A well-nourished child is better able to grow and learn, says Prof. Nnam
Prologue
The 1,000 days between a woman’s pregnancy and her child’s second birthday offer a brief but critical window of opportunity to shape a child’s development. The right diet (nutrition) during these periods will, according to experts, help a baby’s learning, physical skills and emotions to develop properly. But, being hungry or exposed to stress or abuse throughout this time, they also say, could equally have a lifelong effect on a child’s development. From North to South, mothers in Nigeria as in everywhere else, crave knowledge on nutrition and health to give their children a better chance in life. They want hope in a world where malnutrition and stunting rob more than 1 in 5 children under the age of 5 of the opportunity to fulfill their human potential. The solution, however, begins in the first 1,000 days of life—from the beginning of pregnancy to the second birthday of a child. This story therefore is a call to action, and focused on providing parents with proper nutrition information on how to get informed, and get involved, and get going on nutrition issues. Nigeria’s oil had masked the reality on the ground. Only now is the country’s place in the malnutrition crisis becoming clearer. However, for malnutrition, pregnancy and infancy, according to experts, are the most important periods in the fight against this scourge. They are critical periods, they say, as mothers and babies need good nutrition to lay the foundation for the child’s future development, reports Isioma Madike
The sight of women holding their severely malnourished children as they stand outside their homes in many parts of Nigeria, is heartrending. At Agbakpa area of Enugu State recently, naked kids with wrinkled frames were common sights in most neighbourhoods. The story is the same at Kosofe-Mile-12, Lagos State, where incidentally, the biggest food market in the West African sub-region is situated.
Kids of that mould are also seen in virtually all vicinity across the country. Their sight usually casts a dark shadow over Nigeria, where millions of children have inadequate nutrients to nurture their tiny bodies. Many of them are skinny, listless and sick in their localities.
If they survive, the nutrition experts say, they will grow up shorter, weaker and less smart than their better-fed peers. Some of them are underweight, according to their mothers, and about half of what they should. Others are light as a leaf. Out of ignorance, their mothers jabbed their protruding stomachs, infrequently. One interesting thing, however, is that they live mostly in the remote areas and are usually within the age bracket of two years. Some of them are pipe-stem thin with rather large teeth jut from a somewhat perpetually open mouth etched on a face with skull-tight skin and buzz-cut hair.
They often grit their teeth when they talk. At Issele-Uku in Aniocha Local Government Area of the oil-rich Delta State, are many such sights. In one of its villages, for instance, one-year-old Ngozi, who is underweight rests on a bed next to her equally malnourished mother, is one of such kids.
“You see her arms? They are almost the width of my thumb,” said Adaolie, as she carried her flabby, emaciated daughter with one palm. “She is too weak. She can’t even sit by herself,’’ the distraught mother added. Poor hygiene, low public health spending, little education and awareness have not helped. Born into a family of four, Ngozi and her siblings are not fortunate to enjoy a balanced diet on a daily basis.
Theirs is a typical example of grinding poverty. Ngozi’s predicament started when she was still a foetus in her mother’s womb as her father was said to have lost his two eyes to Glaucoma before her birth. Her father’s misfortune only placed a great burden on her mother, who, at the time, was a fulltime housewife with little education and no formal vocational training. With the near-absence of the breadwinner of the family, her mother could only struggle to make sure the family does not starve to death.
Faced with this pitiable situation, Ngozi, like her other siblings, was denied the needed nutrients from birth. From what her mother told this reporter, it is also obvious that her mother did not eat what she was supposed to throughout her pregnancy. Adaolie said: “When you hold her in your arms, it’s easy to be struck by the fragility of a new human life.
I remember feeling both exhilarated and, at some moments, terrified when she was born. It was such an awful experience. One of the greatest comforts in those early months, however, was watching her struggle to gain weight.” In many of such communities, poverty wears a human face, and women can’t afford to eat the locally grown fruits and vegetables, as they sell off everything to buy things they do not have.
They also struggle against parasites and a lack of clean water. In some of such rural villages, the infant mortality rate is disturbingly high. Basic essentials are hard to come by and torn mosquito nets are used to fend off malaria. This gloomy picture may have informed the recent media dialogue with media practitioners on the Sustainable Development Goals (SDG) as Child Rights by the Federal Ministry of Information and Culture in collaboration with UNICEF held in Enugu State. Interestingly, SDG 2 aims to achieve “zero hunger”. It is one of the 17 SDGs established by the United Nations in 2015.
