By Chioma Obinna
Some weeks ago, Doctors Without Borders, otherwise known as Médecins Sans Frontières, MSF, released photographs, showing malnourished persons in the Internally Displaced Persons, IDPs, camps in Borno State. According to the MSF, at least 30 persons die every day in the camps.
The startling revelation on how Nigerian children are dying of malnutrition angered President Muhammadu Buhari as well as got a lot of Nigerians worried. Sunday Vanguard spoke to UNICEF’s Nutrition Advocacy Specialist, Dr. Zacharia Fusheini, who revealed further that 37 percent of Nigerian children do not get the right foods and the country parades the highest number of stunted children.
Fusheini, who decried underfunding of nutrition in Nigeria, disclosed that, currently, 2.5 million children in the country are suffering from severe acute malnutrition, SAM. He said out of the 500,000 children UNICEF is targeting for treatment this year, only 400,000 will be covered due to lack of funds. Fusheini also noted that although the bulk of malnutrition in Nigeria is found in the North, each state in the country has substantial number of its resident malnourished, saying if nothing urgently is done, the country may be losing part of its annual GDP to malnutrition.
Burden of malnutrition
Malnutrition, like in any African country, has been a concern for policy makers and government partners. Nigeria currently has a lot of malnourished children. We have not less than 13,000 children suffering from stunting, a chronic malnutrition as a result of long term effect of nutritional and other health challenges. This is so huge compared to other African countries.
Another nutritional challenge we have in Nigeria is severe acute malnutrition, SAM. In other words, children who are severely malnourished stand the chance of dying. They are nine times likely to die if not treated. We have currently above 2.5 million children under five years suffering severe malnutrition and majority of the children are in northern Nigeria where the severity is very high and some states have over 50 percent of children who are stunted and quite a number of them who are wasted, which is also severe acute malnutrition.
We also have other pockets of malnutrition like iron deficiency in children and pregnant women as well as women of reproductive age. Also, some issues have to do with zinc, vitamin A and iodine deficiencies which are mostly rampant and cut across Nigeria.
Causes of malnutrition
Malnutrition has multiple causes. It could be that the situation started even before the child was born. We have what we call the 1,000 days window, which is from the day of conception of the child in the womb of the mother up to two years of birth. This period is so important for the survival and nutritional improvement of the child. So, right from day one, the child can be affected by malnutrition. And depending on the nutritional status of the mother, the child could also be affected while even being in the mother’s womb. That is one angle where we have children being malnourished before they are born
After birth, children are supposed to immediately be put on breast milk without water within the first six months of life. What we have seen in Nigeria is that most mothers, after delivery, give water and other liquids to the child. By doing this, the mothers are defying the principle of exclusive breast feeding and that can also contribute to the child being malnourished and the weight getting lower than expected.
It might also be due to food practices which are not appropriate. After six months, the child is supposed to eat other foods. If you don’t prepare the foods to have the right nutrients and in terms of quantity and quality, then you should not expect the child to grow properly. For instance, we have 37 percent of children who don’t get the right amount of diets in their foods. That could lead to malnutrition in the child. It is recommended that children should be fed three to four times a day with snacks in between foods. Feed the child on demand and continuously breastfeed him while giving the complementary foods.
The last angle is the multidimensional factors (underlying factors). For example, the child might be having repeated diarrhoea which is as a result of hygienic condition.
Right diets for children
We have minimum amount of diets needed to feed a child, based on. When you give birth to a child, the child needs to take breast milk only on demand and you need to initiate it within one hour of birth because the first breast milk that comes out, which is the colostrums, is so important and gives immunity to the child. After six months, the breast milk alone will not be enough for the child because the child is now developing.
And the foods must child will need additional nutrients; so you need to introduce complementary foods. In this case, you will continue with the breast milk but also give food that are a little solid and conducive for babies to take because the child cannot take foods that adults take. You need foods that are watery. The contain vital nutrients. When you do these things you are appropriately feeding the child while observing the right hygiene practices.
Role of breast feeding in preventing malnutrition
Exclusive breast feeding is important and it plays a major role in a child’s development. If you look at the prioritisation of preventive health, child health services and intervention, exclusive breast feeding is a proven intervention to reduce child mortality. When you practice exclusive breast feeding within the first six months of birth you are improving the nutritional status of the child because the breast milk contains all the important nutrition needed by the child for growth. It contains adequate amount of proteins, carbohydrates, fats and oil, micronutrients, vitamins and the minerals needed. It provides the first immunity for the child. The immune system will be able to fight infections. It also helps mothers to avoid the issue of contamination of food for the child. It is also helps to develop the brains of the child and other organs properly.
Implications in adulthood
The fiirst 1,000 days is the period when the children are more vulnerable and can easily fall to malnutrition. If you don’t prevent that, most children get stuck around that period. And It is irreversible in the case of stunting where their heights are too short for a particular age. The worst thing about stunting is not just about the physical shortness that we see but also about the brain, body organs and that is why some children drop out of school. In some, it affects their intelligence and performance. When a child is stunted becomes an adult, he can’t perform as a normal person who was not stunted. If it is converted into financial terms, the child, nation and everybody is losing something.
The other issue is that when children are stunted there is evidence showing that they lead to loss of GDP of a country; you know for example that when you invest to prevent stunting, for every $1 dollar you use to prevent stunting, you get a return investment of $16; that is a huge amount. In other words, that child would have helped earn 16 times of what he/she is currently earning now in adulthood, if he was not stunted.
The implication in other diet-related diseases at adulthood is also a problem. When children are malnourished, there is also evidence that when they become adults, they have complications of diabetes, hypertension and other chronic diseases. This is why stunting is regarded as a dangerous disease condition for children. During the last African Development Bank meeting, there was evidence that African countries are losing between 3-16 percent of their GDPs to stunting alone.
It is a malnourished situation where the signs are not visible to the eye. For example, lack of vitamin A can reduce immunity in the system, lack of iron can reduce the level of haemoglobin in the blood, which can also lead to diseases and other complications in the body. Lack of iodine also has implications. These micro nutrients are needed in very small amount, not like the micro nutrient like the protein, carbohydrate, they are needed in small amounts but they are not visible.
However, the absence can cause problems like brain impairment. It can also cause the problem of under developed organs. They are classified as hidden hunger because nobody pays attention to them but they are very important.
Poor nutrition funding
Nutrition is not often recognised by policy makers, government and our communities like sanitation, agriculture etc. Even politically, nutrition is not regarded like when you sink a borehole or build a classroom for people to see. For example when you treat a malnourished child, by buying Ready- to -Use Therapeutic Food, RUF, how many people will see it? That is why government is not paying attention to it especially in Africa.
In Nigeria there is funding challenge. Currently, the number of malnutrition cases is more than the funding available for it. In 2015, Nigerian government and UNICEF treated 400,000 children. These children could have died without this treatment. Now we have an estimated 2.5 million children in Nigeria who need that treatment and we have only treated 400,000./ You can see that gap. And all the treatment funding was coming from external sources. Thanks to our donors like the Children investment Foundation of UK and the UK government, USAID, European Union etc.
We could treat more if government could bring more funding to complement what the donors are bringing. This year, we are targeting to have about 500,000 children treated for severe malnutrition. However, donor funding can only take care of 400,000.
A little over 100,000 children will not be covered; so we are expecting government to come in. As we speak now, some state governments have made commitment but none of the funds has been made available. Nutrition is hugely underfunded in Nigeria. We need government at all levels to dedicate budget lines for nutrition and release the funds.