“There can be no keener revelation of a society’s soul than the way in which it treats its children.” ~ Nelson Mandela
In an early drive around Abuja’s suburbs on the weekends, you are likely to find children, full of energy, playing with their friends. Where the next meal will come from is not one of the things they worry about.
Another drive through another of Abuja’s suburbs will bring you to a graveyard. Nestled among the adult-sized graves are mounds of earth. They, at first glance, look like badly moulded mounds made to hold yam seedlings. Who would dare farm in a grave yard? But a closer look tells another story. These are actual graves, and within them lie the bodies of children, 5 years old or younger.
Every year, over 1 million Nigerian children die before their fifth birthday. The United Nations Children’s Fund (UNICEF) identifies malnutrition as the underlying cause of morbidity and mortality in more than 50 percent of children under-5 years of age in Nigeria.
Malnutrition refers to deficiencies, excess or imbalances in a person’s intake of energy and/or nutrients. It refers to undernutrition or overnutrition. In Nigeria, when we talk about malnutrition, we most commonly mean undernutrition, that is, not getting enough nutrients, which results in stunting, underweight and wasting, or a combination of all three. Undernutrition makes children more vulnerable to infection, more prone to diseases and increases their risk of death.
Severe Acute Malnutrition is the most extreme and visible form of undernutrition. Its face is a child – frail and skeletal – who requires urgent treatment to survive. Acute malnutrition in children occurs when they lose weight rapidly because of diets that do not cover their nutritional needs or diseases such as acute respiratory infection, diarrhoea and malaria. Children that suffer from severe acute malnutrition are unable to fight infections efficiently. The long-term effects include poor cognitive and psychomotor development which affects their ability to learn. Children who are unable to learn properly are disadvantaged; their ability to have a fulfilling life is compromised.
According to an evaluation report by Children Investment Fund Foundation (CIFF), Nigeria has the second-largest number of wasted children globally and the highest percentage of wasted children whose case is severe. In some states, the burden of severe acute malnutrition is as high as half a million children. Though severe acute malnutrition is a nationwide problem, it is clear that a significant number of children suffering from an acute stage of malnutrition are in northern Nigeria. Nine of the North-East and North-West states have rates of child wasting that exceed 80 percent.
While most Nigerians do not seem to be overly concerned about these figures, this could be the most challenging long-term impact of the security situation in the North of Nigeria. “Zero hunger” was one of the 17 Sustainable Development Goals adopted in 2015 by world leaders, yet, since then, not enough has been being done in Nigeria to ensure the target is achieved.
Solutions however exist, with the right will, to tackle malnutrition and specifically severe acute malnutrition in Nigeria. Several programs, supported by both government and donors, have been introduced through the primary health care system. They include nutrition counselling, promotion, protection of infant and you child feeding recommended practices, Community Management of Acute Malnutrition (CMAM), micronutrients fortification and supplementation as well as home gardening and social safety net programs such as conditional cash transfers.
The community based management of acute malnutrition (CMAM) approach is probably the most prominent in tackling severe acute malnutrition. It seeks to educate the community about acute malnutrition and availability of services through community mobilization, early detection of severe acute malnutrition in children through screening using mid upper arm circumference (MUAC) tape, and referral and follow-up of those under treatment. In addition, it allows timely treatment for those without medical complications, with ready-to-use therapeutic foods (RUTF) at home. If properly combined with a facility-based approach for those severe acutely malnourished children with medical complications and implemented at a large scale, CMAM could potentially prevent 19% of the deaths of children in Nigeria.
CMAM can reach more children, achieve higher recovery rates and can be 90 percent cheaper than conventional treatment. Considering the large scale of severe acute malnutrition in the country, this approach would be the most effective in addressing the severe acute malnutrition problem in Nigeria if implemented at scale and integrated with other preventive interventions such as promotion of infant and young child feeding practices and micronutrients fortification. CMAM services are available in only 12 states in Nigeria: Adamawa, Bauchi, Borno, Gombe, Jigawa, Kaduna, Kano, Katsina, Kebbi, Sokoto, Yobe and Zamfara.
In 2014, Children Investment Fund Foundation (CIFF) in partnership with UNICEF and the Federal Government conducted a survey on Severe Acute Malnutrition in Nigeria to assess the coverage of CMAM services in Nigeria. Lack of awareness about acute malnutrition, the existence of CMAM and the way it functions was found to be the greatest barriers preventing access across all states.
How aware are Nigerians of this nutrition emergency which is silently killing its’ children? How concerned are those entrusted with governance about the huge numbers of children who are losing their lives simply because they are under-nourished? Most importantly, what are we as citizens, as advocates, as policy makers and politicians… what are we as Nigerians willing to do to reverse this tragedy?
It will take hard work and commitment to doing the right thing on every level of societal responsibility. It will take political will, the courage to provide governance support to policy makers, to put funding in place in state budgets for nutrition. It will take a community of Nigerians who will not turn a blind eye to our children, who will take every opportunity to advocate, to lend their voice and speak for those who cannot speak for themselves. Every Nigerian infant and child has the right to good nutrition according to the “Convention on the Rights of the Child” and malnutrition is a violation of that right.
The sheer enormity of this problem means that we need more primary health care centres to provide treatment of severe acute malnutrition in Nigeria, most especially in the states with the highest rates of severe acute malnutrition and in all PHC as a basic health service. In addition to this, funding for procurement of Ready-To-Use Therapeutic Food (RUTF) and routine medicine should be allocated, in order to prevent death from severe acute malnutrition and ensure treatment is available for all children who need treatment. There is a significant opportunity cost in not safeguarding the future of Nigeria’s fledgling children. The potential of Nigeria’s future leaders is being destroyed.
Still, every crisis is an opportunity. This is the time to bring in innovative solutions from the food industry, private sector, and agriculture together to focus on solving this challenge.
We at Nigeria Health Watch have begun a campaign, #FeedNaijaPikin, to highlight the issues around malnutrition amongst children under 5 in Nigeria. We are raising awareness about why malnutrition needs to be dealt with if our children are not only to survive, but to thrive, and point out how important it is for the government at every level to put in place additional and sustainable funding mechanisms to ensure that no child in Nigeria continues to suffer from severe acute malnutrition.
One million children are dying every year in Nigeria. That is over 2,700 children dying every day… in Nigeria. We cannot turn a blind eye to them. Our political office holders must be made aware. Our state governments must be held to account. But for them to take action, you, as a Nigerian, must care.
Join us as we advocate to #FeedNaijaPikin. What can you do?
Social Media: If you are on social media (Facebook, Twitter, Instagram, Email) let us know if you think enough is being done about malnutrition in Nigeria. What more can be done? What are you doing? You can leave comments on any of our social media handles with the hashtag #FeedNaijaPikin or send us an email at email@example.com
Advocate: Write, or go to your state governor, your commissioner of health, your senator, and ask them what they are doing about providing funds to tackle malnutrition in your state.
Start a discussion: Share this blog amongst your networks and let us get a discussion going around solving the malnutrition emergency in Nigeria.