February 24, 2019

Why 27million Nigerian children are not doing well in school – Reports

Nutrition: Why Nigeria must bridge gap in North East now

• 500, 000 under age five also die

By Chioma Obinna

Hunger is biting Nigerians hard and children are the worse for it. Reports show that Nigeria is home to over 11 million malnourished children and 17 million others who are stunted.   Today, malnutrition contributes to the death of 500,000 children under the age of five annually. Findings by Sunday Vanguard show that the silent but obvious crisis is impairing the health of children and women, their quality of lives and survival, as well as cognitive development of the children.

Whereas the world is changing the narratives through exclusive breastfeeding and appropriate complementary feeding, the generational circle of growth failure has continued unabated. The 2018 National Nutrition and Health Survey, NNHS, shows that acute malnutrition levels have remained at 19.9 per cent, 3.5 per cent higher than the global estimate of 15 per cent.

Sunday Vanguard looks at the effects of mother’s nutrition and reasons the first 1,000 days of child life is critical for optimal growth and development.

Arinola and Bola are age mates living in the same neighbourhood. They attend the same school and are in the same class. While Bola struggles to meet up with class activities, Arinola is on top of her class. A first look at both of them gives the impression that Arinola is older than Bola even though they are both seven years old.   It is glaring that Arinola is taller and healthier than Bola.   Investigations show that Arinola was born in a standard hospital where her mother attended the recommended four antenatal visits. During the period of pregnancy, the mother took all the necessary precautions and her health was optimal.   She ate the right food, maintained a good weight and was not exposed to undue stress.

At nine months when Arinola was delivered, the delivery was easy and safe. There was no complication and she came out with good weight.   Like every other mother who attended antenatal visits and imbibed lessons from health talk, she was able to initiate exclusive breastfeeding within an hour of birth with the assistance of birth attendants. Arinola was exclusively breastfed for six months after which appropriate complementary foods containing all necessary vitamins and minerals were introduced to her alongside breastfeeding for two years. Arinola is one of the few Nigerian children growing healthily towards achieving their full potentials in life. Bola’s case is the exact opposite. Her mother never attended antenatal care. Her physical looks alone showed she was born malnourished and was malnourished while pregnant for Bola whose delivery was not devoid of complications as she was delivered with low birth weight.

READ ALSO: Nigeria has 11m stunted children – UNICEF

Worse still, even after surviving, Bola’s mother failed to initiate exclusive breastfeeding within the first hour of life. Rather, she was breastfed alongside water and other liquid foods like pap.   In addition, she was denied good nutrition within her first 1,000 days, which, according to the United Nations Children’s Fund, UNICEF, offers a unique opportunity for preventing undernutrition and its consequences.

Today, Bola is one of the 17 million stunted children in Nigeria. Experts say the damage already done to the brain, bone and other organs of Bola and millions of others are irreversible. Bola and the others are also at risk of diseases such as diabetes, hypertension and heart diseases during adulthood.

According to UNICEF, 1,000 days is a critical stage in a child’s life and it usually starts in the womb before birth. The foetus is at risk if the mother lacks essential vitamins and minerals needed for the brain, bone and other development.

Statistics show that many pregnant women in Nigeria suffer from anaemia which can cause health problems for their babies. Once the baby is born, from birth to six months, early and exclusive breastfeeding without adding any other food or liquid is the very best way to ensure good health.

After the first six months, adding sufficient quantities of nutritious foods alongside breastfeeding is absolutely necessary to make sure that the child grows correctly. Most problems happen within this period.

Burden of malnutrition

Meanwhile, the 2018 NNHS show that Nigeria’s malnutrition levels have remained at 19.9 per cent since 2014 which is higher than the global estimate of 15 per cent.

The new survey shows that the prevalence of stunting was 32.0 per cent and has remained the largest burden of malnutrition with stagnated rates of above 30 per cent since 2014, and with many states in the North-West and the North-East recording prevalence above 40 per cent WHO critical levels.

