By Chioma Obinna
It is no news that Nigeria ranks high among countries with unenviable statistics on child malnutrition. She has the second highest stunted children in the world with estimated 17 million due to malnutrition and, according to the United Nations Children’s Fund, UNICEF, 25 million of the children under the age of five are wasting. Most of the children are from the North-East and suffering due to insurgency. Today, it is also not news that Nigerians are hungry but the danger is the fact that they are only interested in having a full belly without minding the quality of the food. Meanwhile, nutrition indicators show that the current situation in the country is dangerous for children who are the future leaders.
According to UNICEF, malnutrition is a condition that results from eating a diet lacking in nutrients. The damage resulting from malnutrition to physical and cognitive development during the first two years of a child’s life is largely irreversible. Sunday Vanguard writes that Nigeria may be breeding a malnourished generation in future.
Recovering but with a blemish
As ten-month-old Halimat Ahmed rests on her mother’s shoulder, her sunken eyes are enough to attract sympathy even from the hard-hearted. Her lips were filled with drool, arms as tiny as a broomstick. She keeps sulking. A closer look at the baby shows a clear difference from old Halimat when she was six months old. Her frame doesn’t fit the frame of a10-month-old baby.
Like every other mother, Halima’s mother is worried that she might lose her. Halimat is the only surviving child of her parents after insurgency hit her community. Halimat is struggling to survive Severe Acute Malnutrition, SAM, an extreme form of malnutrition that makes its victims weak, skeletal and requires urgent treatment. Thanks to a UNICEF-nutrition supported program in IDP camps where she was urgently treated to stop the devastating effect of SAM, Halimat was treated with Ready to Use Therapeutic Food, RUTF, which helps malnourished children regain lost nutrients. The girl has recovered. But did she recover without blemish? Will she grow like other children? These and more are the questions surrounding victims of malnutrition. She is one of the Nigerian children born in a small community in Borno State where insurgency has escalated malnutrition and brought about high food insecurity, as well as sub-optimal infant and young children feeding practices.
The nation is facing SAM that has claimed thousands of children. Findings show that one in 10 of severely wasted children worldwide lives in Nigeria.
Halimat is among the 35 million children aged five and below in the North-East affected by SAM due to insurgency. Recent figures from the United Nations Children’s Fund, UNICEF, revealed that Global Acute Malnutrition, GAM, in the region has crossed the threshold for “serious”.
According to the World Health Organisation, WHO, classification for “serious” is for levels of combined moderate and acute malnutrition exceeding 10 in 100 children.
Worse still, the levels of malnutrition in three states in the North-East – Central Borno, Municipal Maiduguri, Jere; and South, Central and North of Yobe – have crossed the threshold.
However, Halimat and other victims of malnutrition will suffer long term effects of malnutrition, especially in adulthood.
According to UNICEF, although death is the worst outcome of malnutrition’s ugly grasp, it is not the only outcome as children who survive can face an unending list of devastating side effects that last a lifetime.
Studies show that most of the victims are prevented from achieving success in school and pursuing meaningful work in adulthood.
Like Halimat, children affected by malnutrition battle with challenges such as increased vulnerability to diseases, developmental delays, stunted growth and even blindness. Such children, according to experts, will not be able to contribute to the development of the country or achieve their dreams.
According to UNICEF Nutrition Specialist, Akure Field Office, Mrs Ada Ezeogu, during an interaction on child nutrition, an estimated 17 million or 43.6 per cent of children in Nigeria under the age of five have their bodies and minds limited by stunting.
Ezeogu described stunting as a manifestation of the severe, irreversible physical and cognitive damage caused by chronic malnutrition early in a child which is one of the most significant barriers to human development.
Studies show that beyond the age of 2-3, the effects of chronic malnutrition are irreversible. This means that to break the intergenerational transmission of poverty and malnutrition, children at risk must be reached during their first two years of life.
Children who do not reach their optimum height or consistently experience bouts of weight loss during childhood are affected in the long term in numerous ways.
They do not reach their optimum size as adults and may have less physical capacity for work, their brains are affected resulting in lower IQs and they are at greater risk of infection which kills many children during their early years.
