at least >30% of women have not met protein intake requirements. The overall diet (of women and children) is likely to be deficient in essential amino acids, which are important for growth and development. Innovations in the food system are needed to incentivize the production and consumption of more foods with animal protein. • Dietary micronutrient deficiencies remain a problem and are even more serious in women (especially pregnant and breastfeeding women). Food and nutritional policies such as supplementation and fortification, which have been shown to improve micronutrient intake, need to be expanded and maintained. • Staple foods that could provide more nutrients for total nutrient intake are less utilized than foods that serve as ingredients. Strengthen existing policies and create innovative strategies that improve mandatory food fortification at scale, especially for staple foods. • Iron deficiency, inflammation and malaria are associated with an increased likelihood of anaemia in all age groups, while vitamin A deficiency plays an important role in pregnant women and women of reproductive age, and zinc deficiency is a determinant of anaemia in WRA and preschool children. Although these findings provide important insights, further analysis is needed to understand the magnitude of the relative contribution of each risk factor to better inform the design of anaemia control. • The results provide the government and stakeholders with evidence of nutrition vulnerability to prioritise. This provides an opportunity to start the conversation about how to invest in agriculture, nutrition and food systems and who to target. It also provides opportunities for the formulation of evidence-based policies and programmes and a baseline from which to monitor change over time. 2 Key Findings National Food Consumption and Micronutrient Survey (NFCMS) 2021 Key Findings The National Food Consumption and Micronutrient Survey (NFCMS) is a cross-sectional population-based survey. The primary objective of the survey is to assess the micronutrient status, anthropometry, and dietary intake of women of reproductive age (WRA), aged 15-49 years, including pregnant and lactating women, and children (aged 6-59 months) as well as the micronutrient status of non-pregnant adolescent girls (aged 10-14 years) and identify key factors associated with poor nutrition in these populations. The information generated will provide a foundation for the formulation of evidence-informed policies and programmes. In the short- to medium-term, the information will provide a baseline from which to monitor changes over time. Objectives The primary objective of the survey is to assess the micronutrient status and dietary intake of women of reproductive age (WRA) (aged15-49 years), including pregnant and lactating women and children (aged 6-59 months). The study also assessed the micronutrient status of non- pregnant adolescent girls (aged 10-14 years) and identified key factors associated with poor nutrition in these populations. The information generated will provide a foundation for the formulation of evidence-informed policies and programmes. In the short- to medium term, the information will provide a baseline from which to monitor changes over time. The specific objectives of the survey include: 1. assess the food consumption of children (aged 6-59 months), excluding breastmilk, and WRA to determine their intakes of energy, protein, fat, and selected micronutrients, as well as the amounts of specific nutrient-dense foods relevant for food-related nutrition policies and programmes 2. determine the adequacy of nutrient intake in children (aged 24-59 months) and WRA to identify populations at risk of inadequate intake 3. assess infant and young child feeding (IYCF) practices among children (aged 6-23 months) and compare the nutrient density of their complementary feeding diets with recommendations 4. assess the prevalence, severity, and distribution of specific micronutrient deficiencies and other forms of malnutrition (e.g. stunting, wasting, overweight/ obesity) among WRA, adolescent girls, and children (aged 6-59 months) 5. identify key factors (e.g. infection, blood disorders, supplement use) associated with anaemia in WRA and children (aged 6-59 months) to inform strategies to prevent and treat anaemia in these populations 6. measure the coverage of national interventions to improve micronutrient status and dietary intake in WRA and children (aged 6–59 months), including iron folic acid (IFA) supplements, IYCF counselling, vitamin A supplementation (VAS), biofortification, and food fortification programmes 3 Key Findings 7. assess the prevalence of food insecurity and identify other key factors at individual and HH levels (e.g., education, SES) that are associated with micronutrient status and dietary intake in WRA and children (aged 6–59 months), and the micronutrient status in adolescent girls. The NFCMS 2021 collected information on four distinct components: (1) socioeconomic and demographic information of household in sample; (2) dietary intake – types and amounts of foods consumed in the last 24 hours; (3) anthropometry – height/length, weight, age; and (4) micronutrient status through a series of biomarkers analyses of the biological samples were carried out in both local and international laboratories that adopted rigorous quality control measures. The order of field operations, and information collected by each component during data collection is presented below. * The line-listing and household SES teams are the same interviewers. # The dietary pre-training and dietary repeat intake teams are the same interviewers. + Only collected for relevant respondents. FOOD SAMPLES Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7  Pre-training for dietary   24-hour recall LINE- LISTING  Informed consent  Household Questionnaire  Sensitization  Mobilization  Line-listing of all   sampled EAS  Random selection   of respondents  Short diet questionnaire  First dietary 24-hour recall  Nutrition Questionnaire  Anthropometry measurements  Biological sample collection  MRDR in 20% of the sample  Short diet questionnaire  Repeat dietary 24-hour recall  Food samples collection Sensitization Team Line-listing Team* Household SES Team* Dietary Pre-training Team# Biomarker Anthropometry Team Dietary Repeat Intake Team (>20% subsample)# Dietary Intake Team# HOUSEHOLD QUESTIONNAIRE DIET QUESTIONNAIRE BIOMARKER QUESTIONNAIRE DIET QUESTIONNAIRE SAMPLE COLLECTION ANTHROPOMETRY Relationship to head Sex Age in years/months Pregnancy status for girls and women+ SES/Housing/Assets Drinking water/toilet facilities Food access FIES / coping 24-hour recall IYC feeding+ Biofortified food consumption Food fortification coverage Lactation status for women Pregnancy status women 24-hour recall Food fortification coverage & collection (Salt, oil, sugar, wheat flour, and semolina)+ Biological samples and measurements Anaemia risk factors Intervention coverage & health status Weight+ Height/length+ Survey components, order of field operations, and information collected by each component This report presents key findings from the NFCMS 2021. The reporting domains and level of disaggregation are presented in Table 2. For dietary intake, the results are 4 Key Findings presented separately for children aged 6-23 versus 24-59 months at the national level and by location (urban and rural). For WRA, including pregnant women, data was disaggregated by geopolitical zone and by location (urban and rural) at the national level. In addition, lactating women, with higher energy and nutrient requirements are presented separately. For biomarker and anthropometry, results are presented at the national level, geopolitical zone, and by location (urban and rural) for WRA and children (aged 6-59 months); and at national level and by location (urban and rural) for pregnant women (15-49 years old) and non-pregnant adolescent girls (10-14 years old). Reporting domain by target groups and survey components Sampling target groups Non-pregnant WRA (aged15-49 Years) Children (aged 6-59 months) * Pregnant women (aged 15-49 years) Non-pregnant adolescent girls (aged 10-14 years) Reporting domain for dietary intake National & geopolitical region National National No data collected Reporting domain for micronutrient biomarker/ anthropometry National & geopolitical region National & geopolitical region National National Outcomes disaggregated by urban and rural areas National National National National 5 Key Findings Household in-sample key findings Income-generating activities of household heads: Overall, 36.8 percent were involved in agriculture (54.8 percent rural and 10.7 percent urban). Production of animal source foods: 11 percent of households were engaged in the production of animal source foods, very low between rural (13.9 percent) and urban areas (7.5 percent). Land for vegetable gardening: Overall, 3 out of 10 households indicated that they have land for vegetable gardening. The proportion was higher in rural areas (38 percent) compared to urban areas (16 percent). Production of fruits: Overall, 31 percent of households in the sample have trees or bushes that produce fruits and were more in the South East (56 percent) followed by South South (44 percent), and North Central (39 percent). Drinking water: Overall, 62 percent of households have access to an improved source of drinking water (67.4 percent in urban and 58.7 percent in rural). Availability of water: The most common main source of drinking water is the tubewell/ borehole (42.6 percent of households) and prevalent in urban (46.3 percent) than rural (39.9 percent). Sanitation: 55 percent of households used an improved toilet facility (26.5 percent not shared and 28.5 percent shared with at least one other household). Sharing of improved toilets was higher in the urban areas (44 percent) than in the rural areas (18 percent). 6 Key Findings 21% 57% 22% Food Insecurity Food secure Food insecure-> Moderately food insecure Severely food insecure Resources to purchase food: Overall 41.5 percent of households did not have enough food or money to buy food in the past seven days before the survey. Coping strategies: Reliance on less preferred and less expensive foods; food borrowing or relying on help from friends or relatives; limiting portion size at mealtimes; restriction on consumption by adult members of the household; and reduction in the number of meals eaten in a day were used. Financial inclusion: Overall, 59 percent of households had at least one member with an account with a bank or other financial institution (81.5 percent in urban and 43.6 percent in rural. 7 Key Findings Key Findings for Dietary Intake Key Findings: Characteristics of respondents Age of women of reproductive age: Over half of the women (57 percent of non- pregnant and 82 percent of pregnant women) were between 20 and 39 years old. Level of education: 44.6 percent of non-pregnant women, 35.2 percent of pregnant women, and only 7.7 percent of caregivers had completed senior secondary school. Pregnancy status: Nationally, about 26 percent of the sampled pregnant women were in the first trimester of pregnancy, 19 percent were in the second trimester, and 25 percent were in the third trimester. Lactation status: Nationally, about 24 percent of non-pregnant women reported breastfeeding a child of any age (29 percent from rural areas and 18 percent from urban areas). Key findings on macronutrient intakes for women and children Usual mean energy intake for women of reproductive age: Nationally, the usual mean energy intake was 1848 kcal for non-pregnant non-lactating women, 2061 kcal for lactating women, and 1899 kcal for pregnant women (1652 kcal in North Central and 2040 kcal in South East). 