Improving Child Nutrition, Health To Meet SDGs

Stakeholders and experts are worried that some key indicators to improved child health and survival, being part of Sustainable Development Goals (SDGs) set to be achieved by 2030 have shown marginal increase in nearly three decades following the release of 2018 Nigeria Demographic and Health Survey (NDHS) writes CHIOMA UMEHA.

 Research indicates that reducing childhood mortality and improved nutrition, survival and health of the Nigerian child is crucial to any country’s socioeconomic development and quality of life.

Yet, important indicators in the 2018 NDHS like, breastfeeding, immunisation and provision of Insecticide-treated Nets (ITNs), maternal healthcare, health insurance coverage, among others, shows slow progress against the actualisation of the SDGs.

Breastfeeding

According to the 2018 NDHS, the percentage of Nigerian children who started breastfeeding within one hour of their birth only increased by nine percentage points since 2013, from 33 percent to 42 percent.

Experts say that initiation of breastfeeding within the first hour of life is important for both the mother and the child.

The first breast milk contains colostrum, which is highly nutritious and has antibodies that protect the newborn from diseases.

Early initiation of breastfeeding also encourages bonding between the mother and her newborn, facilitating the production of regular breast milk, according to researchers.

Similarly, they say that breast milk contains all of the nutrients needed by children during their first six months of life.

They, therefore, recommend that children be exclusively breastfed during the first six months of their life; that is, they should be given nothing, but breast milk.

According to them, exclusive breastfeeding for six months prevents infections such as diarrhoea and respiratory illnesses and provides all of the nutrients an infant requires for optimal growth and development.

Exclusive breastfeeding for the first six months of life is known to improve the health, growth, and survival status of newborns (WHO 2003).

Reviewing the 2018 NDHS figures on infant feeding, Maureen Zubie-Okolo, United Nations Children’s Fund, (UNICEF) Monitoring and Evaluation Specialist corroborated that exclusive breastfeeding among children aged zero to six months increased from 17 per cent to 29 per cent in 2013, but fell short of the 50 per cent global target.

The World Health Assembly (WHA) has set a target to increase the global rate of exclusive breastfeeding to at least 50 per cent by 2025. To coincide with the timeline of the Sustainable Development Goals, the World Health Organisation (WHO) has extended the targets for maternal, infant and child nutrition to 2030.

Among its benefits, Zubie-Okolo said, exclusive breastfeeding is associated with a lower risk for many early-life illnesses, including diarrhoea and respiratory infections.

She spoke during a two-day workshop on Media Dialogue for Editors and Reporters on Data-Driven Reporting and Dissemination of NDHS 2018 Result and SDGs in Port Harcourt, River State, organised by the Child Rights Information Bureau and the Federal Ministry of Information weekend.

Nigeria, in tandem with international best practices recommends exclusive breastfeeding for the first six months of life (Federal Ministry of Health 2005, 2014).

Despite its benefits, Nigeria attained 29 per cent on exclusive breastfeeding below the global target of 50 per cent, Monitoring and Evaluation Specialist stressed.

She said; “Though the percentage of children who had ever been breastfed was high at 97 in both 2008 and 2018, exclusive breastfeeding among children aged from zero to five months only witnessed a marginal increase from 17 per cent to 29 per cent in five years, from 2013.”

Similarly, the number of those who started breastfeeding within one hour of birth remained slow. For instance, the percentage of children who started breastfeeding within one hour of birth also increased slightly by nine percentage points since 2013, from 33 percent to 42 per cent, while those who started breastfeeding within one day rose from 65 per cent to 82 percent since 2008.

Stunting, Wasting And Underweight

The per cent of children under-five who were stunted based on 2006 WHO Child Growth Standards, Nigeria was 37 per cent.

The prevalence of stunting increases from 19 per cent among children, less than six months to a peak of 47 per cent among children aged from 24 to 35 months, the 2018 NDHS showed. Zubie-Okolo said; “This represents the impact of undernutrition in the first 1,000 days of life of the Nigerian child.

“Stunting, or low height-for-age, is a sign of chronic undernutrition that reflects a failure to receive adequate nutrition over a long period of time. The most direct causes of stunting are inadequate nutrition (not eating enough or eating foods that lack growth-promoting nutrients) and recurrent infections or chronic diseases that cause poor nutrient intake and absorption.”

She observed; “Wasting, on the other hand, is more prevalent (15 per cent) among children age from nine to eleven months. Wasting, or low weight-for-height, is a measure of acute undernutrition and represents the failure to receive adequate nutrition in the period immediately before the survey. Wasting may result from inadequate food intake or from a recent episode of illness or infection causing weight loss.

She explained, underweight, or low weight-for-age, is a composite index of weight-for-height and height-for-age reflecting both acute (wasting) and chronic (stunting) undernutrition.

The 2018 NDHS showed that the children are breastfed for a median of 18.5 months and exclusively breastfed for 3.0 months. 29 per cent of children under six months are exclusively breastfed, the survey said, adding that 37 per cent of children under five are stunted.

Child Mortality

With under-five mortality at 132 deaths per 1,000 live births, this implies that more than one in eight children in Nigeria die before their fifth birthday, the NDHS 2018 also showed.

