Revealing the hidden faces of malnutrition

One of 40 volunteers in the council area, she volunteers to trace malnourished children in her community.Zainab wails on, thin, emaciated; her mother stands in silent shock, watching and helpless. Her baby’s piteous cries reverberates through the cottage hospital in Bungudu, Zamfara.The circumference of her mid-arm hardly reaches the green mark that would mark her […]

One of 40 volunteers in the council area, she volunteers to trace malnourished children in her community.
Zainab wails on, thin, emaciated; her mother stands in silent shock, watching and helpless. Her baby’s piteous cries reverberates through the cottage hospital in Bungudu, Zamfara.
The circumference of her mid-arm hardly reaches the green mark that would mark her as healthily robust. Far from it. The health worker declares a verdict: she is malnourished.
Between September last year and May this year, nearly 11,500 children aged less than five years, like Zainab, have been admitted as outpatients at treatment centres like the one in Bungudu.
Some 211 of them are spread throughout three Zamfara council areas—in Bakura, Bungudu and Shinkafi—run by a project, Working to Improve Nutrition in Northern Nigeria (WINNN). Funded by the British Department for International Development, WINNN is in five northern states.
But in the three Zamfara council areas, the $50 million project hopes to reach some 140,000 children like Zainab.
Older children and adolescents admitted for malnutrition push the numbers of affected children up to 11,700.
An average 400 are admitted every month, put through the paces like Zainab, and recruited into an intensive treatment programme that depends on simple things as groundnut paste, milk and micronutrients blended into a ready-to-use therapeutic food (RUTF).
A total 289 of the children have died from malnutrition, according to data collected in Zamfara.
The state government is battling with a hidden hunger among its children, after a state-backed survey in 2011 found one in five children in Zamfara were malnourished and needed urgent help, said Yusuf Marafa, director of primary health care in the state.
“The number of malnourished children was higher [back then]. Even people from other states used to come to [treatment centres] to collect treatment.” Those are children and families from Sokoto, Katsina and Kaduna.
Poverty is easy to attribute as a reason, along with access to food, says Dr Ibrahim Oloriegbe, national programme manager for WINNN. “Lack of appropriate feeding practice is the cause. Poverty makes food not available. There are several people for whom maybe the only thing available is a carbohydrate diet, no milk, no animal protein, no means to buy beans.”
A predominantly farming community, Bungudu has staples northern states are known for: maize, rice, millet, guinea corn, guava, mango, cashew, beans groundnut, meat, fish, eggs, poultry. The list is endless, says Samaila Bakwai, state nutrition officer and focal person for the state’s maternal and child health week.
Residents use all those foods but with little knowledge about nutritional value.
“That’s what we are encouraging our people, because some are ignorant of ways to utilize,” says Bakwai.
That’s what brought the issue of malnutrition within the communities. You find that some mothers are ignorant of what those food items are providing to the body. Some are still ignorant of it.”
Poor hygiene, not washing hands before feeding children, also predispose babies to life-threatening diarrhoea.
In one corner, a group of three women who have seen their babies through malnutrition, show their babies off proudly. Exclusive breastfeeding helped, they say, as did hygiene and care to prepare local foods as “kunun lafiya” to help their babies.
Nutrition education, food demonstrations for mothers with babies approaching six months and needing to be put on supplementary diets in addition to breast milk, and how to use potable water also count.
At the clinic, washing hands with soap under running water is mandated on Zainab’s mother. Once she gets through screening, she is ushered inside the clinic to pick up the RUTF—commonly known as plumpy nuts.
Zainab gets one and half sachets per week, and will need to feed on the paste for 11 weeks. Supply is threatened by inadequate funding, officials admit, even though the state government has been trying to purchase plumpy nuts and drugs since the anti-malnutrition project started in 2011.
Availability of the plumpy nuts has also been threatened by need, officials say: families have fed it to other household children faced with no other food to eat, and men have taken it out of the mouths of their children in the belief that the high-protein diet boosts sexual performance.
Private companies producing RUTF could knock down the price and placing plumpy nuts on essential-drugs list would make it easier and compulsory for governments to buy them for children facing malnutrition.
As yet, only a single company manufactures and ships the UNICEF-backed RUTF that Zainab will use until she recovers. That,  along with medications for diarrhoea, worm infestation, vitamin A deficiency, malaria and a course of antibiotics.
And she could, if her mother follows the instructions she is given at the clinic. In the eight months before Zainab’s admission, more than 9,500 children have recovered from malnutrition upon treatment—86% of the children affected and admitted in Bungudu alone, and closely followed by Bakura and Shinkafi.
Without volunteers to fish her out, Zainab could have easily not have recovered.
“We push our people to do volunteer work,” says Garba Marafa, district head of Kekun Waje and chairman of Bungudu emirate council’s nutrition committee. “We need government to motivate volunteers.”
In the past three years, WINNN has helped transport RUTF and strengthen advocacy, says Marafa, “which resulted in making policymakers commit themselves to providing resources to transport RUTF from the capital down to out-patient treatment centres.”
Idris, the community volunteer, will follow up on Zainab once she gets home and continue combing Bungudu for more malnourished children. In return, she gets a stipend and the satisfaction of knowing she helped save a toddler somewhere.