Prioritize the first 1000 days of a child’s life — UNICEF

Nemat Hajeebhoy is the Chief of Nutrition, United Nations Children’s Fund (UNICEF) Nigeria. In this interview, Hajeebhoy, who was on a recent field visit to Kaduna State speaks on malnutrition in children under-five in Nigeria, and UNICEF’s commitment towards supporting Kaduna State in tackling malnutrition in children, among others.

Can you briefly tell us about the malnutrition rate among children under-five in the country, and Kaduna State in particular?

There are between 35 and 40 million children under-five in Nigeria. There are different forms of malnutrition. One is stunting, which means that children are short for their age. This is an indicator of chronic malnutrition. One out of three children in Nigeria suffers from stunting.

The other form of malnutrition is wasting, which is when children are too thin for the heights that they have. In Nigeria, about three million of the 35 million children are estimated to suffer from severe wasting. That is a very high number by global standards.

Then there is anaemia. The last Nigeria Demographic and Health Survey done in 2018, revealed that close to 60% of our children are anaemic. Which means that they don’t have enough iron.

Kaduna State is estimated to have about 1.5 million children under-five. And in Kaduna State, the average is higher than the national average. So instead of one out of three children being stunted, one out of two children is stunted or 50% of them.

We have quite a high rate of wasting; about 5%. And we also have about 50% of children being anaemic.

And we need to do quite a bit here in the state to make sure that children are healthy.

How important is adequate or proper nutrition in children under-five?

It is absolutely essential and vital. This is the period in our lives as human beings with the most rapid growth.

The first 1000 days of life from pregnancy to the time a child is two years of age is the most important for us as human beings and we tend to forget that.

Human beings are also mammals, and the specialty of mammals as a species is that we breastfeed our young ones. The reason we breastfeed is that breast milk has the required vitamins, minerals and hormones that are needed for the child’s growth to be complete.

If a mother during the first 1000 days from when she is pregnant, breastfeeding; and when a child is born to when he or she is two years of age, doesn’t get the required food, the child will become malnourished and that is a guarantee. If children become malnourished during this early age, especially if they get stunted, it cannot be reversed. So, the deprivation is there for life.

That is why Akinwumi Adesina who is the head of the African Development Bank says if you are investing in nutrition in the early days, you are investing in ‘gray matter infrastructure’. That means you are investing in brain development, and the human capital of the country. And he always calls for attention to that.

Therefore, it is absolutely vital and critical to our growth. I also tell people to think of a car; if you have a car but you don’t put fuel in it, will the car run? So just like that, if you have children and you don’t feed them well, they will not be able to grow well.

You went on a field visit to Kabobo community, Igabi LGA earlier. What was your assessment of the UNICEF-supported integrated mobile health outreach work for children being done in collaboration with the state government?

There are some hard-to-reach LGAs in Kaduna State. Igabi LGA is one of them, which means access to services is not possible all the time. In such LGAs, there is deprivation in terms of services for children.

We went to a school, in that community, and the women’s leader said that there were 30 communities around with only that one school that has poor infrastructure with two classrooms. Thus, there is no way the children can learn fully.

Water and sanitation facilities in such places are usually not available, and if available, are not well maintained. So, in that type of environment, children are going to fall ill and be malnourished. So, a large number of the children were either stunted or wasted.

Though testing for anemia was not done during the visit, a large proportion of those children are likely to  be anemic.

What struck me during the visit was when I looked at the cards the mothers and children had. For example, I talked to one mother who has an18 months old baby and came to get her child vaccinated for the first time. That means at 18 months the child has not received any vaccinations. That is quite serious.

Sometimes children will miss a dose but this child has not received anything.

Another mother that I spoke to has a six months’ old child that had received initial vaccination like the first two or three vaccines like Bacille Calmette-Guérin (BCG), etc. But since then, no other vaccinations have been received by the child.  So that was an opportunity also for that child to catch up on the vaccination.

The mothers were very vibrant, and were willing to walk 15 to 30 minutes to the outreach camp. But it means that these services need to be provided more frequently.

Some of the mothers at the outreach lamented the unavailability of ready-to-use therapeutic food (RUTF) for their malnourished children. How is UNICEF going to help the situation in such localities?

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 the breast early, and only one out of two children exclusively breastfeed. We need to really push the breastfeeding rates up.

Only one out of three children is getting the diverse diet that they need at six months of age and beyond. We need to really improve children’s diets every day. A child must get four out of seven food groups. Like they must have starch, some vegetables, some oil and fat and ideally some protein. If children don’t get that, then they are going to become malnourished.

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.

On the shortage of RUTF in Kaduna State, UNICEF is offering the federal government and states a unique opportunity through what is called the Child Nutrition Match Fund. 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.

What is your advice to Kaduna State and Nigeria in general when it comes to nutrition in children?

My advice is that we have to prioritise our mothers and children, especially those in the first 1000 days of life. We need to scale up the coverage of all the preventive tools we have at hand such as vitamin A supplementation, multiple micronutrient supplementation, breastfeeding, feeding children, and diverse diets.

So, we need to scale up to 70 to 80% coverage. That means the health system and the food system need to come together and work hand-in-hand to make sure that our mothers and babies have both the health and the food that they need to live well and lead healthy lives.

Secondly, the government, whether at the LGA, state or at the federal level, needs to unlock resources to put into nutrition. Right now, we know that there is a big gap in what is needed to sustain the coverage of nutrition interventions in the country.