Malnutrition and Its Alarming Endemic Situation in Nigeria

Public Health experts see malnutrition as one of the major public health and development concerns, globally. In Nigeria, especially in Nasarawa, Kaduna and Niger, the situation is dreadful – as revealed at a stakeholders meeting in Abuja recently. Iyobosa Uwugiaren, who was at the meeting writes

The two-day review meeting on ‘’Allocation, Release and Utilisation of Nutrition Budget’’ – with key stakeholders from the legislature and nutrition line ministries in Kaduna, Nasarawa and Niger States, held between 28 and 29 June in Abuja, was timely and strategic.

Organised by Civil Society-Scaling Up Nutrition in Nigeria (CS-SUNN) under the PINNS 2.0 Project, the strategic meeting was apparently designed to evaluate 2021/2022 nutrition budget performance and make a case for adequate fund provision in the 2023 annual budget/allocation. 

And at the end of the meeting, there was a resounding resolution by stakeholders on the need to set up nutrition departments and create other steps – as means to improving nutrition budget in the three states and the nation in general. 

Public health experts said that ‘’malnutrition is one of world’s major public health and development’’ trepidations. In Nigeria, the situation is said to be dire. To be sure, UNICEF said in its recent report that five in 10 children under five years old suffer from the effects of being malnourished.

 This, experts said, may have an all-encompassing impact on the lives, future and productivity of Nigerian children, if deliberate and sustained efforts are not taken urgently to address the situation.

The nutrition endemic in Nigeria has been attributed to poverty. And one of the concerns of poverty is the lack of access to nutritious food, which influences people to poor nutrition. By extension, poverty increases the chances of malnutrition. Malnutrition, in turn, tricks communities in poverty. And poverty and malnutrition are said to be intricately related.

Indeed, the recent report by the global institution, UNICEF, that malnutrition is a direct or underlying cause of 45 percent of all deaths of under-five children, makes the conversation at Abuja stakeholders meeting well-timed.

In the report, Nigeria has the ‘’second highest burden of stunted children in the world’’, with a national prevalence rate of 32 percent of children under five.

‘’An estimated two million children in Nigeria suffer from severe acute malnutrition (SAM), but only two out of every 10 children affected is currently reached with treatment. Seven percent of women of childbearing age also suffer from acute malnutrition’’, the global organisation said.

The report also suggested that states in northern Nigeria are the most affected by the two forms of malnutrition – stunting and wasting, adding that high rates of malnutrition pose significant public health and development challenges for the country.

According to the report, stunting, in addition to an increased risk of death, is also linked to poor cognitive development, lowered performance in education and low productivity in adulthood – all contributing to economic losses estimated to account for as much as 11 percent of the nation’s Gross Domestic Product (GDP).

Also, The Global Nutrition Report – the world’s leading independent assessment of the state of global nutrition, data-led and produced each year to cast a light on progress and challenges – aims to inspire governments, donors, civil society organisations, businesses and others to act to end malnutrition in all its forms, also suggested that despite some progress, diets are not getting healthier and make increasing demands on the environment, while deplorable levels of malnutrition persist.

‘’The high human, environmental and economic costs of continuing our current trajectory are so significant that we will pay a far higher price if we fail to act. While COVID-19 is exacerbating the problem, this report shows that it is just one part of a much bigger picture’’, the report has warned.

The Report may just be referring to Nigeria, when it stated further that ‘’in the Africa region, no country is on course to meet any of the diet-related NCD targets.’’

To be sure, the current nutrition situations in Nigeria, especially in three states: Niger, Nasarawa and Kaduna, lead credence to the report – as it relates to Nigeria

Nutrition Situation in Niger, Nasarawa and Kaduna States 

Niger State 

The scope of nutrition challenges in Niger State – as presented by the State Nutrition Officer, Asmau Abubakar Mohammed, is alarming: Number of children exclusively breastfeed-6.2%; incidence of low birth weight (less than 2.5KG), 6.3%; number of children that are stunted (short for their age) 28.2%; number of children that are wasted (thin for their height) 5.0%; number of children underweight 14.2%; and infant mortality rate is 67/1000 live births.

