The impact of malnutrition, particularly in the first one thousand days of a child’s life, is dire even if it is not fatal. Many infants and children who suffer from malnutrition are affected by stunting, recurrent infections or chronic diseases.
In this report, DOOSUUR IWAMBE examines how RUTF saved 3-year-old child who was abandon by his mother in Borno state.
With bright eyes and a playful smile, Ibrahim Shehu (not real name), is a happy and healthy 3-year-old child who love playing and jumping around with children of his age in his neighborhood.
If you met Shehu today, you would probably never suspect the long, uphill battle he has faced to get to this point. Born in Dikwa Local Government Area of Borno State, little Shehu’s mother abandoned him when he was barely 3-months-old with his father, after their divorce.
Shehu’s father, who could not take proper care of him because of his disabled condition and the difficulties of daily survival, left him in the care of his grandfather, Modu Baba, an octogenarian from Dikwa Local Government Area, Borno State.
Baba, who was rendered homeless after Boko Haram insurgents displaced him from his ancestral home, has been living with other Internally Displaced Persons in Bolori IDP camp.
Catering for his grandson Shehu, became a herculean task hence he was struggling to earn a living working as a security guard. He told our reporter through an interpreter that his grandson was doing well at the initial stage until he suddenly started noticing some changes.
He said, ‘’Boko Haram invaded our community in Dikwa where we were staying; rendering all of us homeless. We ran away from Dikwa on foot to Maiduguiri.
As at that time, the mother of Shehu was in Maiduguri. When we came to Maiduguri, we were practically beggars, because we were left with nothing. There, I picked a job as a security guard.
‘’The mother of this boy has four children and Shehu is the last-born. By the time he was born, he was barely three months old when my son divorced his mother.
The mother now left the child with my son on the excuse that she cannot carter for him. My son now handed Shehu over to me because he rely on mobility aids, ‘’wheelchair’’ for movement.
‘’This child was never breastfed by his mother and as a result of that, it was difficult for him to grow like other healthy children.
He was taking pap mixed with groundnuts, cow milk popularly referred to as ‘’nunu’’. That was how he came down with malnutrition.
‘’I noticed that shehu was growing thin, frail with a big stomach. At first, I thought it was just some kind of minor sickness so I was giving him some local herbs.
I became confused when his ribs started becoming visible, his stomach bigger and eventually; he could hardly stand on his own without support.
‘’I knew he was sick, but little did I know that he was suffering from Severe Acute Malnutrition (SAM) until I took him to a United Nations Children’s Fund (UNICEF)-supported medical clinic in the IDP camp, where I was told he was suffering from SAM.
‘’Upon our arrival at the clinic, they immediately commenced treatment on Shehu with the Ready-to-use Therapeutic Food (RUTF). He took the RUTF for some months, and to my greatest surprise; he was back on his feet again.
“I am so happy now because he is not sick anymore and as a matter of fact, he hardly falls sick. He is also fat as you can see for yourself, he can play, eat and drink now’’, Baba said.
Children suffering from severe acute malnutrition like Shehu are nine times more likely to die from related complications than healthy children are.
He is one of the estimated 2.5 Million Boys and Girls under the age of five suffering from Severe Acute Malnutrition (SAM) every year in Nigeria.
According to the Nutrition Sector annual projections, an estimated 371,000 Boys and Girls under the age of 5 in Borno, Adamawa and Yobe (BAY) states will suffer from Severe Acute Malnutrition (SAM), a life- threatening condition. In North East Nigeria, the nutrition surveillance data indicate slight improvement on the nutrition situation since the beginning of the response.
However, the widespread insecurity, population displacement, poor Food Security situation, sub-optimal Water, Hygiene and Sanitation Practices and high disease burden continue to strain the on-going efforts to curb malnutrition in all its forms in the region.
According to the latest Nutrition Survey, the prevalence of Global Acute Malnutrition (GAM) among Boys and Girls aged below 5 Years is 11% in Borno, 13% in Yobe and 6% Adamawa, indicating very high levels of malnutrition according to World Health Organization classification.
The Protracted Access Constraints has made the Situation even worse in Rann (Kala Balge), South Yobe, Magumeri, Jere and Konduga Local Government Areas.
What is RUTF?
RUTF (ready-to-use therapeutic food) gives malnourished children the vital nutrients they need to recover. The original and most well known RUTF, Plumpy’nut, was invented in 1996 by French pediatrician André Briend.
As the name suggests, Plumpy’nut is a peanut-based paste served in a foil pouch. This means that it is portable, non-perishable, and can be eaten by babies who are not yet ready for solid foods.
The exact ingredients for an RUTF can vary based on the brand, but the standard RUTF has the same features: high in calories, nutrients, and vitamins to help children suffering from acute malnutrition rapidly gain weight.
RUTF’s history goes hand-in-hand with Concern’s own history. This was not just an invention: It was a revolution in how we treat malnutrition.
It ensures rapid weight gain in severely malnourished children and has improved the lives of hundreds of thousands of children over the years.
