Combating Malnutrition In Women, Children

If Fulfilled, Buhari’s A-Meal A-Day Would Help Check Spread

A RECENT statistic from the Federal Ministry of Agriculture and Rural development said that about 30 percent of Nigerian children and 20 percent of pregnant women in Nigeria are malnourished. Explaining this, the Permanent Secretary, Federal Ministry of Agriculture and Rural Development, Sonny Echono noted that malnutrition, especially inadequate mineral and vitamins to women and children, poses a major challenge to the health of the country’s citizens.

Surprisingly, this was made public few months to the expiration of the country’s 15-year national policy on nutrition. What the data says is that a high number of the country’s population is suffering from malnutrition, which implies there will be a ripple negative consequence, as this category of malnourished population has a high tendency of transferring it to their offspring.

X-raying the issue, UNICEF Nigeria, Chief Nutrition Officer, Arjan de Wagt, said Nigerian children from age zero to two years are most affected by malnutrition and are most at risk of the consequences of malnutrition, which include poor growth, poor physical and mental development and then death. He also stated that young malnourished children have a much higher risk of dying from common illnesses than those that are well malnourished, as almost half of all childhood deaths have malnutrition as an underlying factor.

According to de Wagt, Nigeria is home to the highest number of stunted children in the continent and ranks second globally with more than 10 million stunted children.

“While stunting, where children are too short, might not seem like a major problem, it is an indication that the nutritional situation has not been good and that other aspects of health and physical and mental development might also be affected,” he said.

The 2013 Nigeria Demographic and Health Survey (NDHS) reported 37 per cent of Nigerian children under five as being stunted. In addition to a lack of basic protein and energy, other causes of under-nutrition are a lack of micronutrients such as vitamin A, iodine, iron, and zinc. Almost 63 per cent of women are anaemic and 31 per cent are iodine deficient, while close to 30 per cent of under-fives are vitamin A deficient and 20 per cent are zinc deficient.

The research also revealed that 37 per cent of children under age five are considered to be short for their age or stunted, while 21percent are severely stunted. South Eastern part of the country had the lowest record of stunting with 16 per cent. This varies from 18 per cent in the South South to 55 per cent in the North West.

The data from NDHS also stated that 18 percent of children under age five are considered wasted or too thin for their height and nine per cent are severely wasted. This condition is worse in the North West and North East, which record 27 per cent each. In addition, 29 percent of children under age five are underweight or have low weight for their age, while 12 per cent are severely underweight.

Analysing the effect of these statistics, a lecturer in the Department of Human Nutrition, University of Ibadan, Dr. Thomas Adepoju, said malnutrition is a public health challenge because of its unfavourable consequences on health and the productivity of affected individuals. According to him, since women are the agents of reproducing young ones, whatever affects them will directly or indirectly affect the entire family, especially the children.

“Childhood malnutrition, both protein-energy malnutrition and micronutrient deficiencies, is a major cause of morbidity and mortality among children under-five years of age, as it makes them prone to infections with reduced resistance to such opportunistic infections. Those that survive such attacks grow to become suboptimal individuals with lower economic productivity later in life. It also lowers cognitive development and reduces attention span of school children. Malnutrition can also make the children to be prone to nutrition-related non-communicable diseases in their adulthood. High percentage of malnutrition in women and children can, therefore, lead to economic loss through huge investment in curbing it and eventual low productivity of such individuals,” he said.

So, how can Nigeria effectively tackle the problem, considering the high rate of poverty in the country?

Adepoju explained that globally, women are the principal guarantors of nutrition, food safety and quality at household and community levels, as they often purchase, handle, prepare and serve food for the family and in community institutions. Besides, they play a pivotal role in securing and preparing food for the family. As such, women have the primary responsibility of caring for the children, as well as providing nutrition information for the household.

“Empowering women through formal education to a reasonable level, as well as passing information through nutrition education and enlightenment programmes are very imperative in reducing prevalence of malnutrition,” he said. “Knowledge about importance of good nutrition will inform women’s choice of food purchase, mode of preparation, and combination of food groups, which are cost effective in providing adequate diets for the family.

“Women empowerment through soft loans and small grants to establish small scale businesses, home gardening, development of entrepreneurial skills, and giving them freedom to control their earnings will go a long way to reduce poverty and prevalence of women and children malnutrition rate in Nigeria”.

On his part, Wagt noted that while poverty can contribute to malnutrition, very poor people are not necessarily malnourished.