8 Key Findings Usual mean energy intake for children 24-59 months: Nationally, the usual mean energy intake for children aged 24-59 months was 1200 kcal (1235 kcal for boys and 1163 kcal for girls). Food sources contributing to energy intake: Refined palm oil (palm olein), rice, and red palm oil were the main contributors to energy intake for both women and children nationally (palm olein, maize flour, and rice main contributors in the Northern zones; rice, palm oil, garri, palm olein, and bread in the Southern zones. Usual mean protein intakes for women of reproductive age: Nationally, non- pregnant non-lactating women and lactating women had intakes of 47 grams and 53 grams, respectively while pregnant women had a usual intake of 49 grams (North Central and North East had an intake of 42 grams and South West had an intake of 53 grams). Protein inadequacy in women of reproductive age: About 35 percent of non- pregnant women have an inadequate protein intake, 58 percent of pregnant women, and 66 percent of lactating women have inadequate intake (51 percent urban and 63 percent rural dwellers for pregnant women). Intake of animal-sourced protein for women of reproductive age: The usual intake of animal-sourced protein among non-pregnant women is 14 grams. Across the zones, it ranged from a low of 8 grams among women living in the North East to a high of 23 grams among South South women. Intake of plant-sourced protein for women of reproductive age: The mean usual intake of protein from plant sources was 35 grams irrespective of pregnancy status while it was different for non-lactating women (34 grams) and lactating women (40 grams). Across the zones, women in the North West had the highest intake of 41 grams, while South South women had the lowest intake of 26 grams. Usual mean protein intake for children 24-59 months: Nationally, the usual mean protein intake for children aged 24-59 months is 29 grams (30.6 grams in urban and 28 grams in rural). Only 2 percent had inadequate intake. Food sources contributing to protein intake for women and children 24-59 months: The main food sources for protein were rice, maize products, and cowpea products for both women of childbearing age and children 24-59 months. Intake of animal- and plant-sourced protein for children 24-59 months: The usual intake is 7 grams and 22 grams from animal and plant sources respectively. 9 Key Findings Contribution of macronutrients to total usual energy intake among non- pregnant women Contribution of protein to total usual energy intake: The mean contribution of protein to total usual energy intake was approximately 10 percent for women across the various categories and children 24-59 months (Animal sources contributed approximately 3 percent and plant sources generally contributed about 8 percent). Contribution of macronutrients to total usual energy intake among children aged 24-59 months Usual intakes of fat: Nationally, the usual fat intake in non-pregnant women is 68.7 grams (North Central 58.4 grams and South East 79.3 grams). The usual fat intake of pregnant women living in rural areas was 67.4 grams and those in urban areas had an intake of 76.8 grams. The mean fat intake of children aged 24 –59 months is 45 grams. Food Sources contributing to fat intake: Among women and children, the main sources of fat were edible oils (palm oil, its products, and other vegetable oils). Percentage contribution of fat to total energy intake: The contribution of fat intake to overall energy intake was approximately 33 percent and 34 percent for women and children respectively. 10 Key Findings Usual intake of Carbohydrates in women: Usual mean carbohydrate intakes were 251 grams for non-pregnant non-lactating women, 280 grams for lactating women, and 255 grams for pregnant women (229 grams in the North Central and 274 grams in North West). Usual intake of Carbohydrates in children 24-59 months: The usual carbohydrate intake is 162 grams (170 grams in urban and 158 grams in rural areas). Food sources contributing to carbohydrate intake: Rice, maize, and cassava (garri) products were the major food sources across all groups of women and children 23-59 months. In the case of children, sugar was a higher contributor than bread when compared to women. Percentage contribution of carbohydrate to total energy intake: The mean contribution of carbohydrate intake to overall energy intake was approximately 54 percent across the sampled categories of women (also 54 percent for children 24-59 months). 11 Key Findings Key findings on micronutrient intakes for women and children Pr ev al en ce o f m ic ro nu tr ie nt in ad eq ua cy a m on g w om en a nd c hi ld re n (a ge d 24 -5 9 m on th s) *Ir on in ad eq ua cy re pr es en ts re su lts fo r N on -P re gn an t N on -la ct at in g (N PN L) w om en 12 Key Findings *Ir on in ad eq ua cy re pr es en ts re su lts fo r N on -P re gn an t N on -la ct at in g (N PN L) w om en N ut rie nt in ta ke in ad eq ua cy (% ) a m on g no n- pr eg na nt W R A by re si de nc e, z on e an d w ea lth q ui nt ile 13 Key Findings Calcium Usual mean calcium intake in women: 466 mg for non-pregnant non-lactating women, 502 mg for lactating women, and 490 mg for pregnant women (pregnant women in urban areas 534 mg and 465 mg in rural areas; non-pregnant women 351 mg in North East and 591 mg in South East). Calcium inadequacy in women: 90 percent for lactating women and 95 percent for non-pregnant non-lactating women (89 percent for South East and 100 percent in North East). Food sources contributing to calcium intake for women and children 24-59 months: The main calcium contributors are bread, shellfish, fura da nono, baobab powder, and soybean. Usual mean calcium intake in children 24-59 months: The usual calcium intake of children aged 24-59 months was 305 mg. Calcium inadequacy in children 24-59 months: Nationally, 92 percent of children 24-59 months had inadequate intake of calcium (88 percent urban and 94 percent rural). Iron Usual mean iron intakes in women: 16.1 mg for non-pregnant non-lactating women and 18.9 mg among lactating women and 17.2 mg among pregnant women nationally (17.5 mg in rural areas and 14.3 mg in urban for non-pregnant non-lactating women; 13.7 mg in North Central and 19.1 mg in North West). Iron inadequacy in women: 45 percent of non-pregnant non-lactating women, 82 percent of pregnant women, and 16 percent of lactating women had inadequate iron intake (59 percent in North Central and 31 percent in North West; 36 percent in the lowest wealth quintile and high 54 percent in the highest wealth quintile). Food sources contributing to iron intake for women and children 24-59 months: Condiments (mainly locust beans and seasonings used in preparing soups and sauces), pepper, millet, maize, and rice products. Non-heme iron is the major form in the diet. In all the zones. Usual mean iron intake in children 24-59 months: The usual iron intake of children aged 24-59 months is 10.7 mg (9.9 mg in urban and 11.1 mg in rural). Iron inadequacy in children 24-59 months: 18 percent nationally (16 percent rural and 22 percent in urban; 15 percent in males and 20.7 in females). Zinc Usual mean zinc intakes in women: the mean usual zinc intake of non-pregnant- non-lactating is 8.5 mg, lactating is 9.4 mg, and pregnant women is 8.8 mg (6.7 mg in North East and 10.9 mg in South South). 14 Key Findings Zinc inadequacy in women: 46 percent of pregnant women and 26 percent of non- pregnant women had inadequate zinc intake (49 percent in North East and 4 percent in South South for non-pregnant women; 51 percent in rural and 40 percent in urban for pregnant women). Food sources contributing to zinc intake for women and children 24-59 months: The main contributors to nutrient intake of zinc among women and children were garri, rice, maize products, and beef. Products from cowpea, millet, and sorghum were also among the foods that were commonly consumed by women and children. Usual mean zinc intake in children 24-59 months: Nationally, the usual zinc intake of children aged 24-59 months is 5.0 mg. Zinc inadequacy in children 24-59 months: Inadequate zinc intake is 3.5 percent nationally (4.4 percent rural and 1.9 percent urban). Vitamin A Usual mean vitamin A intake in women: 924 mg for non-pregnant non-lactating women, 966 mcg for lactating women, and 972 mcg for pregnant women (1567 mcg in South and 629 mcg in North West). Vitamin A inadequacy in women: 26 percent of non-pregnant and 58 percent of lactating women had an inadequate intake (48.3 percent in North West and 1.3 percent in South East. Food sources contributing to vitamin A intake for women and children 24-59 months: The main food sources of vitamin A are palm oil, banga (palm nut soup), palm olein (a refined version of palm oil fortified with vitamin A). Mango fruit with some leafy and non-leafy vegetables were also notable foods that contributed to vitamin A intake. Usual mean vitamin A intake in children 24-59 months: The usual vitamin A intake of children aged 24-59 months is 575 mcg. Vitamin A inadequacy in children 24-59 months: 12.4 percent had inadequate intake of vitamin A (17.8 percent rural and 0.8 percent in urban). Vitamin C Usual mean vitamin C intakes in women: 61 mg for non-pregnant and 64 mg for pregnant women. Mean intake of pregnant women living in urban areas is 72 mg and 60 mg in rural areas. Vitamin C inadequacy in women: 53 percent among non-lactating women to a high of 87 percent among lactating women (44.7 percent in South East and 67.9 percent in North West). Food sources contributing to vitamin C intake for women and children 24-59 months: The main contributors among women and children were pepper, tomato, onion, mango fruit, cocoa drink, and tubers like sweet potato and white yam. 15 Key Findings Usual mean vitamin C intake in children 24-59 months: Mean intake of 41 mg (38 mg in rural and 47 mg in urban areas. Vitamin C inadequacy in children 24-59 months: Low prevalence of inadequacy, less than a tenth (5 percent) of all children. Vitamin B1 (Thiamine) Usual mean vitamin B1 intakes in women: U\usual mean thiamine intake of women was similar (0.8-1.0 mg) irrespective of residence, zone, and wealth quintile. Vitamin B1 inadequacy in women: Nationally, about 65 percent of non-lactating women and 67 percent of non-pregnant women have a risk of inadequate thiamine intake which increased if the woman was lactating (77.3 percent) or pregnant (86.9 percent). Food sources contributing to vitamin B1 intake for women and children 24-59 months: The main foods that contributed to the overall thiamine intake of women and children were bread, products from maize, rice, and millet. Noodles and sorghum products contributed across all age groups. Usual mean vitamin B1 intake in children 24-59 months: The usual intake of vitamin B1 is 0.5 mg with no substantial difference across the sex and residence of the children. Vitamin B1 inadequacy in children 24-59 months: 32 percent of children have an inadequate intake when compared with recommendations. Vitamin B2 (Riboflavin) Usual mean vitamin B2 intakes in women: Riboflavin intake of women across all categories was a mean of 0.7 mg. This level of intake was consistently similar when intake was disaggregated across residence, zone, and wealth quintiles and only reached a high of 0.9 mg among women in the highest wealth quintile. Vitamin B2 inadequacy in women: Intake was generally inadequate in at 80 percent of the women (94.8 percent in North-East and 59.3 percent in South-West). Food sources contributing to vitamin B2 intake for women and children 24- 59 months: rice, bread, pepper, catfish, cocoa, and fura da nono were the main contributors to vitamin B2 intake. Among children, cocoa drinks had a higher contribution to riboflavin intake compared to women. Usual mean vitamin B2 intake in children 24-59 months: The usual mean intake was 0.4 mg. Vitamin B2 inadequacy in children 24-59 months: 59 percent of all children had an inadequate vitamin B2 intake (70 percent among rural and 39 percent in urban areas). 