In September, as part of a campaign to highlight the issues around malnutrition amongst children under 5 in Nigeria, Nigeria Health Watch published a blog piece titled, “#FeedNaijaPikin: The fight to invest in Nigeria’s future flagbearers.” Our aim was and still is to raise awareness about why malnutrition needs to be dealt with if our children are to survive and thrive; to point out how important it is for the government at every level to put in place additional and sustainable funding to ensure that no child in Nigeria continues to suffer from severe acute malnutrition and to get a discussion going around solving the malnutrition emergency in Nigeria.
In this blog, three things were made clear:
- Every year, over 1 million Nigerian children die before their fifth birthday and the United Nations Children’s Fund (UNICEF) identifies malnutrition as the underlying cause of morbidity and mortality in more than 50 percent of these children.
- The community based management of acute malnutrition (CMAM) approach is probably the most effective approach to tackling severe acute malnutrition.
- Lack of awareness about acute malnutrition, and of CMAM have been identified as the greatest barriers preventing access across all states.
To further educate ourselves, the Nigeria Health Watch team went to Zamfara state in North West Nigeria, a state that has slow progress in tackling malnutrition. Latest figures show that 57.4% of children under-five in Zamfara state are stunted and 28.1% are underweight. This compares to a national average of 29.8% and 17.2% respectively.
There had been a labour strike in Zamfara, which resulted in many public health facilities being shut down when we visited, thankfully, the Community Management of Acute Malnutrition (CMAM) site at Nahuche had just re-opened. Sited in Bungudu LGA, the CMAM centre is an hour’s drive from the state capital, Gusau. Nothing prepares you for your first visit to a CMAM site. Nothing prepares you for the first time you see a two-year-old child, no bigger than a 9-month-old baby, withered skin hanging loose over protruding bones, with barely enough strength to turn in his mother’s arms. Nothing prepares you for the long line of mothers waiting for their turn to be assessed, with their children whose ages you would be hard pressed to even guess. Nothing prepares you for the suffering you encounter at a CMAM centre.
The starting point in identifying children with severe acute malnutrition, is through the community mobilization efforts of health workers who measure the Mid-Upper Arm Circumference (MUAC) of children under 5 to identify those with severe acute malnutrition. When new arrivals come to the CMAM site, the child goes through a triage system where they are referred for one of three interventions, depending on the severity of the child’s malnutrition:
- Stabilization Centre (SC), this is where the child may have other acute health challenges and need medical intervention before being treated for the severe acute malnutrition
- an Outpatient Therapeutic Programme, where the Ready-to-use-Therapeutic Foods (RUTF) is provided to caregivers.
- Supplemental Feeding Programme (SFP), where the child’s diet is supplemented with the RUTF which is administered at their home by a caregiver.
In addition to the distribution of the RUTF packs, supplementary support was provided to caregivers at the Nahuche CMAM site with the Infant and Young Child Feeding (IYCF) programme. This is a critical intervention that involves nutrition officers and community workers going into different communities to provide food demonstrations to caregivers, showing them how to use food items like groundnuts, millet, soya beans and palm oil to prepare nutritious meals.
It became quite clear as we spoke to some of the caregivers and nutrition officers that the root cause of malnutrition and severe acute malnutrition was a combination of compounding issues, beginning with the nutritional deprivation of the children. This is most often due to poverty, but also a poor understanding of the nutritional value of many readily available food items. The poor education levels of the young mothers further exacerbates the problem.
