By Chioma Umeha
• Culture Prohibits Mothers From Feeding Newborns With Colostrum
• UNICEF Seeks Expansion Of Interventions To All LGAs
By Onche Odeh
The figures are scary but real. That more than half the number of all children between the ages of six to 59 months you see in Bauchi are stunted or low height for age, a form of malnutrition caused by long-term insufficient nutrient intake and frequent infections.
The situation is not better with women as Bauchi is rated in the 2015 National Nutrition Health Survey (NNHS 2015) among 10 states, mostly in Northern Nigeria with over 10 per cent prevalence level of malnutrition in Nigeria.
In 2014, Global Acute Malnutrition (GAM) and Severe Acute Malnutrition (SAM) were reported above critical cut-off points of 15 per cent and two per cent respectively for Bauchi and two other States including Jigawa and Yobe.
Although none of the States surveyed in 2015 reported such critical prevalence, results of the last National Nutrition and Health Survey (NNHS 2015) showed that Bauchi is still in nutrition crisis.
This is ironical for the State which is known for high farming and related activities. The state is known to be a high producer of nutritious crops like Millet, Maize, Rice, Sorghum, Wheat and legumes such as Cowpea, Groundnut, Soya-beans as well as expansive livestock farming.
The reality behind the high malnutrition figures in Bauchi state becomes evident as one move away from Bauchi, the capital, to the villages where the farms are located.
Interactions with locals and nutritional specialists working in Bauchi revealed that the rampant cases of malnutrition in the State is a consequence of various factors which include cultural restrictions, some of which are tied to oppressive traditions, high level of illiteracy; inadequate and inappropriate knowledge on Maternal, Newborn and Child Health, among others.
This was typically seen in the case of Hauwawu Mohammed, a nine year-old female child who was brought into the Outpatient Therapeutic Centres (OTPs) in Bara over 15 weeks ago with a paltry weight of nine kilogrammes and a Mid-Upper Arm Circumference (MUAC) of 8.5cm.
Hauwawu was brought into the clinic with several underlining medical conditions that were evidently triggered by lack of adequate maternal care.
INDEPENDENT gathered from a staff of the clinic that her mother gave birth to another child before she turned one year.
Hauwawu could be counted as one of the few lucky ones that suffered similar plight as she was rescued and discharged from the clinic in healthy condition after undergoing 12 weeks of treatment with Ready-to-Use Therapeutic Food (RUTF) and some routine drugs. Then, she had recovered to a weight of 13 kg and MUAC of 12.cm. Her case, however, revealed that many mothers in Bauchi are still unaware of the negative implication frequent child-bearing has on their children and their own health.
A rather surprise revelation on why the level of malnutrition may be high among infants and young children in Bauchi State is subsumed in a traditional belief that forbids mothers from feeding their newborn children with colostrum, the first breast milk expressed and fed babies by mothers during child birth.
Medical knowledge has shown that colostrum helps to boost the immunity of newborns against diseases, as it is a rich source of micronutrients.
INDEPENDENT found in Bauchi that some mothers have been fed with an age-long belief that the first milk expressed from their breast after child-birth endangers the life of the child, hence it is usually squeezed out and thrown away.
Confirming this practice, Dr. Jackson Martins, a Nutrition Specialist with the Bauchi Field Office of the United Nations Children’s Fund (UNICEF) said: “Culture and tradition play very significant role in the well being and health challenges facing young children and mothers in Bauchi. One of the big challenges is in the area of exclusive breast feeding, which the practice around do not seem to encourage.”
Martins who spoke in an Interview with INDEPENDENT in Bauchi said: “Some women have been indoctrinated to believe that the first milk that comes out of their breast immediately after childbirth (colostrums) is not good.
“They say it is bad, and that it causes the child to have diarrhoea. The perception is that it is unacceptable to give the child that first milk.
“This shows the low level of knowledge of the people. We know that colostrums boosts the child’s immunity at birth.”
Giving other reasons why malnutrition is prevalent in Bauchi, he said: “Bauchi state is an agrarian state where the people farm maize millet, and breed cows, but ironically has a high level of malnutrition. This is attributable to some basic and underlining immediate factors. “There is inadequate and inappropriate knowledge that among the residents. This is compounded by discriminatory practices that limits households from accessing good feeding.”
Continuing, Martins said: “Although the state produces varieties of highly nutritious food, there is insufficient access to these food by majority of the people. This adds to the inadequate access to maternal and Child health services, as well as poor water sanitation and inadequate health services to make the problem of malnutrition worse in Bauchi.”
On how culture has also contributed to the high rate of malnutrition in the State, the UNICEF Nutrition expert said: “The influence of the grandparents over the mother is also another reason for the high rate of malnutrition in the state.
“By reason of culture, they (grand-parents) determine what happens to the grand-child. Most times when there is a problem, they would want to compare things with what used to be in their time. This brings challenges to practices that are supposed to improve childhood nutrition.”
Another weird reason the UNICEF Nutrition Specialist said is fuelling malnutrition in Bauchi is the influence of certain influential persons in their communities.
