Two-year-old Umar is in his mother Saratu’s arms, a playful boy. She says he was not always this healthy, and that just over six months ago, “His spinal cord was showing like a tree, he could not sit or stand and whenever I needed to carry him on my back, I had to tie him in multiple wrappers to hold him in.” Umar and other children like him in the Rano and Garun Malan LGAs of Kano State were able to recover from the serious effects of malnutrition, thanks in part to an innovative intervention. The programme is based on educating mothers about nutritious foods which are easily available in their communities that they can readily include in their family diets.
The programme began during the maternal, newborn and child health week in November 2017. Producers of HealthZone, a television health show, working with the Isah Wali Empowerment Initiative (IWEI), a Kano-based NGO, launched a mother and child health malnutrition initiative. Their goals were to:
- educate women on the impact of adequate nutrition on pregnancy outcomes and child development;
- highlight the benefits of proper nutrition, and
- teach women how to prepare nutritious food from locally sourced ingredients.
Alongside these educational activities, the initiative also planned to screen pregnant women for pre-eclampsia, eclampsia, diabetes, malaria and STIs; to assess children for malnutrition and also to provide micronutrients and deworming medications to children.
At the beginning of the intervention, 149 children were screened for malnutrition in Rano and Garun Malam LGAs using the World Health Organization (WHO) child growth standards of Mid Upper Arm Circumference (MUAC), weight, and height measurements. 13% of the children were severely malnourished, 19.5% were borderline malnourished and an astonishing 63% were stunted, an indication of chronic malnutrition during the first 1000 days of life. This stunting rate is higher than the 51.4% figure of stunted children in Kano State according to the United Nations Children’s Fund (UNICEF).
Nigeria’s Malnutrition crisis
Malnutrition in Nigeria has been referred to as a silent catastrophe with devastating effects for much of our under-5 population. According to UNICEF, about 2.5 million children suffer from severe acute malnutrition each year and 37% of children under 5 years of age are stunted. The dichotomy between these figures and the evidence of Nigeria’s relatively abundant resources and vast arable land raises the question of where we are getting it wrong and why a significant number of Nigerian children are malnourished. Northern Nigeria has about 88% of Nigeria’s severely malnourished children.
For Hajiya Halima Hanga, Executive Secretary of IWEI, this dichotomy is paradoxical, as many of the parents have access to the nutritious foods their children need, but poverty often drives them to sell the foods. “Even though the children are eating they are not eating the right kind of food; for example, the chickens lay eggs but the parents take it to the market; they also farm beans and sell it,” rather than use them to feed their children, she said.
Many interventions launched by governments and partners to address this issue involve the use of imported Ready to Use Therapeutic Food (RUTF). However, all year round, tons of food- maize, millet, groundnut, beans, soya beans and others- are harvested all over the country. These foods contain all the micronutrients necessary for a child’s well-being, growth, and development. They are also the main contents of the imported ready to use therapeutic foods, so the obvious question seems to be, why have we not been able to use our own locally available foods to fight the scourge of malnutrition in Nigeria?’ This was the topic for discussion at our recent policy dialogue on malnutrition where several potential solutions were proffered.
Nutritious foods from local sources; a simpler, more sustainable solution
After screening the children, HealthZone and IWEI enrolled 28 of the children with the most severe nutrition needs into the intervention program. With support from the Emir of Kano, MRS Oil and other partners, they provide ‘Soy Kunu’ for the children and weekly nutrition counselling for the mothers of the children. The counselling and demonstration activities take place at Mahmoud Dawaki primary health care centre PHC in Rano, an agrarian town about 60Km off the Zaria – Kano Highway. Soy Kunu is a locally sourced and prepared blend consisting of peanut, millet and soya beans manufactured by Kano-based Nurture All Foods. The three seeds are ground together into ready-to-use powder form, and later prepared by adding boiled water to make a porridge. Apart from providing the Soy Kunu free of charge, the company also helps train the mothers to prepare the food themselves at home. Since November 2017, these children have been receiving soy kunu packages as their mothers receive nutrition training on a weekly basis.
