February 25, 2018

Sad story of Nigeria’s stunted and ‘wasted’ children

Sad story of Nigeria’s stunted and ‘wasted’ children

By Chioma Obinna

When Deborah Egbe was pregnant for her first child, her dream was to have a child that would grow into adulthood and contribute to the development of her community. Like every other mother, she tried to follow the instructions of health workers but fate dealt her a big blow.

Nine months after she was delivered of the baby, she lost her husband.   Deborah, a full time house wife, was shattered. Life became meaningless. The 27-year-old did not know where to begin. Although she had proposed to do exclusive breastfeeding for her baby, challenges of life robbed her of this dream. She was forced to give water and local pap to her baby within two weeks of delivery.

Because she had to work to survive, her child was denied of the benefits of human milk which experts say is better than any food. Science has proved that breast milk is a complex living substance like blood with a long list of active germ-fighting and health-promoting ingredients which boosts children’s nutrition. A month later, her son took ill and was diagnosed of malnutrition. While Deborah is wallowing in self-pity, Jesica Egonu, who managed to complete six months exclusive breastfeeding for her child, could not continue with complementary feeding for the child.

Six months after, she decided to go back to her business and left her child at the mercy of the house maid who fed the child with anything available.   At 10 months, the child took ill. When efforts to treat her at home failed, she was taken to a nearby hospital. The baby was dehydrated and diagnosed of diarrhoea. She was treated and discharged. A month later, the diarrhoea came back, this time serious and, within days, she had lost so much weight. It was at this point that she was taken to a General Hospital where it was found that the child was malnourished.

Jesica and Deborah’s children are among the 43.6 per cent Nigerian children stunted and the 2.5 million children severely malnourished.

Meanwhile, a new report released by the United Nations Children’s Fund, UNICEF, showed that despite millions of funds invested in nutrition, more Nigerian children under the ages of five are suffering from acute malnutrition.   According to the 2016-2017 Multiple Indicator Cluster Survey, MICS, report, the country is witnessing ‘stagnant or worsening situations’.

The report showed a rise in major indicators used to measure childhood malnutrition. It revealed that underweight prevalence (children too thin for their age) increased from 24.2 per cent to 31.5 per cent during the year under review.

According to UNICEF Monitoring and Evaluation Specialist, Mrs. Maureen Zubie-Okolo, the report, which is an instrument to strengthen national statistics, also showed that stunting prevalence increased from 34.8 per cent to 43.6 per cent while wasting prevalence grew marginally from 10.2 per cent to 10.8 per cent respectively.

More children in the rural areas, the report said, are more stunted with 49.3 above the national average of 43.6, while children underweight in the urban areas are 23.0, wasted 10.5 and in the rural areas, underweight 35.3 and wasted 10.9.

North-West topped the list of stunted children with an average of 58.5 followed by the North-East with 52.4, North-Central 34.9, South-West 19.4, South-South 19.0, and South-East 16.9 respectively.

The MICS report also looked at the Nutritional Status of the six zones of the country. It found that North-Central is 4,541, North-East 5926, North-West- 10, 487, South-East: 1, 525, South-South 2,243 and South-West 2,915.

The report further revealed a rise in the percentage of women who breastfeed exclusively 54.0 and the South-West topped the list with 43.9, followed by South-South 27.2, South-East 25.3, North-Central 24.9, North-East 21.3, and North-West 18.5.

The report showed a sharp increase in malnutrition rate in Nigeria compared to 2007, 2011 MICs, and 2013 Nigeria Demographic Health Survey, NDHS.

Findings by Sunday Vanguard showed that stunting prevalence remained relatively stable between 2007 and 2013; it went up in 2016 and 2017.

According to Nigeria’s facts sheet on nutrition, the disparities in malnutrition related to various background characteristics are significant in Nigeria, but are often more pronounced for stunting. Children from rural areas are almost twice as likely to be stunted as children from urban areas. A child whose mother has no education is four times more likely to be stunted than a child whose mother has secondary or higher education. Children from the poorest 20 per cent of households are also four times more likely to be stunted than children from the wealthiest 20 per cent of households.