He said: “Some prominent persons in the community also determine what happens in the community. They are behind the belief that the best part of the food should go to the husband.”
Further probe also revealed that Bauchi is not left out in the common belief that a child could become a kleptomaniac in future if he is fed with eggs.”
The nutrition crisis in Bauchi has, however, attracted widespread attention, as UNICEF has led an aggressive intervention towards cutting the rate of malnutrition in the State.
As at the end of 2016, over 90 per cent of 17,000 severely malnourished children between the ages of six and 59 months have been rescued from death through UNICEF supported Community-based Management of Acute Malnutrition (CMAM) interventions across the State.
This is being hosted in three Local Government Areas (LGAs) with high burden that are serving as pilot sites.
Young Yakubu Mammam sani was admitted into the Bara Primary Health Clinic, one of the CMAM intervention centres, in May 2016 with total body weight of 3.5kg and Mid-upper Arm Circumference (MUAC) of 8.8cm. There was a follow-up on him, after being treated with Ready-to-Use Therapeutic Food (RTUF) and some routine drugs.
There was a follow up on him in July, after which he was able to regain his weight to 6.4KG and MUAC to 13.5cm.
Salihu Nura’s case was a little more precarious when he was brought into the clinic. He weighed 2.5 kg and had a MUAC of 8cm. With appropriate intervention he was able to regain his weight to acceptable level and MUAC to 10.2cm after three months.
Abdullahi Bello, UNICEF Nutrition Specialist who works from Kirfi said the children they have seen so far in the clinics have been very lucky, as almost every one of them has survived, except for those that are lost due to lack of follow-up.
He is, however, concerned about the inherent gaps in the intervention from the government end.
“I can categorically say that we have enough stock of Ready-to-Use Therapeutic Foods (RTUF), but there is a huge gap in with the routine drugs that are supposed to be provided by the government. For almost one year now they have not been provided, but with regards to RTUF, there is not stock-out,” he said.
Selamat Negash, UNICEF Nutrition Specialists, Bauchi Field Office who spoke on UNICEF’s nutrition intervention in Bauchi State in the past year told INDEPENDENT that the agency is supporting the State through four key areas.
She said: “There is the Community Management of Acute Malnutrition (CMAM) Programme and Nutrition intervention scale-up- for the idenbtification and treatment of children with Severe Acute Malnutrition (SAM).
“Another is improving infants and young child feeding to promote optimal feeding and nutrition practices at household levels by building capacity of caregivers. UNICEF is also working on reduction of micronutrients deficiencies, which we ride on the Maternal Newborn and Child Health (MNCH) to promote as well as systems strengthening,” Negash said.
Speaking on how the combination of these efforts and strategies has worked in Bauchi, she said: “In 2016, the programme reported that more than 17,000 children between the ages of 6 and 59 months that were severely malnourished were reached with appropriate treatment.”
Negash said most of the cases recorded by the UNICEF Programme were through active case finding, adding that some others were brought to the facilities by the parents or caregivers.
She said: “Treatment outcome has been very good here in Bauchi. According to the international standards rates 75 per cent cure rate as the bench mark. But here in Bauchi, the cure rate is as high as 90 per cent, with minimal death rate. We also have mechanism in place to trace defaulters using community volunteers.”
Currently, UNICEF is supporting these interventions in just three LGAs (Kirfi, Danbam and Kartagum), which Negash disclosed were selected in consultations with the state government based on the burden.
She said the programme must be expanded to all the LGAs in the State to achieve significant progress toward redressing the malnutrition crisis in Bauchi.
“If the programme could be expanded to the rest of the LGAs in Bauchi, more lives would be saved. This is in the plan of UNICEF in 2017. But it requires commitments both from the donors and the government to mobilise appropriate resources towards making this happen,” Negash said.
To ensure that this is done, the UNICEF Nutrition Specialists said: “We (UNICEF) are doing a lot of advocacy to high level officials to mobilise resources so that UNICEF can do same from donors. “Hopefully UNICEF will be able to expand to more LGAs and many more children would be saved from death from malnutrition.”
As part of current efforts to douse the rate of malnutrition in the state, UNICEF says it is using health workers as nutrition counsellors. They are assisted by community volunteers to promote good feeding practices.
Negash said same advocacy has also been taken to the traditional and religious leaders as well as those who are respected by the members of the community.
“The main strategy is more of interpersonal communication through a support group comprising of people trained on optimal nutritional practices.
She said more than 30, 000 care givers and mothers were reached with messages on infants and young child feeding in 2016,” Negash told INDEPENDENT.
On how the system could be strengthened, she said: “It requires a multi-sectoral approach because the cause of malnutrition is multi-dimensional.
“The health sector alone cannot solve the problems of malnutrition in Nigeria. The National Nutrition Health Policy stressed the need for a multi-sectoral approach. For example, the health sector could focus on sensitisation for behavioural change and identification of malnutrition cases; agriculture is an important sector; industry because some of the food must be fortified; the social sector targeting the vulnerable community, and education as schools can used to promote behavioural change.”
She said efforts toward institutionalisation of this approach are already on at the state level with the constitution of a multi-sectoral committee under the leadership of the state government.