Imagine 1.1million Nigerian children under age five dying annually, it is like having 10 plane crashes every day, with each fully loaded with 300 Nigerian children, under the age of five. As alarming as this may sound it shows that Nigeria is losing its infants to malnutrition among other factors (under five Mortality rate-u5MR) yearly.
According to the World Health Organisation (WHO), 1.1 million under five children die annually in Nigeria and Nestle Nutrition Institute Africa (NNIA), one of the 23 affiliate Institutes of the Nestlé Nutrition Institute (Global) worldwide, has established that malnutrition accounts for over 50 per cent of u5MR, and that rates Nigeria as second nation with high rate of infant mortality globally, after India.
In order to halt this malnutrition-induced under five mortality deaths (u5MR), the NNIA called a meeting of stakeholders, who can reach out to all mothers, both expectant and nursing, in urban and rural areas. The venue was the Jevinik Restaurant, Isaac John, GRA, Ikeja Lagos.
Members of Nutrition Society of Nigeria (NSN), dieticians, health workers across the country were there. So also were Prof Ignatius Onimawo, who talked on ‘Nutritional requirements and health statistics during complementary feeding period in Nigeria’; Dr Bartholomew Brai; NSN, State Chairperson, Dr Abimbola Ajayi; Mrs Oluwatoyin Adams of Lagos State Ministry of Health, who spoke on, Hidden hunger during complementary feeding: Challenges and way forward.
The participants all agreed that the nutrition knowledge of Healthcare providers (HCPs) needs to be improved to help mothers make informed decisions, especially in the first 1,000 days of the child, as good nutrition from birth to two years is a critical window of opportunity.
The experts said nutritional requirements and health statistics during complementary feeding period; and hidden hunger during complementary feeding account for micronutrient deficiency in children below five years. The facts are: Iron – 76.1 per cent; Vitamin A – 29.5 per cent and Zinc – 12.8 per cent. Some children die during this period as well.
Prof Onimawo said the 1,000-Day-Window, including the important intrauterine period, the 200-Day-Window, is a highly vulnerable period for physical, motor and cognitive development of any child, and most are particularly susceptible to an inadequate supply of micronutrients.
“Exclusive breastfeeding without water for the first six months of a child is recommended and the gold standard. When the child is six months, there is a need to move on by adding other foods. This is when some mothers and caregivers miss it, and children end up having Hidden hunger. An inadequate supply of micronutrients, with or without adequate energy and protein supply, is defined as Hidden hunger.
“Most traditional foods are too bulky and of low energy density (0.3kcal/g instead of about 1.0kcal/g), therefore infants are sometimes unable to consume enough to satisfy their energy and nutrient requirements. Complementary foods therefore, need to have a high energy and micronutrient density, and should be offered as small, frequent meals,” he said.
According to Mrs Adams, children who are undernourished before they reach their second birthday and later gain weight rapidly after the age of two years are at high risk of nutrition-related chronic disease as adults. “Three in every 10 Nigerian children are deficient in Vitamin A and Iodine. Children suffering from hidden hunger have diets that are deficient in micronutrients. They habitually eat large amounts of staple food crops (such as maize, wheat, and rice) that are high in calories but lack sufficient micronutrients, and low amounts of foods that are rich in micronutrients such as fruits, vegetables, animal and fish products,” she said.
She continued: “Studies consistently show that poor families spend significant resources on soft drinks and street foods of low nutritional value, suggesting that there is some spending flexibility and a demand for time-saving, convenient foods. The transition from exclusive breastfeeding to family foods, referred to as complementary feeding is a very vulnerable period. This is the time when malnutrition starts in many infants; contributing significantly to the high prevalence of malnutrition in children under five years of age world-wide.”
Mrs Adams said WHO estimates that two out of five children are stunted in low-income countries. If complementary foods are not introduced when a child has reached six months, or if they are given inappropriately, an infant’s growth may falter. Complementary feeding means giving other foods in addition to breast milk, these other foods are called complementary foods.
She said: “Complementary foods should be given in amounts, frequency, consistency and using a variety of foods to cover the nutritional needs of the growing child while maintaining breastfeeding. Good nutrition is essential at this time to ensure healthy brain and body development. Insufficient nutrient intake and illness resulting from the introduction of pathogens in contaminated foods and feeding bottles are major causes of malnutrition.
“The 2013 Nigeria National Demographic Health Survey (NDHS) in comparison with 2008 results revealed an increase in wasting from 14 per cent to 18 per cent underweight from 23 per cent to 29 per cent and marginal drop in stunting from 41 percent to 37 per cent. These are the visible signs of malnutrition, but there are other forms of malnutrition that are less obvious and have more to do with the quality of food than the amount of food consumed. Four out of every 10 are deficient in Iron while 13 per cent, 35 per cent, 24 per cent,13 per cent and 28 per cent of their mothers are suffering from Vitamin A, Iodine, Iron, Vitamin E and Zinc deficiencies respectively.”
“Poorly timed introduction of complementary foods (too early or too late) and infrequent feeding also have impact on children, hence “children need to be fed frequently throughout the day because of their small stomach size. Infants have a small gastric capacity (about 30 ml/kg body weight),” she stated.
The participants agreed that the way forward included providing timely and targeted counseling on feeding practices (before conception, antenatal and postnatal visits). Efforts should be made to improve knowledge of adolescent/youths on infant and young child feeding (i.e Nutrition Education in Secondary schools, Vocational Centres, Seminars at NYSC orientation camps etc.).
Enhance access to nutritionally adequate complementary foods and/or fortified products to enrich home-prepared foods. Parents should seek improved enlightenment on infant and young child feeding(ie exclusive Breastfeeding, complementary feeding). fortification of foods (staples) to achieve adequate and complementary feeding diets. Addition of Multiple Micronutrients ie Micronutrient Powder (MNP) to complementary foods to reduce malnutrition in under five children.
