By Abdullah Tijani
In 2019, arms-wielding bandits invaded the village of Roginsamiyya in Goronyo Local Government Area of Sokoto State, located in the northwest region of Nigeria, shooting into the air as they dispossessed villagers of their properties and took some hostage.
Some villagers, however, escaped to an internally displaced persons’ or IDPs’ camp, a 400-person capacity project of the Sokoto State government in Dantasakko community. Among the escapees were the parents of Zainab Alilu who was only a year old when her parents arrived at the camp.
Months after their arrival, due to severe food and nutrition shortage faced by IDPs, little Zainab had severe acute malnutrition (SAM), a condition that causes rapid weight loss and makes under-five children 11.6 times more likely to die than well nourished children due to debilitating symptoms like: lower respiratory infection, severe dehydration, and high fever.
When her weight went down to 115 milliliters or -3 pound, way lower than 19 pounds – the average weight of a one-year-old – she almost died. But she didn’t. She survived because of the intervention of Community-based Management of Acute Malnutrition(CMAM), a malnutrition treatment center set up in the camp by United Nations Children’s Fund (UNICEF), in collaboration with the Sokoto State Primary Health Care Development Agency and the European Union in 2019.
A project of necessity
Since 2018, the activities of bandits have increased across Nigeria, especially in the northwest and north central regions where the bandits frequently attack, kidnap, dispossess communities of their valuables and sometimes kill in the process. This has resulted in 728,688 displacements across the two regions, with Sokoto alone having 45,402 displaced persons.
While most IDPs live in camps and camp-like structures, others are spread across host communities. State governments are often primarily responsible for IDPs daily upkeep in these camps. But IDPs at Dantasakko complain that they barely receive provisions from the government.
“We gather branches of dead trees from a nearby bush,” said Saadu Garkuwa, a resident at the IDP camp. “These branches are sent through a driver to the town (Sokoto) where the money would be used to buy us food provisions.”
Unfortunately, despite the residents’ efforts to make ends meet, Saadu complained, “nobody can boast of a three-square meal a day.”
A 2019 study conducted by the World Food Programme, WFP and Nigeria’s National Bureau of Statistics revealed that IDPs in Sokoto, Zamfara and Katsina States face severe food shortage. According to the study, two in every IDP household do not have sufficient food supply, inhibiting many families from getting optimum food intake and often resulting in SAM, especially among children.
Of the one million children who die in Nigeria every year, SAM is responsible for half of those deaths, the result of a 2018 National Nutrition and Health Survey conducted by the National Bureau of Statistics and the National Population Commission with the support of UNICEF, says. The same survey also showed that Sokoto was among five states with the highest prevalence of SAM, above the 2% warning recommended by the World Health Organisation (WHO), others being Borno, Jigawa, Katsina, Yobe and Nasarawa.
It was in a bid to reduce the prevalence of SAM in these states that UNICEF established the CMAM in Sokoto and other affected states.
Alilu is one of 4,565 children treated between 2019 and 2020 for SAM across the six medical centers established in Sokoto State.
Admitted children at the centers are fed with nutrients-concentrated milk and food, at least once a day in addition to daily drug doses until the child regains weight and health.
In neighbouring Zamfara State, one of the states with high burden of malnutrition, UNICEF also established 13 centers where 5,755 children have been treated of the disease, Walton Beckley, the UNICEF Nutrition Head in Sokoto, said in an interview with Guardian.
Though UNICEF’s fight against malnutrition is yielding results as more children get treated, a major setback is slowing down the victory achieved against malnutrition. Since the beginning of 2021, Saadu noted that the center has not received malnutrition-treating drugs. With the absence of such drugs, mild to medium cases of SAM could become complicated and life-threatening, according to a report by the WFP, and hamper the progress already recorded.
Causes and Prevention
Umar Imam, a director at the Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University, Sokoto, noted that to tackle malnutrition, it is imperative to discuss the preventive measure and the type of food fed to the children.
“In this part of the world, the commonest reason why malnutrition is prevalent is because of poor cultural practice.
“Some parents believe that when a child is weaned, that is if you take a child off breast milk, you can give the child the same type of food we give an adult. They will tell you this is what their parents gave them when they were young, and this practice is a big mistake. Among other foods, children need protein to grow,” he said.
Though poor cultural practice contributes significantly to this endemic, this practice is popular because there’s a high level of poverty in the country, he explained.
“A lot of this is caused by poverty. Protein is a bit more expensive,” he said.
A Nigeria Protein Deficiency Report corroborates this in its survey last year when it posited that high cost is the major reason for poor protein consumption.
Future and Long-term Consequence
It is generally assumed that when a patient recovers from an illness, that will be the end of it. While this might be true for some diseases, according to Imam, some illnesses like malnutrition could have long-term consequences, especially if he was treated for the illness as a child.
“There is a new field of study known as epigenetics which now explains the effect of environmental experience the children have before their birth and immediately after their birth on long term health consequences. A child that developed an illness when he was one year old, even if he recovered, that illness might be a reason why he would develop another disease later in future. Sometimes up to five years it is said that any disease suffered by a child within that period can be a reason why the child would be struck with another disease in future.
“Malnutrition is among the illnesses,” Imam said. “A child with malnutrition even after recovery will be at risk of developing another disease later in life, in adulthood, sometimes when he is forty, fifty and even sixty. He can develop cancer, diabetes, and hypertension.”
Notwithstanding the long term consequences, treatment of malnutrition ravaging the children is the priority. In fact, a local and sustainable approach needs to be developed.
Imam observed, “though UNICEF has taken a great initiative to battle malnutrition, foreign aid like this one feeds the children with ready-to-use therapeutic food (RUTF) which is not only costly, but tends to be unsustainable.”
He suggested finding local foods which are rich in protein, and can serve a better option to the RUTF.
“One of the local foods we can utilise for this purpose is soya beans. It is nutritious and affordable. We need to start looking for solutions around us instead of waiting for help coming from overseas,” he concluded.