In 2013 alone, the NDHS showed that malnutrition rate in children under five years was 37 per cent, or six million stunted (chronically malnourished or low height for age), more than half of them severely. In addition, 18 per cent of children suffer from wasting (acutely malnourished or low weight for height), half of them severely while 29 per cent are underweight (both acutely and chronically malnourished and low weight for age), almost half of them severely.

Sadly, with the recent report, health watchers are doubtful if Nigeria will attain the UN Sustainable Development Goal, SDGs, 2, by 2030. The SDG 2 harps on “End hunger, achieve food security and improved nutrition as well as promote sustainable agriculture”. It also requires that by 2030, countries would have ended all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under-five years, and addressing the nutritional needs of adolescent girls, pregnant and lactating women and older persons.

Experts say there is need for improved investment in nutrition as well as behavioural change in order to prevent and ultimately reduced cases of malnutrition.

Reacting to the report in a chat with Sunday Vanguard, National President of Nutrition Society of Nigeria, NSN, Dr. Bartholomew Brai, who regretted government’s low commitment towards improving nutrition in the country, said only commitment and action by government would improve the nutritional status of Nigerian children.

Brai lamented that most of the nutritional programmes in the country are donor-driven involving organizations like UNICEF, World Health Organisation, WHO, etc., saying this has remained a challenge.

“Check where there is government’s commitment and action, they experience improvement but, all over the country, generally, government’s investment in nutrition is very poor”, he said.

“Like in Osun State right now, malnutrition rate has increased.   This time, we have Civil Society Scaling-Up Nutrition in Nigeria (CS-SUNN) just to increase advocacy and get government commitment towards nutrition in Nigeria.

“You could see that the result of the report is a real challenge; instead of us going up, we see ourselves going backward.   We should be talking about reducing the malnutrition cases but, unfortunately, the MICS report showed that we are going backward.   So we have problems. Government needs to show commitment but only God knows how this commitment will come.   I am aware that states like Kaduna, with the help of UNICEF, have done much now. If you go back to Kaduna now, you can see that they have gone far.   Kano is also trying on how to improve theirs, because malnutrition rate in Kano is also very high.   It depends on individual government”.

Proffering solution to the problem, Brai advised that at the household level, families should look inward, adding that there is need for them to diversify their diets.

Lamenting that the report calls for a behavioural change, he regretted, “If you go to some communities, everything they have they sell. If it is orange tree, they will pluck all of them and sell. If they are fishermen, they will sell all the fish. We should learn to really make use of what we have to feed ourselves.   Even right in our homes, we should encourage consumption of vegetables and fruits that are readily available.

“Though we have food challenge, I feel we can still use what we have to feed these children.   Families should ensure that the children get varieties and not only enough but diversified diets. Not amala or eba in the morning, afternoon and night.   Let there be enough protein, fruits and vegetables, where these children can get the micronutrients because one of the problems is micronutrients”.

Giving a nutrition situation in Nigeria in a presentation tagged: “Scaling up Nutrition in Nigeria: What will it cost?,” the Head of Nutrition, Federal Ministry of Health, Dr. Chris Osa Isokpunwu, said that nearly one million children under the age of 5 years die in Nigeria every year.

According to him, the situation has made Nigeria one of the highest contributors of under-5 mortality in the world.   Sadly, about half of it was due to malnutrition.

He lamented that some of the children who survive often become stunted, a major indicator used to measure childhood malnutrition.

Isokpunwu listed some of the causes to include, inadequate access to food, inadequate dietary intake, diseases, inadequate care for children and women, insufficient health services and unhealthy environment and inadequate education among others.

To achieve better nutrition for Nigerian children as well as stop these deaths, Isokpunwu recommended behavioural change in the area of exclusive breastfeeding and complementary feeding of infants after the age of six months.

It needs to be mentioned that a UNICEF report showed that Nigeria, in 2016, invested huge amounts of money in nutrition through the Federal Ministry of Health. In the same year, some states from the North, such as Kaduna, invested N300 million, Sokoto N50 million, Bauchi N10 million, Gombe N17 million and Jigawa N150 million. Nevertheless, malnutrition cases in the country have continued to soar.