Malnutrition is said to be a pathological condition brought about by inadequacy of one or more of the nutrients essential for survival, growth, development, reproduction and capacity to learn and function in the society. This is invisible, yet deadly. Breast, which is the ‘first kitchen’ for the baby’s meal, remains a therapy for attacking this malady. As such, experts insist, infants should not be deprived of this nature’s take away food. ISIOMA MADIKE reports
Oluwatoyin Mordi, who lives in Otuke Village in Sango Ota, Ogun State, has seen many of her community’s children suffer from malnutrition, some of them dying as a result. The 32-year-old feels fortunate that she didn’t lose any of her own. She fed two of her babies with water as well as breast milk during the first six months of their lives, but only because she didn’t know other better options. “I didn’t know I should have given them only breast milk at that age. I only learnt that later at the Ifako General Hospital, Agege, Lagos, where I had gone to see a friend, who newly gave birth to a baby at the health centre in February, 2018. I wish I knew what I now know then,” she explained with regret etched into her voice.
Amaka Chibuzor, 36, is also a mother of two young children. Her first baby was often sick and used to cry through the night, but after learning about better breastfeeding practices, Chibuzor changed the way she feeds her second baby, now four months old and in good health. She said: “With this child, I can sleep well because he is not ill. I breast-fed him immediately after birth and had given him no other foods thus far.
Even when he is ill I still breastfeed him because now I know it is important.” This is a sharp contrast to Clara’s first experience with motherhood when she fed her baby boiled sugar, water, and butter, which made him ill often. This was due to misconception and lack of awareness that breast milk is a complete meal for an infant. “I often took him to the primary health centre at Alapere-Ketu, Lagos, where I live, with abdominal cramping, diarrhea and vomiting. The health bills were always making me broke,” she recalled.
Relieved and smiling, another woman, who preferred to be identified simply as Ofunne, recounted the ordeal she had to go through a few years back in her Egbeda, Lagos abode. Her youngest child, Emmanuel, unexpectedly fell ill and Ofunne had no idea what to do.
“He is smiling and being playful now that he is cured. You should have seen him when I took him to the hospital. He could not eat and his temperature was very high and he looked frail,” she said. For almost a week, then one-yearold Emmanuel was unwell and had a very high fever. With each passing day, he became weaker and a neighbour advised his mother to seek treatment at a primary health care facility in their neighbourhood, where integrated nutrition services were provided.
“I was very worried. I had never seen this before and my other child had never suffered from this disease. Things were tough and I didn’t know whether the fact that we were struggling to find enough food had anything to do with it,” she told Saturday Telegraph. Ofunne, with little education and two children under the age of three, relies solely on her husband for survival. The man, an Okada rider, who also grows crop on a small rented piece of land, has lately been struggling to harvest enough for food and sale. As a result, the household has had very limited food intake, with the youngest, Emmanuel, being the most affected. After screening, Emmanuel was found to have severe acute malnutrition. He also had a high fever and no appetite after initial medical assessment.
“We had to transfer him to a Stabilisation Centre for in-patient management of severe acute malnutrition with medical complications in a general hospital. “We needed his medical condition to be stable first so we could handle his nutritional rehabilitation,” said a nutrition services provider at the centre, who preferred to remain anonymous. Two weeks ago at another primary health centre in Gbagada, Lagos, one and half-year-old Bolanle gave a loud cry as she was placed in the spring scale with her legs dangling in the air.
A health worker quickly noted down her weight, lifted her out and returned Bolanle to her mother. The news was not good. Bolanle weighed five kilos, only two thirds the average weight of a normal toddler her age. “My baby is very ill,” said Bunmi staring at her daughter.
She had been queuing with other mothers of malnourished children at the health centre, which is a few yards away from her house. “For about four days, she has been suffering from severe diarrhoea, high fever and lack of appetite,” the mother said of Bolanle. “From the screening and weight records, Bolanle was severely malnourished but with no complications,” Ahmed, one of the nutritionist said, adding, “We have many cases like these coming to the Outpatient Therapeutic Programme.
This month alone, we received over 10 new cases of severe mal- nutrition,” he told Saturday Telegraph. Pathetic as Bolanle’s case may seem, hers, is not an isolated case. In the queue on this day is Aminat with her eight-month-old baby – Sadiq.