“Just imagine the size of the stomach of a child between birth and two years. It does not take much food to fill such a tiny stomach,” he said.

He was, therefore, of the opinion that while financial poverty could be a factor in malnutrition, it is more of a lack of knowledge, poor habits and practices. He disclosed that the Federal Ministry of Health National Strategic Plan of Action for Nutrition 2014-19, outlines key interventions that need to be scaled-up to support good nutrition in Nigeria.

“It is key for government at all levels to support the financing and implementation of the plan, which includes the cost of the interventions. For instance, it costs N1, 000 per a young child per year to provide community nutrition programmes and communication campaigns on good nutrition. Eighty-seven Naira is needed to provide vitamin A supplements to a child twice per year, while fortifying foods (adding vitamins and minerals to flours, oils, sugar) costs 40 Naira per person per year.

“Per capita, these are small investments with huge returns. According to a recent World Bank publication on Scaling Up Nutrition in Nigeria, over the long term, stunting results in 10-17 per cent loss of wages and it is estimated that Nigeria loses over US$1.5 billion in GDP annually to vitamin and mineral deficiencies alone.”

He listed the underlying causes of malnutrition to include poor breastfeeding and poor sanitation. He reiterates that a baby from birth to six months only needs breast milk, as anything else can harm the child. Water only fills up the baby’s stomach but does not have any calories.

“So, that the baby’s stomach is full does not mean it has taken in any nutritious breast milk. This is aside the fact that a lot of water is contaminated and causes diarrhea. But breast milk contains all the fluids a baby needs during the first six months,” he said.

He listed other major causes of malnutrition in Nigeria to include poor sanitation and hygiene, as well as poor access to clean water are major causes of malnutrition, while diarrhoea prevents nutrients from being properly absorbed into the body.

“In parts of Nigeria, girls get married and pregnant at a much too early age. Teenage pregnancies have a very high risk of leading to malnourished babies. Ten per cent of all babies born in Nigeria are already malnourished when born, which means that even at birth, they are already at a great disadvantage.

“Children from six to 24 months old need nutritious food. Filling their still small stomachs with plain porridge does not provide the nutrients they need. Fruits, vegetables, animal products such as milk, eggs, meat and cooking oil need to be added to the food to make it more nutrient-dense.

“Besides frequent breastfeeding, children from six to 24 months need three to four meals and one to two snacks each day. But because they have small stomachs, just two to three feeds per day is not enough to provide the nutrients they need,” Wagt said.

On the need for concerted efforts to check malnutrition in women, Adepoju said that a malnourished woman would give birth to a malnourished child, while a malnourished girl will become a malnourished mother, who will eventually give birth to another malnourished child to sustain the vicious circle.

The Human nutrition lecturer believed government, could play a great role in the reduction or eradication of malnutrition in women. This way, the vicious circle and chain of suboptimal human beings will be broken and there will be improvement in productivity, longevity, and reduction on government spending on health, including reduction in allocation for intervention programmes targeted at reducing prevalence of malnutrition, which would lead to better economy for the nation.

Buttressing Adepoju’s stand, Nnam said that government should particularly address malnutrition in women of childbearing age to ensure that they produce healthy children, who will be able to actualise their potentials and contribute positively to nation building. For her, malnourished mothers propagate the inter-generational cycle of malnutrition by producing malnourished children.

In the build up to the 2015 general elections, one of the presidential candidates and the eventual winner of the election promised to provide a meal-a-day for school children. In tackling malnutrition in Nigeria, what role can this electoral promise play in checking malnutrition?

Adepoju said that investing in nutrition is a necessity in today’s world, as evidence has shown the importance of good nutrition to intellectual and educational development. This is because poor nutrition in childhood leads to growth retardation, which is associated with substantial reduction in mental capacity and adverse school performance, even in mild to moderate cases, and ultimately leads to reduced work capacity.

“When children from poor background go to school without breakfast, their performance goes down by around 0.1 standard deviations (4 percent). School feeding programme of ‘a meal a day’ will, therefore, help such children to do better in school through paying more attention in class. It will also encourage more children to attend school, thereby improving school enrolment and reduce dropouts. Such programme, if well planned and implemented with adequate daily diet, will also assist in reducing the degree of malnutrition in school children and consequently reduce prevalence of children malnutrition in Nigeria,” he explained.

The President, Nutrition Society of Nigeria, Professor Ngozi Nnam stated that introducing school meal programme is a clever way of improving nutrient intake of school children, because if the programme is properly implemented, the child will get at least one third of his or her nutrient requirement for the day.

