Malnutrition: When insecurity, inflation endanger the Nigerian child

As Boko Haram insurgency forces thousands of residents of the northeastern part of the country to flee their homes and live in Internally Displaced Persons (IDP) camps, the lives of the children are being further endangered by malnutrition.

The 12-year insurgency has caused thousands of deaths, destruction of property worth billions of naira, loss of means of livelihoods by many families, drop in household incomes, lack of access to farmlands and food insecurity. The outbreak of the COVID-19 pandemic and the economic and social disruptions that came with it as the country battled to contain its spread has further compounded the suffering of the victims of insurgency, especially those in Borno, Adamawa and Yobe states.

Findings from across other parts of the country showed that many families have cut down their consumption of foods that are rich in protein, a very crucial dietary component needed by children to grow and develop well, due to the high cost of purchasing them.

In a recent report, the United Nations Children Fund (UNICEF) ranked Nigeria as the country with the highest-burden of malnutrition in Africa and the second highest in the world.

The global agency, in the report that analysed 91 countries, including Nigeria, disclosed that one out of every three children in the country was stunted and one of every 10 children was wasted for not eating the right food combinations.

The report found that the COVID-19 pandemic has affected how families feed their children as it has disrupted essential services and thrown most families into poverty.

“Close to 17 million Nigerian children are undernourished, meaning they are not getting the food or nutrients they need to thrive and grow well, leading to irreversible developmental harm.

“The findings of the report are clear: millions of young children are not being fed diets adequate for their growth and development,” UNICEF Nigeria Deputy Representative, Rushnan Murtaza, said.

In another report, the UN agency stated that malnutrition was the biggest threat to child survival and development in the northeastern part of the country. According to UNICEF, children with Severe Acute Malnutrition (SAM) have a nine times higher risk of dying than well-nourished children.

Data from UNICEF, nutrition partners and state governments showed that about 10,165 children died from SAM in Borno, Adamawa and Yobe states between January 2017 and July 2021.

During a recent visit to Muna IDP camp in Maiduguri, the Borno State capital, which is the epicentre of Boko Haram insurgency, The Guardian witnessed the devastating impact of malnutrition not only on children but also their mothers.

The IDP camp is home to 9,958 households with a total population of 50,226, out of which 10,045 are children under five years. The congested camp, which is divided into A and B for administrative convenience, has two primary healthcare facilities where services are provided for the people. 

It was a little before noon, the weather was calm. Seated at the waiting area of Muna Primary Healthcare (PHC) Clinic B in the camp were three young women, all breastfeeding their frail-looking babies while waiting to be screened to access nutritional services. The sight of these children could make one break down in tears; they looked very thin for their ages and the outline of their ribs was visible. Their mothers were not looking healthy either. And it was gathered that about 1,495 children in the camp who had SAM were admitted and treated between January and September 1, 2021. 

A mother of seven, 30-year-old Fana Modi, had just come to the camp. She looked traumatised and helpless. Her little son, who is one year old had boils all over his body and wept uncontrollably while sucking her mother’s breast.

According to a health worker in the camp, food donation to the IDP was not regular and most of the women have their food preferences. The Infant and Young Child Feeding (IYCF) Counselor for Muna B Clinic, Hadiza Ahmed Abubakar, told journalists that most of the women in the camp preferred their local food.

“And so, instead of cooking the rice, beans and other food items they receive from donors, they exchange them for their choice foods, which is usually wheat and maize. Some of them sometimes sell the foodstuff and use the proceeds to solve other problems.

“Government is not doing enough for the camp. People here need food; even some of the mothers are malnourished. The International Red Cross Society (ICRC) used to supply food to the camp but has stopped since last year. The State Emergency Management Agency (SEMA) once in a while brings food items but it is not regular,” the health worker said. 

While in the health facility, which UNICEF and other partners support to provide integrated emergency PHC services to IDPs living in the camp and environs, Aisha Lawal, a 30-year-old mother of six, alongside her husband, brought her 15-month-old baby who had a fever for treatment. The couple had fled their home in Dikwa, Goshe Ward in Dikwa Local Council of Borno State in 2016 with three children following an incessant attack by the Boko Haram insurgents. They have been living in the camp for the past five years and have given birth to three additional children.

Speaking through an interpreter, Aisha told The Guardian that the baby was her sixth child and that her husband was a successful farmer until they were displaced from their home. She lamented that the major challenge at the camp was hunger, confirming that the ICRC, which used to supply food to the camp, stopped last year. 

