Tackling malnutrition in children

NIGERIA is one of six countries that account for half of all child deaths worldwide, with one million children under-five dying every year and malnutrition contributes to nearly half of these deaths.

A new document jointly developed by the United Nation Children Fund (UNICEF) and the Federal Ministry of Health (FMoH) titled “Malnutrition: Nigeria’s Silent Crisis,” noted: “Malnutrition is called a silent crisis because it can be happening around us, and we do not always know it is there. Although we have all seen photos of malnourished children who look sick and very thin, they only represent a small portion of children who are suffering from malnutrition.

“There are many children who do not look that way and yet they are also malnourished because they are not receiving the nutrients they need to grow and develop to their full potential. For these children, malnutrition over a period of time (especially in the 1000 day window of opportunity between conception and a child’s second birthday), silently causes poor brain and body development, weakens the immune system, and worsens the impact of common illnesses such as diarrhoea. Malnutrition contributes to the deaths of about a half-million Nigerian children each year.”

Head, Nutrition, FMoH, Dr. Chris. Osa Isokpunwu, told journalist at a recent training workshop on nutrition organized by UNICEF, in Kano, that: “Every single day, Nigeria loses about 2,300 under-five year olds and 145 women of childbearing age. This makes the country the second largest contributor to the under–five and maternal mortality rate in the world.”

Isopkunwu said malnutrition is a pathological condition brought about by inadequacy of one or more of the nutrients essential for survival, growth, development, reproduction and capacity to learn and function in the society.

According to a Fact Sheet on nutrition by the World Health Organisation (WHO) and UNICEF, child nutrition in Nigeria has improved in recent years, but around 11 million children under the age of five are stunted and there are regional and social disparities, with particularly high levels of stunting in the north-east and north-west and among the poorest quintile.

According to the 2013 Nigeria Demographic and Health Survey (NDHS), conflict in the north-east has further aggravated the nutrition situation. Fields have been destroyed, farmers are afraid to return to their land, and hundreds of thousands of people have fled.

Stunting is what happens to a child’s brain and body when they d not get the right kind of food or nutrients in their first 1,000 days of life. It is irreversible.

According to the WHO and UNICEF document, Nigeria has made progress in micronutrient deficiency control, but about half the children aged six to 59 months do not receive vitamin A supplementation. Vitamin A deficiency can mean a child will be growing up with lower immunity, which can trigger frequent health problems and poor growth.

WHO and UNICEF recommend that babies should be exclusively breastfed during the first six months of life. In Nigeria, the rate of exclusive breastfeeding is just 15 per cent.

President, Nutrition Society of Nigeria (NSN), Prof Ngozi Nnam, malnutrition is a condition that occurs when people consistently do not consume or absorb the right amounts and types of food and essential nutrients. Globally, it contributes to nearly half of all child deaths — that is more than three million children each year.

Nnam said the main indicator of childhood malnutrition is stunting — when children are too short for their age. “Stunted children have poor physical growth and brain development, preventing them from thriving and living up to their full potential. With over 11 million stunted children, Nigeria is facing a crisis of malnutrition and ranks second behind India among all countries with the highest number of stunted children,” she said.

Is there a window of time to prevent malnutrition? Isokpunwu said: “Yes! The 1,000 day period- from the start of a woman’s pregnancy until her child’s second birthday- represents a critical window of opportunity. Adequate nutrition during this period can avert malnutrition, ensuring that children have the best possible opportunity to grow, learn, and rise out of poverty. When nutrition is not optimized during the 1,000 day window, the effects are often irreversible.”

What are the benefits of addressing malnutrition? The nutritionist said adequate nutrition during the 1,000 day window produces a lifetime of benefits for individuals, families, and nations. He said well-nourished children will have improved brain and physical development; they will develop good motor skills, have stronger immune systems to fight off infection and disease, and have sharper mental abilities.

Isokpunwu said healthier children will be better able to focus and learn, and will thus have improved school performance and complete more years in school.

He further explained: “Improvements in school performance and completion will lead to increased job opportunities and personal income, adding at least 10 percent to lifetime earnings and helping families step out of the cycle of poverty.

“Well-nourished, well-educated children will grow into a more productive labor force as adults. Improvements in nutrition could lead to a boost in Gross Domestic Product (GDP) growth by as much as 11 percent annually.
Also, investments in nutrition produce returns up to 25 times greater than the initial investment—for every N100, 000 spent, we generate N2.5 million in economic returns.

Which strategies work to improve malnutrition? The nutritionist said the following four proven strategies can protect mothers and children from malnutrition:

• Mothers should put babies to the breast in the first half-hour after birth and breastfeed them exclusively for the first six months without any other foods or liquids — not even one drop of water!

• After the first six months of life, mothers should start giving their children sufficient quantities of a variety of healthy foods such as fruits, vege- tables, eggs, and meat, along with continued breastfeeding for up to 2 years or beyond.

• Mothers and children should be ensured access to essential vitamins, minerals, and nutrients.

Meanwhile, The Lancet, one of the world’s most highly respected medical journals, in January 2008, demonstrated the availability of 13 proven nutrition interventions that could address the problems of malnutrition and save millions of lives.

The set of interventions focused on the “window of opportunity” from minus nine to 24 months (that is from pregnancy to two years old) for high impact in reducing death and disease and avoiding irreversible harm.

These include: appropriate policies and guidelines in place infant and young child feeding; micronutrient deficiency control; and community management of acute malnutrition.

Nnam said: “While we are grappling with the challenge of under nutrition, the incidence of obesity and related manifestations of over-nutrition are beginning to emerge at relatively significant levels.”

The NSN President noted that nutrition is the bedrock of development and that for an individual to develop well that individual needs to be in the state of good nutritional status.

The nutritionist further explained: “And it’s only people that eat well, and combine their food well, and they are in the state of good nutritional status can reach their desire potentials in life, and will be able to make significant contribution to the development of the nation.

“Poverty rate is not the major cause of malnutrition in Nigeria because, most of these people we say are “poor”, around their environments, they have fruits that could really make them be in good nutritional status. The problem is not poverty, the problem is that they lack nutrition knowledge.”

She added: “Also let’s take fats and oil for instance: adding vegetable oil or fortified margarine improves the taste of our meals, gives us the feeling of satisfaction. I must also encourage Nigerians to ensure they consume foods that are fortified with essential micronutrients such as fortified margarine, iodized salt, fortified flours and others.

“It is important we clarify the dynamics of food intake and healthy weights. When we eat properly in ways that meet our daily energy and nutrient needs we maintain healthy weights? This means our food intake matches our daily nutrient needs considering our physiological requirements and physical activity levels.”

What is currently being done at national and state levels to address malnutrition? Isokpunwu said: “Nigeria is taking important steps to address nutrition. For one, we have joined the SUN movement, which stands for Scaling Up Nutrition. This is an exciting new global effort aimed at bringing country and global leaders together to fight against malnutrition. Nigeria is one of the newest countries to become a SUN member, and we are joining more than 45 countries and over 100 international organizations and donors to rally around a common agenda and solutions, with the goal of mobilizing broad commitment and resources to advance our nutrition agenda.”