Nearly half of all deaths of children under five are attributable to malnutrition. Experts say improving infant and child nutrition expands opportunities for them to reach their potential while impacting national development, reports APPOLONIA ADEYEMI
A visit to the Family Health Clinic at Oke-Ilewo in Abeokuta South Local Government Area on any clinic day is usually a delight for mothers who bring their babies for one form of medical attention or the other. Many of the health challenges of children which mothers and guardians seek the attention of medical doctors for include immunisation to prevent childhood diseases, the treatment of diseases, among others. With every available seat in the clinic waiting area having been occupied by the numerous clients who wait patiently for the start of clinic activities, the arrival of Mrs Teniola Oluwalogbon was noticeable because of her advanced age of over 70 years, and the apparently malnourished 18-month old baby boy she carried into the clinic.
Although the baby was wearing clothes, but part of his body that was exposed gave him away as an obviously dying child: his head that was without a shielding cap could rightly be likened to a mere skull. Furthermore, his deep sunken eyes were as if the boy was dosing as he could hardly dilate them; his cheeks similarly appeared as a dry bone while his hands and legs were so thin they could hardly move. The boy was clearly tired and irritable, showing loss of fat, muscle mass, and body tissue. He couldn’t even cry out loud enough to be heard and he apparently displayed discomfort with himself.
On the arrival of Oluwalogbon and his ailing boy into the facility, all eyes at the clinic vicinity were promptly turned on the aged mother and the malnourished boy she brought along, though some curious clients had muttered loudly that the boy was too young to be her direct son, which the elderly woman subsequently confirmed. Mrs Oluwalogbon told the New Telegraph that the malnourished boy, Babatunde Oluwalogbon was her grandchild, born to his first son who is a 32-year-old unemployed person and his wife who recently developed mental health condition that incapacitated her from caring for the little boy. Several months of near lack of care for Babatunde from his ailing mother, however resulted in the son’s initial ailment.
For fear of losing his grandson to the numerous health challenges he had presented with, Mrs Olowalogbon intervened, taking over the care of Babatunde so as to save him. Two weeks before deciding to seek health care for his grandson at the Family Health Clinic in Abeokuta, Babatunde who has become too skinny had presented with severe diarrhea, high fever, with rash all over the skin and lacked appetite to eat any meal. At that stage, Babatunde’s grandmother became worried about her grandson’s deteriorating health.
Sadly, the poor financial status of Mrs Oluwalogbon and that of her unemployed son did not help the situation as the provision of needed nutrients for Babatunde had been impossible. “I don’t know what to do; I hope the doctor’s attention will help my boy regain his failing health,” Oluwalogbon muttered as she expressed her grief and frustration to those in close proximity with her.
The severity of Babatunde’s poor condition therefore prompted nurses and other care workers at the facility to bypass the early arrivals at the clinic and quickly ushered Oluwalogbon and his son into one of the doctor’s consulting room. By the time they were through, Babatunde has been diagnosed with severe acute malnutrition. He ended up being referred to Ibadan based University College Hospital (UCH), a tertiary centre with human and infrastructural capacity to effectively treat the severe paediatric malnutrition. Malnutrition is more than lack of food; it means an absence of vital nutrients.
When pregnant and breastfeeding women become malnourished, their unborn children and infants can’t develop normally. Children who lack diverse diets suffer from weakness, stunted growth, illness as shown in the case of Babatunde, and sometimes even die preventable death. The case of Babatunde is typical of other Nigerian children whose health conditions deteriorate due to poor nutrition and inadequate diet.
These were the focus of a two-day media dialogue on Sustainable Development Goals (SDGs) as Child Rights – Child Malnutrition, which was held in Enugu from April 21 to 22. The workshop was organised by the Child Care Information Bureau (CRIB) of the Federal Ministry of Information and Culture in collaboration with UNICEF. UNICEF’s Nutrition Officer, Nkiru Enwelum lamented that Nigeria was still lagging behind in the area of implementing key life-saving nutrition interventions including iron, folic acid supplementation and the initiation of breastfeeding which should be done within one hour of delivery. She said, “Countries that are doing well in nutrition interventions have achieved 80 per cent coverage, meaning that 80 per cent of their population is getting the needed interventions.”