Poor feeding practices, such as inadequate breastfeeding, offering the wrong foods, and not ensuring that the child gets enough nutritious food, contribute to malnutrition.
Nigeria needs N5bn to halt malnutrition in North East
According to UNICEF, Nigeria needs N5 billion to urgently purchase RUTF in order to halt emergence of new cases of SAM estimated to affect 258, 950 children living in the North East by the year 2020.
UNICEF nutrition specialist, Aminu Usman who made this known during a media dialogue on Integrated and Timely Response to Nutrition Related Humanitarian Needs in Maiduguri, Borno State, said that the money was much needed to avert a further exacerbation of the malnutrition crisis, which was fuelled by insecurity in the region.
While noting that a lot has been achieved in addressing the challenges of malnutrition in the region, he raised concerns of new cases of severe acute malnourished children due to influx of new arrivals of internally displaced persons, lack of access to hard to reach areas and late presentation of malnourished children whose parents were ashamed to seek treatment.
Usman however disclosed that the Department for International Development (DFID), has committed a total of £41million to address what he termed as the “deteriorating nutrition related crisis” in Borno and Yobe states from April 2019 to March 2020.
He explained that out of the sum, £36 million targets 922,249 children in nine local government areas of Borno State, while £5 million targets 585, 565 children in three local government areas in Yobe State.
Usman who noted that the funding from DFID was inadequate to arrest the situation, added that there was a funding gap of N4.4billion.
He called on government at all levels to avert a further deterioration of an already poor nutrition situation in the North East. “Nutrition sector estimates there will be 258,950 boys and girls suffering from Secure Acute Malnutrition (SAM), in 2020 in Adamawa, Borno and Yobe states. N5billion is needed to necessitate procurement of 258,950 cartoons of Ready to Use Therapeutic Food (RUTF) for SAM.
“Funding has been secured for 29, 314 cartoons of RUTF, there is a funding gap of N4.4 billion for procurement of 229, 636 cartoons.
“The affected community coping mechanisms is still low and any shock will result in further deterioration of nutrition status and so, it is important to have a robust contingency plan”, he said.
On her part, UNICEF nutrition specialist, Abigael Nyukuri, said the malnutrition crisis was worst in Rann, South Yobe, Magumeri, Jere and Konduga local government Areas, due to poor food security, sub optimal water, hygiene and sanitation practice as a result of heightened insecurity in the listed areas.
“Malnutrition is an emergency situation in Nigeria, we need an integrated approach from all sectors to tackle this emergency.
“Malnutrition has led to almost 50 percent death in children, hgh rate mortality, irreversible brain damage and compromised intellectual capacity in adulthood as well as over 16 percent loss of the nation’s gross domestic product”, she said.
Meanwhile, the Minister of Information and Culture, Lai Mohammed, has said that a large number of children living in conflicts, northern rural hard to reach communities and communities under emergencies were deprived of basic social amenities.
He stressed the need for government at all levels to invest in child malnutrition, increase awareness on the consequences of malnutrition, resource allocation for food and nutrition security.
“Nigeria’s future depends on producing children who are well prepared to take their place in tomorrow’s society. Most unfortunately, a large number of these children are at risk of deprivations of basic social amenities, of which nutrition is inclusive; and especially in the Northern rural and hard-to-reach communities.
“This, therefore, calls to mind the need for us to specifically address malnutrition in children because it directly impacts on their survival and development.
“It is imperative to combat Malnutrition, because it can cause death in young children, particularly those under five years of age. There should be concerted effort to fight malnutrition out in totality to ensure the attainment of desired results,” he said.
Combating the silent crisis of malnutrition in Nigeria
Experts in the nation’s health sector have revealed that to effectively combat malnutrition, there is the need to rethink intervention by focusing on adequate use of nutritious and readily available community resources, in conjunction with educating and empowering women to be less dependent on their spouses.
These practices according to them are invaluable in breaking the cycle of poverty, and assist in removing the blanket of pervasive cultural practices that limit the freedom of women and girls across regions of the country, whilst strengthening community support for women and children by engaging and involving men in conversations around gender, health, and wellbeing.
‘’1000 days plus also encourages the practice of exclusive breastfeeding up until six months of life, and advocates for increased access to family planning services.
It is our belief that the Nigerian government should prioritize nutrition programs, increase funding to combat malnutrition, and work more expansively with other sectors and international organizations to foster a multisectoral approach to tackling nutrition crisis in Nigeria’.
‘’In this Sustainable Development Goals (SDGs) era, we should all be engaged in developing innovative solutions and implementing programs that will translate the SDGs and other various global nutrition targets to real-time and measurable impact in the lives of women and children.
‘’The question is not whether we can end all forms of malnutrition in our time, but whether we have enough courage and compassion to scale up the gains we have already made to help mothers live a healthier life, achieve their dreams, and redefine their children’s story of survival’’, Dr. Andrew Chuka, Abuja based medical practitioner said.