She further lamented that her family barely eat two meals in a day, adding that food supplies from the SEMA were not enough for the number of households living in the camp.

“We survive by going to the farm and picking some grains which we sell N30.00 and use the proceed to buy food for our families. Though life in the IDP camp is not easy, I would rather live in the camp than go back to the community and suffer Boko Haram attacks. We need food, mosquito nets, soap and adequate water in this camp,” she said.

In Lagos State, found by The Guardian during the week showed that the cheapest crate of egg now retails at N1, 600, almost double the price just before the COVID-19 lockdown last year. A single tilapia fish goes for N1000 while a kilo of chicken retails at between N1, 600 and N1, 800.

The prices of fruits and vegetables have also skyrocketed beyond the reach of many. Beans, which used to be one of the cheapest sources of food protein, now retails at N700 per derica, with many families unable to afford the price.

Blessing Francis, a primary school teacher and mother of three children, said that the situation had gotten out of hand, revealing that in a bid to make ends meet, she had to cut out many foods from the family’s daily menu.

“One egg is now N100. Meat and fish is now something we eat maybe once a week. Most of the time, I cook concoction rice for them to eat, with nothing else. I don’t add anything to garnish the rice most times because everything is so expensive. But what can I do? Last year, I could cook a pot of stew with N1, 000 but now, that will only buy pepper; things are going from bad to worse,” she said.

Anthonia Adeyemi, a mother of four and petty trader, said she knew that her children were suffering but she could not help the situation.

“I am a daily trader and we feed along that line. Whatever I make in a day will determine how we eat that day. Food is very expensive these days. Some foods that we used to savour have now become luxury. These days, I’m not looking at a balanced diet, but what will fill each person’s stomach that is not too expensive. It is you that knows which food is balanced or not,” she said.

Nevertheless, UNICEF warned in its report that “poor nutritional intake in the first two years of life can harm children’s rapidly growing bodies and brains, impacting their futures.”

At a media dialogue on child malnutrition organised recently, in collaboration with the Child Rights Bureau of the Federal Ministry of Information and Culture in Maiduguri, UNICEF described malnutrition as the biggest threat to child survival and development in the northeastern part of the country. 

Speaking at the event, the Officer-in-charge of UNICEF in Maidugiri, Samuel Sesay, said that households were experiencing unprecedented levels of food crisis and hunger, adding that conflict, multiple displacements, climate change and the COVID-19 pandemic were contributing to the growing number of children affected by undernutrition in the region. 

Sesay stated that malnutrition was the underlying cause of nearly half of all the deaths of under-five globally. He said the importance of good nutrition on children’s development was enormous, impacting their education, health, earning power and family finance as well as the country’s economy. 

“It is unacceptable that children continue to bear the greatest burden of the insurgency and COVID-19 pandemic. Ensuring good nutrition in children is a cheaper route to nation-building,” Sesay said. 

According to him, UNICEF has been supporting government and partners in the Northeast on early detection, referral and management of SAM in children and in the provision of ready-to-use therapeutic food in a feeding programme for outpatients. 

Also, a consultant paediatrician and professor of public health, Ashiru Garba, said there was enormous geographic variation in nutrition outcomes, with the worst malnutrition concentrated in the northeast and northwest regions.

He warned that malnutrition leads to impaired physical growth and cognitive development, delay in school attendance and reduction of sub-optimal physical attainment resulting in lost employment and socialisation opportunities throughout life. 

Garba expressed regret that up to 45 per cent of all preventable child deaths were attributable to undernutrition. He revealed that a full course of therapy to save the life of a child suffering from SAM costs between $100 to $200, and put the yearly national cost of treating one million underweight children in the country at $50 million. The professor said that about $8.5 billion was lost globally to malnutrition, adding that the health situation had impeded efforts to reduce poverty. 

According to him, about $70 billion is needed globally to reach the World Health Assembly’s target of reducing stunting and anaemia in women, as well as increasing exclusive breastfeeding by 2025.
In his breakdown of the figure, Garba said that about $7 billion was needed yearly from 2016 to 2025 to meet the target.

According to him, spending must be prioritised on universal salt iodisation, micronutrient supplementation (vitamin A, iron, folic acid and calcium), food fortification, promotion of exclusive breastfeeding and use of high-quality complementary foods, balanced energy, protein supplementation of undernourished individuals and the treatment of severe and moderate wasting.

