Written by Ijeoma UKAZU

Nigeria’s malnutrition conundrum

Among under-five childhood killer diseases, malnutrition alone bears 53 percent, hence making child survival difficult in Nigeria.

The magnitude of problems caused by malnutrition is severe; malnourished children with a high risk of disability, premature death and are highly predisposed to infectious diseases. Nigeria bears one of the highest burden of malnutrition in Africa and in the global space.

According to the National Demographic Health Survey, NDHS 2013, malnutrition is a leading cause of under-five death with 53 percent, neonatal put at 29 percent, malaria 20 percent, diarrhea 11 percent, pneumonia 14 percent, HIV 4 percent, injuries 3 percent amongst others.

The situation calls for urgent intervention as the future of the Nigerian child is threatened following several reports showing worsening nutritional status of children in the country.

It is even more telling when one takes into cognizance assertion by Mr. Bill Gates, Country Director, Bill and Melinda Gates Foundation, that "Nigeria is one of the most dangerous places in the world to give birth with the fourth worst maternal mortality rate in the world ahead of only Sierra Leone, Central African Republic and Chad. One in three Nigerian children is chronically malnourished."

Gates’ claim has a link provided by a recent survey carried out by Nigeria Bureau of Statistics with support from United Nations Children's Fund, UNICEF, the Multiple Indicator Cluster Survey, MICS 2016/2017, shows that malnutrition burden in Nigeria is skyrocketing with predictable outcome if the looming danger is not addressed.

The study shows that stunting, wasting and underweight rates have worsened in the country when compared to the same survey in 2015.

The 2017 MICS puts Nigeria’s stunting rate at 43.3 percent, as against 32.9 percent in the 2015 survey. It shows that in 2017, the rate of wasting was 10.8 percent, while in 2015, the figure was 7.2 percent. The study also shows that underweight rate in the country was at 31.5 percent in 2017, while in 2015, the rate was 19.4 percent.

Global records recently showed that while stunting and other forms of malnutrition have reduced worldwide, from 198 million to 151 million people, the burden is presently increasing at an alarming rate in West and Central Africa, from 22.8 million to 28.8 million people.

The study by MICS has now shown that Nigeria is playing a major part in the increased burden of malnutrition in West Africa, and by extension, globally.

Health experts say, stunting is referred to as low height for age and it is caused by long term insufficient nutrient intake. Its effects after age two are irreversible.

Wasting on the other hand, is referred to as low weight for height and it is usually the result of acute significant food shortage.

An earlier report by UNICEF showed that about six million children are stunted in Nigeria, with more than half of them severely malnourished.

UNICEF says children from rural areas are twice as likely to be stunted as children from urban areas, adding that a child whose mother has no education is four times most likely to be stunted than a child whose mother has secondary or higher education. It also noted that children from the poorest 20 percent of households are also four times more likely to be stunted than children from wealthiest 20 percent of households.

This survey has shown that the Nigerian government, states and local governments, healthcare stakeholders and the citizens still have a lot to put into eradicating malnutrition in the country, if indeed the country wants to improve on its health indices, as well as its economic development.

Global bodies have established that there is a correlation between the healthy nutrition indices of a nation and its economic prosperity.

Globally, stunting is an indicator for measuring a country’s development. Experts worry that Nigeria may be breeding a generation of malnourished leaders. Several factors have been identified on why malnutrition is gradually eroding the future of young Nigerians.

World Health Organisation, WHO, classified malnutrition as chronic (stunting) and acute malnutrition (wasting). WHO specified that prevalence 40 percent of stunting is considered critical while wasting as high as 10 percent and above is also critical and should be considered an emergency.

But recent data available to date indicates child nutritional status levels are below the WHO classification.

Looking at the National Data from the 2013 NDHS, more than five million newborns in Nigeria lack essential nutrients and antibodies that would protect them from diseases and death as they are not being exclusively breastfed.