Child malnutrition also impacts on educational attainment. The degree of cognitive impairments is directly related to the severity of stunting and Iron Deficiency Anaemia. Studies show that stunted children in the first two years of life have lower cognitive test scores, delayed enrolment, higher absenteeism and more class repetition compared with non-stunted children. It also impacts on economic productivity. The mental impairment caused by iodine deficiency is permanent and directly linked to productivity loss. The loss from stunting is calculated as 1.38 per cent reduced productivity for every 1 per cent decrease in height while 1percent reduced productivity is estimated for every 1percent drop in iron status, according to Haddad and Bouis, 1990.
Adults who were undernourished as children are at risk of developing diseases such as obesity, diabetes and cardiovascular issues.
Regardless, Nigeria is said to be paying lip service to issues of child nutrition. Some states are yet to provide a budget line for nutrition.
Malnutrition, according to experts, is caused by a combination of complicated factors including poverty, political instability; climate change, feeding practices, disease, contaminated water, poor sanitation among others. Nigeria is battling with these causes.
According to the World Poverty Clock, no fewer than 91.6 million Nigerians are extremely poor and living on less than one dollar per day. Prices of foodstuff are unpredictable and many parents are jobless and lack the purchasing power to buy healthy, nutritious foods.
According to the latest National Nutrition and Health Survey, NNHS, 2018, acute malnutrition remains at alert levels while chronic malnutrition, as characterised by stunting, remains the biggest burden at serious or high levels according to WHO/UNICEF classification.
The 2018 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.
The country’s Exclusive Breastfeeding, EBF, rate is also low, no thanks to the inability of mothers to breastfeed their children exclusively for the first six months of life.
Currently, 3 in 4 babies are not exclusively breastfed, a practice, according to scientists, reduces the number of child deaths from malnutrition.
The 2018 NNHS also shows that breastfeeding remains widespread among the Nigerian population.
Child feeding indicators are poor and sub-optimal. The survey reveals that more than 80 per cent of newborns do not timely receive milk and colostrums within one hour of birth; only 27 per cent of 0-5 months old infants are breastfed exclusively, and so majority are introduced to complementary foods before the age of six months earlier than the time WHO/UNICEF’s recommended that mothers exclusively breastfeed their children, and in the process predisposing the children to unhygienic feeding conditions and vulnerability to illnesses and malnutrition.
Nearly 60 per cent of the children (6-24 months) assessed were not fed to the recommended minimum meal frequency for their age and breastfeeding status; 65 per cent do not meet the minimum dietary diversity and only 17 per cent of children aged 6-23 months receive the minimum acceptable diet while less than 50 per cent are fed on iron-containing foods.
The 2018 NNHS further reveals that the national GAM prevalence among children 6-59 months of age based on weight-for-height was 7.0 per cent with MAM of 5.5 per cent and SAM of 1.5 per cent. The rates indicate that acute malnutrition levels have remained at alert levels of 5-9.9 per cent over the years since 2014. The prevalence of underweight among children aged 0-59 months was 19.9 per cent, just at the margin of the 20 per cent threshold for “serious” situation that it has been since 2014, higher than the global estimate of 15 per cent but consistent with the rates in the West and Central Africa region.
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 North-East recording prevalence above 40 per cent- the WHO critical levels.
The survey recommends that improving nutrition in the first1, 000 days window and in adolescent girls was critical to improving the nutrition status of the entire population of Nigeria.
According to the President of Nutrition Society of Nigeria, Dr Bartholomew Brai, nutrition is a fundamental right.
Without good nutrition, Brai says the mind and body cannot function well, hence, appropriate investments on good nutrition can help reduce the global burden of diseases and impaired quality of life.
At a workshop on ‘Advancing Nutrition, Health and Wellness through the Media’, organised by Nestlé Nigeria and the Lagos Business School, he said proper investment on nutrition can help to improve our health, prevent certain diseases, maintain a desirable weight, and maintain Nigerian’s energy and vitality.
To him, good nutrition leads to higher earnings and mental acuity, which, in turn, supports macroeconomic and societal growth.
Critical health watchers believe that there is need to intensify efforts to reduce stunting through proper nutrition, especially now that Nigeria was at a critical stage of malnutrition and proper nutrition is germane to human growth and a well-nurtured generation will contribute meaningfully to the development of the society.