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Severe Malnutrition, A Disturbance in Nigerian Health Sector

PUBLIC HEALTH INFORMATION:

  • Good nutrition is a human right.
  • Over 15m Nigerian children malnourished
  • Malnutrition is the major cause of Child mortality in Nigeria.
  • Pregnant women who are not adequately nourished would give birth to babies with low weight.
  • You must not eat meat, fish or egg to be healthy.
  • You can prepare nutritious food from locally sourced ingredients.
  • Govt and other relevant authorities must do more to address the problem of hunger and malnutrition
  • A malnutrition free generation is possible if mothers are properly educated about local foods and children are treated with those locally available nutritious foods.

CASE FILE

An 18 month old boy is brought to the emergency room for evaluation. He and his siblings were all removed from their home earlier in the day, after a neighbor’s complaint. There are no parents or guardians present to give a history, although the police officer comments that the mother is thought to be a street hawker. The 12 year old sister, who seems to be the primary caregiver, is worried that the toddler is sick, stating that “he’s gotten really skinny” and he “keeps a cold,” with constant rhinorrhea and cough. She is unsure if he has seen a doctor, but thinks that he “got all his immunization”.

Diet history is revealing: meals are generally prepared by the 12 year old and 10 year old siblings, and consist of packaged macaroni and rice, whatever spaghetti or noodles they could find, and occasionally fast food from neighbours.

On exam, the toddler is anxious, clinging to his older sister. He appears thin, with a large head and subcutaneous wasting. Vital signs are appropriate for age. Weight is 9 kg (<3rd percentile); height is 72 cm (<3rd percentile); head circumference is 47 cm (10th percentile). Exam is significant for subcutaneous wasting, sparse hair, dry skin, and a scaling rash in the diaper area. There are no overt signs of trauma, and no focal neurologic deficits.

Laboratory evaluation is significant for a microcytic anemia and a decrease in serum albumin. The toddler is admitted to the hospital for protection, and monitoring during the refeeding process, which proceeds without incident.  With the provision of sufficient calories and protein in the diet, weight gain begins to improve.

 

DISCUSSION:

According to the WHO, Malnutrition refers to the cellular imbalance between the supply of nutrients and energy and the body’s demand for them to ensure growth, maintenance, and specific functions. It can either be Undernutrition or Over-nutrition (obesity), although it is most often used to describe forms on undernutrition.

Malnutrition unfortunately remains a significant problem, especially in Nigeria with her high poverty-stricken areas. Malnutrition may present as marasmus or kwashiorkor, or more commonly, with overlap between the two.

Marasmus involves inadequate intake of protein and calories and is characterized by emaciation. Kwashiokor refers to an inadequate protein intake with reasonable caloric (energy) intake. Kwashiokor is the form of Protein-Energy Malnutrition most commonly seen in Nigeria. Kwashiorkor has been known to occur in toddlers weaned to a protein deficient diet (white rice, yams, cassava, etc).

Malnutrition In Nigeria

It is quite alarming that 80 per cent of the world’s stunted children, live in 14 countries and Nigeria is the second largest contributor after India. An estimated 2.5 million children under the age of five suffer from Severe Acute Malnutrition (SAM) every year as detailed by UNICEF. Northern Nigeria has about 88% of Children with Severe Acute Malnutrition in Nigeria.

Malnutrition is a very serious condition that makes children ten times more likely to die from common childhood illnesses such as such as diarrhoea, pneumonia and malaria. Every year, nearly 420,000 children under five die as a result of this deadly combination in Nigeria.

According to Nigeria’s facts sheet on nutrition, the disparities in malnutrition related to various background characteristics are significant in Nigeria, but are often more pronounced for stunting. Children from rural areas are almost twice as likely to be stunted as children from urban areas. A child whose mother has no education is four times more likely to be stunted than a child whose mother has secondary or higher education. Children from the poorest 20 per cent of households are also four times more likely to be stunted than children from the wealthiest 20 per cent of households.

THOSE AT RISK OF MALNUTRITION

Those who live in poverty are at increased risk, as are infants, adolescents, pregnant women, alcoholics, and patients with eating disorders. Pregnant women who are not adequately nourished would give birth to babies with low weight.

CAUSES OF MALNUTRITION IN NIGERIA

  1. Poverty and armed conflict in parts of Nigeria: This has increased the number of displaced persons, especially in Northern Nigeria, since the advent of Boko Haram terrorism.
  2. Low Education Status, Inadequate and/or inappropriate knowledge and discriminatory attitudes,  limit household access to actual resources
  3. Insufficient access to food
  4. insufficient health services
  5. Inadequate maternal and childcare practices
  6. Poor sanitation/water and inadequate health services
  7. Poor Government Funding of Child Nutrition
  8. Political, cultural, religious, economic and/or social systems, including women’s status, limit the utilization of potential resources.

