Malnutrition: Not just a ‘Northern problem’

Veronica is three months old, but has the look of a baby one day old. She’s caught in the grip of severe acute malnutrition (SAM). “For the past two weeks, she has not been suckling,” her mother told nurses at Calabar’s General Hospital on Mary Slessor Road when she was brought in. Over 24 hours […]

Veronica is three months old, but has the look of a baby one day old. She’s caught in the grip of severe acute malnutrition (SAM). “For the past two weeks, she has not been suckling,” her mother told nurses at Calabar’s General Hospital on Mary Slessor Road when she was brought in.
Over 24 hours nurses frantically made sure Veronica was put back to breast, “to see how the milk can come out,” says Inyang Essien, nutritionist at the hospital. Veronica can’t get milk, her mother can’t get food. “While they are here, we are feeding them,” says Essien. “Even the mother of the baby is not feeding well.”
Seventy percent of children aged six to 23 months do not receive adequate diet.
Adequate diet is important to break the vicious cycle of malnutrition tying mothers to their children, and children as future parents. It is fast becoming Nigeria’s silent crisis, say analysts, pointing to growing numbers of children like Veronica spread across the northern belt of the country.
Even government-sanctioned statistics indicate nearly half of all children under five in the northwest are stunted (too short for their age), 27 percent are wasted (too thin for their age) and 47 percent are underweight (weight too low for their age). In the northeast, 42 percent of children are stunted, 20 percent are wasted and 31% are underweight.
On a national scale, the figures haven’t changed much since 1990. And now hospital findings reveal malnutrition isn’t just a problem found in the arid north.
The lush rainforest south holds its share of malnourished children like Veronica. Delta, Bayelsa and Ebonyi are marked red-priority states. Only Lagos, Ogun, Ekiti and Abia are in the green zone; others fall into weak yellow alert.
Veronica is among eight children hospitalized at General Hospital, Calabar. At least 20 are brought there every month. Cross Rivers runs a government-sponsored free programme to treat indigent children under age five, but its impact is lost on the mothers and their children. They largely depend on the kindness of nurses and doctors and the mercy of goodwill visitors coming through the wards.
“A lot of people don’t have money to give the necessary food,” says Dr Friday Odeh, paediatrician at the hospital. “Some of them that even have the food don’t know how to combine the food. So it is ignorance, poverty and then of course infection.”
The trio of conditions responsible for malnutrition among Nigeria’s children. Malnutrition itself has been implicated in nearly 53 percent of all deaths of children in Nigeria as early as five years ago.
Malnourished children grow into malnourished adults who in turn have malnourished children. Nigeria’s own survey in 2013, found stunting was more common children born to mothers who are poor, rural, in lowest wealth quintile, had no education at all and were themselves malnourished. Researchers have identified a 2,000-day window-from conception to age two-within which nutrition can be helped to reduce death and disease and avoid irreversible harm.
The interventions target behaviour change, micronutrient, deworming, complementary feeding and therapeutic feeding. The World Food Programme says addressing hunger, especially child chronic under-nutrition, is an efficient way to fight poverty. Each one percent decrease in malnutrition gives an equivalent 4 percent decrease in poverty, it said.
The United Nations Children’s Fund, UNICEF, says investing in nutrition is one of the greatest opportunities for social and economic change. Better nutrition and healthier children could boost gross national product by 11% across Africa and Asia, prevent half of all child deaths, increase school attainment by at least one year.
It could also boost wage rates by five to 50 percent and make children 33% more like to escape poverty as adults. And each one percent decrease in poverty rate achieves a 0.25 percent decrease in malnutrition.
Back in Calabar, mothers learn better nutrition and exclusive breastfeeding. Children start off on ready-to-use therapeutic food-a paste of groundnut, milk, vitamins and minerals meant to ramp up the protein and energy supply for malnourished children. It has gotten the name “power food” among health workers. Top health officials have disclosed two unnamed firms have indicated interest to produce power food locally, considering a ready supply of ingredients, a ready market and a need to drive down the price.
At present, it is produced in South Africa and imported by UNICEF for malnutrition programmes around the country. “It costs about $54 to get enough for one child, but then you get the product, you haven’t transported it yet,” says Dr Arjan de Wagt, UNICEF nutrition chief. “To get it into the country and to get it to the right place costs about $76 to treat one child.”
“We don’t have enough money to import enough. At the moment in the country, about 25 percent of children who need it are being reached,” saving some 200,000 lives, Wagt adds. “The other children are not being reached because there’s not enough RUTF. They are not being helped.” That is nearly 70 percent of one million children affected each year by SAM.
“Everybody has resources that need to be brought in. It is not about the money but the resource where you have comparative advantage,” says Dr Chris Isokpunwu, head of nutrition at the federal health ministry.
“The potential in the private sector is huge, not just in food industry. They have areas of comparative advantage-bringing out the right nutrition messages, making their products nutrition sensitive, and creating the awareness of how to promote adequate nutrition, making the environment suitable to encourage, to promote and to protect exclusive breastfeeding.”