Kano: The story of children’s struggle against malnutrition
Sa’adatu Umar was only 12 months old when she was weaned after her mother got pregnant again. The baby’s grandmother, Malama Fatima Umar, promptly took custody of the child and started her on the main food items available in the community - maize, millet and guinea corn.
But that was the moment Sa’adatu’s trouble started as she never ate any of the carbohydrate meals offered to her, a development that caused her to come down with severe fever, leading to numerous hospital visits.
Malama Fatima, 65, who recalled her granddaughter’s story, in front of her mud house at Tsaure village in Bichi Local Government Area of the Kano State, said the child’s health kept deteriorating in spite of the medical attention she had been receiving.
“Since the illness began, I took Sa’adatu so many times to the hospital in the town, where the doctors examined her and prescribed drugs. But the problem never abated. We spent a lot of money but she never ate,” she said.
However, it was learnt that after a month, a health team that had visited the village to sensitize residents on malnutrition, came across baby Sa’adatu and immediately ran quick on-the-spot tests using the mid-upperarm-circumference tape to take her body mass index (BMI).
The results were frightening as the sick child, who by then was barely able to sit, had already manifested some of the lifethreatening signs of acute malnutritionpersistent diarrhoea, abdominal distension and swelling, large head, and extreme emaciation. At that point, a nutrition officer in the team, quickly pulled out a package from her bag, prepared a porridge-like mixture made up of groundnut, soya beans, crayfish and milk and fed Sa’adatu.
After a month, the sick child began to show signs of improvement after taking this diet and relevant drugs, but her grandmother, alone and out of money, could not afford the cost of additional drugs and instead opted for local herbs.
On a Friday morning in August this year, Malama Fatima had just concluded her prayers when she heard a brief, chocking sound coming from sleeping Sa’adatu. She quickly checked on the toddler and discovered she was not breathing. When she turned her over, she noticed the child’s motionless eyes looking upward to at the ceiling. Sa’adatu was dead.
“I was really hopeful about her recovery, I thought she would live but that was not to be. Her father was always away transporting tomato to Lagos. When I told him what happened, he was sad but thanked God that his wife was pregnant,” she said. “It was an act of God and He would compensate my son,” she added.
Less than two kilometres away from Sa’adatu’s community, Daily Trust on Sunday came across another child, Hussaini Abdussalam, in Badume village, who was also battling to survive acute malnutrition.
His mother, Nafisa Abdussalam, who at 20, already has four children, with Hussaini being the youngest, said the child had been struggling with persistent fever and diarrhoea.
Our correspondent noticed that throughout the 20-minute interview with his mother, the 2-year-old sobbed inconsolably and scratched his watery eyes and hairless head, dotted by rashes. He had also started showing signs of acute malnutrition.
“I have been trying to feed him but he won’t eat anything. I even gave him milk but he pushed it aside.He is very feverish, all his body is hot,” she said, adding that he has been experiencing intermittent illness for almost a year.
She said the sick child, like his three older brothers, doesn’t get any different food from the type available to the community, such as rice, maize, millet and guinea corn, which the family often struggles to get.
Nafisa, with no formal education or source of income like most housewives in rural communities, said Hussaini’s sickness was taking a toll on the family because feeding his three siblings was also a big challenge.
“I took my son to the hospital where the doctor examined him and prescribed drugs. But I cannot afford N1,000 to buy the drugs. I asked my husband, who is a petty trader in the village market, but he told me things are hard. Even to feed the others, I have to often borrow from the neighbours,” she said.
At Bankaura, another adjoining village, our reporter identified twin boys who were both showing signs of acute malnutrition such as large head and distended stomach.
Habiba Aminu, mother of the 3-yearold toddlers, Hassan and Hussain, said they were the youngest of her five children who have been experiencing persistent fever since they were born. “I take them to hospital all the time but the symptoms only subside after treatment and later return,” she said.
Like Nafisa, Habiba also said she had difficulty feeding her children as most of the time she had to borrow to prepare a meal for the family. “These days, even my husband doesn’t come home with food. I had to borrow to feed him and the children,” she said, clutching her two sick children.
Daily Trust on Sunday reports that the stories of these malnourished children are just a signpost of a silent malnutrition emergency that is slowly creeping across many rural communities in Kano. The trend is worsened by the growing population of families living on less than 1$ a day (approximately N390), due to the economic recession sweeping through the country.
Dr. Halima Kabir, a consultant paediatrician at the Aminu Kano Teaching Hospital (AKTH), said malnutrition,“which literally means a child is not growing well,” is one of the five killer diseases of under 5years children; the others being diarrhoea, measles, pneumonia and malaria.
She said malnutrition usually occurs due to deficiencies in macro nutrients such as carbohydrate and protein or micro nutrients like vitamin A and Zinc. She said malnutrition takes three major forms such as edema, extreme emaciation (with skin wrinkles or old-looking face) and stunted growth.
According to her, the direct cause of the condition is lack of food due to natural disasters like famine or man-made catastrophe like wars, while the indirect causes are poor weaning practices, nonimmunization of children, congenital malformations and heart defects.
She said far from lack of food, children can become malnourished even before they were born because most mothers in the rural areas do not attend ante-natal clinics, take vitamin supplements or practice exclusive breast feeding when the children are born. “A mother who fails to attend antenatal sessions or take folic acid denies vital nutrients to her baby even before birth, causing intra-uterine growth retardation. When the child is born, and the mother does not practice exclusive breastfeeding and later weans the child at one year plus, this causes the child to be malnourished,” she said.
