As the war against malnutrition rages MOSES EMORINKEN, from Abuja writes on the various initiatives to combat the scourge and guarantee children, especially aged under-five their right to life
Her name is Marvelous and she is three years old. Her father refused her admission into the hospital for lack of money. Also, state nutrition officers do not have enough supplements to sustain her. We have been managing her for about nine days with our personal money. She died this morning.”
The above was the heartbreaking email the Director of Nutrition of the Federal Ministry of Health (FMoH), Dr. Chris Isokpunwu, received in June 2018, from a state nutrition officer concerning the late Marvelous who suffered from Severe Acute Malnutrition (SAM).
Marvelous is one of many children under age five that die as a result of acute malnutrition in Nigeria.
A recent report by the United Nations Children’s Fund (UNICEF) reveals that 49 per cent of Nigerian children under five years of age are not growing well, stunted, wasted or overweight.
Globally, 149 million children are stunted, or too short for their age, while a staggering number of 13.1 million children in Nigeria are affected.
The report further revealed that although 50 million children are wasted or too thin for their height, the number of affected children in Nigeria stands at 2.9 million.
According to the World Health Organisation (WHO), malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. It is the gravest single threat to global public health. Globally, it contributes to 45 per cent of deaths of children aged under 5 years.
Under nutrition can lead to delayed growth or wasting, while a diet that provides too much food, but not necessarily balanced, leads to obesity.
The body of a malnourished child finds it difficult to grow and resist diseases the way it should. More problematic is the fact that their cognitive development is greatly impaired, hence, their low learning abilities.
Children suffering from severe acute malnutrition are nine times more likely to die from related complications than healthy children are.
Recent nutrition assessment by the WHO in the three most-affected states of Borno, Adamawa and Yobe states in the region indicate various degrees of malnutrition among children under-5 and pregnant or lactating mothers.
Also, generally, 2.7 million women and children in Borno, Adamawa and Yobe states need nutrition support including 310,000 children in need of treatment for severe acute malnutrition and 250,000 who suffer from moderate acute malnutrition.
According to Dr. Isokpunwu, “A malnourished child who is not treated will grow up as an unproductive adult.
“In the 2018 Nigeria Demographic and Health Survey (NDHS), 6.8 per cent of children under the age of five have Severe Acute Malnutrition (SAM). SAM has a high mortality rate. If a child is too thin for his or her height, the mortality rate is higher – it is almost about 20 per cent. This means that one in five children will die if we do nothing about it.
“According to available data, we have a burden of malnutrition of 2.5 million yearly. This means that about 500,000 children will die yearly if we don’t treat them.”
The Chairman, Coalition for Maternal, Newborn, Child and Adolescent Accountability Mechanism (C4MAN), Dr. Ejike Orji, explained that the nutritional value going to most Nigeria children is very poor.
Economic implications of malnutrition
Recently, Nigeria overtook India to become the country with the poorest people in the world after crossing the 80 million mark. This means that a typical poor family does not earn up to $1.9 daily for their needs.
Therefore, it has become increasingly difficult for children of the poor to escape the devastating consequences of malnutrition because the emphasis is mostly on eating to survive and not eating for nutritional benefits.
Also, with an annual population growth rate of about 3.2 per cent, which is so below our annual economy growth rate which is about 2.1 per cent, Nigerians are becoming poorer, and malnutrition thrives.
The UNICEF report pointed that – stunting, caused by malnutrition in infancy, hinders cognitive as well as physical growth. Experts say the effects of this is to a large extent irreversible and stunted children generally complete fewer years of schooling and eventually earn less as adults.
It becomes an endless wheel of affliction because malnourished children also tend to become malnourished mothers, thereby perpetuating the cycle.
Dr. Orji added: “There is a direct correlation between poverty and malnutrition. If you look at poverty and intellectual comprehension, you will see that the intellectual capacity of poor people is far less than that of the children of the elite. This is not to say there hasn’t been any breakthrough within the poor, but when it happens it is about one out of ten.
“If you go back and check the one child that comes from a poor family, somehow, within the poverty setting of that family, there is a way the nutritional enhancement of that child might have happened without anyone knowing.”
“Malnutrition has huge economic implications at the individual level, household level, community level, and the country as a whole.
“On the household level, it means if children fall sick more often, the family will spend more on hospital bills and the parents will spend more time at home taking care of the child instead of putting the effort in working and making money.
“On the community level, the child and parents are not contributing to development. Nationally, it impacts on our Gross Domestic Product (GDP). Research shows that malnutrition can reduce the GDP of the country by at least 10 per cent. It means if we want to grow our economy, we have to grow our children.
“Also, malnutrition cuts across different economic and social strata, although it is higher among the very poor; it is four times as high among the very poor as it is among the rich. However, it is equally high among the rich because the rate among the rich is almost about the national average. This goes to tell us that it is not just a matter of poverty, but about ignorance,” Dr. Isokpunwu told the Nation.
Treatment with ready-to-use therapeutic foods
In 2007, the World Health Organisation (WHO), in collaboration with the United Nations Children’s Fund (UNICEF), the World Food Programme (WFP), and the United Nations System Standing Committee on Nutrition (UNSSC) released a joint statement on community-based management of Severe Acute Malnutrition (SAM) which recommended that children with uncomplicated SAM be treated with ready-to-use therapeutic foods (RUTF).
RUTF is a vitamin and mineral fortified peanut paste mixed with dry milk products. It has been described as a miracle cure for children suffering from Severe Acute Malnutrition by the Doctors Without Borders.
According to WHO, the therapeutic food has revolutionised the treatment of severe malnutrition – providing foods that are safe to use at home and ensure rapid weight gain in severely malnourished children.
