The Nigerian government continues to pay lip service to funding malnutrition programmes, but the dire consequence has been the underdevelopment and death of many children around the country. Solomon Elusoji writes
Muhammed Saidu rests on his mother’s bosom as he looks on, his sunken eyes probing the room absently. His lips are pursed, his back hunched, and his arms, which are as tiny as broomsticks, hang at his sides. Hid did not laugh. Although he is over two years old, Muhammed struggles to fit the profile.
“He started purging after I stopped breastfeeding,” Muhammed’s mother, Wasilia Saidu, says in her local language. “Then he stopped eating, and started losing weight. That was when I brought him here.”
They are inside the lobby of the Yanawaki Primary Health Centre in Kano. Other women clutching skeletal babies are there, too. Garbed in the customary hijab wear, they sit on long benches, some comforting their crying babies, others looking up, waiting for hope.
The Yanawaki Primary Health Centre is an outpost centre for the Community Management of Acute Malnutrition (CMAM), an outpatient therapeutic program designed to treat children like Muhammed, between the ages of six months to five year old, who show acute signs of being malnourished. The science is disturbingly clear: if you are malnourished until age 3, your neural formation suffers, and most of that underdevelopment is fixed for life.
In Nigeria, it is easy to shrug off stories of malnourished children. A lot of people think it is something peculiar to war-torn nations like Somalia and Sudan. For those who acknowledge its existence, they see it as a ‘northern problem’. But, based on available statistics, that isn’t true.
According to numbers from Nigeria’s Federal Ministry of Health, about one million Nigerian children die before their fifth birthday, each year, and malnutrition contributes to nearly half of these deaths.
It is also estimated that two in five Nigerian children suffer from stunting, one of the major signs of malnutrition. With over 11 million stunted children, Nigeria ranks second, after India, among all countries with the highest number of stunted children.
Across the six regions of the country the story is not different, though scale of suffering may be higher than the other. Inside the paediatric ward of the University of Ilorin Teaching Hospital, Ibrahim Aliu, an 18-month-old boy recuperating from kwashiorkor flails his hand weakly. There are others like him inside the spartan ward. And they are the lucky ones, who have a shot at accessing the miracles of modern medicine. The staple diet for most of the children is Amala, a local meal made out of yam and/or cassava flour. Most of the parents refuse to give their children eggs or fishes, because it is generally believed such protein-ladled luxuries lead children down the path of stealing—a taboo that has been there for many years in Nigeria.
A nutritionist at the Massey Children Hospital, Lagos Island, Temitope Sikiru, believes the major cause of malnutrition in the country is ignorance. According to her, most mothers do not know the right food to give to a child. A striking example is a mother who prefers to buy a N50 gala for a one year old, when that same amount is enough to purchase two pieces of egg.
“It is not until you have big money that you can feed a child well in this country,” Sikiru points out. “There are lots of very cheap things you can buy for your child. You have 20 naira crayfish that you can add to pap. We have oranges, vegetables that are cheaply sold everywhere. Most mothers just do not know and that is why these children become malnourished.”
The Network Coordinator, Civil Society Scaling Up Nutrition in Nigeria (CS-SUNN), Dr Philippa Momah shares Sikiru’s view.
“It is terrible that Nigeria is producing the highest number of stunted children in Africa. We are a blessed country. We have no excuses for producing such. We have the food, it’s just ignorance,” she says.
“We need the media to publicise the wonderful foodstuffs that we have. We have all the staples, legumes, animal products, fruits and vegetables. We can combat malnutrition with feeding mother and children with these foods.”
Also, the statistics show that poverty is a huge driver of malnutrition: over 50 per cent of children under age 5 in northern Nigeria are stunted, and this correlates with the fact that the region has the largest number of people living in penury.
“The major cause is poverty,” a government nutritionist, Akheituame Catherine, argues, “and this is as a result of corruption in the land. There are not enough funds available to fight it.”
The double barrelled approach perhaps offers a better explanation: there’s a lot of ignorance out there, and there’s also a lot of poverty. When combined together, a horrendous, blood-thirsty monster mutilating and decapitating Nigerian children is unveiled.
The percentage of children in Nigeria, who are wasted or too thin for their height, has steadily increased over the last decade, rising from 11 per cent in 2003 to 18 per cent in 2013, according to the Ministry of Health. Plus, up to one million Nigerian children under age 5 are affected by severe acute malnutrition (SAM) each year. These children have severely low weight for their height, and are at risk of dying, unless giving urgent attention.
The economic cost of malnutrition is huge. Every malnourished child is a liability. If they survive beyond childhood, as many of them do, their brains will be underdeveloped, leading to low levels of intelligence. It is not difficult to draw a correlation between the mass failure of secondary school students and the high rate of child malnutrition in the country.
“Yes, there is a correlation,” Deputy Director/Head, Child Rights Information Bureau (CRIB), Federal Ministry of Information, Abuja, Rose Madu affirms. “It is when the IQ is well developed that someone will be intelligent.” So the question on the lips of many has been how responsive is the Nigerian government to malnutrition in Nigeria.