Different approach, huge impact
Looking at some of the children six months after, it is clear that this intervention has yielded admirable results. The children are now well nourished and appear healthy. “He is now practising how to walk, unlike six months ago that he couldn’t even sit; he was looking like a skeleton,” Jamila Umar says, holding her obviously healthy son Buhari who was smiling and kicking his feet around.
Hajiya Halima Hanga said some of the children could not lift their arms or stand before the intervention started. Perhaps the biggest impact this intervention has had is on the survival of all these children from chronic malnutrition. As the coordinator of the program, Ms. Muneerah Ashafa put it, “Our biggest success is that we have not lost any of these children to malnutrition”. This position was corroborated by Halima Mohammed, grandmother of Uzairu, another 22-month-old child receiving the intervention. “Without this kunu, he wouldn’t have been like this now. Six months ago, he was too lean, and his head was too big”, she said.
Maintaining the impact and preventing future malnutrition crises
Sustaining an intervention, in the long run, is most times harder than initiating it. Because of the prevalence of malnutrition, especially in the rural areas, it requires the participation of the people in the community for any successful intervention to be sustained. HealthZone and IWEI apparently understand this. To achieve sustainability and help stem future malnutrition crises in Rano and Garun Malan LGAs, they selected 10 young women from each of the local government areas to serve as community health ambassadors. These women, who will work as volunteers, received training on how to determine the nutritional status of children under five and train pregnant and breastfeeding women to prepare nutritious foods for themselves and their children from local sources. The training was modeled after the WHO standard using weight, length and upper arm circumference to measure the nutritional status of children. The ambassadors would visit households in their communities on a weekly basis to assess children and provide the nutrition training for women. This will help early identification of malnourished children.
Although HealthZone and IWEI have done a remarkable job in bringing these 28 children out of severe malnutrition, the other 93 stunted children also require a special intervention that will help cushion the effects of this lifelong challenge. Even though the damage of stunting is irreversible, creating a program for them that will periodically determine their health status and follow their educational development will go a long way in minimizing the difficulties they may face later in life because of damage caused by stunting. From the training they receive, these women can now prepare therapeutic foods themselves from local ingredients. But no matter how available the ingredients are, the women need money to purchase them. Therefore, business capacity building will be important for these women for their futures, and to ensure that they can keep their children healthy.
Identifying local foods that will help mothers better nourish their children is an important step in the right direction against the scourge of malnutrition in Nigeria. This intervention, despite its limited scope, has shown it is possible to arrest the problem if mothers are properly educated about local foods and children are treated with those locally available nutritious foods.
More of these interventions, working in partnership with local NGOs, are needed in Nigeria, if we are to ever see a significant reduction in the country’s level of malnutrition. With donor support under pressure, we need to identify and sustain local solutions to our malnutrition crisis that can be scaled up to reach more children. We also need a greater focus on preventative measures, which starts with educating mothers on the preparation of nutritious meals for their children.
This is commendable, using readily available resources to address health challenges in our community. Is this going to be an ongoing project or is this a one-off intervention?
This is an ongoing intervention and not a one-off, the plan is to make sure that the trained Community Health Ambassadors and Program Co-ordinators work in Garun Mallam and Rano to provide counselling for the next year. However, for such essential community interventions to remain sustainable, requires sustained funding, especially for Ready-To-Use Therapeutic foods and fortified foods for the malnourished children. So, private and public-sector organisations can help support this programme to ensure that children who need the intervention have access to it.
Using local foods is not only readily available and relevant but also cheaper. Same approach has been in use since the 70s at Ahmadu Bello University, Zaria. The preparation was known as Kwashipap. Prepared from Millet, egg and some palm oil to provide Vitamin A for the eyes. It was the wonder pap as observed by all of us as Medical Students.
The searching question here is why do we always fail to carry through with our local simple scientific break through?
Food for thought.
In Nigeria, we have local foods that often get overlooked, and their nutritional benefit overlooked. That is why we need to get back to basics. Better promotion of our local foods, educating people especially mothers on the potency of our local foods. In addition, mothers need education of what to feed their babies at the different stages of the child’s development ie, 0 – 6, the importance of breastfeeding, from 6 months up, supplementary foods as they continue to breastfeed (depending on the child’s appetite), following on from that, what foods to feed their child from 1 years + etc. etc.