Daily Trust (Abuja)

3 February 2013

Nigeria: Could This Malnutrition Be As a Result of Witchcraft?

Maiduguri — In the last 14 years, Hafsat Shehu (30) gave birth to seven children and her two-year-old child, Rabilu Shehu who suffers from malnutrition is her last born for now.

She said despite enormous challenges of bringing up children, she is willing to have more.

"My mother had 12 children and did not go for any planning. She stopped giving birth naturally and I won't hesitate to do same," she said.

Hafsat, who hails from Rugungumai ward in Bichi local government area of Kano State, told this reporter during an interview that she got married at the age of 13.

She has remained a full time house wife while her husband, who is averse to modernity, including child spacing earns livelihood through farming.

Hafsat said she delivered all her seven children at home without recourse to any medical facility.

She was seen at the Malikawa Garu Comprehensive Health Centre in Bichi local government together with dozens of women after some volunteers convinced them to take their emaciated children to the centre to get medical attention.

The centre is one of those chosen to handle the Community Based Management of Acute Malnutrition (CMAM) programme, an initiative of the United Nations Children Fund (UNICEF) as a way of reducing infant mortality in Nigeria.

Like the rest of the children, Rabilu was diagnosed of acute malnutrition - a severe ailment that has claimed the lives of many children and ravaging many more especially in northern Nigeria and other countries in the Sahel region.

Experts say poor nutrition is measured by shortness, underweight and thinness, an inferior disposition inherent in all the children seen at the Malikawa Garu health centre.

Hafsat told this reporter that she never thought that the sickness of her child had anything to do with 'Tamowa' (hunger), adding that at the beginning, she and her husband attributed the health challenges confronting Rabilu to witchcraft.

"After some interventions from traditional healers, we then thought that Rabilu was suffering from Shawara (yellow fever) but after endless efforts to cure him failed, we began to believe that he was actually attacked by 'Mayu' (witches). This is because we realized that he was shrinking every day; lost appetite and hardly slept," Hafsat said.

She said after some months, their trouble was compounded when a traditional healer told her that Rabilu was suffering from 'Shan Inna' (polio).

"We were about taking Rabilu to hospital in the city when Khadija (one of the volunteers) advised that we should take him to Malikawa health centre, insisting that the sickness of my son had to do with dietary problem. We agreed with her suggestion and went to Malikawa Garu," she said.

Coincidentally, journalists from about ten states in northern Nigeria met Hafsat and the rest of the women at Malikawa Health Centre.

Their trip to the health centre was at the instance of the UNICEF 'D' Field office in Bauchi which was meant to sensitize the media on the need for collective action on the Sahelian food crisis that puts an estimated 18.7 million people at risk of hunger and 1.1 million children at risk of severe malnutrition.

Some three million children were estimated to be suffering from Moderate Acute Malnutrition (MAM) in the Sahel region.

Apart from Nigeria, other Sahelian countries include Chad, Niger, Mali, Burkina Faso, Mauritania, Northern Senegal, and Northern Cameroon.

Participants for the training in Kano were drawn from Adamawa, Bauchi, Gombe, Jigawa, Kano, Nassarawa, Plateau, Taraba and Yobe States.

In Nigeria, it is believed that the precarious security situation, including religious extremism occasioned by the Boko Haram insurgency as well as tribal and ethnic rivalry affecting most of the northern states have put lives of children in the region in jeopardy.

More so, parents who are mostly farmers find it difficult to patronize their farms because of fear of the unknown, a development which makes food production in recent times very dismal.

Herders equally have difficulty in accessing animal fodder, water, vaccinations among others.

Similarly, border closures between Niger and Nigeria, and the Mali crisis are aggravating the dilemma, experts say.

"The circumstances that cause vulnerability have changed. With food prices that are high, you don't need a drought to spell a crisis, the drought merely stimulated these dynamics," said Sahel expert Peter Gubbels.

As part of efforts to address the problem of malnutrition among children in Nigeria, the UNICEF established Centres for Managing Acute Malnutrition (CMAM) in two states in 2009 but has been extended to 11 states in 2011 in northern Nigeria while annual admissions have increased from 4,000 children in 2009 to 40,000 in 2010 and 141,000 children in 2011.

Similarly, the number of CMAM sites stands at 378 Primary Health Care Centres (PHCs) in the affected states that include Adamawa, Bauchi, Borno, Gombe, Jigawa, Kano, Katsina, Kebbi, Sokoto, Yobe and Zamfara.

Mr Niyi Oyedokun, a health specialist with the UNICEF 'D' Field in Bauchi said at least 25 community volunteers have been trained in each health centre who are expected to go round the communities under the clinic, moving from house to house to mobilize children suspected to be malnourished.

He said the volunteers use a special tape to measure the children's mid upper hand and when they see anyone is less than 11.1cm, they will bring him to the clinic.

At the clinic, he said five health workers have been trained on how to manage severe acute malnutrition without medical complications.

"By this, it means the child does not have severe diarrhea or respiratory tract infection like pneumonia and then the child has appetite and can eat through his mouth," Niyi said.

He said once the child is taken to the hospital, the health workers will use the tape and measure the arms of the children, adding that often, the skin is flattened because of malnutrition and warned that while carrying out the measurement, it is necessary to be cautious not to squeeze the skin.

For instance, it was discovered that Rabilu's arm was just 9.7cm which meant he suffered from severe acute malnutrition because his upper arm fell under red.

Niyi said children whose upper arms start from 11.5 to 12.5cm suffer from moderate acute malnutrition.

He said after taking the weight of the child, appetite test will be carried out after the mother and the child were taken to the hand washing section where they would wash their hands with soap and water.

"The mother will be given the ready to use therapeutic food which is suitable for the child suffering from acute malnutrition without complications. No injection will be administered to the child because the food is oil based, the mother will squeeze the package very well so that the contents mix very well.

"She will be putting it on her fingers and be giving it to the child. This is known as appetite test to determine whether the child can it or not," he said.

He said if it is discovered the child cannot eat, he will not be admitted at the primary health centre.

"The clinic will refer the child to the General Hospital where the UNICEF had trained doctors, nurses and nutritionists on how to manage such cases."

Niyi said when the child is taken to the General Hospital, the health personnel will not use the ready-to-use therapeutic food, rather, the powdered form which mixed with water is used so that even if the child cannot eat, the mixture will pass through his nose using a tube which has the same content as the oily therapeutic food.

He said the child will also be given antibiotics and after three to four days, he will be better in terms of appetite.

"In essence, what is being done at the General Hospital is stabilization of the child to regain his appetite and to address medical complications. When the child becomes stabilized, the General Hospital will refer him back to the clinic where he will be admitted into the programme of addressing the malnutrition he is suffering from," he said.

Niyi noted that managing malnourished children is a herculean task.

"The history of the child must be taken, including his age, temperature, weight, iron level and the paleness of his body. Care must be taken, not all sorts of foods are given to the malnourished child because some (kind of food) can lead to their death because of the nature of their body.

He stated that the potentials of children who suffered severe acute malnutrition are affected but they can survive and when they grow, they will not be a liability to the society.

Rabilu and many of his ilk would have to take up to 150 sachets of the therapeutic food at the health centre before being discharged from the programme.

Observers say governors in northern Nigeria need to adopt a holistic approach of stemming the crisis as well as step up food production in order not to mortgage the future of millions of children who are battling with malnutrition.

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