16 Key Findings Vitamin B9 (Folate) Usual mean vitamin B2 intakes in women: The mean usual folate intake of non- pregnant women is 200 mcg; 197 mcg for non-lactating women, and 217 mcg for lactating women (189 mcg for women in the lowest quintile and 208 mcg for women in the highest quintiles). Vitamin B9 inadequacy in women: Inadequacy of vitamin B9 intake was greater than 90 percent across all categories of women with the highest prevalence of inadequacy among pregnant women is 99.9 percent (88.8 percent in South West and 99.4 percent in North East). Food sources contributing to vitamin B9 intake for women and children 24-59 months: The main food sources that contributed to the overall folate intake of women and children are cowpea, maize, and millet products, cassava (garri), baobab powder, and rice. Usual mean vitamin B9 intake in children 24-59 months: 122 mcg nationally, which when disaggregated by residence was 131 mcg among urban dwellers and 116 mcg among rural dwellers. Vitamin B9 inadequacy in children 24-59 months: 63 percent of children 24-59 months nationally had an inadequate intake of folate (54.4 percent in urban and 67.6 percent in rural areas). Vitamin B12 (Cobalamin) Usual mean vitamin B12 intakes in women: Nationally, the mean usual vitamin B12 intake of non-pregnant women is 2.6 mcg (0.9-1.8 mcg in Northern zones and 4.4-5.0 mcg in Southern zones. Vitamin B12 inadequacy in women: Nationally, 54.2 percent of non-pregnant women have inadequate intake of vitamin B12 (87.9 percent in North West and 8.4 percent in South South). Food sources contributing to vitamin B12 intake for women and children 24-59 months: The main food sources of vitamin B12 for women of reproductive age are fish (mackerel, sardine, catfish, and hake), and beef. Usual mean vitamin B12 intakes in children 24-59 months: Children aged 24-59 months had a usual intake of 1.4 mcg nationally (1.2 mcg in rural and 2.1 mcg in urban areas). Vitamin B12 inadequacy in children 24-59 months: The inadequacy of vitamin B12 intake was 51.7 percent nationally (60.3 percent in rural and 43.0 percent in urban areas). 17 Key Findings Key Findings on Infant and Young Child Feeding Infant and Young Child Feeding Indicators Infant and Young Child Feeding Indicators based on residence 18 Key Findings Ever Breastfed: Almost all (97 percent) children (aged 6-23 months) were ever breastfed. Similar patterns were observed in urban and rural areas, and for girls and boys. Continued Breastfeeding: Nationally, 57 percent of children (aged 12-23 months) received continued breastfeeding. It was more common in rural areas (62 percent) than in urban areas (46 percent). Introduction of Solid, Semi-Solid, or Soft Foods: Most children aged 6-8 months (95 percent) consumed at least one solid, semi-solid, or soft food the previous day. Minimum Dietary Diversity: More than half (58 percent) of the children aged 6-23 months achieved minimum dietary diversity. Minimum Meal Frequency: Nationally, 84.8 percent of children aged 6-23 months achieved a minimal meal frequency. Minimum Acceptable Diet: Nationally, 41.4 percent of children aged 6-23 months consumed a minimum acceptable diet. The proportion of children with a minimum acceptable diet was 42 percent, 53 percent, and 28 percent for children aged 6-11, 12-17, and 18-23 months, respectively. Minimum milk feeding frequency for non-breastfed children: Only 10 percent received Minimum Milk Feeds which was significantly lower in rural (3.9 percent) compared to urban 19.6 percent). The proportion of children that received the minimum number of milk feeds was 9 percent, 17 percent, and 8 percent for children aged 6-11, 12-17, and 18-23 months, respectively. Egg and/or flesh food consumption: One-third (35 percent) of children aged 6-23 months consumed egg and/or flesh foods the previous day. Sweet beverage consumption: Nationally, 24 percent of children aged 6-23 months consumed sweet beverages the previous day (33 percent in urban and 20 percent in areas). Unhealthy food consumption: Nationally, 55 percent of children aged 6-23 months consumed unhealthy foods the previous day (70 percent in urban and 47 percent in rural areas). Zero vegetable or fruit consumption: One in six (17 percent) children aged 6-23 months did not consume fruits or vegetables the previous day. No differences were observed by sex or residence. Bottle Feeding: One-fifth of children (20 percent) aged 6-23 months used a feeding bottle with a nipple the previous day. No differences were observed by sex or residence. 19 Key Findings Key findings on the nutrient density of the complementary diet of children aged 6-23 months. Nutrient density of the complementary diet in infants aged 6-8 months Nutrient density of the complementary diet in infants aged 9-11 months 20 Key Findings Nutrient density of the complementary diet in children aged 12-23 months Usual energy intake and nutrient density of the complementary diet in infants aged 6-23 months: The mean usual energy intake from the complementary diet was 333 kcal. The usual energy intake was adequate when compared with recommended intakes for this age group. Usual protein intake and nutrient density of the complementary diet in infants aged 6-23 months: The protein density was 2.7g/100kcal. The protein density of the complementary diet of the children aged 6-23 months was also above the respective desired nutrient densities for each age classification. Nutrient densities of minerals and vitamins: The mean densities of calcium, iron, and zinc, vitamins B1, B2, and C in the complementary diet of children aged 6-8 months had mean densities that were below the recommended Desired Nutrient Densities. Nutrient densities of minerals and vitamins by age group: Children aged 12 –23 months had inadequate densities for calcium and vitamin B9- folate. 21 Key Findings Biofortification Coverage Respondents that consumed selected biofortified foods the previous 30 days 100 80 60 40 20 0 Yellow Cassava or any food product made from it Orange Fleshed Sweet Potato or any food product made from it Orange maize or any food products made from it Pe rc en ta ge 3.4 4.7 13.5 Consumption of biofortified crops: Only 3, 5, and 14 percent of the respondents consumed yellow cassava, orange-fleshed sweet potato, and orange maize, respectively in the last 30 days. The consumption of biofortified foods were notably highest in the North east of the country compared to other zones. About 5% consumed at least more than one biofortified food in the previous 30 days with the highest proportion coming from the North East. Consumption of yellow cassava: Consumption was 1 percent in the North West and 8 percent in the North East. No differences were observed by residence (i.e., urban vs. rural) and wealth quintile. 22 Key Findings Consumption of orange-fleshed sweet potato: Consumption was 17 percent in the North East and 2 percent in all other zones. No differences were observed by residence and wealth quintile. Consumption of orange maize: Consumption of orange maize was 38 percent in the North East and between 4 and 14 percent in all other zones. No differences were observed by residence and wealth quintile. Frequency of consuming biofortified crops: Among the non-pregnant women who reported having consumed biofortified crops, the vast majority reported consuming it on 1 to 9 days in the past 30 days (77, 84, and 56 percent for yellow cassava, orange-fleshed sweet potato, and orange maize respectively), whereas few consumed it daily (2, 0, and 16 percent for yellow cassava, orange-fleshed sweet potato, and orange maize, respectively ). 23 Key Findings Fortification coverage and intake of Fortifiable food vehicles Coverage of Selected Food Vehicles among Households of the sampled Non-Pregnant Women at National Level Consumption of fortified food vehicles: A high proportion of households of sampled non-pregnant women of reproductive age consumed vegetable oil (90 percent), sugar (88 percent), salt (99 percent), and bouillon (99 percent) in any form. Consumption of flours: Fewer households of sampled non-pregnant WRA consumed flours in any form (57 percent for maize flour, 29 percent for semolina flour, and 28 percent for wheat flour). Consumption of branded food vehicles: The proportion of respondents whose households consumed these foods in a branded* form was 33 percent for vegetable oil, 22 percent for sugar, 13 percent for wheat flour, <1 percent for maize flour, 23 percent for semolina flour, 47 percent for salt, except for bouillon, which remained high at 96 percent. Consumption of unbranded and unknown oil: Higher in the northern zones (65 percent North central, 56 percent North East, and 68 percent North West) compared to the southern zones (South East 23 percent, South South 26 percent and South West 32 percent). 24 Key Findings Usual intake of food vehicles (in grams) among non-pregnant women Usual intake of vegetable oil: The mean usual intake of vegetable oil among non- pregnant women was 27 grams Usual intake of wheat flour: The mean usual intake of wheat flour among non- pregnant women was 39 grams Usual intake of sugar: The mean usual intake of sugar among non-pregnant women was 12 grams Usual intake of salt: The mean usual intake of salt among non-pregnant women was 4 grams Usual intake of bouillon: The mean usual intake of bouillon among non-pregnant women was 6 grams. Usual intake of rice: The mean usual intake of rice (raw) among non-pregnant women was 61 grams. Contribution of fortifiable vehicles to energy intake: vegetable oil contributed 13 percent, wheat (8 percent), sugar (5 percent), and rice (25 percent). 25 Key Findings Usual intake of food vehicles (in grams) among children Usual intake of fortifiable vehicles among children: The mean usual intake of vegetable oil among children was 19 grams, wheat flour (26 grams), sugar (11.5 grams), salt (2.6 grams), bouillon (4 grams), and rice (38 grams). 