How UNICEF is fighting severe, moderate acute malnutrition in Sokoto State

At a health facility in Taloko Ward, Gonronyo Local Government Area, Sokoto State, mothers sit closely in a group with their children on their laps.

The building serves as a Community Management of Acute Malnutrition (CMAM) centre where children from surrounding villages who are malnourished are assessed and treated.

Each child seems to be at a different stage of malnourishment: Some were just admitted while others are already recovering and hopeful to be discharged soon.

Twenty-two-year-old Khadija Ibrahim’s face is brimming with smiles due to the progress her daughter, Amina has made during her visit to the health facility.

Amina was admitted to the health facility where she received treatments for severe malnutrition and is gaining weight after a course of Plumpy’nut, a high-energy peanut paste that helps children quickly regain weight.

“I never thought she would survive. She had fever and was very thin,” said Kahadija Ibrahim as she feeds Amina with the highly nutritious Ready to Use and Therapeutic Food (RUTF) in her hand.

Amina is not alone. Many malnourished children have been brought to the Outpatient Therapeutic Program (OTP) by their caregivers for treatment with the use of the Ready to use Therapeutic Food (RUTF). Some of them recover rapidly in few weeks while some take longer period and this basically depends on the caregiver.

According to reports from the health facility, more than 150 children has been successfully treated at the OTC in Goronyo Local Government, Sokoto State.

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).

Malnutrition is one of world’s major public health and development concerns. In Nigeria, the situation is dire.

Currently, UNICEF says 5 in 10 children under five years old suffer from the effects of being malnourished. This has an overarching impact on the lives, future and productivity of Nigerian children.

UNICEF Nutrition specialist in Sokoto, Walton Beckley, said that northwestern Nigeria has, for a long time, been characterised by very poor development indicators.

According to him “The 2018 Nigeria Demographic and Health Survey showed that Sokoto state has the highest prevalence of children with Severe Acute Malnutrition (SAM) at 6.5 percent.”

Beckly explained that the increase in violence and internal displacement, coupled with global effects of the COVID-19 pandemic, has worsened the plight of populations in Sokoko state.

“Rural populations who once depended almost entirely on agricultural activities for their livelihoods, no longer have access to their farms and even when they do, the fear of being killed or abducted prevents them for getting on with their regular activities,” he said.

“Affected populations now must depend on food aid or host populations for their daily survival. The effect of these is the further deterioration in the health and nutritional status of especially children and women.”

He explained that “routine programmatic assessment done for internally displaced populations gives figures of up to 30 in every 100 children under 5 years being acutely malnourished.

“Children with severe acute malnutrition are up to 12 times more likely to die from common illnesses than well nourished children.”

The nutrition specialist added that UNICEF with support from the Bureau of Humanitarian Assistance (BHA) of the United States Agency for International Aid (USAID), has been collaborating with the primary health care authorities in Sokoto and Zamfara states to provide life saving humanitarian nutrition interventions to affected populations since April 2020 (and also Katsina state, since December 2020).

“Through this support from BHA, UNICEF has procured RUTF (ready-to use therapeutic food), which is a key commodity for the treatment of children with severe acute malnutrition,” Becley said.

He maintained that the support has also ensured that a total of 47 health facilities in the worst affected LGAs in Sokoto (22) and Zamfara (25), now have staff that are trained to provide service for treating SAM children.

He said, “In addition to treatment of SAM children, there are now structures in these facilities and surrounding communities, to promote activities for the prevention of malnutrition through social and behaviour change communication for improved Maternal Infant and Young Child Nutrition (MIYCN).

“Pregnant women and eligible children are also receiving supplements for the prevention of micronutrient deficiencies.

“Since the programme started in April 2020, around 32,000 SAM children have been admitted for treatment in Sokoto and 52,000 in Zamfara.

“Over 92 percent of these children have been successfully treated. 87,000 pregnant women and caregivers of children under 2 years in Sokoto and 172,000 in Zamfara have been counselled on maternal, infant and young child feeding for the prevention of malnutrition, and 13,500 pregnant women in Sokoto and 16,800 in Zamfara have received Iron and Folic Acid Supplementation.

“Without this support from the USAID BHA, thousands of children with SAM may have died or developed lifelong complications. Thousands of pregnant women may have also suffered from complications of childbirth including the increased possibility of them dying or their children being born undernourished.

On his part, Senior Nutrition LGA Consultant, Dr. Ikenna Ezi Isu, said “many malnourished children have been brought to the Outpatient Therapeutic Program (OTP) by their caregivers for treatment with the use of the therapeutic food called “Ready to use Therapeutic Food (RUTF)”, some of them recover rapidly in few weeks while some take longer period and this basically depends on the caregiver.

“Some of the caregivers adhere to the instructions about the key messages of RUTF while some do not, some adhere to hygienic and Infant and Young Child Feeding (IYCF) principles/practices and some don’t, so this plays a great role in the recovery process of the malnourished child

According to him “This intervention started here in 2019, and the center is tagged as an emergency area. The intervention was started of the insurgency and the rate of malnourished children in the area, so UNICEF had to intervene.

“Although the intervention was on before 2019, but as of then it was not tagged an emergency area. It became an emergency area in October 2019 and we have been combatting malnutrition since then.

He noted “We have so many success stories and some of them are documented. We also have some pictorial evidence from most of the success stories that we have from here.

“Some of the children came here very severely wasted and you could even see their ribs and their backbones were visible. They could barely walk. Some of the even came with edema and kwashiorkor.

“But with the ready to use therapeutic food, RUTF that we have been using period, it has really helped most of these children and most of them have also recovered and are doing well now. Their caregivers are very happy and they always sending their appreciation to UNICEF and the state for what they have been doing for them.

“One of the major challenge we encounter is misuse of the RUTF by the caregivers. Instead of giving the children the RUTF, some of the caregivers tend to sell them. We have been checkmating the sale of the RUTF through our community mobilizers,” he said.

“They have been going from community to community checking for people who sell and misuse the RUTF. Each of the wards have community nutrition mobilizer who goes round. If we give the caregivers their ratio and they are supposed to be given their child two or three RUTF per day, we then communicate to the community nutrition mobilizer in that particular ward telling the number of RUTF we gave to a particular caregiver and they go to check after some days and if the number of the RUTF remaining is not up to the number that should remain, we assume they are selling.

“Some of them don’t sell, they share among the family and this makes the child to eat less than what is required and this makes the progression of the child’s nutrition status to be slow. The child will not improve as expected. But, the introduction of the community nutrition mobilizers has really made a difference.”