Tackling malnutrition in children under-5

Three-year old Abdulhamid was one of the children brought by their mothers to the integrated mobile medical outreach carried out by the United Nations Children’s Fund (UNICEF) in collaboration with the Kaduna State Government and other partners in Kabobo community, Afaka Ward, Igabi LGA.

The MUAC test showed Abdulhamid had Severe Acute Malnutrition (SAM), and because he had swollen feet and stomach, medical experts at the scene suggested immediate medical attention to check complications and other health conditions.

SAM, the worst form of acute malnutrition, refers to the condition where the Mid-Upper Arm Circumference (MUAC) measurement is less than 115mm or weight for height (wasting) less than minus 3SD z-score below the median in children six to 59 months old.

Hajara Abdullahi, resident of a neighbouring village, came to the outreach with her six-month old daughter. She said that her daughter had become very emaciated and was vomiting, stooling and having a fever. She also lamented that she had not been producing breast milk to feed the baby.

Test on her daughter  at the outreach showed she was severely malnourished. Hajara was given some packs of Ready-to-use therapeutic food (RUTF) to administer on her.

Hajara was among many mothers of children suffering from malnutrition and other health conditions in the LGA.

The Mai Angwa of Kabobo, Alhaji Abdullahi Kabobo, said the community lacked a Primary Healthcare Centre (PHC) and that the children suffering from malnutrition and other diseases such as measles and pregnant women had to be taken all the way to the PHC in Mando Ward – over five kilometres away – whenever they fell ill.

He said, “We need a treatment centre for malnutrition in this community. We also need supplies of RUTF to treat the malnourished children. We also need food demonstration programmes on how to provide nutritious foods for the children.”

The Nutrition Officer in Igabi LGA, Lami Adama Abdullahi, said many children in the community and neighbouring areas suffered from malnutrition. She said that as a result of the lack of PHCs they were usually referred to the PHC in Mando.

She called on UNICEF to assist the LGA with RUTF, noting that there was a shortage of it due to the large number of children suffering from malnutrition.

Salamatu Balarabe, Health Secretary of Igabi LGA, also said the major challenge in tackling malnutrition in the LGA was lack of RUTF. She said it affected the instant treatment of severely malnourished children after MUAC checks had shown the need to admit them in their CMAM site.

She further said, “We don’t even have the RUTF available now. We are trying to make kunu lafiya (health pap) but RUTF contains so many things and provides better treatment with supportive drugs.”

While harping on the need for a medical facility in the community to expand access to medical care, particularly for women and children, she noted that the integrated mobile medical outreach had helped in assuaging the suffering of the people travelling far to access care.

She further said it had helped provide access to immunisation, nutrition services and medical treatment.

According to Nemat Hajeebhoy,  the Chief of Nutrition, UNICEF, there are between 35 and 40 million children under-five in Nigeria, with one out of three children in Nigeria suffering from stunting, about three million suffering from severe wasting and close to 60 per cent anaemic.

She said Kaduna State was estimated to have about 1.5 million children under-five and that the average for Kaduna State was higher than the national average.

She noted that, “So, instead of one out of three children being stunted, one out of two children is stunted or 50 per cent of them. We have quite a high rate of wasting; about five per cent. And we also have about 50 per cent of children being anaemic.”

The need to fight malnutrition in children under-five and generally ensure children are healthy inspired Hajeebhoy’s mission to Kaduna State in February. She embarked on field visits to the government, nutrition stakeholders and partners, as well as a field visit to UNICEF-supported integrated intervention sites involving nutrition and others.

Explaining the malnutrition situation in Kaduna, Chinwe Ezeife, Nutrition Specialist, UNICEF Kaduna Field Office, said, “The indices were poor, or some are still poor, but a lot of improvements have been recorded over time.”

She explained that, “Stunting rate is still at 48.1 per cent. That means over 750,000 children in Kaduna State are stunted. For child wasting, we have 4.8 per cent; that represents above 150,000 children, and there is a severe wasting burden of over 61,759.

“However, there are disparities in some communities, especially the ones that have hard-to-reach areas where you travel over five kilometres without having any health facility. When we isolate such communities, the SAM rate of 1.1 per cent, according to the 2018 National Demographic and Health Survey (NDHS 2018), will not stand. In some of those areas, it may range up to six  per cent and above.