26 Key Findings Fortification status of household food samples Fortification of food vehicles collected in a sub-sample of non-pregnant women: Most samples were fortified at any level. Vitamin A in sugar (74 percent), iodine in salt (100 percent), iron and zinc in wheat flour (100 percent each) while iron and zinc in semolina flour was also 100 percent. Conversely, about one-third was fortified at any level with vitamin A in vegetable oil (31 percent) and vitamin A in wheat flour (26 percent). Mean amounts of fortificants in food vehicles collected in a sub-sample of non- pregnant women: 2.6 mg/kg vitamin A in vegetable oil, 3.1mg retinyl palmitate/kg vitamin A in sugar, 60 mg/kg iodine in salt, 0.8 mg retinyl palmitate/kg vitamin A, 53.9 mg/kg iron, and 42.2 mg/kg zinc in wheat flour, and 0.8 mg retinyl palmitate/kg vitamin A, 38.6 mg/kg iron, and 36.0 mg/kg zinc in semolina flour. 27 Key Findings Diet Quality Proportion of women who achieved Minimum Dietary Diversity for Women (MDD-W) Minimum Dietary Diversity Score: The diversity score of non-pregnant women in Nigeria is 3.6 out of a possible score of 10 (3.0 in the North West and 4.6 in the South West). Minimum Dietary Diversity for Women (MDD-w): 27.7 percent of non-pregnant and 28.8 percent of pregnant women achieved minimum dietary diversity. The proportion of non-lactating and lactating women who achieved minimum diversity were 28 percent and 25 percent respectively (13.3 percent in North West and 53.8 percent in South West). Global Diet Quality Score (GDQS): More than two-thirds of women (72.2 percent of non-pregnant women and 69.9 percent of pregnant women) had a GDQS between 15 and 23, which corresponds to a moderate risk of poor diet quality outcomes. Global Diet Recommendations (GDR): The GDR Protect score reflects adherence to global dietary recommendations on healthy components of the diet, and scores can range between 0 and 9. The higher the GDR score, the more recommendations are likely to be met and vice-versa. The mean score was 4.0 for non-pregnant women and 4.1 for pregnant women. The GDR Risk score: The GDR Risk score is used as a proxy for ultra-processed food intake and scores can range between 0 and 9. Across all categories, the score was below 2 ranging between 0.6-1.5. 28 Key Findings Key Findings for Anthropometry Children aged 6-59 months Anthropometric status for children (aged 6-59 months), Nigeria 2021 Stunting: Nationally, stunting is very high (33.8 percent) in children 6-59 months, and differs by age category (lowest in the 6-11-months (16.8 percent) and more than double at 39.8 percent in the 24-35-months, residence (rural is 40.0 percent and 20.8 percent in urban areas), zones (14.2 percent in the South East and 48.6 percent North West zone), wealth (47.9 percent among poor and 13.2 percent among wealthy), and level of education completed by caregiver (45.6 percent with none and 14.6 percent with post-secondary education). Severe Stunting: One in six (17.1 percent) children 6-59 months is severely stunted nationally and differs by age (21 percent among 24-35 months and 7 percent among 6-11 months), residence (21.3 percent in rural and 8.4 percent in urban areas), zone (28.1 percent in North West and 5.3 percent in South West), wealth (29.4 percent among poor and 3.7 percent among rich), and level of education completed by the caregiver (25.9 percent with none and 4.8 percent with post-secondary). Wasting: Overall, wasting is high (11.5 percent) and differs by age (25.4 percent in 6-11-months and 5.1 percent in 36-47 months), zones (17.1 percent in North East and 6.8 percent in South West), and wealth (14.3 percent among poor and 8.6 percent among rich). Severe Wasting: Nationally, severe wasting is high (3 percent) and differs by age (6.5 percent in 6-11 months and 1 percent in 36-47 months), and zones (6.3 percent in North East and 1.2 percent in South West). 29 Key Findings Underweight: One in four children aged 6-59 months (25.5 percent) is underweight, and differs by sex (27.3 percent among males and 23.7 percent among females), residence (29.4 percent in rural and 17.4 percent in urban areas), zone (35.8 percent in North West and 9.6 percent in South East), wealth (36.8 percent among poor and 13.9 percent among rich) and level of education completed by caregiver (33.3 percent with no education and 13.5 percent with post-secondary education). Severe Underweight: Overall, the prevalence of severe underweight in children (aged 6-59 months) was 9.3 percent and differs by age, (11.4 percent among 6-11 months and 6.5 percent among 36-47 months), residence (11.1 percent in rural and 5.4 percent in urban areas), zone (13.7 percent in North West and 2.4 percent in South East), wealth (15.7 percent among poor and 4 percent among rich), and level of education completed by caregiver (14.8 percent with no education and 2.4 percent with post-secondary education). Overweight: Overweight in children 6-59 months was low (1.5 percent) and no significant variation across the background characteristics. Obesity: Overall, obesity in children (6-59 months old) was 0.6 percent and differs by zone (1.7 percent in South East and 0.1 percent in South West and South South). Adolescent girls (aged 10-14 years) Prevalence of normal weight, thinness, overweight, obesity and stunting among adoles- cent girls (aged 10-14 years), Nigeria 2021 Stunting: Overall, one in five (21.7 percent) adolescent girls aged 10-14 years are stunted and differs by residence (25.8 percent in rural areas and 14.5 percent in urban areas), and wealth (33.2 percent among poor and 9.6 percent among rich). Thinness: Nationally, 15.4 percent are thin and there is no significant variation in the prevalence of thinness in adolescent girls (aged 10-14 years old) across the background characteristics. Overweight: Overweight is very low (3.1 percent) nationally among adolescent girls (aged 10-14 years old) and differs by residence (4.4 percent in urban and 2.3 percent in rural areas) and wealth (5.6 percent among rich and 1.8 percent among poor). 30 Key Findings Obesity: Overall, obesity is 1.1 percent and there was no significant variation across the background characteristics. Women of Reproductive Age (WRA, aged 15-49 years) Prevalence of thinness, normal weight, overweight, and obesity among WRA (aged 15-49 years), Nigeria 2021 Thinness: Overall, the prevalence of thinness is 14.2 percent and differs by age (18.4 percent among 20-29 years and 9.9 percent among 15-19 years), residence (16.1 in rural and 11.1 percent in urban areas), zones (21.7 percent in North West and 6.4 percent in South East), wealth quintile (27.3 percent among poor and 6.9 percent among rich), and level of education completed (22.5 percent with no education and 9.2 percent with post-secondary). Overweight: Nationally, 15 percent are overweight and differs by age (24 percent among 40-49 years and 4.2 percent among 15-19 years), residence (17.9 percent in urban and 13.1 percent in rural areas), zones (21.2 percent in South East and 9.7 percent in North West), wealth (21.4 percent among rich and 8.1 percent among poor ), and level of educational completed (24 percent among those with post-secondary and 10.7 percent among those with none). Obesity: Overall, 8.1 percent are obese and differ by age categories (15.6 percent among 40-49 years and 1.6 percent among 15-19 years), residence (12.5 percent in urban and 5.2 percent in rural areas), zones (15.4 percent in South East and 3.6 percent in North West), wealth (15.9 percent among rich and 2.2 percent among poor), and level of education completed (16.3 percent among those with post-secondary and 4 percent among those with no education). 31 Key Findings Coverage of national interventions to improve micronutrient status. Intervention coverage among children aged 6-59 months. Coverage of nutrition-specific interventions among children (aged 6-59 months), Nigeria 2021 Vitamin A Supplementation: Coverage is low. One in four children (25 percent) received a vitamin A capsule in the last 6 months nationally, and differed by age (32.6 percent in 6-11 months and 20.1 percent in 36-47 months), residence (36.1 in urban and 19.3 percent in rural), zones (41.9 percent in North Central and 8.0 in North West), wealth (41.7 percent among rich and 12.8 percent among poor) and level of education completed by caregiver (41.7 percent with post-secondary and 18.5 percent with no education). Nutrition Counselling: It is poor, only 15 percent of caregivers received some form of nutrition counseling nationally. Coverage of nutrition counseling and specific key messages: For those who received counselling, 81 percent of caregivers reported receiving counseling on breastfeeding; 83 percent on when to start feeding foods other than breastmilk; 87 percent on giving a variety of foods; 89 percent on giving animal source foods; 85 percent on how often to feed a child; and 75 percent on not feeding sugary drinks. 32 Key Findings Use of micronutrient powder or any sprinkles with iron: Coverage is very low. Use of iron/micronutrient powder is 7.1 percent nationally and differs by zone (10.4 percent in South West and 2 percent in South East. Deworming: Deworming treatment was 27.5 percent nationally and differs by age 33 percent among 48-59 months and 16.9 percent among 6-11 months), residence (41.2 percent in urban and 20.3 percent in rural areas), zone (60.2 percent South South and 7.5 percent in North West), wealth (51.7 among rich and 13 percent among poor), and level of education completed by caregiver (46.2 percent with post-secondary and 17.9 percent with no education). Use of ready-to-use therapeutic feeds/plumpy’nut: The use of therapeutic foods in the past 12 months is low (2.4 percent) nationally, and differs by zone (0.5 percent in South East and 5.9 percent in North East); overall, 14.1 percent reported using it the day preceding the survey and differs by zone (49.8 percent in South South and 14.1 percent in South West). Wasted children who received ready-to-use therapeutic feeds/plumpy’nut: Nationally, only 2.8 percent received ready-to-use therapeutic foods in the past 12 months and 21 percent of children received it the day preceding the survey. Intervention coverage among adolescent girls (aged 10-14 years) Coverage of nutrition-specific interventions among adolescent girls, Nigeria 2021 33 Key Findings Use of multivitamins in the past six months: Only 8.4 percent of adolescent girls used multivitamins and differs by residence (13 percent in urban and 6 percent in rural areas) and wealth (15.1 percent among rich and 1 percent among poor). There was no significant variation in the use of multivitamins at least once in the past seven days, among adolescent girls across the background characteristics. Use of iron or iron/folic acid tablets in the past six months: Overall, use of iron/folic acid tablets was 11 percent, and differs by residence (16 percent in urban and 8 percent in rural areas) and wealth (22 percent among rich and 5.7 percent among poor). There was no significant variation in the use of iron or iron/folic acid tablets at least once in the past seven days, among adolescent girls across the background characteristics. Deworming in the past six months: Overall, one in four (25 percent) adolescent girls used deworming treatment in the past 6 months and differs by residence (31 percent in urban and 21 percent in rural areas) and wealth quintile (41.2 percent among rich and 12.6 percent among poor). Frequency of use of multivitamins in the past seven