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A powder to fight ‘hidden hunger’

Food rations are doled out on camp, but Munir “couldn’t even eat a full meal a day,” his mother, Aisha Mohammed, 30 recalls.

NYSC Orientation Camp once sheltered graduates on compulsory national service for three weeks every year. Now it shelters more than 4,700 people displaced from their homes by Boko Haram insurgency.

Nearly 1,000 of them are children aged under five. Among them is Mohammed Munir, 1. He and his three siblings and mother are among the newest arrivals on the camp.

Food rations are doled out on camp, but Munir “couldn’t even eat a full meal a day,” his mother, Aisha Mohammed, 30 recalls.

A community nutrition mobiliser doing the rounds with mothers and babies on the camp chanced upon Munir and referred him to the “clinic”—an outpost that serves the purpose of health facility for residents on the camp.

“He was not eating well. He even developed some infections,” his mother recalls.

A micronutrient powder programme was on for children aged between six and 23 months. At 10 months, Munir was eligible. He was fed complimentary food from his family’s meal.

For each feeding, his mother dished a portion she judged was sufficient. She then added a bit of a micronutrient powder she had been provided at the clinic—three pouches of 30 sachets expected to last a total 90 days.

After the first 90 days, mother and child would take a break for another 90 days, then return for a second dose of three pouches.

Yagana Ngoma and her son Musa

Each 1g sachets delivers per serving vitamins A, C, D, E, B1, B2, B6, B12, niacinamide, folic acid, iron, zinc, copper, selenium and iodine. The delivery is exactly the reference nutrient intake based on the national guidelines for micronutrient deficiencies control in Nigeria.

Micronutrients—you know them as vitamins and minerals—are essential components of good quality diets. They have a profound impact on health. They are required in tiny quantities but are essentially the building blocks of healthy brains, bones and bodies.

The first 1,000 days of life is an important window of opportunity to ensure good nutrition. It starts the moment a baby is conceived—and the mother’s nutrition before and after that pivotal point—and continues with six months of breastfeeding.

At this point, the mother’s milk is hardly able to provide all the needs of a growing child. Complimentary infant and young child feeding is introduced.

But the vagaries of diets, food security and basic nutrition have been seriously impacted by the insurgency in the north east.

1g sachets of micronutrient powder

Powdery means

Micronutrient powder is a means to improve quality of young children’s diets once they go on complementary feeding at six months of age.

On four camps for displaced people in Borno—NYSC camp and Teachers Village in Maiduguri Municipal, Gubio Road camp in Konduga and Muna IDP camp in Jere—mothers are turning to micronutrient powder to fortify their children’s diet with vitamins and minerals.

“When I carry the baby, I notice his weight is increasing compared to before. Even his looks are shiny now,” says Mohammed.

“My expectation is that he will improve more. And I am going for the subsequent visit after three months.”

Micronutrient powders added into solid, semisolid or soft food ready for consumption by children are not new. The World Health Organisation has documented studies indicating on average, MNPs reduce anaemia in infants and young children up to 23 months by 26% and iron deficiency by 52%.

The United Nations Children’s Fund has been procuring MNPs on behalf of 80   countries since 2007—a third of them low-income countries. Demand for MNPs in sub-Saharan Africa has increased since 2013, accounting for 30 countries.

Outside of camps for displaced people, MNPs have also been part of maternal, neonatal and child health weeks in communities as far as Benue and elsewhere, according to a study in the journal Public Health Nutrition.

One of the telling effects of MNP is a boost in appetite. Mohammed noticed it in her son.

“He couldn’t eat a full meal a day, but here he was eating three, four times daily,” she says through a translator.

Women on all four camps observe the same effect. For some time, the observation was counterproductive. They are in dire straits, livelihoods upended, scrimping to feed and depending on handouts—and now having an infant with a bursting appetite to handle.

“When you refer women for MNP, they reject it, saying how can they go collect something to boost appetite when they have nothing to give to the child?” says Fatima Mohammed, a community nutrition mobiliser, one of a handful working to identify children in need of MNP on NYSC camp.

“We tell them there are essential nutrients the child needs in this window period. You miss it, you miss it forever.”

One of Aisha’s twins gets middle upper arm circumference test, used to determine level of malnutrition in children

Healthy but needy

Children born in or being raised on camps for displaced people are vulnerable. But so too are children outside of the camps.

Displacement, the rise of IDP camps and their strain on host communities are taking a toll on food security.

Food rations come into NYSC orientation camp for displaced people. But the host community surrounding it are under strain and getting little aid. Some 300 children so far have been registered for micronutrient powder supplement, but many of them are coming from host communities outside of the camp.

The running goal for micronutrient supplementation is catch all children aged six to 23 months—that’s what it takes to be eligible.

“A child can look healthy and still be deprived of one or more nutrients,” says a staff of Borno state government working with UNICEF on the project. He can’t speak on behalf of either the government or UNICEF, but he is knowledgeable about how and why the programme runs.

“These are IDPs living on support of international nongovernment organisations and government. They don’t have the food that has the content of all nutrients. They most always are using one food—carbohydrate. They can get nutrients from soup but they don’t use soup always—just yaji.”

Balu Aji and her son Abba on Muna camp for displaced people in Maiduguri

Yaji is the mix of groundnut and pepper commonly used as condiment and sweetener in foods in the north of the country.

“We are not after physical look,” the staff goes on. “Once the child is six to 23 months, we provide micronutrient power, because there is possible deficiency of micronutrients.”

That is advice for mothers like Falmata Mohammed and Mariam Mustapha. They live in Shuwari, an inner city suburb of Maiduguri, not on camps for displaced people. During assessment, their children at seven months of age did not typically fit the spectrum of malnutrition, but they are on the supplement nonetheless.

Mustapha in particular exclusively breastfed her baby for six months. Just when she was start complementary feeding, the community nutrition mobilisers came to her doorstep.

“I have received counselling in monthly support group meetings with the mobilisers and they have told us the micronutrient powder is essential to the development of children’s brains,” she recalls.

“I have seen my baby improving rapidly in health and eating habit.”

The support group meets a day or two every month, according Fanta Aji, community nutrition mobiliser on the Gubio Road camp.

Before that, for the first 10 days every month, community nutrition mobilisers hunt for children aged six months and above to be placed on micronutrient supplement.

Like twin boys Hassan and Hussaini born to Aisha Mohammed. Her twin babies were seven months old when they started on the powder. Their first supply is for three months each and they would go three more months before their next supply.

They live on a camp for displaced people on Gubio Road on the outskirts of Maiduguri. They were forced to live the camp briefly to attend to family needs and only returned after the three months of rest ended. Aisha cannot read, and the community nutrition mobiliser is following up to ensure she does not miss her next supply of the powder.

The four last days of every month is for follow and Aisha will be getting a visit.

Aisha and her twin sons, the last of four children

Food, not medicine

On the other end of town is the camp for displaced people in Muna, Jere council area, merged into what’s become the Maiduguri metropolis.

Balu Aji was on a routine visit to the camp clinic with her son Abba when she chanced upon the micronutrient supplement. She has been faithfully administering it on her son—and is just ending her first month of rest.

“When I started, I had challenges,” she says.

“He was vomiting and had diarrhoea. But I knew the powder wasn’t a drug and couldn’t be responsible for that. I continue until his system got used to it. Both the vomiting and diarrhoea stopped.”

Recently displaced, Yagana Ngoma arrived on the camp with a 12-month-old baby Musa. She is yet to go for her baby’s second supply but shes already passing the message on to other women. Six women have visited to get micronutrient powder for their children since she spoke with them, she says.

Her message: “It is food, not medicine.”

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