Vanguard (Lagos)

10 December 2012

Nigeria: Malnutrition - Great Concern, Little Action in Nigeria

Photo: Florian Lems/MSF-AUSTRIA
18 Years Old Ashta Mohamet and her daughter during a consultation by MSF nurse Jean Blaise Djedouboum at MSF's Ambulant Therapeutic Feeding Center (ATFC) in Koudiguine. Since April MSF runs a feeding programme in 11 health centers in Biltine district.

Malnutrition occurs whenever a child is not getting enough food or eating balanced diets. The consequences of malnutrition can be dire, as the United Nations Standing Committee on Nutrition asserts that malnutrition is the largest contributor to non-communicable diseases in the world. The physiological manifestation of malnutrition at an early age can induce reduced physical and mental development during childhood.

The fifth report on World Nutrition Situation states that stunting affects 147 million pre-school children in developing countries, while Nigeria is believed to be home to 10 million of such children.

The Convention on the Rights of the Child (CRC), domesticated in Nigeria since October 2003, states that access to good nutrition is a fundamental right, particularly for children under five years.

However, imagining malnutrition is one thing, but beholding a malnourished child is another. Anyone who has visited any of the 216 Community-Based Management of Acute Malnutrition, (CMAM), sites set up by UNICEF in the seven Sahelian States -- Gombe, Jigawa, Borno and Yobe, Adamawa, Bauchi and Kano -- may not forget in a hurry, the sight of the unfortunate Nigerian children affected by Severe Acute Malnutrition, SAM.

CMAM is a community-based approach in treating children with severe acute malnutrition. In the sites, children admitted with SAM are given specialised feeding and therapeutic care to help rehabilitate them. The problem remains a "silent" one.

Little or nothing is being done to tackle it even at almost epidemic level in the country despite UNICEF's alert in 2011 that over one million children will suffer severe acute malnutrition in 2012 in the eight countries in the Sahel region including Northern Nigeria. Without any intervention, SAM has up to 60 percent mortality risk.

Statistics show that about 1.1 million children are threatened in the Northern region mostly due to poverty, insecurity and lack of access to portable water.

However, the silent crisis is largely crippling other states of the country even in states like Lagos. Emphasis has been on the fact that good nutrition and no normal child can grow into a healthy, strong and happy adult without the intake of dietary diversification.

Surveys show prevalence of malnutrition beyond 10 percent known as Global Acute Malnutrition, GAM, in 5-15 percent in all surveys across all states. This is an emergency. So what needs to be done?

UNICEF Nutrition Specialist,D Field Office, Dr. Niyi Oyedokun, says annual CMAM admissions in these states have increased steadily from 1,701 in 2009 to 18,118 in 2010; 57,185 in 2011 and 83,522 between January and September 2012.

In a presentation at a two- day Media Dialogue on Child Malnutrition in Nigeria held in Kano recently, he posited that essential nutrition actions was needed as well as multi sectoral approach to tackle the problem.

The nutrition expert regretted that there has not been maximum coverage as it is in seven out of 10 states currently affected. Worse still, sites in the implementing states represent only 11 percent of the total wards, thereby affecting access to the treatment sites and consequently coverage.

"From January - July, 2012 only 23 percent of children that could have been reached had access to treatment. In view of this, there is an urgent need to increase the coverage. In responding to a nutritional crisis, it is recommended to use the proven high impact and cost effective

interventions referred to as the Essential Nutrition Actions. Focus on the period from pregnancy and through the first two years of a child's life. When implemented together, contribute about 60 percent reduction in child's mortality." he stated.

Regretting that early warning signals were given since 2011, Oyedokun lamented that most of the state governments were not forthcoming in terms of support, appealing to them to show more commitment to the problem.

According to Oyedokun, establishment of a Statutory State Committee on Food and Nutrition as provided in the National nutrition policy is needed but unfortunately, only two states out of the Sahel states have established such committees.

He called for dietary diversification for children to include exclusive breastfeeding for six months, complementary feeding for 24 months and consumption of some food nutrients, such as Vitamin A, iodised salt and zinc supplementation.

"The first 1,000 days of a child -- from pregnancy to 24 months after delivery - have been identified as the period which presents a unique opportunity to prepare the child for whatever it would become later in life. Oyedokun advocated for multi-sectoral approach.

"There is a need to improve integration of these services with Nutrition interventions such as CMAM to allow for better planning and more efficient use of available resources, allow for provision of continuum of care, avoid parallel programming and increase reach and enhance accountability & better coordination.

He explained that with the community-based approach, most children with SAM without medical complications can be treated as outpatients at accessible, decentralised sites.

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