It is a question being asked about children across Nigeria, where years of oil revenue has done little to change the statistics of children who are malnourished and stunted from negative to positive, leaving them with mental and physical deficits that will haunt them their entire lives.
Expectedly, the ripple effect goes beyond the educational sector and cuts across all sectors of the economy. Yes, a modern economy needs an intelligent workforce, but malnutrition halves intelligence power by producing half-baked workers.
And though, Nigeria might be lucky to produce some of the most intelligent people in the world, but if the intelligence level of the larger population is low, great ideas will rise and fall.
Although monstrous in proportion and neatly knitted in the nation’s socio-economic fabric, experts believe that Nigeria’s malnutrition is not unsolvable.
For instance, the CMAM initiative, pioneered by the federal government and UNICEF, has been one of the most visceral responses to the malnutrition dilemma. It was piloted in Gombe and Kebbi states in 2009, and has been extended to the 11 northern states where malnutrition poses the greatest threat. Recently, it was widely reported that more than 830,000 children have been cured in the programme. Plus, the cure rate is rising steadily – at 85 per cent.
CMAM is carried out during weekly appointments spread across eight weeks, approximately, at primary health care centres. It involves educating parents and caregivers on nutrition, highlighting the importance of breast-feeding and basic hygiene; assessing the nutrition status of the children and administering treatment for other illnesses where necessary; sharing Ready-to-Use Therapeutic Food (RUTF) to mothers and caregivers to feed the child with.
The cost for CMAM is US$160 for each child treated, including US$76 for the RUTF; the remaining US$84 covers all other costs, including staff time and training, transport and storage of supplies, and basic medicines. Since its introduction in 2009, the programme has been funded by the Children’s Investment Fund Foundation (CIFF), DFID, ECHO, the European Union, USAID, the Bill and Melinda Gates Foundation, and JICA. Still, more needs to be done to save the Nigerian child.
“We have 683 centres across the country,” a senior Nutrition Specialist at UNICEF Nigeria, Bamidele Omotola says. “We need more. But the reason why you can’t get more is because there is no point creating a centre without having adequate infrastructure, human resource, and supplies.”
Although the federal government has made several moves in combating malnutrition (piloting CMAM, joining the Scaling-Up Nutrition movement, championing multi-sectoral initiatives like the Maternal Newborn and Child Health Week, Saving One Million Lives, and others), there are questions over its political will to tackle the monster headlong and comprehensively.
Conversely, it is a feral slap on the Nigerian child that the special task of funding malnutrition programmes has been left to international non-governmental organisations. It is not enough to provide support (or a platform) for these funds to be put into action, the government has to actively get in the game by creating, for example, a special budget for malnutrition programmes like CMAM. And though chronic malnutrition is an emergency, it just doesn’t look like one for the federal government.
To be sure, the Deputy Director of CRIB, Madu, argues that the government “has done a lot”, she also concedes that the government “still has a lot to do, by committing more money into fighting the scourge”. According to her, most of the government’s projects on malnutrition are “donor-driven”.
To reiterate, malnutrition is a national problem, and not a northern emergency. The critics point to the dearth of cases of kwashiorkor and marasmus down south. But malnutrition, a condition that occurs when people consistently do not consume or absorb the right amounts of essential nutrients, is all around us, stalking and cutting down the mental and physical capacity of our future citizens.
And, as suggested by the Medical Director of Massey Street Children Hospital (MSCH), Dr. Abiyewa Emokpae, funds devoted to malnutrition would largely go into educating the general population on the need for nutritional balance for children, exclusive breast-feeding, and other vital, basic information that can radically alter the country’s feeding habits, both for children and their mothers. An educated population is an empowered one.
The Save the Children, a non-profit had blamed the situation in Nigeria on lack of investment in social protection by the government.
According a document, the charity said, “The amount of money going towards social protection programmes in Nigeria is minimal. It amounts to just 0.6% of GDP, which is less than many other sub-Saharan African countries. Children in particular are under-served, as they are disproportionately represented in poor households, and are affected if their parents or carers suffer from a shock. Although social protection was to be prioritised under the 2003–2007 National Economic Empowerment Strategy (NEEDS), the more recent Vision 20:20 strategy lacks a mention of even the most minimal safety nets. This loss of political interest is reflected by the fact that even in 2007–2009, when the need for social protection was likely to have increased due to rising food prices, spending on such programmes actually fell.”
The document further offered some solution. It advised the governments at all levels to prioritise social protection rather than depending on aid, if they must deal with malnutrition.
“Nutrition-sensitive social protection will not be achieved in the absence of political will both at federal and state government levels, along with the mobilisation and earmarking of sufficient financial resources. The fact that Nigeria currently spends less on social protection than other sub-Saharan African countries, and that two-thirds of its overall social protection expenditure goes to the civil service, shows that the problem is not a lack of money,” it said.
The onus, now, is on the Buhari-led government to sit down and come up with a comprehensive plan to banish malnutrition from the country. A failure to do that, and to continue to pay lip service to one of this nation’s greatest monsters, will be a confirmation of this administration’s disregard for the general well-being of its people.