Hauwa Mohammed cuddled her six months old baby, Muhammed Umaru, while waiting to be attended to at a health centre where she has gone to seek help.
The baby looks too small for his age, skinny, pale and with swollen cheeks and feet. These are symptoms of Severe Acute Malnutrition (SAM).
Hauwa is one of many women accessing medical help for their children at the Community Management for Acute Malnutrition (CMAN) in the Out Patients Therapeutic Centre (OTP) in Nasarawo Health Clinic, Yola North, Adamawa State.
The 25-year-old mother is a first time mum with little or no experience in child care or upbringing. She seems not to know much about the importance of Exclusive Breastfeeding (EBF) hence, her rush to introduce the baby to pap early.
She said she introduced her baby to pap few weeks after birth when she noticed that her breast was not producing enough milk for the baby.
She narrates that shortly afterwards the baby born healthy with good weight started emaciating and turning pale.
"He was big when I gave birth to him but when I breast fed him he was not satisfied but kept crying. I was asked to give him pap. I noticed that he started dropping in weight instead of growing fat. My neighbour referred me to this centre; this is my first time here. But I heard the treatment will help him regain his weight." she said.
Hajiya Bilkisu Muntaka who was visiting the centre for the third time said instead of her nine months old baby to grow, he became skinny and weak and that sprang up her worry.
"I was breast feeding him but it had little effect on him. He became sick and I took him to a private clinic where he was diagnosed with malaria, shortage of blood and malnutrition. We were referred to this centre for treatment. This is our third week and I have seen improvement," she said.
She added that aside the Ready to Use Therapeutic Food (RUTF), the health officials also teach them personal hygiene and methods to prepare food that can help them feed the babies well.
Amina Abdullahi's story was not different from the other two women. Her 10-month baby started emaciating and her feet began to swell before she was located by community volunteers that combed their communities in search of malnourished children.
Amina said she attended ante-natal during her pregnancy but she did not do Exclusive Breast Feeding (EBF) for the baby.
"I introduced the baby to pap because I was told that breast milk will not be able to satisfy her. I later introduced her to tuwo, pap, rice and kunu," she said.
The Nutrition Focal Person, Yola North, Adamawa State, Naacha Bitrus, at the centre said, they were able to attend to malnourished cases with the help of the support groups that go to the communities to mobilise women to come to the health facility.
"When they come we screen the children with Mid-Upper Arm Circumference (MUAC) tape, if the child falls on the red mark, they are for RUTF, if they fall on the green or yellow we give them micronutrient powder," she said.
Naacha said that part of the screening they do include, low birth weight, fever and any other medical disorder, adding that if the child has no other ailment aside malnutrition, RUTF is given to it.
"In case of any complication, we refer them for immediate attention to specialists where we have our stabilisation unit. After they are stabilised they are referred back to OTP to continue with the RUTF programme," she stated.
She explained that RUTF is given to the malnourished child every week for eight weeks and it is administered according to the weight of the child.
Part of what they teach the women at the centre is proper hygiene ranging from hand washing to how to prepare their children's food.
"We teach them how to wash their hands before they attend to their babies because it is vital. We give them health talk so that they will know that the solution does not lie only on the food but proper hygiene because we will discharge them after eight weeks.
"If they don't take their time to learn how to take care of their children at home and know what to give them, they will go back to square one again. And that is why we give them health talks on the type of food they should give to their children and how to prepare readily available nutritious food for their children. The RUTF is meant to correct the defect the child has. That is why we call it miracle food," the Nutrition Focal Person said.
While explaining how they administer the medication to the children, she said the RUTF powder is given to a child between age six and 23 month for a period of eight weeks.
"In administering RUTF to a child, in the first visit we give it along with Amoxicillin syrup, and Vitamin A. The second visit we give Albendesole for deworming so that the parents can see the importance of the RUTF," she said. With this programme, the centre attends to about 15 to 20 children in a week and has recorded successes.
"Death rate has reduced since we started in 2014. From January to May 2017 the centre recorded one death and the child was brought in too late. We attended to him but discovered that the mother did not return for the next visit. We put a call through to the phone number on our register and were told the child had died," she said.
In a paper presentation titled, 'Ignorance, Major Cause of Malnutrition', Professor Oluwatoyin Osundahunsi of the Department of Food Science and Technology, Federal University of Technology, Akure (FUTA) stated that the non-availability of adequate food intake is a major cause of malnutrition in Nigeria and most parts of sub-Saharan Africa.
Different surveys of nutritional assessment in Nigeria reveal low intakes of protein, energy, iron, calcium, zinc, thiamin and riboflavin in almost all age groups and in both sexes.
Malnutrition and related diseases (diarrhoea, measles, anemia and gastroenteritis) are the causes of most deaths in infants and young children. The underlying causes of malnutrition in Nigeria are poverty, inadequate food production, inadequate food intake, ignorance and uneven distribution of food, poor food preservation techniques, improper preparation of foods, food restrictions and taboos, and poor sanitation.
Every day, Nigeria is said to lose about 2,300 under-five year olds and 145 women of child bearing age. This makes the country the second largest contributor to the under-five and maternal mortality rate in the world
Recently, at a two-day media dialogue on child malnutrition sponsored by UNICEF in conjunction with the Federal Ministry of Information and Culture with the theme, 'Investing in Child Malnutrition for the Future, #StopMalnutritionNigeria' in Yola, Adamawa State, it was revealed that about 2.5 million children are suffering from SAM in Nigeria which contributes to half a million deaths of children in the country.
UNICEF Nutrition Specialist in Bauchi, Philomena Irene, at the workshop said that malnutrition was a global issue and devastating in the north-east.
"Though it is not an issue limited to the north-east alone, there are pockets of it everywhere but is highest in north-east and north-west," she said.
She said that with the intervention of UNICEF and the government, 500,000 children have been reached with RUTF in Adamawa State, adding that if the governments did not invest on how to improve nutrition in Nigeria, they will spend more on health related cases in the future.
"If we do not invest in children we will not have gains in the future, especially our developmental growth we will not have children who are professionals because their brains will not develop appropriately, the cognitive skills will not develop," she said.
She also advised mothers to take time to breast feed their babies exclusively especially in the first six months before introducing supplementary food to them.
She added that there were appropriate complementary feeding that were good for the children which they taught mothers.
"We teach them how to prepare these foods for the children, how many times they need to feed their children and the importance of key household practices like hand washing before feeding the child and washing the children's hand. Washing of hands before preparing the meal for a child is necessary to avoid issues like diarrhea," Irene said.