Malnutrition, especially in infants and children below five years, has plagued Nigeria like a tumor for the last few decades especially in northern Nigeria where it is more pronounced. Although several organisations worldwide, governmental and private, have made efforts to combat and stop malnutrition, not much have been achieved in this direction. Shittu Ahmed Obassa writes on the nutrition agenda by stakeholders for Under-Five Children facing Severe Acute Malnutrition.
The outcome of the National Demographic Health Survey (NDHS) has consistently) painted the three geo-political zones of North-west, North-east and North-central in red with regard to all the social indicators.
Even though, these are the providers of the staple foods consumed by the other parts of Nigeria there seems to be recurring severe acute malnutrition and the challenges give cause for concern as many children hardly live beyond their first birthday.
The bottom line of the recurrence of severe acute malnutrition in the most afflicted communities is chronic or endemic poverty, ignorance, and unwillingness to adapt to changes brought about by the various interventions such as the application of the Ready to Use therapeutic Food(RUTF), exclusive breast feeding in the first 1000 days after birth sans water, complementary feeding, fortification of food with vitamin A as well as diversification of food in addition to the best key house holds practices.
Even experts now advocate Infant and Young Children’s feeding as yet another panacea to the relapse that occurs after the malnourished children have been fully rehabilitated at Community-based management of acute malnutrition (CMAM) facilities located in a few local government areas.
Needless to say that it is the children of the poorest of the poor that die from this kind of severe acute malnutrition in their hundreds in the states that share borders with the Sahel or semi-arid region such as Katsina, Kebbi, Sokoto and Zamfara.
Recently, the Nutrition Specialist in the Kaduna Field Office of United Nations Children’s Fund (UNICEF), Dr. Florence Oni told the participants at a two-day meeting of the Zonal Committee on Food and Nutrition (ZCFN) held in Minna, Niger state, that the plight of children under five years in Katsina, Kebbi, Sokoto and Zamfara states was as bad as eight children dying in every minute, and that two of these children were usually less than one-month old.
She recalled that in Katsina state, the wife of the state governor, Hajiya Fatima Ibrahim Shema recently commissioned an investigation at five hospitals across the state with a view to identifying causes of death among the children under the age of five and the damning outcome of the exercise was that more than half of them were dying from severe acute malnutrition.
But the policy makers’reaction oftentimes has been that “the issue of malnutrition in Katsina state is UNICEF’s business,” meaning that the malnourished children brought to the health facilities for treatment is the headache of the international agency.
The attitude is the same in Kebbi, Sokoto or Zamfara state where the authorities have budget lines for nutrition activities and the state committees on food and nutrition meet regularly on the challenges of severe acute malnutrition in their communities.
According to her, following persistent high-level advocacy and collaboration with major stakeholders such as traditional rulers in Kebbi and Zamfara states, for instance, there seems to be a remarkable improvement in terms of the reduction of the incidents of severe acute malnutrition but that the progress is slow. She said the volume of work done in curbing the menace had been possible through integration and adequate planning.
“We don’t need the international agencies to fund the country’s programmes, with adequate planning on the part of the policy makers,” she argued.
She stressed the need for multi-sectorial approach towards addressing severe acute malnutrition with equity in order to ensure a drastic change from the existing situation in the states under her jurisdiction.
The nutrition specialist pointed out that the committee on food and nutrition needed to be well constituted at both the state and local government levels and properly funded, aside from the fact that there are peculiarities in each of the eight states and Federal Capital Territory (FCT) which cannot be overlooked.
In her opinion, experience and information-sharing at different levels nutrition activities should be followed up in order to make much impact after funds must have been released for relevant interventions and the activities carried out.
The Director of Planning in the Kebbi State Ministry of Economic Planning, Malam Mohammed Sani Umar, concurred with the UNICEF Nutrition Specialist regarding the peculiarities of the states but said the results from the interventions are the same because the programming is not based on the current situations in the affected states.
“Until we are ready to discharge our social responsibilities we are not likely to improve the situations of malnutrition in our communities,” he maintained.
The Deputy Director, Nutrition Division, Federal Ministry of Health, Dr. Chris Osa, also corroborated the views of Dr Oni by saying that malnutrition is contributory to the death of half of the children under the age of five, adding that wasting, stunting and underweight are various forms of malnutrition prevalent in both the north-west and north-east. He further disclosed that more than N300 million has so far been raised for CMAM activities in Katsina, Kebbi, Sokoto and Zamfara States.
He stressed that Nigerian chapter of the Scaling Up Nutrition (SUN) Movement which came into being in November 2011 is an initiative geared towards tackling the menace of malnutrition, with the relevant stakeholders playing their respective roles effectively. He identified poverty as one of the major causes of recurring severe acute malnutrition in the afflicted geo-political zones and proffered some solutions.
These include improvement in women’s nutrition, early child exclusive breast feeding which should span the first two years after birth, timely, safe, appropriate and high quality complementary feeding, appropriate micronutrient intervention which can be gotten from fortification of foods, iodization, supplementation and fruits.
Others are promotion of good hygienic practices as well as access to clean water for drinking, prevention and treatment of severe acute malnutrition, promotion of healthy practices and appropriate use of health facilities nearest to the communities.
In order for incidents of malnutrition to reduce considerably, Dr Osa also advocated behaviour change communication through mass media, resources mobilization, research, monitoring and evaluation aside from coordination and multi-sectorial partnerships. He further emphasized advocacy, effective service delivery and capacity building for the relevant service providers at the health facilities as remedies .
