Homegrown alternatives to beat malnutrition

Is the solution to malnutrition a power food packed noodle style? Or does it lie in changing how families farm or eat?

A health policy dialogue convened by Nigeria Health Watch has been considering local alternatives to fight the malnutrition ravaging Nigeria’s children.

It has spawned a social media campaign #FeedNaijaPikin. Up to 2,000 children face severe acute malnutrition each day—and the risk of dying from it.

One option is to find local recipes that can stave off or treat malnutrition and market it to families across the country.

At present, severe acute malnutrition (SAM) is treated with ready-to-use therapeutic food—a high-energy, high-protein “power food” packed with minerals and vitamins to pull children with SAM from the brink of death.

It is not produced in Nigeria. The United Nations Children’s Fund ships it in from South Africa for use in centres where it helps communities manage acute malnutrition.

After weeks, this child is picking up weight after treatment for severe acute malnutrition in Bakori, Katsina

Local solution

The urge for a local solution came after Bangladesh tried a different “power food”—a halva semolina recipe, with some sugar, fortified with micronutrients and cooked in ghee (or clarified butter).

The Catholic Relief Services has recently piloted use of Tom Brown—a meal of maize, millet, soya milk and groundnut—in Yobe State.

It found after some weeks, children with moderate acute malnutrition (MAM) fed  Tom Brown “transited from MAM and recovered,” said Adia Oro-ghene, a senior programme manager at the organization.

A separate 2016 recipe for malnutrition drawn up by a project Working to Improve Nutrition in Northern Nigeria showed Tom Brown contains at least 154 kilocalories per serving. It has protein and fat, is short on vitamin C but makes up with a good measure of vitamin B6, niacin and calcium. It put the meal cost at N2.74 a serving.

The project lists five other recipes, all costing less than N20 a serving.

But a family’s food in parts of the country worst hit by malnutrition are sourced by men.

Getting them to choose the right foodstuff is crucial to getting anti-malnutrition recipes into homes, says Oro-ghene.

“There is great need for education of men who buy the food for the family.”

“The higher north you go, the fewer women who farm,” said Dr Maryam Al-Mansur, maternal and child nutrition expert, founder of Arewa Cafeteria, which promotes health nutrition.

“Having a woman with a veil on farm? No. If you want to tackle malnutrition, it has to be at state level and lower, not national.”

A child is fed RUTF at a centre for community management of acute malnutrition in Zamfara.

“Power Food”

For years, moves have been on to push local production of RUTF—the ready-to-use therapeutic food used to treat SAM.

Millions of dollars of UNICEF funds go into purchasing RUTF yearly. Counterpart funding for the product from state governments is insufficient, but UNICEF swears by RUTF.

Local production of RUTF is an option but fraught with problems. Concerns exist over groundnut contaminated with aflatoxins. And the product has to go through three different levels of quality assurance before market.

“We don’t think local; that’s our problem,” says Ayodele Tella, of the Post-harvest Loss Alliance for Nutrition. “We think everything must be foreign.”

After Dangote, only two other firms have spoken of interest in starting RUTF production. One firm began production last year, but its output is hardly enough to meet market demand.

“Indomie-ised” RUTF

Indomie is a popular noodle brand in Nigeria, popular among middle and low-income families, and one option is to package and market local anti-malnutrition recipes in similar fashion. It could be a long step in infant and young child feeding practice.

“Most of the communication we do don’t look at what noodle sellers do,” says epidemiologist Emmanuel Benyeogor.

“Mass media campaigns should be thinking like a marketer. Noodles sell a million pack a day and the same people who don’t have money, who you want to give free medicines, will use the little money they have to buy noodles.”

The target is “disruptive innovation”—say, an app linking local food makers and sellers and health policy that recognizes their role in the food chain.

“You want to feed naija pikin, the fight should be on instigating disruptions, letting small guys do what the big guys do.”

Under the baobab–Parents in Ruga Bagga, Katsina, gather in support group for exclusive breastfeeding, which has helped them stave off malnutrition in their children

Movement

Groups that work in nutrition believe an indomie-ised RUTF will provide food that children can eat every day—much in the same way children already eat noodles at will—and not become malnourished.

It is a deviation that countrywide plans and policies food and nutrition haven’t figured, and remain inactive.

“We have beautiful plans of action,” says Beatrice Eluaka, coordinator of the Civil Society Scaling Up Nutrition in Nigeria.

“When we go out for conferences, we get applauded but our plans of actions end up decorating our shelves.”

“How did we get to SAM and MAM when we are not at war?” says Chioma Kanu, programme officer at the Civil Society Legislative Advocacy Centre.

“I can understand the northeast but northwest? It is because we have deviated and buying cakes rather than fruits. We need to start nutrition education in the household.”

The obstacle disruptive innovation will address is creating access to food after quality is taken care of.

It happened with sticking a visible brand to iodised salt and vitamin A, even though nearly all salt brands on the market are iodised as a rule.

“The foods we eat are fortified but we are not promoting them,” says Francis Aminu, of Dangote Foundation.

“The Indomie you see today didn’t come out of thin air. They went through health workers. Once a healthworker adopts it, you can’t stop.

“People identify with products. If you are promoting [infant and young child feeding] and there’s no product people can identify with your message, it won’t go a long way.”