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Malnutrition amidst COVID-19: Thousands of children suffer damage, death In Sokoto

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The nation’s total focus on battling and containing the COVID-19 pandemic appears to have given bandits in Sokoto and Zamfara States some ‘respite,’ as they have continued to unleash terror on hapless villagers in these areas, which has resulted in increased displacement of women and children. The situation has also led to severe hunger and increased malnutrition. 

The Guardian investigation revealed that these states are currently hit by malnutrition – a terrible crisis that is killing many children in the North West.
Presently, Sokoto State has the highest prevalence of malnutrition in Nigeria, with 7.9 per cent of children aged six and 59 months severely malnourished (NDHS, 2018). 

It is an endless tales of woe from the traumatised victims. One year after bandits drove Zuwaira Lawal and her family away from their village- Kamitau, in Goronyo Local Government Area of Sokoto, she is still struggling to save her three-year-old malnourished baby from dying. 

Twenty-year-old Zumaira recalled how her husband and 24 other villagers were instantly massacred that day, by the bandits: “It was terrible! I only managed to escape with my three children, without any property. The bandits stole our land and cows.”

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Now resettled at Illela- a safer community at Goronyo LGA, without any means of livelihood, the mother of three said she survives and caters for her children through begging for alms.  

“Sometimes, people give us something, sometimes they don’t. Getting drinking water is also very difficult. We have to trek far distance to fetch water from a borehole,” she said. Aside bandit attacks, the lockdown, occasioned by the pandemic, has contributed in no small measure to food scarcity, and increased price of staple food. 

“Now things are even worse. People stay in their houses. Shops and mosques are closed,” she said.  When her last baby, Hassan, fell ill six months ago, and was vomiting and stooling, she tried all she could to save him. 

“I gave him herbs and drugs, but he only got worse. Then he stopped eating completely,” she recalled. “Then I heard about the free malnutrition treatment programme taking place at the Sabon-Gari Dole Primary Health Care Centre, and made a last attempt to save my baby. 

“Someone told me about the United Nations Children Education Fund (UNICEF) programme at Sabon-Gari Dole, so I brought my baby for treatment.” Two weeks after, Hassan has started regaining weight and is a lot better. Hassan is one of the many children currently receiving free treatment for acute malnutrition at Sabon-Gari Dole Primary Health Care Centre, Goronyo Local Government in Sokoto State. 

The Community Management of Acute Malnutrition (CMAM) officer in charge said about 150 children had been treated successfully from October 2019 till date, at the Out-patient Treatment Centre (OTC). 

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Investigation revealed that displacement of rural communities by bandits contributed to the current malnutrition crisis in Sokoto and Zamfara States: Conflict between herdsmen and farmers in Sokoto and Zamfara States, coupled with criminal banditry, resulted in the displacement of rural populations in 2018 and 2019, according to information from the state. 

By mid-2019, there were thousands of internally displaced persons (IDPs) living in makeshift camps and amongst host communities in several affected Local Government Areas of both Sokoto and Zamfara States. Most of these IDPs are women and children. 

Many families, including children were rendered homeless, without food and any source of income. Unfortunately, the COVID-19 pandemic is worsening the situation. And only UNICEF seems to be responding to the malnutrition issue.

With support from the European Civil Protection and Humanitarian Aid Operation (ECHO) of the European Union (EU), in collaboration with the State Primary Health Care Development Agencies of Sokoto and Zamfara, UNICEF has set up Severe Acute Malnutrition treatment sites in 20 wards (seven in Sokoto and 13 in Zamfara).

These wards are in seven LGAs: Three in Sokoto (Rabah, Goronyo and Sabin Bini), and four in Zamfara (Shinkafi, Maradun, Zurmi and Birmingham Magaji) that are badly affected by the violence. All the 20 wards have a high number of IDPs and malnourished children, currently benefitting from the intervention. 

The CMAM officer in charge at one of the wards in Sabon-Gari Dole Primary Health Care Centre, Bashar Saidu, explained how Hassan and other children get saved everyday at the centre. 

