Malnutrition: A silent pandemic ravaging children

Malnutrition remains a silent pandemic ‘consuming’ children in Nigeria. It is mostly being fueled by ignorance of parents and caregivers, poverty, inadequate food intake and poor sanitation, among others. COVID-19 may have stopped a lot of things, but it did not stop malnutrition, writes Justina Asishana

Thirty-six-year-old Aisha Isah was beaming sunnily. This was the first time in weeks that she could smile after being told that her son, Ibrahim, was out of the woods and would survive his battle with acute malnutrition.

Initially, when she noticed there was something wrong with him, she began self-medication on him, administering herbal remedies. But he gradually deteriorated, becoming more bones than flesh. Taking him for orthodox care became a last resort when all else failed.

Aisha did not know that her son was being ravaged by malnutrition until he became too weak to eat or drink anything. This made her take him to the Minna General Hospital, where one of the Severe Acute Malnutrition (SAM) Centres in Niger State is located.

After the doctor examined him, Aisha said that she was directed to the SAM Centre for further examination, “then they told me that my son had severe acute malnutrition and needed urgent care.”

According to anthropometric measurements, a three-year-old like Ibrahim should be weighing about 14kg. But he weighed 6kg when he was tested at the SAM Centre. His mid-upper arm measurement (MUAC) was 10 cm indicating red which meant the child was acutely malnourished.

“When he was admitted, he had to be fed through a tube in his nose, because they said his case was very serious and he could not take food through his mouth. They asked me why I didn’t bring him earlier and I told them I thought the problem was that he was teething, so I was using herbs. It was at the hospital that they explained to me what malnutrition is," she said.

Two weeks after he was brought in, Ibrahim was discharged and followed up strictly with checkups.

“I am happy that today, the nurses told me that Ibrahim is finally out of danger and is now weighing 14.2 kg, which is the required weight for his age. I am so happy, my mind is finally at ease. What would I have done if I didn’t know what was wrong with him and he died?”

According to the World Health Organisation (WHO) in an April 1, 2020, report, across the world, “47 million children under 5 years of age are wasted, 14.3 million are severely wasted and 144 million are stunted, while 38.3 million are overweight or obese.

“Around 45% of deaths among children under 5 years of age are linked to undernutrition. These mostly occur in low- and middle-income countries,” like Nigeria.

UNICEF reports that an estimated two million children in Nigeria suffer from severe acute malnutrition, but only two out of every 10 children affected, are able to access treatment. UNICEF also rates Nigeria as having the second-highest burden of stunted children in the world. The country has a national prevalence rate of 32 per cent of children under five years and seven per cent of women of childbearing age, suffering from acute malnutrition.

The WHO, emphasizes that “the developmental, economic, social, and medical impacts of the global burden of malnutrition are serious and lasting, for individuals and their families, for communities and for countries.”

It is noted that when it comes to COVID-19, the stunting is a lagging indicator whose impact one may not see for a year or more. The longer families suffer from food insecurity and spotty access to basic health services, the worse COVID’s impact on stunting could eventually be.

“If we were to look at other nutrition indicators, like the nutrition targets and indicators for the Sustainable Development Goals, we would see that the pandemic is already doing great harm. Wasting (low weight for height) is a manifestation of acute malnutrition—and its prevalence is spiking right now,” Niger state Nutrition Officer stated.

A recent Lancet study published in July 2020,  found that wasting could account for up to one-quarter of all COVID-related childhood deaths.

How taboos, myths and misconceptions fuel malnutrition indices in Niger

“When I gave birth to my son, I was told not to do exclusive breastfeeding with him. Also, in my community, in Magama local government area, we do not feed our children eggs, because it is believed that eating eggs will turn them into thieves,” Hauwa Ndagi said.

According to Hauwa, this may be the reason her two-year-old son, Nuhu, still looks like a six-month-old and has been diagnosed with severe acute malnutrition. She explained that her mother-in-law frowned at her doing exclusive breastfeeding for her baby. “She told me that she never did it for her son (my husband) and I am married to him today and he is okay. There should therefore be no reason I should breastfeed my own son exclusively for six months.”

The Niger State Nutrition Officer, Hajiya Asmau Mohammed, told The Nation that a lot of myths, misconceptions and taboos are militating against the people obtaining optimal and adequate nutrition.

“It is mostly believed in some parts of Niger State that a pregnant woman should not eat eggs or give her child eggs. The reason attached to this belief is that the child would become a thief.

“But egg is one of the essential foods a child needs when growing up. According to this belief, there are a lot of foods women and children should not eat and when you look at such foods, they are mostly protein which is the main building block of the cells.”