Intervention nutrition far below 80% coverage in Nigeria
On the contrary, there are none of these interventions that Nigeria is getting up to 80 per cent coverage in their implementation, she said. Data from the National Demographic Health Survey (NDHS) shows that the North Central region has managed to get 60 per cent coverage for early initiation of breastfeeding and 50 per cent coverage for vitamin A supplementation. Also, data shows that the North East has less than 10 per cent coverage for iron and folic acid supplementation. “The North West has a similar story,” she added.
However, Enwelum said the South East is the only region that has achieved nearly 70 per cent coverage in Vitamin A supplementation. She stated that up to 80 per cent of children in the country are not getting needed life-saving nutrition interventions that they are supposed to get, thereby resulting in a high rate of malnutrition in the country.” In addition, statistics from the NDHS highlighted the huge malnutrition burden in the country. “Nigeria bears the greatest malnutrition burden in Africa.
The country also has the second highest malnutrition burden in the world.” Also, the NDHS shows that out of 35 million under-five children, 14 million are stunted; three million wasted, while 24 million are anaemic. Wasting is defined as low weightfor- height. It often indicates recent and severe weight loss, although it can also persist for a long time. It usually occurs when a person has not had food of adequate quality and quantity and/ or they have had frequent or prolonged illnesses. While stunting is the impaired growth and development that children experience from poor nutrition, repeated infection, and inadequate psychosocial stimulation, anaemia results from a lack of red blood cells or dysfunctional red blood cells in the body which leads to reduced oxygen flow to the body’s organs.
With this profile, achieving Goal 2 of the United Nations Sustainable Development Goals (SDGs), which is ending hunger by 2030 remains a difficult task for Nigeria, said Enwelum. The burden of malnutrition as presented by Babatunde in this report is indeed huge: UNICEF’s nutrition officer disclosed that 45 per cent of all child deaths in the country is from poor nutrition, adding that poor nutrition in the 1000 days from conception of a child to two years of age results in permanent and irreversible damage to the brain.
While highlighting some consequences of malnutrition on children, Enwelum said such could make children become more susceptible to diseases, resulting in impaired brain development and lower intelligent quotient and may also lead to premature death. According to Enwelum, malnutrition in children could result in a weakened immune system, leading to increased risk of infectious diseases. The risks of non-communicable diseases (NCDs) such as diabetes, cancer, stroke, hypertension also abound for the malnourished baby, not only in his childhood, but also in his adult life. In addition, she stated that malnutrition can equally result in lost productivity and increased healthcare costs.
Forms of malnutrition
Apart from children that suffer wasting and stunting, some are underweight from poor nutrition, meaning that they have low weight for their age as well as those that are overweight or obese. Being overweight is a serious medical condition that affects children and adolescents. It’s particularly troubling because the extra pounds often start children on the path to health problems that were once considered adult problems — diabetes, high blood pressure (HBP) and high cholesterol. Childhood obesity can also lead to poor self-esteem and depression.
Often micronutrient deficiencies do not have physical manifestations in children; hence, the conditions are referred to as the hidden hunger. They include iron deficiency which causes anaemia and tiredness/weakness, vitamin A deficiency which causes a type of blindness, and calcium deficiency that causes weak bones.
Adequate nutrition key to child development
Speaking on how to address health issues arising from malnutrition, a former national publicity secretary, Nutrition Society of Nigeria (NSN), Olusola Malomo, said that adequate nutrition for children should begin even before their conception, which warrants an advocacy encouraging adolescents and people of childbearing age to consume adequate diet aimed to prepare their body for conception and childbearing during pregnancy. “When you are pregnant, eat adequate diet including vegetables and proteins. “When you give birth, do exclusive breastfeeding and introduce the baby to breastfeeding within one hour of birth.” He reasoned that when everyone in the family, especially husbands, support the breastfeeding mother, it will be easier to breastfeed the babies exclusively.” Malomo advised that working class mothers should not just hand their babies over to house helps, but should monitor to ensure that the child is the one consuming the meal. He stated that if every family can work on adequate nutrition for their children and ensure that at least 80 per cent of infants and under-five eat well, it means the society will be better, because by this measure we can produce genius in these children who in turn will be doing the right things in terms of achieving the best in their education.
Importance of normal brain development
The former national publicity secretary of NSN explained that the left and right side of the brain in kids will develop well if they consume adequate diet, adding “the advantages are massive.” On the contrary, he stated that damages arising from poor and inadequate nutrition results in irreversible damage in children. In a new study in which scientists analysed data collected from the UK Millennium Cohort Study on 7,855 infants born between 2000 and 2002 and followed them until age 14, showed that longer breastfeeding duration was associated with higher verbal and spatial cognitive scores throughout the study.