The Borno State Deputy Nutrition Officer, Alhaji Abdullahi Madi, revealed that at least 12,410 cases of SAM were recorded in the state between January and July 2021. He noted that while 10,281 of the cases were treated, 57 deaths were recorded.

He listed challenges hindering progress in the fight against malnutrition in the state to include insecurity, lack of available resources, inadequate health services and lack of access to hard-to-reach areas.

UNICEF Nutrition Manager, Sangita Jacob Dagai, stated that prevention of malnutrition in the first two years of a girl child could help to break the cycle of undernutrition.

He explained that there is a link between maternal and child nutrition, revealing that over 60 per cent of women, including adolescent girls aged between 15 and 49 years, were anaemic in Borno and Yobe states.

He stated that in the last five years, there had been no significant change in Minimum Acceptable Diet (MAD) among children between six and 23 months in Yobe and Adamawa states.

UNICEF Nutrition Specialist in Maiduguri, Ifeanyi Maduanusi, however, disclosed that the organisation had adopted a multi-sectoral approach in combating child malnutrition in the Northeast, saying food security, nutrition, health, water sanitation and hygiene sections had been integrated to achieve better impact. 

In an interview with The Guardian, the Founder of the Child Health Advocacy Initiative (CHAI), a non-profit healthcare and development organisation focused on promoting the health and wellbeing of Nigerian children, Lola Alonge, concurred that the number of malnourished children in the country was alarming.

She said: “Before COVID-19, many parents struggled to provide children with nutritious food but there is now an increase in child malnutrition due to poverty, unemployment and changes in the availability and affordability of nutritious food and decreased access to health and nutrition services.

“Without urgent action, millions of children are at risk of suffering irreversible health damage due to lack of nutritious food. Proper nutrition is crucial for a child’s mental, emotional and physical development as poor nutrition drains children of their energy and vitality, which makes it difficult for them to thrive in life.

“Children who are food-insecure are more likely to be in poor health and struggle in school. There could also be lifelong implications where children may never reach their full potential as a result of poor nutrition during their formative years,” the expert said. 

Alonge listed different types of malnutrition to include stunting, wasting, underweight, obesity and micronutrient deficiency also known as hidden hunger.

“Children need a healthy, balanced diet containing foods from each food group so they can get a wide range of nutrients to help them stay healthy and grow well. Micronutrients are essential for development, disease prevention and overall wellbeing,” she added.

On how to tackle the problem, Alonge urged relevant government agencies to improve the screening of children for malnutrition, create employment and empower families, put an end to conflict and violence, support families through cash transfer and promote agriculture and food security.

She also advised the government to increase bio-fortification as well as large scale food fortification through the addition of vitamins and minerals to staple foods during processing to improve their nutritional quality, especially flour, wheat, oil, salt and sugar.

To Alonge, investing in nutrition is one of the most cost-effective and proven techniques to help children prosper and thrive, warning that without adequate and sustainable investment in good nutrition, the Sustainable Development Goals would not be realised.

“Governments, the private sector and civil society organisations must prioritise child nutrition and work together to address the current worrisome state of poverty and malnutrition in Nigeria,” she said.

A nutritionist, Dr. Oghenefego Ofili, noted that the nutritional habit of a woman during pregnancy is very important as it contributes greatly to the growth and wellbeing of the foetus.

Ofili said: “The link between poverty and access to quality food cannot be ignored. With increasing poverty levels, we would certainly have more children being undernourished and the high food inflation with zero increase in income levels automatically places poorer families on survival mode. Then, when you add a culture that prioritises adults (especially the man of the house) when it comes to getting the biggest chunk of protein (meat, fish or egg) available, children will get little or nothing and this will adversely affect their nutritional intake. 

“Children being malnourished are prone to infections and diseases. I’m particularly concerned about the long-term effects of malnutrition on cognitive development and the ability to become productive adults. For example, outcomes associated with stunting include increased risk of mortality, increased disease risk, developmental delays, diminished ability to learn and lower school achievement, and reduced lifelong productivity.” 

According to her, WHO, UNICEF and many other bodies have provided information on practical solutions, all we need to do is take action.

“We also need to invest in educating young people on essential nutrition actions that would safeguard the lives of their children before they become parents. Primary Health Centres need to begin to function effectively in providing counselling and treatment to women and children and the multipronged approach must include income generation and strategies to reduce poverty across Nigerians,” Ofili said.