Scourge of child malnutrition, under-five mortality

Malnutrition is known to be widespread in Nigeria. Though a national problem, it is more prevalent in the Northern part of the country.

With about 2.5 million children severely malnourished, malnutrition not only contribute close to 50 per cent of deaths in children under five, but also results in massive cost for the nation.

Nearly 1million children under the age of five years die in Nigeria every year. This makes the country one of the highest contributors to the under–five mortality in the world and about half of these deaths are due to malnutrition.

Good nutrition is the bedrock of child survival, health and development as well nourished children grow and learn better, participate in and contribute to their communities, and are also resilient in the face of disease, disaster and other crisis.

Poor physical growth and brain development resulting from poor nutrition in children make them not to thrive and live to their full potential. Adequate nutrition during the first 1,000 days (from the start of a woman’s pregnancy until her child’s 2nd birthday) can avert malnutrition, ensuring that children have the best possible opportunity to grow, learn, and rise out of poverty. Effects of malnutrition are often irreversible after this period. Malnutrition occurs when a person does not receive adequate nutrients from diet. This causes damage to the vital organs and functions of the body.

Ironically, Nigeria is battling with double burden of malnutrition and over-nutrition. Certain illnesses and infections, such as tuberculosis, measles, and diarrhea are directly linked to acute malnutrition.

Malnutrition leads to integrational cycle of growth failure as nutrition affects all stages of the lifecycle. Child growth failure, low birth weight baby, early pregnancy and low weight and height in adolescents.
According to experts, there are multiple dimensions of child malnutrition that can coexist in individuals, households and populations which could manifest in form of stunting, wasting, micronutrient deficiencies and overweight/obesity.

While stunting (under-nutrition) refers to the percentage of children aged 0 to 59 months whose height for age is below minus two standard deviations from the median of the WHO Child Growth Standards, wasting which is a Severe Acute malnutrition (SAM) is the percentage of children aged 0 to 59 months whose weight for height is below minus two standard deviations (moderate and severe wasting) and minus three standard deviations (severe wasting) from the median of the WHO Child Growth Standards.

According to statistics, over 11 million under five Nigerian children are stunted, ranking Nigeria second only to India. Nigeria also accounts for one-tenth of the global burden of severe acute under-five malnutrition (SAM). About 2,300 children under the age of five die every day in the country; more than a half of these deaths are related to malnutrition causes.

In 2016 alone, about 34,889 children were affected by malnutrition in the Southeast with 6,700 deaths were recorded while in the South-South, 86,304 children were affected, out of which 16,700 died.

The Southwest had 84,417 cases of malnutrition in 2016 and 16,300 deaths while North-West recorded 1,594,462 cases and 308,000 deaths; North-Central 43,635 cases with 8,400 deaths; and North-East 695,998 cases and 134,000 deaths.

According to the World Bank, Nigeria loses over $1.5billion in GDP annually to vitamin and mineral deficiencies alone. At a two-day Media Dialogue on “Leveraging Resources for Child Malnutrition in Nigeria” organized by the United Nations Children Fund in collaboration with the Child Right Bureau of the Federal Ministry of Information and Culture, Head of Nutrition, Federal Ministry of Health, Dr Chris Osa Isokpunwu disclosed that about N2.8billion is required within the next five years to tackle the scourge of child malnutrition in the country.

He noted that this investment would help avert 890,000 stunting in five years and save about 123,000 lives annually. Isokpunwu noted that the budget for child nutrition was created for the first time in Nigeria in 2014, describing child malnutrition as “a silent killer which has to be stopped” in view of its devastating consequences.

He observed that the national budget provided only N2.4 million for child nutrition in 2016, while nothing was provided in the 2015 budget and N30 million was provided in 2014 but was not released.

Isokpunwu who stressed the need for adequate funding for child nutrition, observed that if government fails to address the issue of malnutrition in children under the age of five, all efforts at reducing death among children under the age bracket would be counter productive.

He explained that the National Strategic Plan of Action for Nutrition 2014-2019 was designed to improve the nutritional status throughout the lifecycle of Nigerian people, with a particular focus on vulnerable groups including women of reproductive age and children under five years of age.

According to him, the National Strategic Plan of Action for Nutrition has the targets of reducing the number of under-five children who are stunted by 20 per cent by 2019; reducing low birth weight by 15 per cent by 2019; ensuring no increase in childhood overweight by 2019; reducing and maintaining childhood wasting to less than 10 per cent by 2019; reducing anaemia in women of reproductive age by 50 per cent by 2019; and increasing exclusive breastfeeding rates in the first six months to at least 50 per cent by 2019.

Isokpunwu, therefore, stressed the need to develop a specific and fully funded budget line for nutrition in the annual state budget, increase public sector budget for nutrition-specific interventions progressively increased; and health systems strengthened and ensure that nutrition is integrated in all related policy areas – Agric, Gender, Wash and Planning.

In a paper entitled “Child Nutrition Situation in South-East and South-South Zones of Nigeria”, a Nutrition Specialist at the Port Harcourt office of UNICEF, Ngozi Onuora, lamented that every single day, Nigeria loses about 2,300 under-five-year-olds and 145 women of childbearing age as a result of malnutrition.

This, she said, dents the country’s image as the second largest contributor to the under-five and maternal mortality rate in the world. Onuorah noted that inadequate government commitment and funding for nutrition programmes, Capacity gap in the implementing partners programme officers, poorly motivated workforce, poor attitude of health workers and poor coordination of MNCHW in the States among others as challenges.

She observed that in order to address the alarming rate of under-nutrition in the country, there must be an increased Government and Private investment in Nutrition either as co-financing and direct funding of nutrition specific and sensitive interventions, increased access of all needy children to nutrition services, adequate funding of MNCHWs to ensure that all needy children have access to nutrition services as part of the child survival program.

Speaking on Children Friendly Budgeting: Addressing Child Malnutrition, a Social Policy Specialist, UNICEF Enugu, Ken Ozoemena observed that effects of malnutrition are often irreversible if nutrition is not optimized during period.

He, however, noted that government is not meeting its commitments to children supposedly due to budget constraints adding that the realisation of the rights of children as enshrined in UNCRC demands adequate budgetary allocation to sectors that directly impact survival and development of children.

Ozoemena stated that placing children at the centre of the development planning would allow for sustainable socio-economic development for all people.