He said: “When the baby comes here, we first measure his/her Mid-Upper Arm Circumference (MUAC). If it’s below 11.4 cm, and the child weighs four kilogram and above, and has no medical condition, then the child will be admitted for the programme. We refer those with medical condition to the In-patients Care Centre (IPC), where they will receive food and treatment. After treatment at the IPC, the child is sent back to the Out Patient Treatment Centre (OTC). 

“When they come each week, we check their MUAC and weight to see if these are increasing. If there is no progress after two consecutive visits, we refer them to the IPC. But we expect progress within one week.”

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At the centre, Zumaira, and other caregivers- about 50 women with their malnourished children- were seated at the OTC, waiting their turn for the clinical assessment and the weekly RUTF ration. 

UNICEF Nutrition Head, Sokoto, Walton Beckley, explained that about 4,565 and 5,755 children with acute malnutrition had been admitted for treatment in Sokoto and Zamfara so far. He said about 3, 963 and 5, 057 children with acute malnutrition had been successfully treated in Sokoto and Zamfara States respectively. 

“About 3,716 and 4,706 in Sokoto and Zamfara States received iron and folic acid supplements,” he said. “In Sokoto, about 5,688 pregnant women and caregivers of children less than two years have received advice on how to take care of their children and feed them to prevent malnutrition. And in Zamfara State, about 8, 219 women had received same advice.”

But while treatment at the OTC is completely free and the RUTF procured by UNICEF, investigation revealed that this is not the case at the IPC, where treatment is not entirely free. 

Explaining the reasons for these, the CMAM person said: “At the IPC here, there is no therapeutic milk, such as F75 and F700, which is normally given to patients that don’t eat the RUTF. So caregivers are told to buy milk and give the child. A can of formula milk will cost about N3, 000 or N4, 000, and the caregiver is expected to buy the milk continuously until the child recovers. 

‘But because caregivers do not have money or any other source of income, they fail to get the milk for their children and so; we have cases of mortality. Aside purchasing milk, the caregiver sometimes buy some routine drugs, while some are given free”

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Lack Of Financial Support From Government And Others, Slowing Down Effort To Curb Malnutrition
DESPITE the success of CMAM programme, investigation revealed that government has not shown enough commitment towards the plan. For instance, it was gathered that the 2019 Sokoto State approved budget for nutrition has not been released till date. 

If this is released, Mr. Beckley said it could be channeled to nutrition programmes like CMAM. “The state government is our main partner. The facilities and staff are provided by government, while we provide technical support, with the hope that government will eventually completely own the programme.” 

According to him, setting up a stabilisation centre or IPC is not as easy as OTC. “We have been working with donors to ensure that we get the stabilisation centre working. But only UNICEF is responding to the crises in Sokoto presently. We are trying our best to ensure that the children do not develop medical complication before being brought to the OTC.” 

To make better progress and save more children, he said there was need for government and other humanitarian organisations to step in and help save the children. 

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“We also need other agencies, such as World Health Organisation (WHO) to step in. From our screening results, we have a huge number of children that are moderately malnourished, but our programme is not designed to address this. We are focused on children that are severely malnourished; so we need other agencies that can address this such as World Food Programme (WFP), to step in and assist. 

“The RUTF is very expensive to procure and get across to children that need it. One child will consume at least a carton of RUTF throughout the programme. If this programme funded by ECHO runs out, the continuation of the programme may be badly affected,” he said.

On Why treatment is not free at the IPC, UNICEF State Nutrition Supervisor, Sokoto, Ijanada Aliyu Jacob, said: “Normally, we work with the state government, and because we want the state government to take ownership of the activity, we allow government to give its support in purchasing the items. We cannot solely take the responsibility of doing all the supplies. So, we hope to get the state government’s support, so that all treatment at the IPC can also become free. 

“Another challenge we have at the IPC is lack of human resources. Not all staff is skilled in mixing the milk and treating the child. So, the staff need to undergo training.”

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