“Under-five children anaemia is still high, over 48.40 per cent, meaning about 754,835 cases. Anaemia in pregnancy is also part of the contributing factors to these indices. Because there is still low birth weight, and anemia in pregnancy is 64.20 per cent.

“Some indices have improved over time. For instance, the exclusive breastfeeding rate stands at 41 per cent. Dietary diversity is low. The minimum acceptable diet of 12 per cent and meal frequency of about 13 per cent show that the dietary diversity is low. And without improving dietary diversity, we may not be able to get these children to get the adequate nutrients required for development, especially the brain development that is required.

“That’s why some of our major programmes now are concentrating on that 1,000-day window of opportunity. That’s from conception to two years. We want to do very important high impact low cost interventions. That’s also why we’re bringing in multiple micronutrient supplements for pregnant mothers to supplement them to ensure that in vitro, the child is already developing well.”

Ezeife added that the Governor of Kaduna State, Uba Sani, had committed to N500m for the nutrition fund, and that UNICEF would match and procure the equivalent of N500m worth of RUTF multiple micronutrient supplements and other types of nutrition commodities.

On the shortage of RUTF, Nemat Hajeebhoy, UNICEF Chief of Nutrition, said UNICEF was offering the federal government and states a unique opportunity through what was called the Child Nutrition Match Fund.

She said, “In that, if the state puts in one naira, we will match with one naira, and that can be used to procure commodities like RUTF which are in short supply.

“The Governor of Kaduna State has committed to putting money into the Child Nutrition Fund. My request to the state is to make sure that happens quickly, and to release the money. We can then match it and help the state to procure commodities.

“For us, RUTF is a last resort. It is used when a child is really sick and needs treatment. We always say that prevention is better than cure. We want to prevent it. First, what we would like to do as UNICEF is partnering with the state to make sure that our children don’t get wasted or stunted.

“If you look at the data for Kaduna State, for example, one of the easy things that mothers can be supported to do is to initiate breastfeeding early, and to exclusively breastfeed children for six months. But in Kaduna State, only one out of 10 children is put to breast early, and only one out of two children exclusively breastfeed. We need to really push the breastfeeding rates up.

“We want to ensure that all children are adequately breastfed, and that all children get the food that they need. If that happens along with immunisation, then we will have very few children who will need RUTF.”

Speaking on the implications of malnutrition in children, UNICEF’s Nutrition Officer in Abuja, Nkeiruka Enwelum, said, “Inadequate nutrition has lots of consequences on general health and wellbeing and on how often you fall ill. There is also the implication of increased mortality, especially in children less than three years of age and in women of reproductive age as the main population groups of concern.

“The foods that we eat give us different things in our bodies. Failure to eat some of these things in the right quantities can result in poor growth and development in the body.”

On Kaduna State, she said it was commendable that political will had been secured from the government, but that a lot needed to be done.

She further said, “Every child in Kaduna State deserves to get their Vitamin A supplementation, their Albendazole. Pregnant women must receive their multiple micronutrient supplementation. And essentially, we want to see a Kaduna State where no child or woman is malnourished.”

During the mission, the UNICEF Nigeria Chief of Nutrition, Ms Nemat Hajeebhoy, led a delegation on an advocacy visit to the Deputy Governor, Dr Hadiza Sabuwa Balarabe, at the Sir Kashim Ibrahim House.

She said UNICEF was committed to close partnership with the state government towards reducing malnutrition in children under-five in the state.

Hajeebhoy noted that her visit was also geared towards discussing how to jointly work with the state government to support Igabi LGA, including the Tudun-Biri community, on improving the health and wellbeing of mothers and babies.

She called on the state to transition from iron-folic acid to micronutrient supplements, adding that UNICEF was willing to provide support for the transition.

Dr Hadiza Balarabe thanked UNICEF for its support for the state over the days, saying it spanned many sectors, including nutrition.

She said the state was planning to establish nutrition corners in all under-five facilities and other things in order to change the malnutrition narrative in the state.

She further said, “We will continue to partner with UNICEF. Kaduna State is a state that believes so much in partnership because we know we cannot continue everything on our own. We can do a lot with collaboration.”