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Providing relief for malnourished children in Nigeria

© UNICEF Nigeria/2010/Nwosu
Babies and their mothers wait to see staff at the Kadadi Buda CMAM facility.

Sokoto, Nigeria, 7 July 2010 - When the UNICEF Regional Director for West and Central Africa, Dr. Gianfranco Rotigliano, arrived at the village of Kadadi Buda in Gada Local Government Area in Sokoto State, northwest Nigeria, it was 45 degrees Celsius.

Aimma Adamu, the teenage mother whose severely malnourished baby was being weighed on the village clinic’s scale, said that the heat of the day was "just okay for the day"—normal for the end of June.

Further south, the rains had already come and the landscape was green with new crops, but not in Kadadi Buda and its adjoining villages: still waiting for rain, they were parched and sun-baked.

Kadadi Buda is on the fringes of the Sahel.

The villages less than a kilometre away just down the hill are no longer Nigerian but nigerien, in the Niger Republic.

Kadadi Ward has 28 communities and a total population of 25,369; of those, 5,074 are children under five years old.

The 2008 Nigerian Demographic and Health Survey recorded that about 19 per cent of the children in the northwest zone were acutely malnourished (13.9% on national average) and required outpatient therapeutic care in the course of a year: that translates into 970 of the children in Kadadi Buda village

The northern states most affected
Nigeria has the fourth highest number of underweight children in the world (behind India, Bangladesh and Pakistan).

There are estimated to be over two million children suffering from severe and moderate acute malnutrition in the country, and most of them are in the northern states.

The Kadadi Buda Primary Health Care Outpatient Therapeutic Programme (OTP), which the Regional Director had come to visit, was set up to provide treatment for malnourished children in Kadadi Ward but it often helps families from nearby communities as well, including some in the Niger Republic just down the hill.

From March to June, 164 children with severe acute malnutrition had been admitted to the facility.

July and August, when stocks are at their lowest before the September harvest, are always lean months in the north, but the Nigeria Food Security Outlook predicts that communities nearest the northern border—Kadadi Buda is one of them—are likely to face increased food security problems this year because of the late rains.

Although food supplies are under stress there, the National Emergency Management Agency and development partners agree that the situation has not reached crisis levels as it has in the neighbouring countries of Niger and Chad, which are buying foodstuffs from Nigeria.

Aimma, Rakiyya and other women at the centre describe the difficulty they are having keeping their homes stocked, but don’t seem to connect them with the cross-border buy-ups of foodstuffs by their neighbours.

"The money just buys less and less these days," Rakiyya shrugs.

"Once the money my husband gives me runs out, that is it." Nonetheless, malnutrition is not just a matter of food in this part of Nigeria: it is also the outcome of a failure to breastfeed babies exclusively for 6 months and then for another 18 months with complementary foods, bad water, frequent infections and diarrhoea, and poor household and healthcare practices.

Aimma, although a teenager, is in her fifth year of marriage. She lost her first child to complications due to malnutrition when he was 19 months old.

© UNICEF Nigeria/2010/Nwosu
The whole community, including the mothers whose babies had been treated at the Kadadi Buda CMAM facility, greeted the Regional Director.

The community management of acute malnutrition approach (CNAM)
A community volunteer encouraged her to bring Abu Sufyiani, her second son, to the Kadadi Buda OTP facility.

The little boy, who is 13 months old but he looks like a baby of three months, is suffering from diarrhoea and vomiting.

Aimma hopes the staff at the facility, who use an approach called community management of acute malnutrition (CMAM) which enables families to treat their sick children at home with ready-to-use therapeutic foods, will save her baby.

The Kadadi Buda OTP facility is one of five OTP sites with CMAM facilities that UNICEF has helped set up in Gada LGA; it has established another five in nearby Tangaza LGA as well.

Medecins Sans Frontieres Holland is supporting six CMAM sites in the State, and the State Government is planning to open more.

A partenership to fight malnutrition
The Regional Director praised the strong commitment, ownership and leadership exhibited by the State, local governments and communities in establishing the facilities.

"Other states in the region will draw from your experience," he said.

With UNICEF financial and technical support—and thousands of cartons of its ready-to-use therapeutic food (RUTF)—CMAM is now being expanded to Jigawa, Borno, Yobe, Zamfara and Katsina states.

In the meantime, the federal government is developing national guidelines for CMAM, and UNICEF is sourcing funds to purchase more RUTF and support new sites; it is also helping two local companies set up RUTF production plants in Nigeria.

Good nutrition for children is increasingly becoming part of routine health service everywhere in Nigeria.

UNICEF has been a key player in the institutionalization of biannual Maternal Newborn and Child Health Weeks, which provide vitamin A supplements, de-worming medication, long-lasting insecticide-treated bed nets and immunizations free to children under five years old—nationwide.

The Children’s Fund is also loud voice in campaigns to encourage mothers to breastfeed their babies exclusively for six months; it also backs community breastfeeding support groups across the country.

Aimma is confident now that her son will grow up, healthy and strong, and has a career plan for him.

"He will work in the farm in the three months of the rainy season," she says, "and then here [the Kadadi Buda CMAM site] as a cleaner, or a nurse or doctor… anything."

By Geoffrey Njoku and Paula Fedeski



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