For Lagos State, under the 2017 malnutrition report in the Partnership for Improving Nigeria Nutrition System, (PINNS) project as its focal states doesn’t fare better. According to the 2013 NDHS, Lagos recorded stunting rate of 17 percent, and 11.3 percent for wasting.

The MICS 2017 states that Lagos State recorded insignificant improvement in stunting, while wasting prevalence rate went up to 11.4 percent. In the report, Lagos tops the list of states with a high rate of wasting while Kano State tops states with high stunting rate at 58 percent.

Analysts and experts opined that these negative results indicate an alarming trend in Nigeria’s malnutrition burden which will further impede the nation’s economic development if not checked.

Experts also said, in low and middle income countries like Nigeria, the age 3-24 months is a time when growth falters for too many children.

 

An inadequate diet during this period increases the risk of stunting, micro-nutrient deficiencies, illnesses and death. Some of the factors identified include poor infant feeding and attitude of mothers to Exclusive Breastfeeding, (EBF).

The Nigeria Demographic Health Survey, NDHS 2013, put the country’s exclusive breastfeeding at 17 percent while the 2016/2017 MICS revealed a little increase of 23.7 percent. While there is little improvement from the 2013 NDHS, the rate is still below global rate of 50 percent and other neighbouring countries like Ghana where the rate was 52 percent in 2016.

Making her contributions, the Executive Secretary, Civil Society Scaling-Up Nutrition in Nigeria, CS-SUNN, Mrs. Beatrice Eluaka, said malnutrition remains a key contributor to infant and maternal mortality and morbidity, poor cognitive development, increased severity of diseases which adversely affects productivity in Nigeria.

Eluaka, who explained that nutrition is associated with food and how the body utilises the food to grow, to keep healthy and to prevent certain diseases, commended the Lagos State Government for extending maternity leave for female civil servants to six months and introducing a 10-day paternity leave for fathers.

She said Exclusive Breastfeeding, EBF, also prevents malnutrition, noting that the six-month leave policy is a step in the right direction towards promoting EBF.

To encourage exclusive breastfeeding, the Minister of Health, Prof. Isaac Adewole, revealed during the 2018 World Breastfeeding Week, said that the Ministry of Health was working closely with the Ministry of Labour to extend maternity leave in Nigeria from four to six months.

Adewole urged the ministers and other key stakeholders involved in the process of implementing this policy to fast-track the process of this extension as it will go a long way to encourage and boost Nigeria’s EBF rates which will contribute to a reduction in malnutrition.

Explaining the PINNS Project, Eluaka further said that it seeks to strengthen the country’s nutrition systems to be more result-driven, effective, serviceable, efficient and transparent in delivering on their mandate.

She said "it is aimed at holding government accountable on commitments made to allocate, release and use transparently, funds for implementation of high impact nutrition interventions in Nigeria through evidence-based advocacy.

"This project will also contribute to a reduction in malnutrition particularly among women and children in Nigeria as it is focused on strengthening governance, policy implementation, effective coordination, financing, building the capacity of state actors, generation and effective communication of evidence as promoting accountability."

Eluaka however noted the role of the media in the fight against malnutrition as CS-SUNN recognises that the media are instruments of mobilisation, awareness creation, information exchange and dissemination and that they have a great role to play in setting nutrition as an agenda for public discourse.

 

Mrs. Lilian Ajah-mong, Communications Officer, CS-SUNN, in her presentation, said the overall goal of PINNS was to contribute to the reduction of malnutrition among women and under-five children.

Ajah-Mong however identified challenges to malnutrition to include ineffective coordination of nutrition activities of actors at the national and sub-national levels, inadequate fund allocation and releases for implementation of nutrition plans in the annual budgets, limited visibility of nutrition issues, and none use of evidence for action by policymakers.

Other key systemic challenges she identified include; uptake of preventive measures for combating malnutrition such as exclusive breastfeeding and optimal Infant and Young Child Feeding, IYCF, practices rates in the country is still very low and need to be improved upon.

She however said the PINNS project is geared towards strengthening nutrition governance, transparency and accountability in the use of nutrition funds, adequate financing and effective coordination amongst others.

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