Small Quantity Lipid-Based Nutritional Supplementation and Measles Vaccination Coverage in Children Aged 6-23\,Months: A Pragmatic Cluster-Randomized Trial
Abstract
Undernutrition and infectious diseases pose a double threat to child survival, especially in areas with a high malnutrition burden and low vaccination coverage. In this study, we evaluated whether distributing preventive small-quantity lipid-based nutrient supplements (SQ-LNS) alongside routine immunization services may increase vaccine uptake in a pediatric, pragmatic, cluster-randomized controlled trial in northern Nigeria. Twenty geographically defined clusters across two Local Government Areas were randomized 1:1 to the NutriVax strategy (intervention) or standard National Program of Immunization (NPI) services (control). NutriVax provided a monthly ration of SQ-LNS to children aged 6-23 months after routine NPI delivery at primary healthcare centers. The primary outcome was coverage of the first dose of measles-containing vaccine (MCV1) verified by vaccination card among children aged 12-23 months, assessed in an endline population-based household cross-sectional survey 12 months after conducting a similar baseline survey. The endline survey included 1,604 children (801 control, 803 NutriVax); 48% of children surveyed in intervention clusters had ever received SQ-LNS. The odds of receiving card-verified MCV1 were two times higher in the NutriVax arm than in the control arm (odds ratio = 2.08, 95% confidence interval (CI): 1.30-3.35, P = 0.004). The difference-in-differences, cluster conditional analysis indicated a 20.1 percentage-point (pp) increase in MCV1 coverage from baseline (95% CI: 13.7-26.5 pp, P < 0.0001) relative to the control arm. Co-delivering SQ-LNS with routine immunization substantially improved card-verified MCV1 uptake, supporting a scalable strategy to make progress toward targets set by the World Health Organization's Immunization Agenda 2030 in similar settings. ClinicalTrials.gov identifier: NCT06387511 .
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BibTeX
@article{cazes2026small,
title = {{Small Quantity Lipid-Based Nutritional Supplementation and Measles Vaccination Coverage in Children Aged 6-23\,Months: A Pragmatic Cluster-Randomized Trial}},
author = {Cécile Cazes and Baba Waru Goni and Delphine Gabillard and Olumuyiwa Owolabi and Brice Yapi and Juliet Nabunje and Irine Atanga and Ariong'O M. Akinyi and Serge Danho and Eric Balestre and Anani Badje and Fatima Idriss and Mohammed Kasim and Muhammad M. Audu Bukarti and Chikezie Ugonna Emeka and Michelle Chouinard and Jean-Paul Mushenvula and Soma Bahonan and Mélanie Plazy and Ousmane Abdoulaye and Umar Chiroma and Hadiza Maina Adam and Camille Montfort and Nuru Suleiman Muhammad and Renaud Becquet and Kevin P. Q. Phelan},
journal = {Nature Medicine},
year = {2026},
month = oct,
doi = {10.1038/s41591-026-04675-1},
url = {https://hal.science/hal-05784424v1},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Small Quantity Lipid-Based Nutritional Supplementation and Measles Vaccination Coverage in Children Aged 6-23\,Months: A Pragmatic Cluster-Randomized Trial
AU - Cécile Cazes
AU - Baba Waru Goni
AU - Delphine Gabillard
AU - Olumuyiwa Owolabi
AU - Brice Yapi
AU - Juliet Nabunje
AU - Irine Atanga
AU - Ariong'O M. Akinyi
AU - Serge Danho
AU - Eric Balestre
AU - Anani Badje
AU - Fatima Idriss
AU - Mohammed Kasim
AU - Muhammad M. Audu Bukarti
AU - Chikezie Ugonna Emeka
AU - Michelle Chouinard
AU - Jean-Paul Mushenvula
AU - Soma Bahonan
AU - Mélanie Plazy
AU - Ousmane Abdoulaye
AU - Umar Chiroma
AU - Hadiza Maina Adam
AU - Camille Montfort
AU - Nuru Suleiman Muhammad
AU - Renaud Becquet
AU - Kevin P. Q. Phelan
PY - 2026
DA - 2026/10/07
JO - Nature Medicine
DO - 10.1038/s41591-026-04675-1
UR - https://hal.science/hal-05784424v1
AB - Undernutrition and infectious diseases pose a double threat to child survival, especially in areas with a high malnutrition burden and low vaccination coverage. In this study, we evaluated whether distributing preventive small-quantity lipid-based nutrient supplements (SQ-LNS) alongside routine immunization services may increase vaccine uptake in a pediatric, pragmatic, cluster-randomized controlled trial in northern Nigeria. Twenty geographically defined clusters across two Local Government Areas were randomized 1:1 to the NutriVax strategy (intervention) or standard National Program of Immunization (NPI) services (control). NutriVax provided a monthly ration of SQ-LNS to children aged 6-23 months after routine NPI delivery at primary healthcare centers. The primary outcome was coverage of the first dose of measles-containing vaccine (MCV1) verified by vaccination card among children aged 12-23 months, assessed in an endline population-based household cross-sectional survey 12 months after conducting a similar baseline survey. The endline survey included 1,604 children (801 control, 803 NutriVax); 48% of children surveyed in intervention clusters had ever received SQ-LNS. The odds of receiving card-verified MCV1 were two times higher in the NutriVax arm than in the control arm (odds ratio = 2.08, 95% confidence interval (CI): 1.30-3.35, P = 0.004). The difference-in-differences, cluster conditional analysis indicated a 20.1 percentage-point (pp) increase in MCV1 coverage from baseline (95% CI: 13.7-26.5 pp, P < 0.0001) relative to the control arm. Co-delivering SQ-LNS with routine immunization substantially improved card-verified MCV1 uptake, supporting a scalable strategy to make progress toward targets set by the World Health Organization's Immunization Agenda 2030 in similar settings. ClinicalTrials.gov identifier: NCT06387511 .
SN - 1078-8956
SN - 1744-7933
ER -