Still on the scope of nutrition problem, the official said that under five mortality rate is 132/1000 live births; ANC attendance 67% while Health Facility Delivery is37%; complementary feeding – 72% but only 11% compliance with minimal diet required by age (IYCF); early initiation of breast feeding- 12%.

Although there are efforts by the state government to make interventions through the Community Management of Acute Malnutrition approach; micronutrient supplementation – with 25% children aged 12-59 months receiving deworming tablet in the past few months; 91% children aged 6-59 received Vitamin A capsules in the last 6 months(supplementation) and 43% pregnant women receiving iron and folic acid supplement, Asmau said there are still huge challenges.

Some of these challenges, according to the State Nutrition Officer, include, taboos, myth and misconception among the people; inadequate funding of nutrition activities from relevant MDAs; gender issues militating against accelerating nutrition result; uneven scale up of interventions in the state; insecurity in some part of the state and others.

Nasarawa State

In Nasarawa State, the poverty situation in the state – children from the poorest economic quartile have been shown to be four times more likely to be malnourished than children from the richest households as indicated in the Multiple Indicator Cluster Surveys, MICS, 2011

Also, Food Security-Available data shows that total average household expenditure on food for the period between 2009 and 2010 is about 65% (NBS, 2012), while agricultural production has remained small-scale at subsistence level and largely dependent on rainfall.

The State Nutrition officer, Halima Yusuf, who was present at the meeting suggested that investment in agriculture by the state government has not significantly contributed to reduction of under nutrition at the rate needed to meet the state development goals. He argued that the economic consequence of this state of food insecurity in terms of productivity loss, is huge and requires urgent attention

She explained further that malnutrition and nutrition-related morbidity have continued to be of public health concern in Nasarawa State, adding that malnutrition manifests mainly as ‘’under-nutrition, over-nutrition and micronutrients’’ – minerals and vitamins deficiencies.

According to the officer, the trend in under-nutrition among children under five has not shown significant changes as revealed by the Multiple Cluster Indicator Survey (MICS) 2017 and Nigeria Nutrition and Health Survey (NNHS) 2018.

Kaduna State

The situation in Kaduna State is not as bad as that of Nasarawa State. Presenting the State Primary Healthcare Board Report of Nutrition Program Performance & Activities Q1 2022, the State Nutrition Officer of the Kaduna State, Ramatu Musa, who was at the stakeholders meeting, submitted that the state nutrition situation is of ‘’public health concern.’’ She stated that malnutrition accounts for more than 50% of under-five mortality, citing the NDHS 2018 survey.

‘’Maternal – Infant and Young Child Nutrition (M-IYCN) practice have remained unsatisfactory with the rate of timely breastfeeding initiation as low as 35.9%; Only 27.2% of children exclusively breastfed and only 12.7% of children age 6 to 23 months were fed appropriately.

However, it is encouraging to note that the prevalence of stunting, wasting and underweight among children under five years dropped from 56.6%,41.7% and 57.6% (NDHS 2013) to 48.1%, 4.8% and 22.1% (NDHS 2018), respectively’’, she stated.

The presentation revealed that there was significant reduction in malnutrition death from 142 children in 2020 to 58 children in 2021. While new admission reduces from 24,061 children in 2020 to 20,334 children in 2021
There is decrease in the  number of death of children with SAM from 672 in 2017 to 58 in 2021

The data also indicated that there was significant reduction in cured rate from 58.9% in Quarter 4 2021 to 37.2% in Quarter 1 2022, linking it to the stock out of RUTF in the state.

Emphasising some of the state’s achievements, the officer stated that there are 255 health facilities currently providing Nutrition services; strengthen and increase food demonstration corners and food demonstration in 225 PHCs; approval and procurement of RUTF worth ₦87,400,000.00 from the PHC MoU and procurement, training and distribution of  100 phones tablets to 100 H/Ws for effective data collection(ANRiN)worth N6,116,000

In spite of these encouraging achievements, the Nutrition Officer admitted some challenges. They include, reduction in cured rate due to the stock out of Ready to use Therapeutic Food (RUTF), and low number of men reached with nutrition messages – despite the importance of the men in decision making. While only 120 out of 255 wards providing maternal – infant and young child nutrition and only 16 out of 23 LGAs providing CMAM services.

