Nutritional Status Transitions in Children Aged 6–59 Months and Caregiver Perspectives Following a Community-Based Digital MUAC Screening and Counselling Campaign in Kaduna State, Nigeria: A Mixed-Methods Study

Background: Acute malnutrition affects 45 million children under five globally. Nigeria has Africa’s highest number of malnourished children, and wasting in Kaduna State has increased from 4.8% to 5.9%. Evidence on within-child nutritional transitions following community-based screening and counselling, and caregivers’ perspectives on factors influencing these changes, remains limited. This study examined nutritional changes between two MUAC assessments and caregivers’ perceived influences, without evaluating campaign effectiveness. Methods: A mixed-methods study was conducted in Kudan Local Government Area (LGA), Kaduna State, combining a retrospective longitudinal analysis of routinely collected MUAC data from 37,455 children aged 6–59 months with paired measurements at baseline and six-month follow-up (December 2024 to June 2025, the first six months of a 12-month campaign) with 36 in-depth interviews with caregivers. Nutritional transition (improved, static or declined) was defined using MUAC thresholds (well-nourished ≥12.5 cm, moderate acute malnutrition [MAM] 11.5 to <12.5 cm, and severe acute malnutrition [SAM] <11.5 cm). Quantitative data were analyzed using descriptive statistics, cross-tabulations, and paired and independent t-tests. Interviews were analyzed thematically. Results: At baseline, 95.3% of children were well-nourished, 4.1% had moderate acute malnutrition (MAM) and 0.6% had severe acute malnutrition (SAM). At follow-up, 98.9% were well-nourished, 1.1% had MAM and 0.06% had SAM (net MAM reduction 73.9%, SAM reduction 90.6%). In total, 94.9% of children were static, 4.3% improved (all from MAM or SAM to well-nourished; 92.7% of the 1756 children malnourished at baseline) and 0.8% declined. Mean MUAC increased by 0.26 cm (p < 0.001), an increase that includes normal age-related growth. Mean MUAC gain was greater among children aged 6 to 23 months than among those aged 24 to 59 months (0.29 cm vs. 0.23 cm; p < 0.001). A total of 3704 children (9.0%) with a baseline measurement were lost to follow-up; among malnourished children, 128 of 1756 (7.3%) were not re-measured. Caregivers reported improved feeding and hygiene practices but identified household food insecurity, rising food prices and transport costs as persistent barriers. Conclusions: Most children remained in the same nutritional category, while most children malnourished at baseline were well-nourished at follow-up. Without a comparison group, observed changes cannot be attributed to the campaign. Loss to follow-up may also limit interpretation. Evaluating effectiveness requires a controlled design and systematic tracking of children lost to follow-up.