COVID-19: How zero nutrition budget will worsen Severe Acute Malnutrition

Muni’s two year old daughter kept stooling and vomiting for days. She bought some drugs for her at the  patent medicine store but she grew worse. She was later diagnosed of Severe Acute Malnutrition (SAM) at the Primary Health Care centre (PHC)  in her community in Abuja. However, the facility had no Ready-to-Use Therapeutic Food […]

Muni’s two year old daughter kept stooling and vomiting for days. She bought some drugs for her at the  patent medicine store but she grew worse.

She was later diagnosed of Severe Acute Malnutrition (SAM) at the Primary Health Care centre (PHC)  in her community in Abuja. However, the facility had no Ready-to-Use Therapeutic Food (RUTF)  in stock and she still had to wait a while longer  to buy  enough for her baby from a pharmacy in town.

Like Muni many children suffer from Severe Acute Malnutrition in Nigeria (SAM).

Malnutrition is a health condition resulting from eating a diet that is lacking in nutrients. Children that survive the condition do not live to their full physical and mental potential, except when treated with RUTF.

UNICEF estimates that 2.5 million children below five years suffer from Severe Acute Malnutrition every year with about 420,000 deaths recorded, meaning 1,150 children die every day from SAM.

Nigeria still has the highest burden of stunting in Africa and is still the second-highest in the world next to India. The country’s current nationwide childhood under-nutrition indicator stands at 37% stunting, 7% wasting and 23% underweight, According to Nigeria Health and Demographic Survey  (NDHS, 2018).

The three kinds of malnutrition are: stunting, (too short for their age); wasting too thin for their height), and overweight.

With the huge burden of SAM in the country, experts have expressed concern over the zero allocation for RUTF in the 2020 budget.

The federal government had removed the N800m earlier allocated for RUTF in the 2020 health budget.

This is also happening when the COVID-19 pandemic has worsened the malnutrition situation in the country.

RUTF is key in addressing SAM. According to Dr Emmanuel Sokpo, Country Director, Network for Health Equity and Development (NHED) “Ready To Use Therapeutic Food (RUTF) can effectively treat children with SAM at the community level with a 95% cure rate. He said it costs N21, 350 to cure a child with SAM for an eight-week treatment with RUTF compared with six months of treatment with other forms of treatment. “It costs N36,750 to cure a child in the emergency state with SAM,” he said.

He said funding for RUTF covers: procurement, logistic management, staff emolument/training and supervision, provision & equipping of Community Management of Acute Malnutrition (CMAM) sites/Nutrition Units and coordination.

To address the situation, he said there was need to return and release the N800m for RUTF which was removed from the Federal Ministry of Health  2020 budget and  improve the logistic management system

Over the years, there has been growing concern about the danger posed to the health of children in Nigeria and its negative effects on the future of the country.

Prof. Adebayo Fayoyin, PhD, a visiting Professor Caleb University said malnourished children grow up with worse health and lower educational achievements. Malnutrition was seen as something that exacerbates diseases e.g. measles, pneumonia, diarrhoea.

Appropriate budgetary allocation and releases, he said, are the way forward.

Over time, the budget for nutrition has been poor and the country reaches only two out of every 10 children affected with treatment.

Even when there were budgets for RUTF, some states suffer from RUTF stock-outs. One can imagine what the situation is now without an RUTF  budget. For instance, Kano State records the highest number of stunted children with 1.4 million in the North.

The devastating impacts of malnutrition in the state led to the scale-up of Community Management of Acute Malnutrition (CMAM) programme from six to 13 LGAs (out of 44 LGAs) with most disturbing cases among children under-five and pregnant mothers.

“It is, however, worrisome that the state’s CMAM facilities experience persistent stock of RUTF emanating from delay in the release of funding for the procurement of RUTF,” according to CISLAC.

Till date, the country imports RUTF. While stakeholders work towards local production of RUTF, another alternative for addressing malnutrition, it is important that adequate budgetary allocation for RUTF and timely releases are made to ensure availability for children and mothers.

Many  Primary Healthcare Centres lack RUTF. Findings have also shown that the zero budget is taking a toll in some Community Management of Acute Malnutrition (CMAM) as mothers come from remote areas with their children but cannot access it.

Nigeria needs to end the scourge of Severe Acute Malnutrition by ensuring that RUTF is available where and when needed

Beatrice Eluaka Executive Secretary, Civil Society Scaling-Up Nutrition in Nigeria (CS-SUNN), CS-SUNN, called on the government to restore the N800 million in the 2020 budget.

She said while policies and plans are in place in Nigeria to address the problem of malnutrition, the plans are generally not fully implemented due to lack of adequate funding.

“Domestic funding for nutrition has become lean, leading to over-dependence on dwindling donor funding. The government should prioritize nutrition in Nigeria by improving budgetary allocations, releasing and cash backing those allocations while ensuring transparency and accountability in the use of funds directed at addressing malnutrition”.

The Chief Executive Officer of the International Society of Media in Public Health (ISMPH), Moji Makanjuola, said there was a need for increase budget for nutrition.

She said nutrition has become part of wellbeing, adding “When we have these young ones, who don’t have the necessary nutrient needed for optimal growth and development, what kind of leaders are we growing for our country?

“It was a very sad day for me and of course a lot of nutrition advocates in Nigeria that nutrition got zero budget what happened? Are we saying that the voiceless children don’t matter? Are we saying that nutrition doesn’t matter?

“It’s not even much about the children, what about the mothers; a pregnant mother that is not well-fed is likely to bring fort a child that is malnourished and all the other complications that are a rising debate.

She called on the National Assembly and state governments to ensure budgets for nutrition and timely releases in order to get the RUTF to save the lives of women and children.