Similarly, despite the reduction of infant mortality from 75 per cent deaths per 1000 live births to 67 deaths per 1000 live births, the number of neonatal deaths remained unchanged, the survey showed.

At 67 deaths per 1000 live births, she further alerted that the number of neonatal deaths remained unchanged, showing only marginal increase.

The UNICEF Monitoring and Evaluation Specialist stressed that though the survey showed that under-five mortality rate decreased since 2008, from 157 deaths per 1,000 live births to 132 deaths per 1,000 live births, it is still high.

She said; “There has been a slight reduction in infant mortality, from 75 to 67 deaths per 1,000 live births from 2008 to 2018. However, there has been no noticeable change in the neonatal mortality rate over the same period.”

The report also notes that childhood mortality in Nigeria remains high and that every year, an estimated one million Nigerian children die before their fifth birthday.

Based on the trend, Nigeria is one of five countries in the world with the highest number of under-five deaths.

Immunisation

Similarly, the percentage of children that have received all-round immunisation in Nigeria remains very low at 31 per cent between 2008 and 2018, the National Demographic Health Survey (NDHS) stated.

The report also revealed that “the percentage of children who received none of the basic vaccinations declined from 29 per cent to 19 per cent during the same period in review.

“But, the percentage of children age between 12 and 23 months who received all basic vaccinations increased from 23 per cent in 2008 to 31 per cent in 2018.”

Commenting, Zubie-Okolo said that immunisation coverage was one of the indicators used to monitor progress towards reduction in child morbidity and mortality as it was one of the most cost-effective public health intervention.

She said that the objective of the NDHS was to provide estimates on fertility levels, marriage, sexual activity, family planning, breastfeeding practices and nutrition.

Others she said were childhood and maternal mortality, maternal and child health, malaria, domestic violence, disability, and female genital mutilation.

”This information is essential for programme managers and policymakers to evaluate and design programmes and strategies for improving the health of Nigerians,” she said.

Elaborating, she noted that the latest NDHS (2018) was the sixth one in Nigeria since 1990 as part of the Demographic Health Survey programme.

According to her, the sample design for 2018 NDHS is to provide estimates at the national level, for six zones, for 36 states, the Federal Capital Territory (FCT), and for urban and rural dwellers.

She, however, stressed that while the 2018 NDHS trends showed an improvement, they still fell short of SDGs Three which the target is for more than 90 per cent coverage of all basic vaccination among children age 12 to 23 months.

Earlier in his opening remarks, Olumide Osanyinpeju, Deputy Director/Head, Child Rights Information Bureau who represented the Minister of Information and Culture, Alhaji Lai Mohammed said; “Both Multiple Indicators Cluster Survey (MICS) and Demographic and Health Survey (DHS) are survey initiatives designed to assist countries, Nigeria inclusive, in filling data gaps for monitoring human development in general and the situation of children and women in particular.

“These surveys have been instrumental in strengthening national statistics capacities, highlighting and filling gaps in quality data, monitoring and tracking progress toward national and international development goals like the SDGs and, in identifying emerging issues and disparities among groups in societies.”

Nigeria Requires N126 trillion For SDGs

On his part, Dr Davis Omotola, Independent Development Consultant, commenting on the gaps revealed by the 2018 NDHS on the state of children, women and general human development, said that Nigeria requires N126 trillion ($350 billion) to meet the SDGs set for 2030.

Omotola noted that the NDHS further stated that the current public sector gap was estimated at $100 billion after all other possible incomes including oil revenue and the Abacha loot have been pooled together.

While lamenting that poverty was on the increase due to population explosion and insecurity, he said 70 per cent of the poor people in Nigeria were found in 10 states which all happen to be in the North.

Omotola who expressed fears that lack of effective policies and budget constraints could serve as barriers for achieving the SDGs in the next 10 years, maintained that Nigeria needs a large chunk of money to achieve the 17 SDGs goals.

“We have 10 years, but Nigeria does not plan. We are in a country were people just wake up and whatever happens is what we do. We have been talking about insecurity, what is the plan to solve it?

We should have a robust plan

“There are so many plans and policies; we have even the national population policy which proposes four children per family.

We are talking about quality education for all, but we have different definitions of education in different parts of Nigeria.

“We just developed the Economic Recovery and Growth Plan (ERGP) by 2017, the SDGs has been on since 2016, the discussion started from 2012 yet when we were doing ERGP, we didn’t factor in the SDGs except we now begin to realign the ERGP into the SDGs.

“The Sustainable Development Goals is about leaving no one behind and to achieve that we need $350 billion and our total income in 2018 was $398 billion, so it means that we should just spend all that money to achieve the SDGs.

“The President said he wants to lift 100 million people out of poverty, we already have 98 million poor people as of 2018 and 70 per cent of them we know where they are, so what programme are we putting in a place for them?

“Most of our children do not have an education that is skill-based that will make them get the right employment.

“It’s not all these small intervention programmes, we must have policies that are effective, policies that are implemented and of wide coverage. It’s not to do a small thing in one corner of Nigeria.”

Contributing, Dr Guy Modeste, UNICEF Chief of Field Office, covering Bayelsa, Rivers, Delta and Akwa Ibom States, who raised concerns over Nigeria’s failure in using data to tackle its demographical growth, said: “We are facing the critical stage as regards demographical growth, many children are left behind, we need to ensure that no child is left behind.”