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Malnutrition

In the final of this three-part series, Arinze Chijioke, Elijah Akoji and Ekemini Simon look at how State and Federal government-prioritized spending on Child Nutrition can turn around the sad tales of child Malnutrition in Northern Nigeria and thus contribute to helping Nigeria achieve Sustainable Development Goal 3 of Good Health and Well-being.

The United Nations Children Emergency Fund, UNICEF dietary diversity project aimed at addressing infant malnutrition in select states in Northern Nigeria came to an end in 2021 even as the United Nations said that US$396 million is urgently needed to prevent a widespread hunger and malnutrition crisis and scale up humanitarian action in Yobe, Borno and Adamawa states.

Experts opine that if the prevalence of Malnourished Children must be addressed in Yobe and Kano States, the government must not allow it in the hands of international partners alone but must prioritise child nutrition funding.

“For Yobe State, the key reason for the prevalence of Malnourished Children is insurgency which results in the massive displacement of people and their source of livelihood,” said Edem Edem, the National Coordinator and Founder of Green Concern for Development (GREENCODE), a Non-Governmental Organisation that works on humanitarian responses, especially in Northern Nigeria. “Even in Kano State, the government must not allow issues of child nutrition in the hands of international partners alone. There is a need for prioritized funding,”.

Edem noted that most projects of international partners are time bound hence their effort to address the challenge of child malnutrition may be thwarted if the government fails to follow through with adequate funding.

“Analysis of budgets by these States and the Federal Government shows that impressive budgetary provisions are being made for Child Nutrition, however, there is no adequate release of funds needed to enhance the support international partners give which can turn around the prevalence of child malnutrition in Nigeria”.

Analysis of funding of child nutrition by the government of the two mentioned states and the federal government reveals effort yet gaps that must be improved upon.

Yobe State Zero Funding on Child Nutrition

Analysis of policy documents, budget and audited financial statements of Yobe State revealed that the State has only made little effort to address the nutritional concerns of children in the State.

The State currently does not have a policy on food and nutrition. Besides, its budgetary plans only end in the books. For instance, analysis of the approved budget for 2019 through 2023 reveals that it was only in 2020 that the State made budgetary provisions for Child Nutrition.

The government provided “Foodstuff/catering materials supplies for Nutrition for under 5 Children/ Lactating mothers at N55m. Yet, checks into the audited financial statements for the fiscal year revealed that the money was not released.

In subsequent years in 2022 and 2023, Yobe State’s budget that came close to the need was “Grants to Communities/ Vulnerable/Private – Support for Nutrition Activities. 2022 was N80m while N365.3m was appropriated in 2023. The financial statements for these fiscal years are yet to be published thus unknown whether funds were disbursed for the programme.

Analysis of State government spending to address the challenge of drought which could have checked the obstacle experienced by the UNICEF home-gardening project reveals where the government needs to improve.

Although the Yobe State Government budgeted N443.2m in 2021 and N540m in 2022 for a project tagged “Boreholes and other water facilities for irrigation activities (Climate Change) Lava Irrigation scheme”, checks to the financial statements of the State show that no amount was ever released. The state however spent N108.3m for other water projects in 2020. Other years from 2019 through 2022 had no releases.

Kano Impressive Plan but Zero Funding 

The government of Kano State over the years has made splendid plans to address the problem of child nutrition, but most of the government contribution is on paper.

First, in April 2016, the State government established the Kano State High-Level Committee on Food and Nutrition chaired by the Secretary to the State Government.

As a result of the UNICEF dietary diversity project, there was a buy-in by the State Government. This led to the development of the Kano State Multisectoral Strategic Plan of Action for Food and Nutrition (KN-MSPAN) 2019- 2023.

According to the immediate past Governor of Kano State, Dr Abdullahi Umar Ganduje, in his foreword of the Plan, the KN-MSPAN is designed to address the problem of malnutrition, which has been most devastating among young children, pregnant women and lactating mothers.

Beyond the policy, nutrition has been prioritized in the budget of Kano State between 2019 and 2022. However, only N64 million was appropriated specifically for child nutrition and this was in 2021 and 2022.

The few budgetary appropriations on child nutrition are; Active case findings of Severe Acute Malnutrition (SAM) and provision of treatment of which N2m each was budgeted for 2021 and 2022.

There was also the ” Provision and Distribution of Supplementary Food to Children with Moderate Acute Malnutrition (MAM). N20m was budgeted in 2021 and N40m in 2022.

Yet, checks into the audited financial statements of Kano State show that funds were not released for the projects.

FG spends 0.27 Percent of Budgeted Funds on Child Nutrition

The federal government in the last five years of 2019 through 2023 budgeted a total of N41.63bn for child nutrition through the Federal Ministry of Health and Federal Ministry of Agriculture and Rural Development, checks into the Appropriation Acts of the years under review have revealed.