After the visit to Zamfara state, we decided to visit another CMAM centre in Kaduna State. This time, conscious that there is a huge lack of awareness about acute malnutrition and the existence of CMAM among Nigerians, we went with some social media influencers to the CMAM centre sited in Mando Primary Health Care Centre in Kaduna State. Please read short accounts of their experiences below:
I visited both Kaduna and Zamfara States and their problems were similar. I saw children struggling to survive; children over 2 years of age who could neither stand nor walk. I saw teenage mothers who do not know what to feed their new-born babies. Some had already lost children due to malnutrition but still did not know how to avoid it. In Zamfara, the problem was not so much a lack of food or poverty, it was mothers not knowing the right food to feed their children. I remember during the drive into Nahuche, we saw heaps of groundnuts dried and ready to be transported and sold to other parts of the country. I thought to myself, “Why are children dying of malnutrition in a community where there is such an abundance of groundnut; groundnut being the major ingredient for RUTF, used to treat malnutrition?” The government has promised to solve the malnutrition problem in their states. But how long can the children in Nahuche and Mando wait? Atinuke Akande (Nigeria Health Watch)
Before my visit to the Kaduna CMAM Centre, I had a general idea that malnutrition is largely caused by a lack of food. While this may still be true, my interaction with health workers and beneficiary mothers at the Kaduna CMAM Centre as well as the conversation with local government officials has given me further insight into other causes which are much deeper than a “lack or shortage of food”. Issues ranging from cultural and religious practices such as early marriage, economic and social practices such as marrying multiple wives as a sign of wealth and selling all farm produce, even at the expense of starving one’s family and total abandonment of one’s family by the men feature predominantly among the reasons cited by most of the mothers as to why their children and even themselves are malnourished. This implies that solving the malnutrition problem in Nigeria, requires holistic solutions that comprise not only of distributing RUTF and the IYCF but also behavioural change programs that will address these other socio-economic, cultural and religious issues that largely contribute to the problem . Celestina Obiekea (Connected Development)
Considering its resultant effect on the development and growth of infants, malnutrition has always been a thing of concern. However, prior to my visit to the CMAM Centre in Kaduna, this concern sat comfortably at the back of my mind. But the volume of infants suffering from malnutrition opened my eyes to the fact that malnutrition is a critical national health emergency which the government should make a major priority. Usman Shamaki (Writer)
On arriving the CMAM Centre, I was overwhelmed by the level of acute malnutrition. I saw malnourished children, the replica of the horror pictures I had only seen in photographs of the Civil war of 1967 in Nigeria. More so, these malnourished children taking RUTFood were being cared for by equally malnourished mothers and fathers who are not empowered for fatherhood. Jenny Chisom (Blogger)
Before my visit to the CMAM centre in Kaduna, I was used to seeing the disturbing pictures of starving children online and I thought they had to be Ethiopians from the crisis in the seventies and eighties.. Never for one moment did I believe that those children were Nigerians, living in the country termed “Land of Milk and Honey”. Sadly, the cases of malnutrition are on the rise while the government is happily waiting on the NGOs to come to her rescue. We must win this battle; the Federal Government should produce our RUTF or make an alternative available. Demola Adetona (Public Relations and Digital Media Enthusiast)
Nigeria has a National Policy on Food and Nutrition, prepared by the Ministry of Budget and National Planning in 2016. This follows from the high-level declaration made in December 2016 to end malnutrition by 2030; in line with the Sustainable Development Goals (SDGs). In isolation, these pledges cannot come to fruition without adequate funding for nutrition and other high impact interventions. At present, many states have not even met their existing commitments for co-financing nutrition interventions. This situation is untenable, especially as donor fatigue may see development partners reduce their funding to support countries like Nigeria. What then? How will the funding gap be met? The outrage among the general public at the extent of malnutrition in Nigeria is muted, we found through discussions with the wider Nigeria public that many are unaware that severe acute malnutrition is at crisis point in Nigeria. Visiting a CMAM site, we found that there is so much that needs to be done, but in the first instance we need to really ask ourselves, “Why is malnutrition at crisis point in Nigeria, and yet many are so ignorant about the extent of the issue”?
Continue the conversation, send in your answers to the question above. Tweet your support using the hashtag #FeedNaijaPikin and tag your friends. Inform yourself about malnutrition. Also, remember to, “advocate to make nutrition a line item in your state budget”. Make every effort to gain access to your elected representatives at state level- face to face or via social media and demand that they take action.