Hauwa'u's gleeful face could be seen by anyone who entered the children's ward at the Maternal and Child Health Centre in Kofar Sauri, Katsina. She had a skinny baby strapped to her back. The baby who had been vomiting and excreting more than usual -- was brought to the hospital from Dutsin-Ma Local Government Area (LGA), a journey of about 62 kilometres.
She was happy because her baby was finally showing signs of recovery. She explained that the baby's health had significantly improved, compared to when she brought him into the hospital two days earlier.
A few months back, Hauwa's husband, a patent medicine seller, was kidnapped by armed men in their village. The family had to pay a ransom to secure his release, a situation that threw them deep into poverty. As a result of this, nutritious food soon became a luxury in their household.
When Hauwa'u and her sick baby arrived at the medical facility, doctors received them, examined the baby and admitted them. "When they finished testing [the baby], the doctors said the reason for my son's sickness was because of [malnutrition]," the 18-year-old mother explained.
When a child is brought to the facility, the health workers conduct a mid-upper arm circumference (MUAC), bilateral pitting edema, and weight-for-height Z-score (WHZ) test to understand the child's nutritional status. As soon as caregivers present a child, they undergo a screening, where their midarm is screened with MUAC tape. A MUAC measurement of less than 11cm indicates Severe Acute Malnutrition (SAM) and when it is up to 12.5cm, the child is diagnosed with Moderate Acute Malnutrition (MAM). In a case where the MUAC is between 12.5cm and 13.5cm, it shows that the patient is at risk, and the caretakers are advised on how to improve the child's nutrition. However, the child is considered well-nourished when the MUAC is over 13.5cm.
The next step for SAM and MAM patients is an appetite test. Caregivers are advised to wash their hands and feed the child a cup of milk. If the child can drink three-quarters of the milk, that is an indication that they can still eat. When the child cannot, they are referred to a stabilisation centre, where intravenous (IV) treatment and Ready to Use Therapeutic Food (RUTF) are given.
Nigeria's malnutrition crises
According to UNICEF's 2024 'State of Nigeria's Children Report', there was an increase in stunting and malnutrition among children under five, with 40% of children stunted and 8% wasted. The report attributed it to household poverty, unavailability of food, poor feeding practices, and the absence of a diverse and nutritious diet, adding that malnourished children left untreated are at a higher risk of death.
A 2024 survey by Doctors Without Borders/Médecins Sans Frontiers (MSF) in Katsina, Jibia, and Mashi LGAs showed that the state is in a major nutrition crisis, with over 30% of children suffering from Global Acute Malnutrition (GAM). This accounts for 6.8% of malnourished children and SAM, which accounts for 14.4%. The report, which highlighted that MSF treated over 100,000 patients across Katsina, said the centre witnessed a 20% increase in the number of patients with a death record of 800.
MSF launched a nutrition project in the state in collaboration with the Katsina State Ministry of Health in 2021. Currently, the medical non-governmental organisation (NGO) operates four therapeutic centres across Katsina, one of which is the Maternal and Child Health Centre at Kofar Sauri in the state's capital.
Dr Ali Baba Nuraddeen, the Medical Activity Manager at the MSF-supported In-patient Therapeutic Centre of the hospital locally known as Asibitin Kwamuso in Hausa noted that since the commencement of the Nutrition Programme in the state, they have never witnessed an increase in cases of malnutrition like in 2024 as a result of high cost of living, insecurity in the communities and flooding.
Last year, the price of a kilogram of locally produced rice in Nigeria was around ₦917. For a 50kg bag, prices ranged from ₦55,000 to ₦71,000 depending on the location and brand. Currently, a 50kg cost between ₦78,000 and ₦87,000, a situation that is impacting many families.
He noted that though malnutrition cases are high, they have a peak period and an off-peak period. He explained that during this period, the facility receives high number of patients with an average of 100 admissions per day.
In 2024, Nuruddeen highlighed that admissions increased exponentially with the peak season starting in March, earlier than in previous years, and this situation has not yet ended. "On average, we have [had a] 40 to 50% increase on our monthly admission," he noted.
While comparing the results of their work in 2023 and 2024, Nurudeen noted that "when we look at the figures like 2023, from the beginning of the year to the end, we were able to manage 15,000 patients in [the] in-patient therapeutic treatment centre, but this year, due to the increase in activities from January to October, we managed approximately 20,000 patients. We still have two months to the end of the year, but already we have [almost] 50% increase when we compare to the previous years".
A resounding impact
Beyond the MSF-recorded data on patients treated at the in-patient therapeutic feeding centre and the out-patient unit, visits from surrounding communities reveal the impact of MSF's efforts.
Nuruddeen noted that people in almost all parts of the state are aware of the work they do. "So, from our indicators, it is actually working. In the sense that our stabilisation rate in the Intensive Therapeutic Feeding Centre (ITFC) is around 95%, while our mortality rate is less than 5%." Many patients stay in the centre until they have recovered, according to the medical doctor.
"Other indicators like the Leave Against Medical Advice (LAMA) is actually around 1 to 1.5%, which shows the acceptability of our programme in the community and how accessible it is". He further notes that the LAMA indicator shows that caregivers are comfortable with their treatment.
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MSF understands that malnutrition cases managed in the centre are only a fraction of community cases. This compelled them to train community volunteers to screen malnutrition cases and refer such cases to the medical centre.
More patients, less interventions
The nutrition centre faces a daunting challenge in the form of increasing activities like admissions that frequently disrupt the implementation of their plans. According to Nurudeen, this fluctuating workload complicates the centre's ability to effectively prioritise and allocate resources, hindering their efforts to provide consistent and comprehensive nutrition-related care to those in need.
He added that every year, they plan based on their hypothesis but each time they see an increase in activities more than what they anticipated. He further mentioned that, the burden becomes too much for the organisation, making them to compromise a lot on their especially in terms of Infection Prevention and Control (IPC) measures. During the peak period, Nurudeen noted that all the beds are full, with two to three patients on one bed.
MSF urges both local and international NGOs to come to the state for nutrition interventions. According to him, that will go a long way in complementing MSF's nutrition efforts in Katsina.
This intervention and its likes further support the Ministry of Health's effort to provide an efficient and quality health system for Nigerians like Hauwa'u who live in the remotest part of the country , which is one of its four-point agenda.