“It is also believed that the school children will transfer the school experiences to their homes to improve the family dietary habit. The school meal is expected to be nutritionally adequate with variety of nutritious foods that are available in the locality included in the menu. As many such foods are no longer included in the family menu, the school children could influence their parents to introduce variety in their menu.

“It is expected that fruits and vegetables should be included daily in the school meal. With the inclusion, the school child gets used to fruits and vegetables and is likely to demand for them as part of his or her meal at home.”

It is obvious that state governments and private schools should be actively involved in the successful implementation of the project, since they are closer to the people. How should the federal government go about this?

Adepoju suggested that state governments should set up a working committee of expert nutritionists and dietitians, who will study the situation on ground and then plan the appropriate meals on daily basis, as well as supervise the implementation of the project.

“Trainings on best practices on food handling, processing and preparation to retain most of the essential nutrients should be organised for food handlers, who will be involved in the feeding programme. Private schools should team up with state governments and flow along with the trainings. They should encourage parents/wards to also contribute to the implementation of the programme in their schools,” he said.

To ensure that the a-meal-a day project achieves its goal, Nnam said state governments should support the programme, through making budgetary provision, as well as employ more nutritionists to guarantee that nutritionally adequate meals are served in the school. “Private schools should include school meal in their budget and recruit at least one nutritionist to implement the programmme,” she said.

The professor of public health nutrition also suggested that the Federal Government should have adequate budgetary provision, as well as regularly organise workshops and seminars in states to ensure compliance.

Adepoju would want the Federal Government to establish liaison office in each of the state capital to monitor and assist in the implementation of the programme, including assisting the states financially.

While presenting the 2016 budget to the Lagos State House of Assembly, Governor Akinwunmi Ambode said the state government would be feeding children in public schools a meal a day. This, he said, would be done in conjunction with the federal government, which would be providing 60 percent of the expenditure, while the state provides the 40 per cent balance. With this, Lagos State would join the list of the few states that are implementing a-meal, a day programme.

However, the impact of such a programme in a state like Lagos is in doubt, if it is just the public schools the state government would be focusing on. This is because there are more private schools in the state than public schools. It, therefore, means that a good number of school children, especially those in low-cost private schools, would not have the opportunity to benefit from the intervention programme to boost the nutritional level of children attending them.

Providing some insight, the UNICEF Nigeria Chief of Nutrition Officer said that this year, there are an estimated 1.7 million Nigerian children suffering from severe acute malnutrition. And without help, almost one fifth of these are likely to die.

“With UNICEF support, the government is providing ‘ready-to-use-therapeutic-food’ to almost 375,000 of these children this year. The lives of 75,000 young children, who might have been expected to die without this help, will be saved this year alone. Since 2009, about 1.3 million Nigerian children have received this support and more than 200,000 lives have been saved.

“More lives could be saved— an estimated 250,000 in 2015— if the programme could be further scaled-up. Lack of finances is the major factor in not reaching all severally malnourished children. It costs about only about US$62 to procure the specially formulated therapeutic food and bring it to the child. And considering it is such a life-saving intervention, this is a small amount,” Wagt said.

Providing a holistic perspective to tackling malnutrition in the country, Nnam was of the view that enlightenment through programmes is crucial, so that Nigerians will know the best ways to select, combine, prepare and eat their food.

“Nigeria is blessed with a lot of rich and nutritious foods that are locally available all over the villages and within the reach of the poor and rural dwellers. The major problem is that many people are not aware of the rich nutritional potentials of our locally available foods and tend to overlook their consumption.”

For her, the effect of globalisation, urbanisation, industrialisation and modernisation have tended to divert attention from the rich, locally available nutritious foods to processed foods.

“In Enugu State, there are a lot of local nutritious legumes such as black beans, African yam beans and fresh akidi. But many families no longer include such foods in their menu. The habit of preparing stew and soup during weekends to monotonously consume fufu and rice throughout the week should be dropped,” she advised.

She said families should have a variety of local nutritious foods in their menu to ensure adequate intake of nutrients, as well as fruits and vegetables, noting that a lot of fruits waste in many compounds in the villages because of lack of knowledge of their rich nutritional attributes.

“Every opportunity should be used to create awareness on the rich nutritional attributes of our local foods and the need to reintroduce most of them that are getting extinct into our meal plan. Churches, mosques, town hall meetings, end of year get together, parties, conferences, media and any formal or informal gatherings should be used to create the awareness,” she said.