The mean cognitive scores were 0.08 to .26 higher than those of children never breastfed. Malomo stated that the advantage of breastfeeding infants is there, both through colostrum studies and psychosocial studies; it shows that children that are exclusively breastfed do well in academics, sports and a whole lot of aspects. Speaking on how malnutrition can affect the country’s development, Malomo said the brain of the child grows up at a younger age. “If children don’t have the appropriate nutrients to develop, we will have a lot of people who will grow up with mental deficits in how they think.
Their inability to think will affect the development of the society or nation.” Speaking in the same vein, a Professor of Community Health, Dr. Bayo Onajole who is an epidemiologist, said, “The brain of the child develops at a younger age; if they do not have the appropriate nutrients to develop, we will have a lot of people who will grow up and have mental deficit with regard to how they think.” According to Onajole who is a consultant public health physician, the ability of the populace to think will positively affect the development of the society or nation. “If people cannot think outside the box and find solutions, how will the communities grow,” he asked.
On the best period in a child’s growth that malnutrition problems can be nipped in the bud, Onajole said, “It is always better when the child is under five years, but then even in adolescent age,” he noted that the brain is still developing, but the best time is under-five, most especially under one year old. He stated, “This is because that is when children have rapid development of the brain. You can treat malnutrition in other parts of the body, but it is hard to do that in the brain. If you lose weight, you can gain it back unlike in the brain, any damage on it from malnutrition will be for life.” He added: “Any such damage in the brain is irreversible.”
Impact of brain damage and cognitive development
At that early stage, the consultant public health physician said, “When they do not have the appropriate nutrients needed for development, that will affect their cognitive development and when their cognitive development is affected, it affects every other thing because the brain controls the rest of the body.” He added: “It might manifest socially, psychologically and in other features: you may have human beings who are deviants.
“When your emotional development is affected because of lack of proper development, the way you think will be like that of lower animals, and it could be irrational thinking.” Consequently, he said, “When rational thinking is affected, the way you perceive people around you will be affected and when this is affected, it also impacts on the society at large.” On his part, Malomo attributed underlying causative factors of malnutrition to government policies. For example, he noted that a policy on agriculture can affect malnutrition; culture could similarly affect malnutrition. He noted that some women that don’t expose themselves to enough sunlight during pregnancy based on culture may result in their children having vitamin D deficiency.
They may have jaundice too, Malomo added. However, malnutrition being a multisectorial problem, the nutritionist said the environment could play a role. Malomo reasoned that an environment that is not well taken care of as a result of rain could breed mosquitoes which may infect the child with malaria.
That in turn could result in the child being malnourished. The former national publicity secretary of NSN therefore called for more funds to be invested, saying translating policy into action is a problem. “We have some policies that are not felt in the grassroots and we need to monitor and evaluate implementations of food policy to achieve proper nutrition for the country.
We need to intensify nutrition advocacy and talk more about nutrition. “We need to make it a dialogue for families and is beyond hospitals and media publications/broadcasts so that people will read about them. We need to empower our facilities and primary healthcare centers so that we can identify malnutrition on time to prevent the situation getting to stunting, wasting and under-nutrition. “We need to work on it and empower our schools so that they can communicate on adequate nutrition, with people through Parents Teachers Association (PTA), churches, women groups, communities, among others.”
Even among the mothers, Malomo said, if they are aware that feeding the child adequately will take the child to the next level and better place, it will help. “If every mother knows that instead of buying clothes, they should prioritise buying food for their children, it could curb cases of malnutrition.” According to him, some of the cases of malnutrition are not caused by poverty, but misplaced priorities and on the choices mothers and guardians make, he added.
Highlighting the danger that could arise from the high burden of malnutrition in the country, the consultant, Onajole, stated that it will cause an increase in emotional and psychological development disorders in affected individuals. “When you have issues like that, you will have a lot of delinquency occurring and it will lead to more crimes, social abuses and so many other negative things that occur in the society and that will impact the development of the society in the long run.” According to him, malnutrition can also reduce the ability of affected individuals to resist infections. “A sound body will give you a sound mind and that is how it affects the society and the development of the country.”