days among adolescent girls (aged 10-14 years) who reported taking any multivitamin product seven days prior to the sur- vey, Nigeria 2021 Frequency of use of multivitamins and iron or iron/folic acid tablets in the past seven days: Among those who indicated using multivitamins and iron or iron/folic acid tablets, 36 percent took multivitamins and 17 percent took iron/folic acid tablets for the entire seven days. Frequency of use of any iron or iron/folic acid tablets in the past seven days among adolescent girls (aged 10-14 years) who reported taking any iron or iron/folic acid tablet seven days prior to the survey, Nigeria 2 34 Key Findings Intervention coverage among women of reproductive aged, 15-49 years Coverage of nutrition-specific interventions among women of reproductive age (aged 15-49 years), Nigeria 2021 Use of multivitamins in the past six months: Nationally, 13 percent reported using multivitamins in the past 6 months and differs by age (16.2 percent among 30-39 years and 7.4 percent among 15-19 years), residence (16.2 percent in urban and 10.3 percent in rural areas), zone (27.6 percent in South West and 2.6 percent in North West), wealth (18.3 percent among rich and 6.7 percent among poor) and level of education completed (21.6 percent among those with post-secondary and 7.2 percent among those with no education). Use of iron or iron/folic acid tablets in the past six months: Overall, 14 percent of women of reproductive aged took iron or iron/folic acid tablets in the past six months and differs by age (17.9 percent among 40-49 years and 8.6 percent among 15-19 years), residence (18.1 percent in urban and 11.5 percent in rural areas), zone (31.9 percent in South West and 2.2 percent in North West), wealth (18.9 percent among rich and 7.7 percent among poor) and level of education completed (21 percent among those with post-secondary and 8 percent among those with no education). Deworming in the past six months: Overall, 19 percent of women of reproductive aged reported using a deworming treatment in the past 6 months, months and differs by age (22.9 percent among 40-49 years and 16.4 percent among 15-19 years), residence (23.3 percent in urban and 15.9 percent in rural areas), zone (41 percent in South East and 7 percent in North West), wealth (30 percent among rich and 10.4 percent among poor) and level of education completed (28 percent among those with post-secondary and 10.2 percent among those with no education). 35 Key Findings 60% 50% 40% 30% 20% 10% 0% Pe rce nta ge 9.7 19.6 18.2 9.2 13.3 3.8 26.2 1 Day 2 Days 3 Days 4 Days 5 Days 6 Days 7 Days Frequency of use of multivitamins in the past seven days among WRA who reported use of a multivitamin in the past six months, Nigeria 2021 Frequency of use of multivitamins and iron or iron/folic acid tablets in the past seven days: Among those who indicated using multivitamins and iron or iron/folic acid tablets, 26 percent took multivitamins and 32 percent took iron/folic acid tablets for the entire seven days. 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Pe rce nta ge 9.9 16.8 13.3 10.0 11.7 6.6 31.7 1 Day 2 Days 3 Days 4 Days 5 Days 6 Days 7 Days Frequency of use of any iron/folic acid tablets in the past seven days among WRA, Nigeria 2021 36 Key Findings Intervention coverage among pregnant women (aged, 15-49 years) Overall prevalence of any nutrition-related interventions – antenatal care, supplementa- tion, and nutrition counselling - among pregnant women (aged 15-49 years), Nigeria 2021 Antenatal care: Nationally, 45 percent of pregnant women reported receiving at least one antenatal care visit and differs by age category (55 percent among 40-49 years and 28 percent among 15-19 years), residence (56 percent in urban and 38.9 percent in rural areas) and wealth (64 percent among rich and 30 percent among poor). Timing of the first antenatal care visit by month of pregnancy among pregnant women, Nigeria 2021 Adequacy of number of antenatal care visits by the length of pregnancy: Although first trimester visits were adequate (100 percent) as pregnancy progressed, fewer pregnant women obtained adequate antenatal visits (77 percent at the 7th month). 37 Key Findings Adequacy of number of antenatal care visits by the length of pregnancy among pregnant women, Nigeria 2021 Consumed a tablet or syrup containing iron at least once in the past seven days: 86 percent of pregnant women reported consuming a tablet or syrup containing iron at least once in the past seven days. Frequency of use of iron tablet or syrup in the past seven days among pregnant women, Nigeria 2021 Consumed a tablet or syrup containing iron and/or folic acid yesterday: 70 percent of pregnant women reported taking iron/folic acid tablets the day before the interview. Spoke with a health worker or community volunteer about what foods to eat: Overall, 34 percent of pregnant women reported speaking to a health worker or community volunteer about what foods to eat during pregnancy and differs by age (51 percent among 40-49 years and 18 percent among 15-19 years), residence (50 percent in urban and 25 percent in rural areas), wealth (56 percent among rich and 19 among poor), and level of education completed (56 percent among post-secondary and 23 percent among those with no education). 38 Key Findings Spoke with a health worker or community volunteer about breastfeeding: Nationally, 31 percent of pregnant women reported talking to a health worker or community volunteer about breastfeeding their newborn and differs by age (41 percent for 40-49 years and 11 percent for 15-19 years), residence (45 percent in urban and 23 percent in rural areas), wealth (52 percent among rich and 14 percent among poor), and level of education completed (51 percent among post-secondary and 24 among those with no education). Frequency of use of iron tablet or syrup in the past seven days: Overall, 52 percent of the respondents took a tablet or syrup containing iron for the entire seven days. 39 Key Findings Self-reported morbidity Self-reported morbidity among children (aged 6-59 months) Prevalence of self-reported morbidity (reported by caregiver), and anaemia risk among children (aged 6-59 months), Nigeria 2021 Diarrhoea in the past two weeks: Overall, 36 percent reported having diarrhoea in the past two weeks and differs by age (46.7 percent among 6-11 months and 23.3 percent among 48-59 months), residence (39 percent in rural and 30 in urban areas), zones (45 percent in North East and 25 percent in South West), wealth (42 percent among poor and 30 percent among rich), and level of education completed by caregiver (41 percent among those with none and 25 percent among those with post-secondary). Diarrhoea yesterday: those who reported having diarrhoea a day before the interview were 14 percent, nationally and differs by age (23.8 percent among 6-11 months and 5.8 percent among 48-59 months), sex (15.6 percent among males and 12 percent among females), zone (20 percent in North East and 6 percent in South West), wealth (19 percent among poor and 9 percent among rich), and level of education completed by caregiver (19 percent among those with no education and 9.6 percent among those with post-secondary). Blood in stool in the past two weeks: 8 percent of children reported having blood in stool and this differs by zones (10 percent in North East and 4 percent in South West) and wealth (11 percent among poor and 2.4 percent among rich). Treatments for diarrhoea in children: Nationally, 38 percent used Oral Rehydration Salt (ORS), 28 percent used antibiotic pill/syrup, 13 percent used antimotility, and 11 percent used zinc and differing by residence (51 percent in urban and 33 percent in rural areas) and wealth (56 percent among rich and 31 percent among poor) for ORS; zones (36 percent in North West and 9 percent in South South) and level of education completed by caregiver (40 percent among those with no education and 23 percent among those with post-secondary) for antibiotic pill/syrup; and residence (27 percent in urban and 8 in rural areas) and zones (34 percent in North East and 1 percent in North West) for antimotility. 40 Key Findings Reported treatments for diarrhoea in children (aged 6-59 months), Nigeria 2021. Fever: Overall, 46 percent were reported to have had a fever in the past two weeks, and differs by age (50 percent among 12-13 months and 37 percent among 48-59 months) and zone (53 percent in North East, South East and 39 percent in South West). Cough: Nationally, 37 percent of children had a cough in the last two weeks, and differs by age (40 percent among 12-23 months and 32 percent among 48-59 months), zone (51 percent in South East and 23 percent in North West), wealth (45 percent among rich and 33 percent among poor), and level of education completed by caregiver (45 percent among those with post-secondary and 32 percent among those with none). Difficulty breathing: The prevalence of fast, short, rapid breaths or difficulty breathing was 13 percent and differs by zones (22 percent in North East and 8 percent in South West), wealth (10 percent among the rich and 21 percent among the poor), and level of education completed by caregiver (17 percent among those with no education and 13 percent among those with post-secondary). 41 Key Findings Self-reported morbidity among adolescent girls (aged 10-14 years). Overall prevalence of self-reported illness and hospitalization/clinic visits in the last two weeks among adolescent girls (aged 10-14 years), Nigeria 2021 Cough in the past two weeks: Overall, 32 percent reported having a cough, and no significant variation in the prevalence of cough in the past two weeks among adolescent girls across the background characteristics. Fever in the past two weeks: Nationally, 29 percent reported having a fever, and no significant variation in the prevalence of fever in the past two weeks among adolescent girls across the background characteristics. Malaria in the past two weeks: One in five (20 percent) adolescent girls 10-14 years reported having malaria and no significant variation in the prevalence of malaria in the past two weeks among adolescent girls across the background characteristics. Diarrhoea in the past two weeks: Only 16 percent reported having diarrhoea and no significant variation in the prevalence of diarrhoea in the past two weeks among adolescent girls across the background characteristics. Difficulty breathing in the past two weeks: Overall, 32 percent reported having difficulty in breathing differing by wealth (59 among poor and 19 among rich). Hospitalization/clinic in the past two weeks: The prevalence of hospitalization was low (6 percent) nationally and no significant variation in hospitalization/clinic in the past two weeks among adolescent girls across the background characteristics. 