Data obtained from the Open Treasury Portal, a Federal Government portal that provides public access to collated data on government spending at the federal level and for Ministries Departments and Agencies (MDAs) reveals that only one item received funding among the seven budgeted programmes.

The project, “Empowerment of Vulnerable Group (Youth and Women) in Selected Livestock Production Value Chain in Pastoralist Communities in the North-East, North-West North Central Zones livelihood improvement, Food Nutrition and Security” received N56.5m disbursement of funds for the project only in 2021 and 2022.

This project, supervised by the Nigerian Institute of Animal Science was reportedly executed by a General Merchant and Trading Company, Promex Multi-services Limited and

Besides the expenditure, although the federal government did not budget for Consultancy for Child Intensive Nutrition in 2022, the federal government through the National Social Investment Office made an 80% Payment of the Contract for the project to Splash Visions Limited in March 2022 at N57.08m.

The federal government spending on the two projects of Child nutrition amounts to N113.58m. This will imply that the federal government only released 0.27 per cent of the funds it budgeted for child nutrition within the period under review.

Experts’ View on UNICEF’s Nutritional Projects 

A lecturer in the Department of Nutrition and Dietetics at Imo State Polytechnic, Owerri, Patrick Ogbonna has recommended solutions to some of the challenges experienced by the dietary diversity project in Kano State and the home-gardening project in Yobe State.

Ogbonna who is also the Assistant National General Secretary of the Nutrition Society of Nigeria recommends that the use of modern technology in food preservation and processing of dietary food is the key to wriggling out of the challenge of accessibility to water or drought.

He said ” Since inaccessibility to water sources and sometimes drought has been the key challenge to the two projects, what is needed is that these communities need to have modern methods of food preservation using modern technology. Now, we have the solar system. They need food storage facilities powered by solar. So, during their bumper season, they collect the recommended food and preserve it.

“Another is processing the products to a form that can last longer than the usual supply.  Recently, we have micronutrient powder. They can be stored for a longer period than their natural fresh state.

“We can have what we call nutrients concentrate. These recommended foods can be processed and made concentrated and they now add them into the usual meal that the children consume.”

The Nutritionist who noted that it would be foolhardy to expect support from international partners to solve the menace of child nutrition called on the government to own initiatives geared at addressing child nutritional concerns and most importantly provide adequate funding against child malnutrition.

He said the government at all levels should provide credit facilities to the locals for the acquisition of some of the food processing machines which will help with preservation. Beyond that, he asked that the government in the area mostly affected provide solar storage facilities and also put mechanisms in place to ensure food that will address child nutritional concerns are prioritised.

What is more, Ogbonna stressed that the government must make a conscious effort to address the problem of insurgency in the Northern region of Nigeria noting that when people continue to be displaced, child malnutrition will continue to rise. He called on the government to improve its security on organisations that volunteer to help in the combat against child malnutrition.

This story was produced with the support of Nigeria Health Watch through the Solutions Journalism Network, a nonprofit organisation dedicated to rigorous and compelling reporting about responses to social problems.

 

 

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In the first of a three-part series, Arinze Chijioke, Elijah Akoji, and Simon Ekemini examine the success of UNICEF’s Dietary Diversity Project in Kano State, Nigeria. The project, which aims to improve the nutritional status of children under five by increasing the diversity of their diets, has shown promising results.

In 2018, Hadiza Garba, a resident of Bichi local government in Kano State, discovered that her son, Haruna, was not growing or putting on weight at the expected rate. He was unusually irritable and always had slow energy levels and tired more easily than other children.

Haruna was eventually diagnosed with malnutrition at Rasheed Shekoni General Hospital in Dutse, Jigawa State. Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients, or impaired nutrient utilization.

The doctors determined that Haruna had been fed a diet that was too low in protein. Between six and eight months of age, he should have started eating a variety of foods, including milk, meat, egg, other proteins, fruits, and vegetables. However, he was already being fed tuwo, a category of solid meals made from rice, corn, or millet flour with a range of soups, often without any protein.

Some goats belonging to Habiba Abdulrahaman

Hadiza Garba was unaware of the importance of a balanced diet for her son’s health. Her story is not unique. Far too many children are not fed at the right time or with the right frequency and dietary diversity needed to grow and develop to their full potential.

The burden of food poverty

In low- and middle-income countries, two-thirds of children under five, or 478 million, experience food poverty. This means that they are not fed the bare minimum number of food groups they need in early childhood.

In Nigeria, one in three children is stunted and one in ten is wasted. This means that they are not growing and developing as they should. Close to 19.8 million Nigerian children are undernourished, giving Nigeria the highest burden of stunting in Africa and the second highest in the world.

A 2018 Nigeria Demographic and Health Survey report found that Kano State had the highest number of malnourished children in Nigeria. This was attributed to poor infant feeding practices, such as low dietary diversity and minimum meal frequency. The report also found that children in Bichi and Sumail local government areas were the most affected.