The official wording is: “End hunger, achieve food security, improve nutrition and promote sustainable agriculture.” One of the resource persons at the dialogue, Nkeiruka Enwelum, who is the Nutrition Officer, UNICEF Nigeria Country Office, emphasised the fact that SDGs are Child Rights. Enwelum, who dwelt on nutrition essentially, said that micronutrient deficiencies, which often do not have physical manifestations, are referred to as hidden hunger. She said: “The hidden hunger includes iron deficiency, which causes anaemia and tiredness/weakness, Vitamin A deficiency, which causes a type of blindness, and calcium deficiency that causes weak bones.
“Poor nutrition in the first 1,000 days from conception of a child to two years of age results in permanent damage. That is a major consequence of malnutrition. And globally, 45 per cent of all child deaths are from poor nutrition. “A mother who is underweight or anaemic is more likely to have a child who is stunted. Her child will be less likely to grow up strong and healthy, to excel in school, and to gain job and economic opportunities. As a result, that child is more likely to remain in poverty, more likely to be malnourished, and more likely to have stunted children, too.” Malnutrition, Enwelum said, can cause permanent, widespread damage to a child’s growth, development and well-being. Stunting in the first 1,000 days, she added, is associated with poorer performance in school, both because malnutrition affects brain development, and also because malnourished children are more likely to get sick and miss school.
Hidden hunger, she said, can also cause blindness (Vitamin A deficiency), impair learning (iodine deficiency) and increase the risk of a mother dying in childbirth (iron deficiency). Overweight and obesity are others that can lead to serious illnesses like type 2 diabetes and cardiovascular disease. “And this disruption to children’s physical and cognitive development stays with them into adulthood, compromising their economic prospects and putting their futures at risk. Collectively, the loss of potential and productivity has huge implications for the broader socio-economic development of societies and nations.
“It undermines countries’ ability to develop ‘human capital’, or the overall levels of education, training, skills, and health in a population. And the loss is significant,” she said. Similarly, a professor of Community & Public Health Nutrition at the University of Nigeria Nsukka, Ngozi Nnam, also said that good nutrition is the bedrock of a child’s survival and development. According to her, a well-nourished child is better able to grow, learn, play and participate in their communities. They are also more resilient, she said, in the face of crisis.
“Yet, today, many children are not getting the nutrition they need to survive and thrive. This is especially true for the poorest and most vulnerable children. At least one in three children under 5 is affected by malnutrition in its most visible forms: Stunting, wasting and being overweight.
“Children affected by stunting are too short for their age, and their brains may never develop to their full cognitive potential, hindering their ability to learn as children, earn as adults, and contribute fully to their societies. “Those with wasting are desperately thin, have weakened immune systems, and face an increased risk of death: They require urgent treatment and care to survive. As global food systems shift and the consumption of processed foods high in fat, sugar and salt increases, childhood overweight is on the rise in every region of the world, particularly in middle-income countries like ours.
“However, less visible forms of malnutrition, such as hidden hunger, can occur when children become deficient in essential vitamins and other micronutrients. These micronutrient deficiencies affect more than 340 million children under 5 globally, delaying their growth, weakening their immune systems and impairing their brain development,” she said. Nnam also said that currently, many countries are facing a double or triple burden of malnutrition – with concurrent problems of stunting, wasting, micronutrient deficiencies, and overweight. From pregnancy, through childhood, and in adolescence, poor diets are a leading cause of malnutrition in all its forms, she added. Meanwhile, children’s diets, she also said, are shaped by multiple forces – globalisation, urbanisation, inequities, environmental crises, epidemics and humanitarian emergencies – that undermine families’ access to nutritious, safe and affordable foods. She said: “The COVID-19 pandemic has worsened the pre-existing crisis of child malnutrition, threatening families’ livelihoods, disrupting the availability and affordability of nutritious and safe diets, and straining the delivery of essential nutrition services – with dire consequences for the most vulnerable children. “You should know that the first 1,000 days is basically when the child is under 5 and most of the parts of the body of the child are developing both physiologically, anatomically and psychologically. There is a need to monitor and implement a good nutritional programme to allow that child to develop optimally.
“This development is going to affect the child much later in life as he or she grows. A lot of damage done at this stage may be lifelong; and it affects not only the child but also the family, community and the nation at large.” Nnam, who is the President, Nutrition Society of Nigeria, quoting statistics, also said about 37 per cent of Nigerian children were stunted, 29 per cent underweight and 18 per cent wasted while micronutrient deficiencies were high. She added: “While we are grappling with the challenge of under-nutrition, the incidence of obesity and related manifestations of over-nutrition are beginning to emerge at relatively significant levels.” Another Professor/Consultant Community Physician, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Bayo Onajole, aligns with Nnam’s line of thought when he said that the child’s life starts right from conception.