“Again, lack of immunization against diseases like tuberculosis, pneumonia, measles and whooping cough could also cause malnutrition which symptoms may include chronic diarrhoea, weak immunity, anaemia, dehydration and kidney failure. These effects, if not properly handled, can lead to permanent stunting or even death,” she added.
Dr. Halima also explained that stunted growth could cause permanent problems for a child in the form of low intelligence quotient (IQ) resulting in poor school performance. According to the United Nations Children Fund (UNICEF), stunting in early life is linked to 0.7 grade loss in schooling, a 7-month delay in starting school and between 22 and 45 per cent reduction in lifetime earning).
“For a female child, the consequences of stunting are even more devastating because when she reaches reproductive age, the pelvis becomes so small that it can affect her fertility and result in obstructed labour during child birth,” she said.
Suggesting solutions, the paediatrician said malnutrition needs a multidisciplinary approach because the factors responsible for the condition are largely outside the hospital. “For instance, awareness should be raised on the importance of ante-natal care, exclusive breastfeeding and immunization. The government should also empower farmers to produce large amounts of food to ensure food security,” she said.
“On their part, families especially in the village should form the habit of planting basic food items such as spinach, moringa in little gardens in their homes while utilizing common food items like beans and groundnuts which provide rich protein that is vital for children. You don’t have to eat meat or eggs if you can’t afford it but you can still enrich your meals with nutrients,” she said.
Studies have indicated that Nigeria is among countries with the highest rate of acute malnutrition. In 2013, UNICEF ranked Nigeria 13th in its global classification of countries with the highest rate of global acute malnutrition.
Similarly, the National Demographic Health Survey (NDHS), showed an increase of global acute malnutrition from 11 percent in 2003 to 18 percent in 2013. The survey also showed that only nine states, all in the South of the country, are below the acceptable 5 percent level for global acute malnutrition.
Oluwajide Ogunsola, the Programme Manager of KAF Care Foundation, a nongovernmental organization working on malnutrition in Kano, said out of 466 children screened for malnutrition in Bichi area, between March and September 2016, at least 225 have been found to be at risk of or bearing various degrees of malnutrition.
He explained that for over a year, his organization, based in Kano city, has been working with international organizations like Save the Children and local groups to improve the wellbeing of orphans and vulnerable children who are often exposed to the risks of diseases, neglect and abuse.
He said among the 225 children selected from 2,153 households across 10 communities-Tsaure, Bankaura, Chiromawa, Santa Sabo, Yakasai, Badume, Saya, Danzabuwa, Bichi town and Tinki, 32 bore signs of severe acute malnutrition, 58 appeared to be moderately malnourished while 135 were at the risk of acute malnutrition.
He added that those at risk of serious symptoms were fed with “care diet”, a mixture of millet, milk, soya beans and crayfish which provides the nutrients lacking in malnourished under-5 children. The sick ones he said, were referred to clinic for treatment.
Also, records obtained by our correspondent from Badume Model Primary Health Centre (PHC) in Bichi showed that between August and the second week of October 2016, a total of 1,250 under-5-year children, comprising 640 males and 610 females in various stages of malnutrition, reported to the clinic. The record shows that four cases of deaths were recorded during the period.
However, it was learnt that the large number of malnutrition cases recorded by Badume clinic was because Bichi Local Government Council is among six out of the 44 local government areas in the state that offer the Community Management of Acute Malnutrition (CMAM)-a special programme introduced to check malnutrition in the state. The other councils are Kano Municipal, Sumaila, Wudil, Madobi and Tsanyawa.
Ashiru Shuaibu, the official in charge of Badume PHC said every Tuesday, about 500 children throng the clinic to receive free packages of “Ready-to-Use-TherapeuticFood” or RUTF, a nutrient-rich preparation donated by UNICEF as part of efforts to curb malnutrition.
“I wish you came here on Tuesday to see the large crowd that gather for the CMAM programme. They come here from all over the neighbouring communities to get the RUTF. You won’t even get a seat,” he said.
Shuaibu said the clinic administers the RUTF for eight weeks to malnourished children above 6 months of age, but added that patients often start to show marked improvement by the second or third week of administration.
“If you start taking this therapy yourself, you would gain impressive health benefits within a short duration because of the rich combination of nutrients in the package. We exhaust more than 100 cartons of the therapy every week,” he said, adding “It’s very effective”.
Nonetheless, despite the efficacy of the RUTF therapy in improving the condition of acutely malnourished children, Shuaibu said drugs like antibiotics which are vital for fighting malnutrition-induced infections are often expensive and unavailable.
Our correspondent who had a brief access to the clinic’s dispensary observed that apart from the about two dozen cartons of the RUTF therapy, the shelves only contained a handful of assorted drugs. “We have run out of stock for the drugs. We have to buy them,” Shuaibu said.
At the local government secretariat, Garba Muhammad Bagwai, the Primary Health Care (PHC) Co-coordinator said the local government authorities used to procure drugs to boost the CMAM programme, “but due to the current economic recession, we lack the funds to buy the drugs,”
He explained, however, that even with the challenge of inadequate and expensive drugs, the CMAM programme has “succeeded in reducing the rate of malnutrition cases in Bichi by about 80 per cent”, adding that drugs would be bought once funds are available.
Bagwai also called on the state government to extend the CMAM programme to all the PHC centres in the 44 local government councils of the state to tackle the problem of