Driving home the importance of creating and documenting evidence that gingers prompt action on the part of government, the Communication Officer in the Kaduna Field Office of UNICEF, Malam Rabiu Musa, said when the media published a well-researched report on the problems of severe acute malnutrition somebody in authority would be made to see its imperativeness and tackle them. Such a piece with one, two or more pictures on the existing situation will be too graphic to be ignored.
“When we conceal information on the plight of malnourished children we have cheated them. But when we document excellent achievements by relevant stakeholders the public will be happy with us that we have utilized judiciously the resources given to us,” he stressed.
He expressed the belief that there will be a great improvement in management of severe acute malnutrition if only the governments in the various states that have the problem of malnutrition discharge the much expected responsibilities. In other words, it is when government has very well understood the issues connected with the incidents of severe acute malnutrition in their domains that the appropriate authority can fix the problems.
The communication officer blamed grinding poverty and greed for the snail speed progress in view of the quantum of the RUTF that the international agencies have procured for the most afflicted communities.
Musa said it was regrettable that the RUTF which should be administered on the children that have been duly screened to be malnourished eventually found their way to the market or the shelves of patent medicine stores in the communities. Health analysts said parents and workers at the health facilities were the biggest culprits.
The Director of Economic Growth, National Planning Commission, Mr Christian Eze Ezeilo, said with the new National Policy on Nutrition, which is still awaiting approval of the National Economic Council headed by the Vice-President, Alhaji Mohammed Namadi Sambo, there would be performance measurement.
He said the issue of malnourished children was coming to the front burner again in his adult life after kwashiorkor that was brought about by the Nigerian civil war when he was 10 years’old.
Health analysts have roundly criticized the existing nutrition policy for having paid so much lip-service to the emergency nature of malnutrition in the overall development of Nigeria which has an estimated population of 160-7 million.
The director said that the draft would be presented to the council probably in February, 2015.
According to the Joint Planning Board, it was fashioned the new policy on the basis of Vision 20.20.20 by plugging all the loopholes in the old policy. But the Nutrition Officer in Zamfara State, Malam Samila Bakwai Umar, decried the failure of the commission to make known publicly the outcome of the deliberations of stakeholders on the drafted policy since the last meeting that was held in Kaduna.
Dr. Muyiwa owolabi of the Department of Biochemistry, Ahmadu Bello University, Zaria, suggested that the new policy should encourage the institutionalization of the linkage between the National Committee on Food and Nutrition and its state counterparts, bearing in mind that the existing linkage is weak.
He also called for the domestication of the new policy in the 36 states of the federation and that it should percolate down to 774 local government areas where the committee on food and nutrion is virtually non-existent.
Dr Muyiwa stressed the need for a specific clause in the policy which will be emphatic on monitoring and evaluation so as to gauge the impact of the programmes spelt out in the policy that is being formulated so as to move farther away from the existing situation and for good.
In their contributions, the participants have pointed out the need for the state nutrition officers as well as other stakeholders to work together with the media in their endeavours so that the critical issues of human development such as nutrition would from the back to the front burner with an improved partnership.
On this score, Niger, Kaduna, Sokoto and Zamfara states were commended for conducting advocacy with the mass media and it is the recommendation of the Zonal Committeee on Food and Nutrtion that other states should follow suit.
It is the considered opinion of the house that inadequate understanding of the magnitude of nutrition problems among children in the communities have the highest degree of malnutrition in all its ramifications and low prioritization of the issue by policy makers stemmed from inadequate evidence-based advocacy detailing the number of rehabilitated children in pictorial forms as against the irredeemable ones.
They, therefore, noted the commendable efforts put up by Sokoto, Zamfara as well as Katsina states in the production of evidence-based documents good enough for incorporation into their respective state’s advocacy tools.
Again, the zonal meeting identified inadequate funding of nutrition programmes, especially in states such as Kaduna, Kogi, Niger and Katsina states and the Federal Capital Territory(FCT) coupled with what they called weak mechanism for sustainability of nutrition programmes. In this regard, the ZCFN noted the Zamfara State’s innovation in partnering with influential individuals such as Senator Ahmad Sani (Yeriman Bakura) as a good practice and urged other states to emulate the example in addition to the appointment of notable persons as Nutrition Ambassadors as it obtains in Kebbi and Zamfara states.
Furthermore, the participants applauded Kaduna, Kebbi ,Kwara, Sokoto and Zamfara States for their budget lines set aside for nutrition activities and encouraged the committees to intensify their evidence-based advocacies toward ensuring timely release of the allotted funds.
They expressed dissatisfaction at the monitoring and supervision mechanism being operated, describing it as “weak” even though they gave kudos to Sokoto and Kebbi States for funds being released and the logistic support for monitoring. Other states have been advised to do the same.
The meeting said UNICEF had been supporting and enhancing the capacity and skill development of the ZCFN members, adding the the agency should continue in this regard so as to strengthen their capacity for strategic planning and result-based programming.
The house also said efforts should be coordinated towards the final approval of the new national policy on food and nutrition and that states should domesticate it for effective and systematic coordination. It is its opinion that there is weak coordinatiing structure and capacity in respect of NCFN,SCFN and LGCFN.
They decried the non-existence the committee in the local government areas where the bulk of the malnourished, stunted wasted and under-weight children hail from without the sight of the fact that the states have the responsibility to develop and fund media and communication for nutrition and its inherent benefits in the general development of the populace.
Shittu Ahmed Obassa writes in from Abuja