Two months ago, the child had acute diarrhoea and became severely malnourished. At that time she weighed four kilogrammes but after treatment and a supply of the peanut-based paste, she is nearly double that weight. “I couldn’t produce breast milk, I used to feed her with cows’ milk and tea before I knew it was not good for her,” said Aminat, a mother of seven children. “Today, I was told it is her last day at the clinic, she is better now.” The nutrition officer at the centre explained that the major causes of malnutrition in many neighbourhoods are majorly lack of breastfeeding, inappropriate food for babies and children, poor hygiene and sanitation as well as drinking contaminated water. “The other challenge is that there is not enough food in many homes,” said matron of the home, who identified herself only as Motunrayo.
“If a mother has not eaten well, she will not be able to produce enough milk to breastfeed her child and that is a big problem here.” Like Bolanle, most of the children in this bracket are said to come from Nigeria’s poorest communities, where literacy is poor and poverty high. Their mothers are themselves often undernourished, forced into early marriage when they reach puberty, and give birth to underweight babies with weak immune systems. In many Nigerian neighbourhoods, there are children whose bones are popping out of the body.
The sunken eyes, drooping faces, swollen belly, chapped lips and wrinkled skin are common place in most states of the federation. This, incidentally, is the physical description of a child, who is malnourished. Due to lack of food and insufficient health supply, many children in Nigeria suffer from this heartbreaking disease. Though no longer news to a vast majority of the people as many who live in big cities with big houses and drive posh cars, still have plenty of chances to come across the malady. In highbrow areas, they are considered to be low and windows are usually shut when they beg for money for their survival. But Nigerians, as a minimum, deserve a life free from hunger, considering her vast resources. Unfortunately, both poverty and hunger have continued to haunt the country’s landscape.
Hunger is both a cause and consequence of poverty, as people on low income tend to have worse diets, while people who lack adequate nutrition struggle harder to extricate themselves from poverty. The scary picture is the same all over. Illiteracy or lack of awareness has, indeed, taken its toll on Nigerian kids. Mothers, in most communities, according to investigation, do not breastfeed their children well, chiefly because of ignorance or lack of nutrients in their own bodies. They often rely on con taminated water, making their children prone to illnesses like diarrhea, which prevents nutrient absorption. Incidentally, many of these families live on less than $1 a day, which can hardly afford anything beyond local foods like corn mill (tuwo) in the North and palp (akamu) in the South.
These foods are devoid of much-needed protein and other nutrients. For the children, their mothers’ plans mean little unless they put enough of the right food in their stomachs. Almost as shocking as Nigeria’s high prevalence of child malnutrition is the country’s failure to reduce it. “It is a national shame. Child nutrition is a marker of the many things that are not going right for the masses,” said a nutritionist, who identified himself simply as Maduegbune. But, it does appear that the country’s efforts at reducing the number of undernourished kids have been largely hampered by blighting poverty where many cannot afford the amount and types of food they need.
In addition, over reliance on carbohydrate-rich food that fuel and fill the poor rather than truly nourish them in the country’s poorest rural settings, according to findings, have not only added to the problem but have worsened it. The country’s GDP maybe marginally high, but the majority of the children under five years of age are immensely underweight.
They have no source of gaining their weight back or stay healthy, as the most privileged in the society are not taking enough actions to mitigate this. Sadly, about three in five babies, according to global statistics, are not so lucky and are not breastfed in the first hour of life, despite the fact that breastfeeding within an hour after birth is critical for saving newborn lives. Perhaps, this may be the reason why United Nations Children’s Fund (UNICEF) often emphasises that breastfeeding gives the best and the only nutrition babies need in their first six months of life. It helps them, according to UNICEF, to prevent illnesses and boost their brain development. It is also said to be an integral part of the reproductive process with important implications for the health of mothers.
The first 1,000 days of a child’s life, according to nutrition experts, offers a unique window of opportunity for preventing undernutrition and its consequences. But due to poor adherence, malnutrition, which is a direct or underlying cause of 45 per cent of all deaths of under-five children, remains high, especially in Nigeria. To enable mothers to establish and sustain exclusive breastfeeding for six months, the World Health Organisation (WHO) and UNICEF recommend: Initiation of breastfeeding within the first hour of life, exclusive breastfeeding – that is the infant only receives breast milk without any additional food or drink, not even water, breastfeeding on demand – that is as often as the child wants, day and night and no use of bottles, teats or pacifiers.