Garba could not afford the Minimum Acceptable Diet (MAD) or treatment for her son, Haruna. She brought him home and resorted to self-help. The MAD is a binary indicator of infant and young child feeding practice that assesses the quality and sufficiency of a child’s diet between the ages of 6 and 23 months, apart from breast milk.

“The lack of money always caused quarrels between me and my husband at home,” she said. “Sometimes, we even went without food in the house. I did not have any job.”

Solution at last

Garba was helpless and had to borrow sometimes to buy eggs and other diets for her son till 2019 when UNICEF implemented the Dietary Diversity Project to address malnutrition in children aged 6-23 months in Kano State.

While it was inaugurated on October 23rd 2018 by the former governor of Kano state, Abdullahi Ganduje, the Dietary Diversity project started in September 2019 and was implemented through a partnership with the government, traditional institutions, and local NGOs (Kano Emirate Council Committee on Health and Human Development (KECCoHHD) and Society for Women Development and Empowerment of Nigeria (SWODEN)).

Habiba Abdulrahaman

Elhadji Diop, Nutrition Manager, UNICEF Field Office Kano, said that the objective of the project was to improve Infant and Young Child Nutrition which is a primary factor in under-5 malnutrition through the promotion of dietary diversity among children aged 6 to 23 months in the targeted LGAs of Kano state from 28% to 50% by 2020 which would contribute in the long-term to the reduction of malnutrition.

Under the project, 1,080 caregivers of children aged 6-23 months of age received three chickens each for poultry farming to improve access to animal-source foods. In total, 3,240 chickens were distributed to 1,080 caregivers.

Additionally, three goats were also distributed to each of the 72 community support groups women chosen by the communities and created in the two LGAs. Each group had 12-15 caregivers. A total of 216 goats were therefore distributed.

As she received her share, Garba constructed a Goat Pen and a Poultry where she kept them for reproduction. As her hens laid eggs, she boiled some and gave Haruna and her other children. She also sold some of the eggs and took care of other family needs.

“As the goats reproduced, it increased the milk available which I used to also feed my children and also help other women whose children grew without enough breast milk,” she said. “I also sell them in the market and earn more money,”.

Caregivers also received seeds to grow vegetables such as spinach, and tomatoes and agricultural extension workers visited weekly to teach them how to take care of their livestock and vegetable farms.

“A total of 4,320 vegetables and fruits seedlings were also distributed to the 1,080 caregivers of children aged 6-23 months across the two LGAs at 4 seedlings per caregiver,” Diop explained.

Overall, the intervention has helped to ensure that Garba’s children had a more varied and nutritious diet. Now, she is on good terms with my husband because we eat well and there is money for other household needs.

Extending the goodwill

As soon as Habiba Abdulrahaman, a resident of Kofar Kudu received her male and female goats and chicks to enable them to reproduce, she gave them to her daughter who had given birth to a set of twins at the time and that helped her in providing the necessary diets for them after she (the daughter) stopped giving them breast milk.

Hadiza Garba in her goat Pen

“I also made sure that she fed them with meals that had Vegetables as they grew older and that has helped them maintain the acceptable Diet,” she said. “I am happy to have benefitted from the project,”.

Like Garba, Unmi Musa’s daughter was diagnosed with Malnutrition when she was two. After it was managed at the Sumaila General Hospital, with support from friends who bought food for her daughter, Unmi returned home, worried about how she will get the necessary diet her unborn children will need to survive.

Thankfully, she was selected and benefited from the dietary project. Her goats and chickens have reproduced and she ensures that she feeds her children with at least 5 eggs whenever the chicks lay ten and diversifies their meals after six months.

“I also eat the egg and we have not had any case of malnutrition again,” Musa, who is also a resident of Kofar Kudu said.  “I sell the goat and earn more money for the family,”.

Project setbacks

Among the challenges that were experienced during the project were access to water-especially during the dry season- which is the main challenge in sustaining home gardening. To mitigate that, Diop said that community gardens were planted close to water sources.

To deal with the challenge of disease outbreaks in chickens and goats, the project linked the communities with veterinary services to sustain animal husbandry practices.

Unmi Musa, one of the beneficiaries

“Leveraging on the influential role of the institutionalized Emirate Council has been key to mobilizing communities and fostering buy-in on home gardening and animal husbandry practices,” said Diop.

Overall, Diop said that there is an improved consumption of animal-source foods amongst children aged 6-23 months state and communities have started buy-in to sustain homestead food production.

“The project’s midline assessment, conducted in 2022, indicated improved availability of diverse food within households, including animal source foods, “he said. “Evidence-informed advocacy has led to buy-in at the state level as cost estimates from this project have been used to inform the development of Costed State Government 5-year Multi-sectoral Plan of Action on Food and Nutrition,”.

This story was produced with the support of Nigeria Health Watch through the Solutions Journalism Network, a nonprofit organisation dedicated to rigorous and compelling reporting about responses to social problems.

 

 

 

 

 

 

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