42 Key Findings Self-reported morbidity among women of reproductive age (aged 15- 49 years) Fever in last 2 weeks Malaria in last 2 weeks Cough in last 2 weeks Diarrhea in last 2 weeks Hospitalized in last 2 weeks 0% 10% 20% 30% 40% 50% 36.5 Percentage 27.0 23.3 17.2 8.4 Overall prevalence of self-reported illness and hospitalization/clinic visits in the past two weeks among WRA (aged 15-49 years), Nigeria 2021 Cough in the past two weeks: Overall, 23 percent reported having a cough, and differ by zones (31 percent in North East and 18 percent in South West) Fever in the past two weeks: Nationally, 37 percent reported having a fever, and different by age (41 percent among 40-49 years), residence (42 percent in rural and 30 percent in urban areas), zone (49 percent in South South and 27 percent in North West), wealth (42 percent among poor and 29 percent among rich), and level of education completed (42 percent among those who completed primary education and 28 percent among those with post-secondary). Malaria in the past two weeks: (27 percent) of women of reproductive age reported having malaria and differs by age (33 percent among 40-49 years and 20 percent among 15-19 years), residence (30 percent in rural and 23 percent in urban), zones (51 percent in South South and 14 percent in North West), and level of education completed (34 percent among those who completed primary education and 28 percent among those with post-secondary). Diarrhoea in the past two weeks: Only 17 percent reported having diarrhoea and differing by zones (24 percent in North East and 14 percent in South West) Hospitalization/clinic in the past two weeks: The prevalence of hospitalization was low (8 percent) nationally and differs by age (11 percent among 40-49 years and 6 percent among 15-19 years) and zones (20 percent in North East and 4 percent in North West). 43 Key Findings Self-reported morbidity among pregnant women (aged 15-49 years) Fever in last 2 weeks Malaria in last 2 weeks Cough in last 2 weeks Diarrhea in last 2 weeks Hospitalized in last 2 weeks 0% 10% 20% 30% 40% 50% 39.6 Percentage 30.5 19.9 20.1 18.7 Overall prevalence of self-reported illness (fever, malaria, diarrhoea, and cough) and hospitalization/clinic visits in the last two weeks among pregnant women, Nigeria 2021 Cough in the past two weeks: Overall, 20 percent reported having a cough. There was no significant variation in the prevalence of cough in the past two weeks among pregnant women across the background characteristics. Fever in the past two weeks: Nationally, 40 percent of pregnant women reported having a fever, and differs by residence (43 percent in rural and 33 percent in urban areas), and wealth (58 percent among those in the middle quintile and 25 percent among rich). Malaria in the past two weeks: Overall, 31 percent of pregnant women reported having malaria. There was no significant variation in the prevalence of malaria in the past two weeks among pregnant women across the background characteristics. Diarrhoea in the past two weeks: Only 20 percent reported having diarrhoea. There was no significant variation in the prevalence of diarrhoea in the past two weeks among pregnant women across the background characteristics. Hospitalization/clinic in the past two weeks: The prevalence of hospitalization was 19 percent nationally and there was no significant variation in the prevalence of hospitalization in the past two weeks among pregnant women across the background characteristics. 44 Key Findings Self-reported anaemia risk factors in children (aged 6-59 months), adolescent girls (aged 10-14 years old), women of reproductive age (aged 15-49 years old) Pica children aged 6-59 months: Overall, taking pica was reported among 20 percent of the children 6-59 months seven days prior to the survey and differs by age (P < 0.001) and zones (P = 0.006) Pica, smoking, and previous diagnosis of anaemia in adolescent girls 10-14 years: Nationally, 8 percent of adolescent girls (aged 10-14 years) reported taking pica seven days prior to the survey, the prevalence of self-reported smoking is only 0.3 percent, and 4 percent reported diagnosed with anaemia in the past six months. There was no significant variation in the prevalence of pica, smoking, and anaeama among adolescent girls across the background characteristics. Pica in last 7 days Anaemia diagnosis in last 6 months Current smoker 0% 10% 20% 30% 40% 50% Percentage 8.4 4.2 0.3 Prevalence of anaemia risk factors (pica, smoking and diagnosis of anaemia in the past six months) among adolescent girls (aged 10-14 years), Nigeria 2021 Pica, smoking, and previous diagnosis of anaemia in women of reproductive age: Nationally, 5 percent of women of reproductive age reported taking pica seven days prior to the survey, the prevalence of self-reported smoking is only 0.5 percent, and 6 percent reported diagnosed with anaemia in the past six months. There was significant variation in the prevalence of pica by zones (14 percent in South East and 1.3 percent in South West), smoking by residence (0.9 percent rural and 0.1 percent in urban areas), and anaemia by zones (8 percent in South South and 4 percent in South West). 45 Key Findings Pica in last 7 days Anaemia diagnosis in last 6 months Current smoker 0% 10% 20% 30% 40% 50% Percentage 5.0 5.9 0.5 Prevalence of anaemia risk (pica and smoking) and diagnosis of anaemia in the past six months among WRA (aged 15-49 years), Nigeria 2021 Pica, smoking, and previous diagnosis of anaemia among pregnant women (15-49 years old): Nationally, smoking prevalence among pregnant women (aged 15- 49 years) was 0.4 percent. There was no significant variation in the prevalence of smoking among the respondents across the background characteristics. Malaria, Helicobacter pylori (H. pylori), helminths, elevated plasma glucose, and elevated glycated haemoglobin (Hba1c) in children 6-59 months, adolescent girls 10-14 years, and women of reproductive age 15-49 years Overall prevalence of malaria, H. pylori, helminths, elevated plasma glucose, and elevated HbA1c among children 6-59 months, adolescent girls, WRA, and pregnant women, respectively, Nigeria 2021. 46 Key Findings Malaria: Children 6-59 months: Nationally, the prevalence of malaria among children is 24 percent. Significant differences were observed among children by age (30 percent among 48-59 months and 15 among 6-11 months), residence (31 percent in rural and 11 percent in urban), wealth (33 percent among poor and 8 percent among rich), and level of education completed by caregiver (29 percent among those with no education and 7 percent among those with post-secondary). Adolescent girls 10-14 years: Overall prevalence of anemia in this group was high, 34 percent of adolescent girls had malaria, and was different by residence (45 percent in rural and 17 percent in urban areas) and wealth (53 percent among poor and 9 percent among rich). Women of reproductive age: Only 13 percent women of reproductive age had malaria and differed by age (21 percent among 15-19 years and 8 percent among 40- 49 years), residence (17 percent in rural and 7 percent in urban), wealth (19 percent among poor and 5 percent among rich), and level of education completed 14 percent among those with no education and 5 percent among those with post-secondary). Pregnant women: 14 percent of pregnant women had malaria. Differences were observed for age (38 percent among 15-19 years and 8 percent among 30-39 years), residence (18 percent in rural and 7 percent in urban areas), and wealth (23 percent among poor and 4 percent among rich). H. pylori Children 6-59 months: Overall, H. pylori was prevalent among 36 percent of children, Significant difference were observed among children by age (42 percent among 48- 59 months and 32 percent among 6-11 months), sex (38 percent among males and 34 percent among females), and zones (52 percent in South East and 36 percent in South West). Adolescent girls 10-14 years: 55 percent among adolescent girls nationally and significantly different by age (43 percent among 11 years and 66 percent among 12 years). Women of reproductive age: 64 percent prevalence among women of reproductive age nationally and differed by age (67 percent in 40-49 years and 62 percent in 15- 19 years), residence (68 percent in rural and 59 percent in urban areas), zones (76 percent in South East and 54 percent in North West) and level of education completed (69 percent among those who completed primary and 64 percent in those with none). Pregnant women: 59 percent prevalence among pregnant women nationally and differed by wealth (71 percent among middle wealth quintile and 51 percent among rich). 47 Key Findings Helminths Children 6-59 months: Helminth prevalence was 14 percent among children, A significant difference was observed among children by residence (16 percent in rural and 9 percent in urban areas), zones (24 percent in North Central and 0.4 percent in South East), wealth (21 percent among poor and 9 percent among rich), and level of education completed by caregiver (20 percent among those with no education and 9 percent among those with secondary). Women of reproductive age: Helminth prevalence was 7 percent among women of reproductive age and differed by residence (8 percent rural and 5 percent in urban areas), zones (15 percent in North East and 2 percent in South East), wealth (12 percent among poor and 3 percent among rich), and level of education completed (11 percent among those with no education and 4 percent among those with post- secondary) among women of reproductive age. Pregnant women: Overall, there was a 5 percent prevalence of helminth among pregnant women. There was no significant variation in the prevalence of helminth among pregnant women (aged 15-49 years) across the background characteristics. Elevated plasma glucose (plasma glucose > 200 mmol/L or mg/dL) in women of reproductive age: The national prevalence of elevated plasma glucose among women of reproductive age (aged 15-49 years) was 0.7 percent. There was no significant variation in the prevalence of elevated plasma glucose across the background characteristics. Elevated HbA1c (glycated haemoglobin > 5.6%) in women of reproductive age: The national prevalence of elevated HbA1c among women of reproductive age was 16 percent. Differences were observed for age (22 percent among 40-49 years and 13 percent among 20-29 years), residence (21 percent in urban and 13 percent in rural areas), wealth (21 percent among rich and 9 percent among poor), and anthropometry status (34 percent among obese and 13 percent among thin). Haemoglobin genotype 48 Key Findings Prevalence of haemoglobin genotype by target group at national level Haemoglobin genotype in children 6-59 months; Overall, 78 percent of children had normal haemoglobin (HbAA); 19 percent had the sickle cell trait (HbAS), and the prevalence of sickle cell disease (HbSS) was 0.7 percent. The prevalence of sickle cell trait (HbAS) was higher in children residing in rural (20.5 percent) versus urban areas (16.7 percent). Haemoglobin genotype in women of reproductive age 15-49 years; The percentage of women of reproductive age with normal haemoglobin was 75 percent; 23 percent had the sickle cell trait and differed by zones (26 percent in North West and 20 percent in South West), and 0.2 percent had sickle cell disease and differed by residence (0.3 percent rural and 0 percent in urban areas) and wealth quintile (0.6 percent among moderately rich and 0 percent among rich). Inflammation Prevalence of elevated C-reactive protein (CRP), elevated alpha-1-acid glycoprotein (α-1 acid glycoprotein, AGP), and any inflammation by target group at national level, Nigeria 2021 C-reactive protein (CRP): Children 6-59 months: Nationally, 29 percent of children 6-59 months had elevated CRP and differed by age (34 percent in 6-11 months and 22 percent in 48-59 months), residence (34 percent in rural and 21 percent in urban areas), zone (32 percent in North West and South West and 25 percent in North East), wealth (37 among poor and 22 percent among rich) and level of education completed by caregiver (34 percent among those with primary education and 16 percent among those with post-secondary). 