Field experience from designing and implementing a cold-chain system for the 2021 Nigeria national food consumption and micronutrient survey

Improving nutrition is a key component of efforts to promote sustainable development and improve health and well-being. However, it is impossible to effectively improve nutrition in a population without monitoring the nutrition status of vulnerable groups. Monitoring approaches such as micronutrient surveys are critical to allow stakeholders determine the prevalence of malnutrition and identify micronutrient deficiencies of public health importance and at-risk groups. In this regard, the 2021 Nigeria National Food Consumption and Micronutrient Survey (NFCMS 2021) collected biological samples from children aged 6-59 months, adolescent girls, as well as pregnant and non-pregnant women of reproductive age. The micronutrients of interest were retinol, thiamine, riboflavin, cobalamin, folate, iodine, iron, and zinc. Quantitative 24-hour dietary recall data were also collected from children aged 6-59 months, pregnant and non-pregnant women of reproductive age. To achieve its goal, the NFCMS 2021 had to overcome some hurdles. Therefore, the current study details the challenges of developing a cold-chain system for the survey and novel strategies employed to address them. The main challenges encountered included collecting, transporting, processing, storing, and analyzing over 51,143 samples from enumeration areas with unreliable electricity, difficult terrain, and far from functional health facilities. The survey successfully designed and implemented a cold-chain system across 364 enumeration areas in all 36 states and the Federal Capital Territory. This can be attributed to several factors. First, the team reviewed and documented the survey's cold-chain requirements. Second, stakeholder engagement with the federal and state governments allowed the use of Ministry of Health cold stores. This was followed by proximity mapping of survey enumeration areas to all existing cold stores, a visit to verify their suitability, and the selection of the best cold stores for the survey. The survey also procured the right equipments, and trained teams on cold-chain logistics, best practices, troubleshooting, and communication. An innovation of the survey was the use of checklists for decision-making and real-time temperature data loggers and dashboards for monitoring the cold-chain. Using detailed contingency plans for cold-chain logistics and leveraging cost-effective technologies can improve cold-chain transparency, efficiency, and integrity in resource-constrained settings, as was the case of the NFCMS 2021. The survey identified an unmet demand for a detailed manual with updated guidance on designing a cold-chain system for a nutrition survey. Key words: Cold-chain system, micronutrient survey, resource-constrained settings, Nigeria, Africa, NFCMS 2021