Regions with Worst Nutrition Problem

Apart from the three states analysed at the stakeholders Meeting, the Nigeria Demography and Health Survey, indicates that malnutrition is basically concentrated in Nigeria’s northern states. The proportion of stunted children is highest in the North-West at 59% and lowest in the South-East at 16%.

Looking at the states, stunting is most prevalent in Kebbi at 66%, Jigawa at 64% and Katsina at 61% and these are all North-West states. It is least prevalent in the South-East states of Anambra at 14% and Enugu at 14.8%.

In addition, the proportion of children who are wasted – where a child is too thin for their height – is approximately twice as high in the North-East at 10% and North-West at 9%. In the other zones, the percentage is at 4%-6%. This gap in child malnutrition between northern and southern Nigeria has been constant over time.

The Consequences

Medical experts are in agreement that malnutrition, in all its arrangements, inflicts excessively high costs – direct and indirect – on any nation. It is also said to expand the already thin and poor economy, and has significant economic consequences at the individual, household and community level.

At the individual level, experts are of the view that malnutrition leads to impaired physical development with a long-term effect on cognitive development, educational performance and economic productivity in adulthood and on maternal reproductive outcomes.

Malnutrition is also said to weaken the immune system, resulting in a higher risk of severe infectious diseases, including diarrhoea and pneumonia.

At the household level, nutrition expert said the economic consequences are the health expenses and the opportunity costs incurred in caring for sick children. The risk of chronic diseases goes up so more money is spent on medication and accessing healthcare services.

Having a huge number of malnourished children could lead to lost investments in human capital associated with preventable child deaths, experts have consistently argued.

In all, malnourished children frequently suffer from loss of physical growth and may not attain their optimal height. There is a body of evidence that shows associations between height and outcomes in the labour market. Indeed, the World Bank estimates that a 1% loss in adult height due to childhood stunting is associated with a 1.4% loss in economic productivity.

The thinking by experts is that the ‘’economic viability of a country largely depends on its human capital and optimal child nutrition’’ is key to harnessing this.

Concerned by the consequences of malnutrition, the stakeholders in a communique signed by 25 of them, including state lawmakers, permanent secretaries, directors and nutrition officers, they said malnutrition is a condition that occurs when people consistently do not consume or absorb the right amounts, types of food and essential nutrients the body needs. They attributed it to inadequate funding of proven high impact and low-cost interventions designed to reduce and eventually eradicate it.

Noting that political will has a lot to do with this driver – as it is a sensitive aspect of nutrition intervention that affects the nutrition specific intervention, the participants said that all gathered evidences from both primary and secondary data indicated clearly that nutrition is underfunded in comparison with the burden in the states.

To this end, the meeting noted that there is: low level of political will and commitment in some states; low performance of implementing the multi-sectorial strategic plan of action on nutrition; inadequate data on budget performance and ineffective mechanisms to track implementation of nutrition programs.

Other factors noted include, low level of collaboration among MDAs implementing Nutrition specific and sensitive interventions; inadequate human resources for nutrition at all levels; inadequate budgetary allocation and releases for nutrition activities; low acceptance of nutrition best practices due to myths and misconception 

Consequently, participants agreed that there is need for synergy with National Orientation Agency and the media platforms across all levels for advocacy in creating awareness for nutrition budget lines and advocacy to legislators to carryout oversight functions on the level of nutrition implementation

Some of the participants at the meeting include, Dr Hajara Ni’ima Kera, Director Public Health Kaduna; Jessica Bartholomew; State Coordinator Kaduna; Hon. Aminu Ahmad – Chairman Appropriation Committee Kaduna State Legislature and Hon. Aliyu Dogara Mohammed – Chairman Appropriation Committee Nasarawa State House of Assembly.

Others are Hon Mohammed Bashir Lokogoma, Chairman appropriation committee Niger State; Nuhu Usman Bunu, Permanent Secretary, Ministry of Agriculture and Water Resources Nasarawa State, and Emmanuel Mamman Alidzi, Permanent Secretary, Ministry of Finance, Budget and Planning Nasarawa State.

 Quote 

Malnutrition is one of world’s major public health and development’’ trepidations. In Nigeria, the situation is said to be dire. To be sure, UNICEF said in its recent report that five in 10 children under five years old suffer from the effects of being malnourished