March 14, 2023

First 1,000 days crucial for infant health, wellbeing — EXPERTS


By Chioma Obinna

The nutrition situation of children in Nigeria remains worrisome.  According to the 2021 Multiple Indicator Cluster Survey, MICs, 1 in 10 children die before their fifth birthday though an improvement from the MICS 2016 which was put at 1 in 8 children.
Also, a global report tagged: “Fed to Fail” in 2021 rated Nigeria 2nd among countries with the highest number of children with malnutrition in the world and 1st in the whole of Africa.  It also showed that at least 17 million Nigerian children are undernourished; stunted or wasted.
The 2021 multiple Indicator Cluster Survey of the Nigeria Bureau of Statistics and other partners also revealed that only 77 per cent of Nigerian children are not breastfed within one hour of birth and 66 per cent are not exclusively breastfed.
The report further found that among children aged 7-14 years, 73 percent have no foundational literacy skills and 75 per cent also do not have foundational numeracy skills.
While one out of every 4 (26 per cent) children of primary school age are out of school. This remains almost unchanged from 27 per cent in 2016, the report disclosed.
Today, the lowest out-of-school rates are found in Ekiti (2 per cent) and Imo (1 per cent) states while the highest rates are recorded in Kebbi (65 per cent), Zamfara (61 per cent) and Bauchi (61 per cent) states.
However, despite the needed improvement in these areas, experts say much can be done in the first 1,000 days of life to ensure not only the survival of infants but also their growth, cognitive development and well-being all through the stages of life.
According to nutrition experts, the first 1,000 days of life which starts from conception to the second birthday of a child remains the most critical period for laying a good foundation for health, growth, and cognitive development through nutrition and immunisation.
They say 1,000 days period gives the child a fair start in life and nutrition during the period impacts how the body, and immune systems develop, and how it influences the predisposition to diseases later in life.   Sadly, many Nigerian women do not prepare for pregnancy.
Findings have shown that poor nutrition in the 1,000 days which span from conception to 2 years of age results in permanent damage.
Studies have also shown that the brain of an infant developed up to 75 percent within the 1,000 days period and without good nutrition, a child is born disadvantaged with complications of cognitive development and stunting or wasting. Most of the infants who survive suffer acute malnutrition without quick intervention.  Sadly, experts say once it occurs, it is irreversible.
Today, malnutrition is one of the world’s major public health and development trepidations.  The situation is said to be dire in countries like Nigeria where insecurity and harsh economic situation and disruptions of COVID-19 is the order of the day.
Again, a report from the United Nations Children’s Fund showed that an estimated two million children in Nigeria suffer from severe acute malnutrition (SAM), while only two out of every 10 children affected is currently reached with treatment.
It also showed that 7 percent of women of childbearing age also suffer from acute malnutrition.
But a Nutrition Specialist with UNICEF, Mrs Ada Ezeogu told Good Health Weekly, that a brighter future begins with investing in the first 1,000 days as evidence has shown that with the right nutrition, more than one million lives will be saved each year.
Ezeogu, who said the period grants everybody an equal opportunity to lay a good foundation in terms of nutrition, added that evidence suggests that the health effects of poor nutrition and adverse experiences early in life can pass down from one generation to the next.
She said there are, however, interventions to address these problems and save millions of lives within this window of opportunity.