Speaking on some of the factors that encourage malnutrition in the country, Mohammed noted that northern Nigeria, which is rated to have the highest number of malnourished children, has no reason to experience malnutrition, especially with its abundant agricultural resources. This is as she expressed dismay that the people in this part of the country are only interested in farming and selling their products and not after using it for their families.

“A woman may have poultry or a farm but at the end of the day, when the chickens lay eggs, she moves the whole eggs to the market. She does this without knowing that she is moving a very important and high nutrient component of what her family needs, to the market. At the end of the day, she feeds her children with food that is not supposed to be, instead of feeding them with food rich in protein.”

She stressed the importance of the nutrition corners at the Nutrition Centers at the hospitals and health centres emphasizing that, it has gone a long way in sensitizing the parents on what they need to feed their children with.

One of the staff of the Nutrition Center which is also the SAM Center at the Minna General Hospital, Aisha Abdullahi told The Nation that, some of the patients brought to the centre are often weak and not willing to eat.

Abdullahi said that the centre gets children between the ages of three months to five years. She noted that lack of attention, ignorance on the part of the parents, some cultural taboos, myths and misconceptions prevent a lot of mothers from seeking early treatment for their malnourished children.

Nutrition Statistics in Niger State

Abdullahi explained that from February to August 2020, there have been 109 patients at the SAM Center at the Minna General Hospital. She said 24 had severe acute malnutrition, and that while during the lockdown period, they did not admit a lot of patients,  the hospital made an exception in admitting children with severe acute malnutrition.

The State’s Nutrition Officer, Hajiya Asmau Mohammed, said Niger State currently has 2,523,032 under-one children, 1,261,659 under-five children, 1,387,825 women of childbearing age and 3,154,015 pregnant women.

She said that the number of children who are stunted (whose growth is impaired) in the State is 28.2%, children who are wasted (whose weight are significantly below the expected weight or height of a child in that age range) is at 5.0%, children who are underweight are 14.8% while the infant mortality rate is 67/1000 live births.

The State Nutrition Officer said that the State has only one Community-Based Management of Acute Malnutrition (CMAM) centre in Mariga local government area State adding that there are plans to scale up to 11 other local government areas.

She said that the community volume in CMAM in the state is I00. Between 2019 and 2020, 3,595 people have been admitted, 3,135 discharged and 49 transferred. There have been 35 deaths and 379 defaulters.

Given the SAM profile in the State, she said that SAM is being rolled out in seven secondary health facilities which include Suleja, Borgu, Bida, Minna, Kontagora, Rafi and FMC Bida.

She said that these health facilities have had 404 total admissions of malnourished children from 2019 to 2020. Of this, 298 have been discharged with a total death of 33, 18 defaulters and 55 on admission, as at the time she spoke with The Nation.

The ‘State of the world’s children 2019: Children, Food and Nutrition Report’ find that in Nigeria, five in 10 children are malnourished while three in 10 children, aged six to 23 months are on poor diets.

The report which was released on February 16, 2020, states that 13.1 million children in Nigeria are stunted while 2.9 million children are wasted stating that the burden of child malnutrition and under-five deaths are still alarming in Nigeria.

According to UNICEF on the nutrition status of countries states that the states in northern Nigeria are the most affected by the two forms of malnutrition

UNICEF also said 15.4 million cases of acute malnutrition in children under five years old are expected in 2020 in West and Central Africa. This figure represents a 20 per cent increase from earlier estimates in January 2020.

COVID-19 on Malnutrition Intervention Measures

Several intervention measures have been disrupted by the COVID-19 pandemic and may possibly increase the cases of malnutrition in Nigeria.

UNICEF states that several factors threaten the nutritional status of children under five in West and Central Africa which include household food insecurity, poor maternal nutrition, and infant feeding practices, conflicts and armed violence, population displacement, high levels of childhood illnesses, poor access to clean water, sanitation and chronic poverty.m

Current hike of food prices May increase malnutrition

Since the outbreak of COVID-19, nutritionists and other health officials have advised the public to eat well to maintain a strong immune system. But with the prices of food items rising due to scarcity as a result of measures to curb the virus spread, many people are not able to afford fresh and nutritious foods. The hike of foodstuffs may also be related to the flooding in parts of the country which have caused the destruction and washing away of over five million acres of farmlands of rice, maize, millet, sorghum and other crops across Nigeria.

A market survey showed that corn which is usually used for cornmeal for children has risen by N200 as it was formerly N150 before the COVID-19. It now sells for N350 to N400 while Soya beans which are nutritious in making soya-milk for children have risen by N150. It is now selling for N350 as against N200 it was previously sold for.

Mrs Abigail Okoli sells millet now for N400 as against N150 that it was sold for in early February.

This report was supported by the Africa Women Journalism Project (AWJP) in partnership with the International Center for Journalists (ICFJ).