49 Key Findings Adolescent girls 10-14 years: 11 percent of adolescent girls 10-14 years had elevated CRP. There was no significant variation in the prevalence of elevated CRP among adolescent girls (aged 10-14 years) across the background characteristics. Women of reproductive age 15-49 years: Overall, 12 percent of women of reproductive age had elevated CRP and differed by age (9 percent in 15-19 years and 14 percent in 40-49 years) and zone (15 percent in South South and 9 percent in North Central), Pregnant women: Nationally, 28 percent of pregnant women had elevated CRP. There was no significant variation in the prevalence of elevated CRP among pregnant women (aged 15-49 years) across the background characteristics. Alpha-1-acid glycoprotein (α-1AGP) Children 6-59 months: Overall, 57 percent of children 6-59 months and differed by age (59 percent among 12-23 months and 51 percent among 48-59 months), residence (65 percent in rural and 42 percent in urban), zones (64 percent in North West and 43 percent in South East), wealth (66 among poor and 41 percent among rich) and level of education completed by caregiver (66 percent among those with no education and 37 percent among those with post-secondary). Adolescent girls 10-14 years: Overall, 19 percent of adolescent girls 10-14 years had elevated α-1AGP and differed by wealth (25 percent among poor and 13 percent among rich), Women of reproductive age 15-49 years: Nationally, 17 percent of women of reproductive age and differed by age (18 percent in 15-19 years and 15 in 40-49 years), residence (19 percent in rural and 14 percent in urban), zones (24 percent in North West and 12 percent in South West), wealth (21 percent among poor and 14 percent among rich) and level of education completed (20 percent among those with no education and 11 percent among those with post-secondary), Pregnant women: 13 percent of pregnant women had elevated α-1AGP nationally. There was no significant variation in the prevalence of elevated AGP among pregnant women (aged 15-49 years) across the background characteristics. Any inflammation (both CRP and α-1AGP elevated): Children 6-59 months: Nationally, 59 percent of children 6-59 months had both CRP and α-1AGP elevated and differed by age (62 percent among 12-23 months and 53 percent among 48-59 months), residence (67 percent in rural and 45 percent in urban), zones (66 percent in North West and 48 percent in South East), wealth (68 percent among poor and 44 percent among rich) and level of education completed by caregiver (67 percent among those with no education and 41 percent among those with post- secondary). 50 Key Findings Adolescent girls 10-14 years: 21 percent of adolescent girls 10-14 years had both CRP and α-1AGP elevated nationally and differed by residence (22 percent in rural and 20 percent in urban) and wealth (27 percent among poor and 16 percent among rich). Women of reproductive age 15-49 years: 22 percent of women of reproductive age had both CRP and α-1AGP elevated nationally and differed by residence (23 percent in rural and 21 percent in urban), zone (28 percent in North West and 17 percent in North Central), wealth (25 percent among poor and 19 percent among rich) and level of education completed (25 percent among those with no education and 17 percent among those with post-secondary), Pregnant women: Overall, 35 percent of pregnant women had both CRP and AGP elevated. There was no significant variation in the prevalence of any inflammation among pregnant women (aged 15-49 years) across the background characteristics. Anaemia Overall prevalence of any, mild, moderate, and severe anaemia by target group, Nigeria 2021 Children (6-59 months old) Any anaemia: Nationally, 31 percent of children (6-59 months old) had any anaemia nationally. There was a statistically significant difference in the prevalence of any anaemia among children (aged 6-59 months) by age (42 percent in 6-11 months and 22 percent in 48-59 months), residence (36 percent in rural and 21 percent in urban), zones (42 percent in North West and 23 percent in North Central), wealth (38 percent among poor and 18 percent among rich), and level of education completed by caregivers (36 percent among those with no education and 16 percent among those with tertiary education). 51 Key Findings Mild anaemia: 19 percent of children 6-59 months had mild anaemia. There was a significant variation in the prevalence of mild anaemia among children (aged 6-59 months) by age (25 percent in 6-11 months and 14 percent in 48-59 months), residence (20 percent in rural and 15 percent in urban), zones (23 percent in North West and 15 percent in North Central and South West), wealth (21 percent among poor and 13 percent among rich), and level of education completed by caregivers (22 percent among those with no education and 12 percent among those with tertiary education). Moderate anaemia: Overall, 12 percent of children 6-59 months had moderate anaemia. There was a significant variation in the prevalence of moderate anaemia among children (aged 6-59 months) by age (17 percent among 6-11 months and 8 percent among 48-59 months), residence (15 percent in rural and 5 percent in urban), zones (17 percent in North West and 8 percent in South South), and wealth (17 percent among poor and 5 percent among rich). Severe anaemia: Only 0.5 percent of children 6-59 months had severe anaemia. There was a significant variation in the prevalence of severe anaemia among children (aged 6-59 months) by level of education completed by caregivers (1 percent among those with no education and 0.2 percent among those with secondary education). Adolescent girls (10-14 years old) Any anaemia: Anaemia was present in 20 percent of adolescent girls nationally. There was a statistically significant difference in the prevalence of any anaemia among adolescent girls (aged 10-14 years) by age (28 percent in 12 year old and 11 percent in 11 year old) and wealth (27 percent among poor and 15 percent among rich). Mild anaemia: The prevalence of mild anaemia was 14 percent. There was a statistically significant difference in the prevalence of mild anaemia among adolescent girls by age (22 percent among 12 year old and 7 percent among 10 year old) and wealth quintile (18 percent among poor and 9 percent among rich). Moderate anaemia: The prevalence of moderate anaemia was 6 percent. There was no significant variation in the prevalence of moderate anaemia among adolescent girls (aged 10-14 years) across the background characteristics. Severe anaemia: The prevalence of mild anaemia was 0.6 percent. There was no significant variation in the prevalence of moderate anaemia among adolescent girls (aged 10-14 years) across the background characteristics. Women of reproductive age (15-49 years old) Any anaemia: Nationally, anaemia was present in 23 percent of women of reproductive age. There was a statistically significant difference in the prevalence of any anaemia among women of reproductive age (aged 15-49 years) by age (21 percent among 15- 19 years and 27 percent among 40-49 years), residence (28 percent in rural and 18 percent in urban), zones (26 percent in North West, South East, South South and 17 percent in South West), wealth (30 percent among poor and 20 percent among rich) 52 Key Findings and level of education completed (27 percent among those with no education and 17 percent among those with post-secondary education). Mild anaemia: 16 percent of women of reproductive age had mild anaemia nationally. There was a statistically significant difference in the prevalence of mild anaemia among women of reproductive age (aged 15-49 years) by residence (18 percent in rural and 13 percent in urban), zone (18 percent in South East, South South and 16 percent in North Central), and wealth (19 percent among poor and 13 percent among rich). Moderate anaemia: Overall, 7 percent of women of reproductive age had moderate anaemia. There was a statistically significant difference in the prevalence of moderate anaemia among women of reproductive age (aged 15-49 years) by residence (9 percent in rural and 4 percent in urban), zone (9 percent in North East and 4 percent in South West) wealth (9 percent among poor and 5 percent among rich), and level of education completed (12 percent among those with no education and 4 percent among those with post-secondary education). Severe anaemia: Severe anaemia was present in 0.6 percent of women of reproductive age nationally. There was a statistically significant difference in the prevalence of severe anaemia among women of reproductive age (aged 15-49 years) by residence (0.8 percent in rural and 0.3 percent in urban), and wealth (1.5 percent among poor and 0.4 percent among rich). Pregnant women (15-49 years old) Any anaemia: Anaemia was present in 32 percent of pregnant women nationally. There was a statistically significant difference in the prevalence of any anaemia among pregnant women (aged 15-49 years) between residence (37 percent in rural and 21 percent in urban). Mild anaemia: Overall, 22 percent of pregnant women had mild anemia. The prevalence of any anemia was higher in pregnant women residing in rural (26 percent) versus urban areas (15 percent). Moderate anaemia: Only 9 percent of pregnant women had moderate anaemia. There was no significant variation in the prevalence of moderate anaemia among pregnant women (aged 15-49 years) across the background characteristics. Severe anaemia: Severe anaemia was observed in 0.5 percent of pregnant women. There was no significant variation in the prevalence of severe anaemia among pregnant women (aged 15-49 years) across the background characteristics. 