 

FEATURES OF MALNOURISHED CHILDREN

  • Unhappy & irritable, apathetic,
  • Hair & skin changes. The skin appears dry, loose, and wrinkled. Hair may become thin, sparse, and brittle.
  • skin ulceration
  • Diarrhea & dehydration
  • Abdominal distention (Swollen Stomach)
  • Generalized muscular wasting and the loss of subcutaneous fat

Malnutrition in Nigeria

MANAGEMENT OF MALNUTRITION

According to UNICEF, Steps to prevent children becoming malnourished include;

  • supporting and encouraging mothers to breastfeed their babies exclusively for the first six months of life;
  • educating families about the correct feeding practices for older babies and children; and
  • provision of micronutrient supplements and vitamins and fortified food for pregnant women and young children.

In addition to these, and with respect to Nigeria, families need to look inward, with the aim of diversify our diets.

It all begins with the mothers, The need to practice exclusive breastfeeding and complementary feeding of infants after the age of six months cannot be over emphasized.

 

Preparing Nutritious Food From Local ingredients.

We should learn to really make use of what we have to feed ourselves. Even right in our homes, we should encourage consumption of vegetables and fruits that are readily available. It is not about how much we eat (quantity), but the content of what we eat (quality/balanced diet). The diet should contain enough protein, fruits and vegetables, so that the children can  have enough required micronutrients.
Every year, the Nigerian agricultural sector produce tons of maize, millet, groundnut, beans, soya beans and others similar food stuffs. These foods contain all the micronutrients required for the growth and development of a child. Yet, millions of Nigerians are dying from severe malnutrition.

 

Sources of Balanced diet

These Video From Nigeria Health Watch Shows that Malnutrition can be combated with local sources of food,

Here, Soy Kunu a locally sourced and prepared blend consisting of peanut, millet and soya beans is seen, being effectively used to combat acute malnutrition in the North. The three seeds are ground together into ready-to-use powder form, and later prepared by adding boiled water to make a porridge.

 

Final Approach To Tackling Malnutrition In Nigeria

The following economical approach should be employed to tackle the menace of acute Malnutrition in Nigeria.

  • Identify local foods that will help mothers better nourish their children
  • Use of locally sourced and prepared food ingredients consisting of the basic required nutrients, such as shown above.
  • Encouraging the use of community health ambassadors to organize practical seminar and train pregnant and breastfeeding women to prepare nutritious foods for themselves and their children from local sources.
  • Educating Mothers and Women on Malnutrition
  • Educate women and pregnant mothers on WHO standard using weight, length and upper arm circumference to measure the nutritional status of their children.
  • Assessing a Child For Malnutrition
  • 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, government need to create policies to enable business capacity building for these women to ensure that they can keep their children healthy.

 

Vitamin Deficiencies Can Corrected From Sources Which Are Abundant In Nigeria:

Vitamin A is found in cod liver oil, dark leafy greens such as greens, spinach, and vegetables such as carrots, sweet potatoes, pumpkin and mangoes.

Vitamin B1 is found in rice and other whole and enriched grains, seeds and legumes, bananas, most fish, liver, nuts and seeds, potatoes, peas, watermelon, avocado, and poultry.

Vitamin B2 is found in whole grains and fortified cereals, meat, dairy products such as milk, yogurt, and cheese, eggs, fish and shellfish, poultry, kiwi, avocado, broccoli, turnip greens, and asparagus.

Vitamin B3 is found in meat, fish, poultry, fortified and whole grains, mushrooms, potatoes, mangoes, lentils, and peanuts.

Vitamin B5 is found in meat, poultry, whole grains, and many foods.

Vitamin B6 is found in fortified cereals, soy products, meat, dairy products, bananas, watermelon, brewer’s yeast, wheat bran, walnuts, brown rice, meat, fish, poultry, potatoes, and soy.

Vitamin B7 is found in fruits, meats, dairy products, and eggs.

Vitamin B9 or folic Acid is found in dark green vegetables, dry beans, peas, and lentils, enriched grain products and fortified cereals, liver, orange juice, wheat germ, and yeast.

Vitamin B12 is found in liver, eggs, fish, poultry, meat, dairy products

Vitamin C is found in citrus fruits such as oranges and grapefruits and citrus fruit juices, in red, yellow, and green peppers, potatoes, tomatoes and most fresh foods.

Vitamin D is found in cod liver oil, fortified milk, margarine or cereals, dairy products, fatty fish, liver, and eggs.

Vitamin E is found in fortified cereals, wheat germ oil, unrefined vegetable oils, leafy green vegetables, seeds, nuts such as groundnuts, peanut butter, and whole-grain.

Vitamin K is found in dark green leafy vegetables such as cabbage, liver, eggs, milk.

 

Common Foods help Malnutrition

A malnutrition free generation is possible if mothers are properly educated about local foods and children are treated with those locally available nutritious foods.

 

 

Credits:

  • UNICEF
  • Nigeria Health Watch
  • Thisday
  • Vanguard
October 15, 2018

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