“If the mother is not well nourished it affects the growth of the baby within her and the baby  can come out with low birth weight and stunted from the womb.  Once that happens, the baby comes into life already disadvantaged. So you need to put in special interventions to ensure that the baby survives and thrives.  Ezeogu advised mothers before pregnancy, to protect their own health by having healthy diets and eating nutritious meals to ensure that they are in good standing in terms of their nutritional status, as the baby depends on them for all of the nutrients that they need when they get pregnant.
She said babies who are malnourished in the womb have higher risks of dying in infancy and face more lifelong cognitive and physical defects and chronic health problems.
“Undernutrition under age two can be life-threatening.  This weakens the child’s immune system and makes the baby more susceptible to dying from common illnesses such as pneumonia, diarrhoea and malaria.
“Mothers need to be sure that they protect their health by eating nutritious meals and taking the recommended supplements like iron and folic acids that will protect them.”
Ezeogu also explained that after birth, breastfeeding is the golden standard for infant feeding.
She said:  if the mother is well-nourished and the baby is delivered by a skilled birth attendant in a facility, that child comes in well-nourished and once that child arrives, early initiation of breastfeeding is important within one hour of birth.”
She said when the breast is initiated within the first hour of birth, it protects the child from dying in the early stages of life.
“Children who are not put to the breast within one hour of birth have greater chances of dying within one month of life.  The first milk which is yellowish, and sticky produced at the end of pregnancy also provides immunity and prevents the child from easily catching other childhood diseases.
Ezeogu said immediately after initiation the mother should continue with exclusive breastfeeding because breast milk has all the nutrients the child needs to grow both physically and mentally and provide an opportunity for the mother to stimulate the child.
“There is bonding because the child is holistically developing both in terms of mental and psychological wellbeing, Breastfeeding provides all of that and it is the golden standard of feeding children that are below six months.

Ezeogu  said cesarean section should not be a hindrance to initiating breastfeeding within the first hour of life and practising exclusive breastfeeding for six months.
According to her, breastmilk contains about 88 percent of water and little quantity of semi-solid as well as all the nutrients the baby require within the first six months of life.
She said even in a hot climate like Nigeria, the water in the breastmilk is adequate for the baby.
She added that the first milk that comes out of the breast quenches the taste before the milk begins to come.  

Complementary feeding
Ezeogu said at  six months breast milk can no longer   meet all the nutritional requirements of that child, hence, the need for mothers to introduce complementary foods to get some other nutrients.
“At six months, whatever you want to give the baby  at that time must be nutritious.  It must have different food groups so that it can provide different kinds of nutrients and it has to be in a form the child will be able to take it.   It is not like a family meal.  It has to be either semi-solid or very soft for the child to be able to use. However, breast milk is still necessary until age two or more.”

“The breastmilk has antibodies that protect babies.  The first milk which we call colostrum has a lot of antibodies in it and protects the child. Breast milk actually serves as the first immunisation but that does not mean that the child should not get their regular routine immunisations.”
According to the Director of Health Education and health promotion services, Lagos State Primary Healthcare Board, Mrs Owojuyigbe said  immunisation was important as children below age two are vulnerable to illnesses due to weak immune systems while regular immunisation boosts their immunity.
According to her, Immunisation is a way of protecting children from vaccine-preventable diseases as soon as a baby is delivered through the administration of vaccines orally or by injection
Owojuyigbe stressed the need for babies to be  vaccinated against; TB, Measles, meningitis, diphtheria, tetanus, whooping cough, diarrhoea & poliomyelitis etc.
She said children who are immunised are protected against these dangerous diseases which can lead to illness, disability and death, stating that every child  has the  right to be fully immunised, she said immunisation should  commence immediately after birth.
According to her, every child is expected to have completed immunisation before the age of one. She  said that immunisation was not harmful to the child, rather  safe for all children.
Explaining that children may have fever or pain at the site of injection after taking vaccines, she advised that if fever persists, mothers should report to the nearest health facility.
“Every child should be taken for immunisation 6 times during the first year as stated in the immunization schedule. Parents or caregivers should take the child’s health card along to the health facility to record the immunisation given and the date for the next immunisation.”
Speaking at a 2-Day Advocacy Meeting with Media on the First 1000 days of a Child and COVAX Uptake in Lagos State, organised by  UNICEF in collaboration with National Orientation Agency, NOA, Social and Behaviour Change Specialist, Mrs Aderonke Akinola-Akinwole explained that undernutrition during pregnancy, affects foetal growth, and remains a major determinant of stunting.
Akinola-Akinwole lamented that children in Nigeria continue to die from preventable causes of death including pneumonia, malaria, diarrhoea and measles among others influenced by poor health seeking behaviour, and poor hygiene of the pregnant mother and child during the first 1000 days.
“Neonatal deaths account for nearly 40 per cent of overall deaths of children under the age of 5.”