The report also reveals that the national prevalence of acute malnutrition using Mid-Upper Arm Circumference, MUAC, Nigerian women in the reproductive age with 3.8 was severely malnourished, indicating a stable situation, consistent with previous nutrition survey conducted in 2015.

The report notes that improving nutrition in the first 1, 000 days window and in adolescent girls is critical to improving the nutrition status of the entire population of Nigeria.

The report, which also looks at the Infant and Young Child Feeding Practices, observes that although breastfeeding is a widespread practice among the Nigerian population, more than 80 per cent new-borns do not timely receive milk and colostrums within one hour of birth. It says only 27 per cent of 0-5 months are breastfed exclusively, and the majority are introduced to complementary foods before the age of six months earlier than the WHO/UNICEF’s recommendation that mothers exclusively breastfeeding their children, predisposing these children to unhygienic feeding conditions and vulnerability to illnesses.

According to the Chairman, Association of General Private Medical Practitioners of Nigeria, AGPMPN, Dr Tunji Akintade, the development of a child depends on her nutrition status within the first 1,000 days because the effects of malnutrition during this period are irreversible.

Akintade explained that children who became stunted not only experience retarded growth but also suffer damage to the brain leading to poor educational performance, low IQ, poor growth and development and they are at risk of chronic diseases like diabetes, hypertension and heart disease which will require medical treatment in adulthood.

Combating malnutrition

To reverse the trend, the expert stressed that “immediately you cut off the placenta, you are already denying the baby of glucose and breast milk which is the natural nutrient God gave to him”.

He went on: “Milk contains all the nutrients, water glucose; it is the only natural food that contains all that the baby needs for growth including antibiotics in terms of cholesterol that will come first. If we do not have a stunted growth, our brain will develop adequately. If you deprive the brain adequate nutrients, you would have damaged the brain.   You cannot get it back”.

Echoing this view at a Sensitisation Conference for Medical Directors; Orientation of Private Health Facilities on Infant and Young Child Feeding, IYCF, Practices in Lagos, the Founder of the Well Being Foundation, WBFA, Toyin Saraki, said good nutrition in the first 1,000 days was critical to enable children to live healthier and more productive lives.

Saraki, who is also the Inaugural Global Goodwill Ambassador and International Confederation of Midwives, ICM, added,   “Nutritious complementary foods should be added while continuing to breastfeed for up to two years or beyond. If 90 per cent of mothers exclusively breastfeed their infants for the first six months of life, an estimated 13 per cent of child deaths could be averted.

“If the same proportion of mothers provided adequate and timely complementary feeding for their infants from six to 24 months, a further six per cent of child deaths could be avoided.”

She urged Medical Directors of hospitals to play a key role in the success of the Alive & Thrive programme geared towards saving lives, prevent illness, ensure healthy growth and development through the promotion and support of optimal maternal nutrition, breastfeeding and complementary feeding practices in rural and urban Lagos as well as Kaduna.

She lamented that malnutrition in Lagos alone accounts for more than 50 per cent of under-five mortality with a rate of timely breastfeeding initiation at only 28.9 per cent.

“A mere 19.7 per cent of children under-six months in Lagos are breastfed exclusively and only 10 per cent of children aged 6 to 23 months are fed appropriately, “she added.

To the Executive Secretary, Health Facility Monitoring Accreditation Agency, HEFAMMA, Dr Mabel Adjekugbhele, breastfeeding is cheap and studies show that women who put babies to the breast within the first hour of life do better than their counterparts.

“Breast milk contains a lot of water and attending antenatal is crucial to spreading this message because the child’s nutrition starts during pregnancy. Getting women involved and introducing the child into infants’ complementary food alongside breastfeeding for two years is also crucial”, she added.

Health watchers believe that experience from nutrition programme, over the years, shows three reasons nutrition remains a smart investment – it helps children survive and reach their full potential and provide lifetime benefits; helps in meeting key national health targets including reducing the death of mothers and children and, thirdly, it is a smart investment because it accelerates progress on key economic development targets of the country.   In fact, nutrition intervention is the only investment that can achieve all these goals and adding values to all other investments.