UNICEF also said that breast milk, which was the natural first food for babies, provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one-third during the second year of life. It is equally said that breast milk promoted sensory and cognitive development, and protected the infant against infectious and chronic diseases.
Exclusive breastfeeding, UNICEF emphasised, reduced infant mortality due to common childhood illnesses such as diarrhoea or pneumonia, and helped for a quicker recovery during illness. “It contributes to the health and wellbeing of mothers; and helps to space children, reduces the risk of ovarian and breast cancers,” the world health body said. However, while breastfeeding is a natural act, it is also a learned behaviour. An extensive body of research has demonstrated that mothers and other caregivers require active support for establishing and sustaining appropriate breastfeeding practices. This may be the reason why WHO and UNICEF launched the Baby-Friendly Hospital Initiative in 1992, to strengthen maternity practices to support breastfeeding. However, breastfeeding policy tends to be an emotive issue. Yet, international agencies recommend exclusive breastfeeding for 4-6 months followed by continued partial breast-feeding into the second year of life in order to promote infant and child health and minimise the damage caused by the malnutritioninfection cycle.
It provides natural antibodies that help babies resist illnesses such as ear infections. It’s usually more easily digested, according to medical experts, than formula. So, breastfed babies, they say, are often less constipated and gassy. It is also believed to benefit infants because, according to nutritionists, breast milk contains the ideal mix of nutrients for babies, as it contains factors which promote development of the infant’s gut and immune system and which prevent pathogen invasion, and prevents intake of pathogens in food or water. It has been shown to enhance bonding with their mothers. “Breastfeeding usually plays an integral role in forming the deep attachment between mother and baby. Bottle-feeding mothers may not be securely attached to their babies in like manner.
Newborns have a strong sense of smell and know the unique scent of breast milk. That is why a baby will turn his or her head to the mother when he or she is hungry. They can see up close and personal. They are born extremely nearsighted, which means they can only see things about eight to 15 inches away. “There is a well-accepted extra closeness that breastfeeding mothers experience that is both hormonal and emotional in nature. The only disadvantages for the baby in breastfeeding occur when things are not going well, for example, if there’s an inadequate supply of breast milk or an inefficient suck reflex in the baby,” said one nutritionist. It has also been said that breastfeeding has a nearly perfect mix of vitamins, protein, and fat — everything the baby needs to grow.
It has equally been linked to higher IQ scores in later childhood in some studies. Breastfed infants are said to be more likely to gain the right amount of weight as they grow rather than become overweight children. Nutritionists have also said that breastfeeding plays a role in the prevention of Sudden Infant Death Syndrome (SIDS). When children, before the age of five, miss out on the nutrition they need it can affect them in many ways. They may be shorter for their age, perform poorly at school and have problems learning skills, which stops them from reaching their full potential. However, if they have not received enough nutrients or if they have been ill, they will more than likely suffer from malnutrition. A malnourished child is more prone to disease. He needs food to stay alive, and to stay strong. Without proper nutrition, the immune system is not efficient, and disease enters through germs like bacteria and can attack easily. Then a cycle begins. When there is a disease, the child could easily become malnourished.
Malnutrition is a dangerous condition that develops when the body does not get enough nutrients to function properly. While stunting remains the main long-term effects of malnutrition in children. The malady can hinder a child’s ability to grow normally, leaving both height and weight well under normal when compared with children the same age. Stunted growth can be permanent, and a child may never achieve normal height or body weight if chronically malnourished. According to the “British Medical Journal,” malnutrition in children can adversely hinder brain development and intellectual capacity in the early stages of life. Marsamus is one of the effects of malnutrition. It is a severe protein-energy deficiency that can develop as a result of malnutrition. It is characterised by a lack of nearly all nutrients, particularly protein and calories. Equally called an energy deficiency, marsamus is categorised by pronounced and severe weight loss, thin and papery skin that is sometimes darker than normal, distinct hair loss, a pinched facial expression and long periods of apathy.
Kwashiorkor is slightly different. It is an acute type of protein-energy deficiency that is common in children who are malnourished. It differs from marsamus in that calorie intake can be sufficient, but protein intake is severely restricted. Symptoms of kwashiorkor include discoloured, brittle hair that has a copper sheen, rashes, water retention, a distended belly caused by bloating, an enlarged liver and lethargy. If left untreated, this condition leads to coma and eventual death.