53 Key Findings Micronutrient status of children (aged 6-59 months), adolescent girls (10-14 years) and women of reproductive age (15-49 years) Micronutrient status of children (aged 6-59 months) Prevalence of micronutrient deficiencies for children (aged 6-59 months), Nigeria 2021 Iron deficiency and iron deficiency anaemia: Nationally, the unadjusted prevalence of iron deficiency in children (aged 6-59 months) was 10 percent, while the adjusted prevalence was 21 percent and significantly different by age (36 percent in 12-23 months and 8 percent in 48-59 months), zone (28 percent in North East and 9 percent in South South), and level of education completed by caregiver (27 percent among those with no education and 18 percent among those with tertiary education). There was a statistically significant difference in the percentage of children (aged 6-59 months) with iron deficiency anemia by age (17 percent among 12-23 months and 1 percent among 48-59 months), zone (13 percent in North West and 4 percent in South South), and wealth (11 percent among poor and 6 percent among rich). Vitamin A: Nationally, the unadjusted prevalence of vitamin A deficiency in children (aged 6-59 months) was 54 percent, while the adjusted prevalence was 31 percent. Significant differences were observed based on serum retinol for age (34 percent among 36-47 months and 24 percent among 6-11 months), sex (34 percent among males and 29 percent among females), residence (34 percent in rural and 26 percent in urban), zone (51 percent in North West and 6 percent in South East), wealth (40 percent among poor and 21 percent among rich) and level of education completed by caregiver (37 percent among those with no education and 22 percent among those 54 Key Findings with tertiary education). In addition, there was a statistically significant difference in the percentage of children (aged 6-59 months) with vitamin A deficiency based on MRDR by age (3 percent among 24-35 months and 0.2 percent among 48-59 months) and residence (1.8 percent in rural and 0.1 percent in urban). Vitamin B12: Nationally, vitamin B12 deficiency in children (aged 6-59 months) was low (3 percent). There was a statistically significant difference in the percentage of children with vitamin B12 insufficiency (<220 pmol/L) by age (23 percent among 6-11 months and 9 percent among 36-47 months), residence (17 percent in rural and 4 percent in urban), zone (19 percent in North West, North East and 1 percent in South South), wealth (24 percent among poor and 2 percent among rich) and level of education completed by caregiver (19 percent among those with no education and 5 percent among those with tertiary education). Similarly, there were significant differences in children with vitamin B12 deficiency (at risk of megaloblastic anaemia) and defined as serum B12 concentration <148 pmol/L) by age category (8 percent among 6-11 months and 1 percent among 36-47 months), residence (4 percent in rural and 0.1 percent in urban), zone (5 percent in North West and 0 percent in South West), wealth (6 percent among poor and 0.2 percent among rich), and level of education completed by caregiver (4 percent among those with no education and 0.5 percent among those with tertiary education). Zinc deficiency: Nationally, zinc deficiency in children (aged 6-59 months) was 35.2 percent. There was a statistically significant difference in the percentage of children (aged 6-59 months) with zinc deficiency between residence (41 percent in rural and 24 percent in urban), zone (57 percent in North West and 12 percent in South East), wealth (45 percent among poor and 23 percent among rich) and level of education completed by caregiver (42 percent among those with no education and 20 percent among those with tertiary education). 55 Key Findings Micronutrient status of adolescent girls (aged 10-14 years) Prevalence of micronutrient deficiencies among adolescent girls (aged 10-14 years), Nigeria 2021 Iron deficiency and iron deficiency anaemia: The unadjusted prevalence of iron deficiency in adolescent girls (aged 10- 14 years) was 3 percent, while the adjusted prevalence was 4 percent. There was no significant variation in the percentage of adolescent girls with iron deficiency anemia across the background characteristics. Vitamin A: The unadjusted prevalence of vitamin A deficiency in adolescent girls (aged 10-14 years) was 32 percent, while the adjusted prevalence was 24 percent. There was a statistically significant difference in the percentage of adolescent girls (aged 10- 14 years) with vitamin A deficiency between wealth quintiles (37 percent among poor and 11 percent among rich). Vitamin B12: The prevalence of vitamin B12 deficiency was low (2 percent). Significant differences in vitamin B12 insufficiency were observed for residence (11 percent rural and 2 percent urban) and wealth (13 percent among poor and 2 percent among rich) and by residence (3 percent in rural and 0.3 percent in urban) for vitamin B12 deficiency. Zinc: The percentage of adolescent girls (aged 10-14 years) with zinc deficiency was 34 percent nationally. Significant differences in the percentage of adolescent girls (aged 10-14 years), with zinc deficiency were observed for residence (41 percent in rural and 23 percent in urban), and wealth (43 percent among poor and 20 percent among the rich). 56 Key Findings Folate: The percentage of adolescent girls with folate deficiency based on analysis of whole blood lysate (Red Blood Cell folate) was 91 percent. There was no significant variation in the percentage of adolescent girls with RBC folate deficiency across the background characteristics. In addition, there was no significant variation in the percentage of adolescent girls with serum folate deficiency at risk of elevated homocysteine or risk of megaloblastic anaemia across the background characteristics. Micronutrient status of women of reproductive age (aged 15-49 years) Prevalence of micronutrient deficiencies among women of reproductive age (aged 15-49 years), Nigeria 2021 Iron deficiency and iron deficiency anaemia: The unadjusted prevalence of iron deficiency in women of reproductive age (aged 15-49 years) was 7 percent, while the adjusted prevalence was 10 percent. There was a statistically significant difference in the percentage of women of reproductive age (aged 15-49 years), with iron deficiency between zone (16 percent in North East and 5 percent in South West), wealth quintiles (8 percent among poor and 13 percent among rich), and use of iron/ folic acid supplement in the last 7 days prior to the survey (7 percent among those who used supplement and 10 percent among those who did not use it). There was a statistically significant difference in the percentage of women of reproductive age (aged 15-49 years), with iron deficiency anemia between zone (6 percent in North East and 2 percent in South West). 57 Key Findings Vitamin A: 12 percent of women of reproductive age (aged 15-49 years) were vitamin A deficient based on serum retinol, while the prevalence based on Modified Relative Dose Response (MRDR) was 0 percent. There was a statistically significant difference in the percentage of women of reproductive age (aged 15-49 years) with vitamin A deficiency based on serum retinol by residence (15 percent in rural and 7 percent in urban), zone (22 percent in North West and 3 percent in South East), wealth (19 percent among poor and 5 percent among rich), level of education completed (15 percent among those with no education and 5 percent among those who completed post- secondary education), and use of multivitamin supplement in the last 6 months prior to the survey (12 percent among non-users and 8 percent among users). There was no significant variation in the prevalence of vitamin A deficiency based on MRDR among women of reproductive age (aged 15-49 years) across the background characteristics. Vitamin B12: The prevalence of vitamin B12 deficiency was low (2 percent). Significant differences in the percentage of women of reproductive age (aged 15-49 years) with vitamin B12 insufficiency were observed between residence (14 percent rural and 3 percent urban), zone (21 percent in the North East and 0.5 percent in South West), wealth (19 percent among poor and 1 percent among rich), level of education completed (19 percent among those with no education and 2 percent among those with pose secondary education), and use of the multivitamin supplement in the last 6 months prior to the survey 10 percent among those who did not use and 5 percent among those who used a multivitamin supplement). There was a significant difference in the percentage of women of reproductive age (aged 15-49 years) with vitamin B12 deficiency between residence (2 percent in rural and 0.6 percent in urban), zone (4 percent in North East and 0 percent in South West), wealth (4 percent among poor and 02 percent among rich), and level of education completed (4 percent among those with no education and 0.2 percent among those with post-secondary education). Zinc: 35 percent of women of reproductive age were zinc deficient nationally. There was a statistically significant difference in the percentage of women of reproductive age (aged 15-49 years) with zinc deficiency between age categories (38 percent among 20-29 years and 34 percent among 40-49 years), residence (41 percent in rural and 27 percent in urban), zone (60 percent in North West and 16 percent in South East), wealth (49 percent among poor and 25 percent among rich), level of education completed (49 percent among those with no education and 23 percent among those with post-secondary education), and use of multivitamin supplement in the last 6 months prior to the survey (36 percent among those who did not use and 27 percent among those who used a multivitamin supplement). Folate: The prevalence of folate deficiency based on analysis of serum folate was 47 percent for the risk of elevated homocysteine and 23 percent for the risk of megaloblastic anaemia. There was no significant variation in the percentage of women of reproductive age with serum folate deficiency at risk of elevated homocysteine and megaloblastic anaemia across the background characteristics. Folate deficiency based on analysis of whole blood lysate (Red Blood Cell folate) was 95 percent. 58 Key Findings There were significant differences in the percentage of women of reproductive age (aged 15-49 years) with RBC folate insufficiency (RBC folate concentration <748 nmol/L ) by age (97 percent among 15-19 years and 94 percent among 40-49), residence (97 percent in rural and 94 percent in urban), zone (99 percent in North East, North West and 87 percent in South West), wealth (99 percent among poor and 93 percent among rich), level of education completed (99 percent among those with no education and 92 percent among those who completed post-secondary education), and use of iron/folic acid supplement in the last 6 months prior to the survey (91 percent among those who used and 96 percent among those who did not use). In addition, there was a significant difference in the percentage of women of reproductive age (aged 15-49 years) with RBC folate deficiency (RBC folate concentration <624 nmol/L) between residence (94 percent in rural and 88 percent in urban), zone (98 percent in North East and 77 percent in South West), wealth (97 percent among poor and 85 percent among rich), level of education completed (97 percent among those with no education and 82 percent among those who completed post-secondary education), and use of iron/folic acid supplement in the last 6 months prior to the survey (83 percent among those who used and 93 percent among those who did not use). Vitamin B1: The percentage of women of reproductive age (aged 15-49 years) at high risk of vitamin B1 deficiency was 2 percent. There was a statistically significant difference in the percentage of women of reproductive age (aged 15-49 years) who are at low risk and moderate risk of vitamin B1 deficiency by the level of education completed (75 percent among those with no education and 83 percent among those who completed post-secondary education for low risk), and those at moderate risk (23 percent among those with no education and 16 percent among those who completed post-secondary education for moderate risk). There was no significant variation in the prevalence of high-risk of vitamin B1 deficiency among women of reproductive age (aged 15-49 years) across the background characteristics. Vitamin B2: The prevalence of vitamin B2 deficiency was 79 percent. There was a statistically significant differen