The advantage of RUTF is that it is a ready-to-use paste which does not need to be mixed with water, thereby avoiding the risk of bacterial proliferation in case of accidental contamination.
Also, the product, which is based on peanut butter mixed with dried skimmed milk and vitamins and minerals, can be consumed directly by the child and provides sufficient nutrient intake for complete recovery.
According to Dr. Isokpunwu, “RUTF is a specially formulated food that has a high efficacy up to about 95 per cent cure rate. The global cure rate is about 75 per cent. If you use normal foods, you get about 60 per cent cure rate.
“Another advantage is that most of the children will recover within 8 weeks. For normal food, most have to been admitted into the hospital and kept for 12 weeks. For RUTF, you don’t need to admit them in the hospital because they can be treated from home. This has cut out the need for hospitalisation and hospital bills.”
Given the incredible cure rate of the ready-to-use therapeutic foods, and despite the availability of most of the ingredients required for its manufacture in the country, it is sad that we still import over 70 per cent of these foods into the country.
Dr. Isokpunwu added: “The problem is that most of the ingredients for the manufacture of RUTF cannot be sought locally. It is not that we cannot get them, but it is about the quality of the ingredients. The ingredients are groundnuts (peanut butter), sugar (icing sugar), vegetable oil, vitamins and minerals, and milk (powdered milk).
“The challenge for local producers of RUTF is that most of the ingredients are not sourced locally but imported. We do not produce powdered milk in the country. Vegetable oil is the only ingredient sourced in the country. Sugar is manufactured in Nigeria but not icing sugar. We have a higher amount of groundnut in the country but we do not produce peanut butter.
“The major problem with the Nigeria milk and groundnut is the high level of aflatoxin. Aflatoxin is produced by fungus and is very widespread in our soil, contaminating grains like groundnut, millet etc. Because our cows consume these plants, the fungus is also secreted in their milk.
“If we use groundnut that is high in aflatoxin for RUTF, we will further expose our children to infections that will further reduce their growth.
“This is why the Federal Government, with support from partners, have developed interventions to reduce the aflatoxin levels and it is being marketed to farmers. This way, we can start looking towards the manufacture of peanut butter.”
During a meeting with private sector investors and stakeholders, organised by the Aisha Buhari Foundation (ABF) and the Future Assured Programme, at the Villa in November, Mrs. Aisha Buhari, vehemently condemned Nigeria’s perpetual dependence on the importation of RUTF to treat cases of Severe Acute Malnutrition (SAM), especially among children under the age of five. She encouraged local manufacturers to research and invest in the production of the RUTF.
Speaking at the roundtable were some local manufacturers, expressing their experiences, prospects and challenges with the manufacture of the therapeutic food.
According to the General Manager of Erisco Foods, Mr. Tokunbo Agbede, “We have now come up with RUTF products that have been produced. The raw materials are all sourced in Nigeria except for the machine that is needed. As we speak we have procured the machines.”
For the Chairman of Ariel foods, Nigeria, Mr. Dhiren Chandaria, “It is really important that we produce RUTF in Nigeria. We decided to set up the most advanced RUTF factory in the world in Nigeria which is based in Lekki. Our goal is to make it the lowest cost producer in the world coming out of Nigeria. Another goal is 100 per cent of local procurement.”
Advocacy for exclusive breastfeeding
The UNICEF attributed malnutrition to the fact that 34 per cent of children between six months and two years of age are fed food not rich and diversified enough to ensure optimal growth.
The report further revealed that undernutrition is a major concern as it is a hidden hunger caused by a lack of essential nutrients among children under the age of five.
Breastfeeding can save the lives of our children, however, in Nigeria, only 27 per cent of children under six months of age are exclusively breastfed and an increasing number of children are fed infant formula.
Almost 2 in 3 children between six months and two years of age are not fed food that supports their rapidly growing bodies and brains. This puts them at risk of poor brain development, weak learning, low immunity, increased infections and, in many cases, death.
According to Dr. Isokpunwu, “The Federal Ministry of Health in August this year, launched the national zero water campaign, which aims to address the lack of knowledge on how to properly feed children and to promote exclusive breastfeeding and adequate and safe complementary feeding.
“Data also reveals that malnutrition is higher among children between six months and 24 months, which is the period of weaning. This is also the period when children begin the weaning from breast milk to complementary foods.”
For Dr. Orji, “UNICEF introduced the baby-friendly initiative years ago which makes for absolute breastfeeding. It is a pity that it is still not catching on the way it should. Baby-friendly clinics mean that if your wife delivers in that hospital, they will not allow instant formula. This means when you are in that hospital you can only feed your child using breast milk.
“Breast milk is the complete food that the child needs before the age of six months. In some cases, the child doesn’t even need water because the breast milk contains water. The breast milk is not only rich in nutritional components; it is also very good in giving the child some antibodies to be able to fight off some diseases. Also, one of the biggest killers of children is diarrhoea. But if the child is taking breast milk, the chances of getting diarrhoea is reduced.
“One of the entry of diarrhoea to children is not the formula food itself, but the way the women keep the feeding bottles sterile. Breast milk is preventive of gastrointestinal diseases.”
Extreme hunger and malnutrition remain a huge barrier to development in many countries, and Nigeria is not insulated from it.
That Nigeria ranks second after the Democratic Republic of Congo in the West and Central Africa region on malnutrition among children, according to the report on children, food and nutrition by the United Nations Children’s Fund (UNICEF), is indeed worrisome.
One of the Sustainable Development Goals by the United Nations aims to end all forms of hunger and malnutrition by the year 2030, making sure all people – especially children, have sufficient and nutritious food all year.
It is, therefore, time for all and sundry – government, health partners, civil society organisations, communities, and families to begin to contribute their quota to see that we totally obliterate the menace caused by malnutrition in our country.
Leave a Reply