However, malnutrition can involve not only insufficient macronutrients such as protein, carbohydrates and fat, but also insufficient micronutrients such as vitamins and minerals. Vitamin and mineral malnutrition can have an array of effects, depending on the specific micronutrient that is lacking in the diet. For example, a deficiency in the mineral iron can lead to anaemia, or a low red blood cell count. While a lack in vitamin C can lead to scurvy, which causes tiredness and yellowing of the skin.
But, ingesting adequate amounts of vitamins and minerals can prevent deficiency. This malaise could be invisible, yet deadly. As recently as 10 years ago, treatment for severe wasting had to be carried out only in hospitals. Today, in Nigeria, an innovative community-based approach (CMAM) led by the government is reaching large numbers of children – far more than a limited number of hospital beds will ever allow. Nigeria’s CMAM programme welcomes mothers, careers and children to local health clinics across the country. At CMAM, malnourished children are able to recover quickly by eating fortified peanut-based Readyto- Use Therapeutic Food (RUTF). Mothers and children also receive basic health care, treatment for common childhood diseases, and nutrition and feeding advice, which can be followed at home. Working with Nigeria’s Federal Ministry of Health, state Ministries and UNICEF, the community programme delivers life-saving care and treatment to children with severe wasting under the age of five in Nigeria.
All children diagnosed with severe wasting attend regular clinics and receive advice on home care and treatments, including packets of RUTF which can help them, recover quickly. The model for community-based treatment has proven itself to be cost effective with impact.
There is an urgent need for treatment of severe acute malnutrition to become part of essential health services delivered by all clinics across Nigeria. The expectation is that every child who needs treatment should receive it. Insufficient diets are a fact of everyday life for hundreds of millions of children. The signs of malnutrition are so common – a short child or a child who has lost some weight. They often do not appear sick or suffering at first. But they are. Although malnutrition is not merely the result of too little food, it is a pathology caused principally by a lack of essential nutrients, which not only causes growth to falter, it also increases susceptibility to common diseases. This is why a common cold or bout of diarrhoea can kill a malnourished child. Most of the damage caused by malnutrition occurs in children before they reach their second birthday. This is the critical window of opportunity when the quality of a child’s diet has a profound, sustained impact on his or her health, physical and mental development.
Despite the vast numbers of pre ventable deaths worldwide, international assistance over the past decade appears to have paled into nothing when compared to what the World Bank estimates is required to adequately combat the malaise in high-burden countries, where 90 per cent of malnourished children live today. The Country Manager, Nigeria and Regional Representative West Africa, Global Alliance for Improved Nutrition (GAIN), Dr. Larry Umunna, said: “Malnutrition has become a public health concern in Nigeria as micronutrients were absent in staple foods.” Also, Prof. Laolu Akinyele of the Department of Human Nutrition, University of Ibadan, has called for the fortification of food products with micronutrients to reduce high rate of malnutrition-induced diseases. Akinyele, who described micronutrients as nutrients needed only in tiny amounts but which absence in the body have severe consequences said their absence affect every stage of the lifecycle from embryo to the adult stage.
“The lack of micronutrients in foods could cause delayed growth and intellectual development in babies, blindness and anaemia in adolescents; night blindness and maternal anaemia in pregnant women and diabetes and cancer in adults,” he added. Quoting statistics, president, Nutrition Society of Nigeria, Prof. Ngozi Nnam, once said about 37 per cent of Nigerian children were stunted, 29 per cent underweight and 18 per cent wasted while micronutrient deficiencies were also high. “While we are grappling with the challenge of under nutrition, the incidence of obesity and related manifestations of over-nutrition are beginning to emerge at relatively significant levels,” she said.
The Deputy Director/head of nutrition, Federal Ministry of Health, Dr. Chris Isokpunwu, also said that malnutrition was one of the underlying causes of under-five mortality rate in Nigeria, contributing 53 per cent of infant mortality. While blaming malnutrition on low level of exclusive breastfeeding of Nigerian children under the first six- months of life, Isokpunwu urges mothers to scale up nutrition before and during pregnancy till age two of a child’s life in order to empower his mental development.
John Mudzongo, a nutritionist, said: “We are often told that we are what we eat. Not just that, food is what makes you and nutrition comes out of food and one thing we also know is that, if a person is not adequately nourished, the person is practically in no place to do much of anything.”