Saving Baby Iliya

When Aisha Garba’s 13-month-old son Iliya stopped eating and developed a fever, she realized he needed urgent medical help. However, with the nearest facility in Maiduguri, north-east Nigeria a dangerous 196-kilometre journey from her home in the fishing town of Baga, she struggled to find transportation.

“The area is very insecure and there were no escorts for several days. No vehicle could leave Baga without escorts, so I kept going back to check,” she said.

With insecurity rife on the roads, the route to Maiduguri had been dangerous and difficult for months. With each passing day, Garba worried that the worst could happen to her son. Fortunately, she was finally successful.

“I was lucky on the fourth day after he started to get sick, when there were escorts. The journey cost N6,000, which my husband borrowed from his friends at the fish market. But nothing compares to my son’s life,’’ said Garba.

Iliya arrived at the Umaru Shehu Hospital Stabilization Centre in Maiduguri extremely weak and malnourished. He weighed a mere 6.4 kg and measured just 10.5 cm on the mid-upper arm circumference (MUAC) tape. A healthy child of the same age should weigh between 9 and 10 kg and have an upper-arm measurement of at least 12.5 cm.

He came in with a high fever and a stomach massively distended. He was severely malnourished, passing loose stools and had a bad cough,’’ said Dr. Ummi Saleh Galadima, the physician in charge of the Centre.

Opened in 2015, the UNICEF-supported facility caters to children with severe acute malnutrition. Patients are referred from outpatient therapeutic centres and health facilities in internally displaced persons’ camps and communities across Borno State in north-east Nigeria.

With funding from the Foreign Commonwealth and Development Office (FCDO), UNICEF provides free life-saving treatment for children aged 6 months to 5 years with severe acute malnutrition in dozens of stabilization centres across north-east Nigeria. The support includes laboratory tests, treatment with ready-to-use therapeutic foods (RUTF), medical equipment, and three daily meals for mothers throughout the course of their child’s treatment. Families are also given ‘discharge rations’ of rice, beans and oil.

Aisha Garba initially thought her son was suffering from a teething problem, but his situation was much more serious.

“He had lost appetite and there was no neck control. He couldn’t sit up at all,” said Dr. Galadima. “We placed him on anti-malarial and anti-bacterial drugs. He had protein and energy deficiencies, but we couldn’t immediately place him on the nutrient-dense ready-to-use therapeutic food until he was stabilized. We had to place him on F-75, a milk-based therapeutic solution instead. Once he regains sufficient strength and the stooling stops, we will place him on RUTF.”

As most in Borno State are farmers or fishers, increasing cases of severe child malnutrition come with planting seasons, when food items are scarce and sales of farm products are low.

But Dr. Galadima said the number of cases and their severity are getting worse. “The number of cases we had in August were the highest since I started work here,’’ she said.

“Seventy percent of admitted children present with a history of diarrhoea and vomiting and the cases keep increasing every year. Almost all the children are from displaced families who have deserted their farmlands because of insecurity. And the mothers too are malnourished and without jobs. Sometimes I ask myself if we have truly exited the acute emergency phase,’’ she said.

While Iliya has regained neck control and is gradually recovering at the stabilization centre, Dr. Galadima fears that other children who have difficulty accessing the centre quickly might not be so lucky.

“I am a mother, sometimes I cry’’

The doctor has worked at the centre since 2016, over which time the number of beds has increased from 24 to 30 to accommodate rising admission rates.

“We still have to send babies back for lack of bed space, even as of this morning,” she said. “As we discharge babies, there are others waiting to take up the beds.

There are months where we have over 120 cases admitted.”

Between October 2020 and August 2021, the Centre recorded more than 1,000 severe acute malnutrition cases and nine deaths.

Dr. Galadima often switches with other doctors at the 50-bed Mashamari Stabilization Centre located at the other end of town. She says the situation there is similar, with beds constantly full.

“This is my fifth year here,’’ said Dr. Galadima, her voice barely rising over the din of crying babies and busy mothers. “We have to eradicate poverty, and well-to-do Nigerians must rise to the occasion. We must stop insurgency and deal with the issue of family planning and child spacing. This is very important.”

Walking back to Iliya’s bedside, Dr. Galadima said she wishes mothers would emulate Aisha Garba, who defied all odds to seek help for baby.

“Instead of bringing their children to the hospital early, most parents delay at home, giving local concoctions to their children. Sometimes the children arrive when it is too late. This can be very traumatizing. I am a mother; sometimes I cry. Losing a patient to follow up is also never easy. You will be forever wondering if the child survived,’’ she said.

An undeclared epidemic

According to the World Health Organization, undernutrition, a dangerous form of malnutrition, is linked to 45 per cent of child mortality cases globally. Wasting (children being too thin for their height) and stunting (children too short for their age) are two key forms of malnutrition in children under five.  

With a national prevalence rate of 37 per cent, Nigeria has the second highest burden of stunted children in the world.

Most affected are children in north-east Nigeria, which bears the brunt of the protracted conflict that has robbed millions of families of their primary source of livelihood - farming. Experts say that a combination of food insecurity, measles and diarrhoea are some of the factors driving the latest spike in severe acute malnutrition cases in the region.

According to the Food and Nutrition Surveillance System report conducted in September 2021, the worsening malnutrition situation is similar to pre-emergency levels of 2016 across north-east Nigeria and in Yobe State even worse than pre-emergency levels. Worse, the report noted rising admission cases, even though there were 15 per cent fewer reporting sites compared to the previous year. The sad implication is that the gains of emergency programmes have been wiped away.

“It is a challenging situation,’’ said Phuong T. Nguyen, UNICEF Chief of Field Office in Maiduguri, north-east Nigeria. “We will continue to support children with the services they need to survive and thrive. We came out of this crisis before and we will work hard to attain that normalcy again. We are partnering with the government and we hope that security will improve to allow life-saving services to reach more children currently living in inaccessible areas.”