• Causes of preventable diseases, death

Doris Obinna

Nutrition is a subject that deals with food and people. It refers to the food we eat and how the body uses the food to grow, to keep healthy and to prevent certain diseases.
Food is made up of several chemical substances that nourish the body. These food materials are called “nutrients.” Different foods contain varied amounts of nutrients. No single food (except breast milk) provides all the nutrients in the right amounts that will promote growth and maintain life.
Therefore, it is necessary to eat a variety of foods at each meal to ensure adequate nutrition.
However, when the right amount of nutrients needed is not taken, the body becomes weak and malnutrition crops in, thereby, leaving the body undernourished. Children are worst victim of malnutrition.
Childhood malnutrition is a major cause of many preventable diseases and death. Nigeria has the highest number of neonatal and maternal deaths than any other country in Africa and second highest number of neonatal deaths worldwide. Infant and child mortality rates are also basic indicators of a country’s socioeconomic situation and quality of life, according to United Nation Development Programme (UNDP, 2007).
The current level of under-five mortality reported by National Demographic and Health Survey (NDHS 2013) is 128 deaths per 1000 live births. This implies that one in every eight children born in Nigeria dies before reaching the fifth birthday. More than 53 per cent of these deaths are attributable to various kinds of malnutrition compounded by preventable disease.
According to National Nutrition and Health Survey (NNHS), the Global Nutrition Report (GNR) 2015 places Nigeria among the countries displaying commitment to reduce hunger and improve nutrition in children and women. Although it is still one of the five large low-middle income countries where more than half of children under age five are either stunted or wasted, the trends in meeting the global World Health Assembly Resolution (WHAR) targets are positive and Nigeria is obtaining some progress.
An expert on malnutrition and child development, Okonkwo Sunday, said everyone throughout life requires the same nutrients but in varying amounts determined by age, sex, body size and the type of work or level of activity. The fuel for growth comes from the foods children eat.
Nutrition is particularly important during infancy when physical growth is so rapid. He said because growth requires so much energy, young babies must consume an enormous amount of calories in relation to their body weight for the following reasons; for optimal growth, cognitive development, health, and also prevention of chronic disease in later life exists when the child consumes food in adequate quantity and quality and the food is utilised by the body for growth and development.
Sunday said: “The food will necessarily meet the body’s macro and micronutrient needs. Proper childhood nutrition provides for optimal physical growth and also provides adequate immunity for protection against infections. It enhances cognitive development and learning ability and increases physical performance and improves work productivity.”
“Any efforts to address malnutrition must target the first 1,000 days and hence the current focus on prevention through promotion of Infant and Young Child Feeding (IYCF), including promotion of optimal breastfeeding and timely introduction of adequate complementary food; treatment through Community Management of Acute Malnutrition (CMAM).
“These efforts have been limited in coverage due to inadequate government funding as efforts seem to be majorly donor-driven. Children form one third of our population and all of our future. The best global indicator of children’s well-being is growth. Unsatisfactory feeding practices can affect their physical growth and mental development.
“Impaired growth and development in children can affect the rest of their lives and compromise academic performance and the ability to contribute to society. More than half of all child deaths are associated with malnutrition, which weakens the body’s resistance to illness. Poor diet, frequent illness and inadequate or inattentive care of young children can lead to malnutrition.
“Children have the right to a caring, protective environment, nutritious food and basic health care to protect them from illness and promote growth and development. Nutritional status of children during the critical period is of paramount importance for later physical, mental and social development. Children need a wide range of nutrients to perform various functions in the body and to lead a healthy life.”
The nutritionist noted, however, that the pattern of the changing food intake of children during the years of growth presents many interesting facets.
He said: “During infancy and adolescence, when physical growth is most rapid, nutritional requirements are high and, in a child with good physical and psychological health, appetite increases and food intake becomes greater. However, during the latter part of the first year and through the pre-school years, demands for growth are somewhat lessened. At the same time, development and maturation are progressing rapidly. The child in this post-infancy period is exploring his world, adding many new accomplishments, becoming independent in eating and in general activity, learning bowel control, and exerting his will in making selections. In the later mid-childhood there is increased need of nutrients as there is increased physical activity and as well as overall growth.
“Adequate nutrition from fetal stage, in childhood, during adolescence, pregnancy and lactation are of fundamental importance for human development. Nutrition is also important for the skeletal development, which is a part of the growth process. Deficiency of nutrients can adversely affect the linear growth, cognition and muscle development which are often irreversible. Inadequate nutrient intake during childhood leads to under nutrition, which results in growth retardation, reduced work capacity, poor mental and social development, high rates of illness and also difficulty in school.”
Also, speaking further, he said the most effective strategy for tackling under nutrition and specially chronic malnutrition (stunting) is to prevent it and critically this must be done within the first 33 months, from conception (-9 months) to 2 years of age (+24 months).
“Although it is difficult to ‘treat’ chronic malnutrition, actions taken in emergencies are critical to preventing shocks to child growth, which eventually result in chronic malnutrition. This includes providing access to quality foods, micronutrient supplements, timely and effective treatment of acute malnutrition, safe water and good quality health care.”
He warned, however, that in protracted emergencies, chronic malnutrition can increase without any significant increase in the level of acute malnutrition. “In such contexts, chronic malnutrition may be as important a nutritional indicator as acute malnutrition; even if it is slower to change at the population level. It should, therefore, not be discounted in humanitarian responses,” Sunday said.
Studies show that frequent illness adversely affects growth and development of children and those children of age between 2-10 years need with all essential nutrients in required quantity for optimal immunity, faster recovery, healthy physical growth and mental development.

Low breast feeding rate
A study shows that exclusive breastfeeding was just 17 per cent far lower than the sub-Saharan Africa average of 32 per cent. In addition, only one in three mothers in Africa attains average of 32 per cent. Also, only one in three mothers initiates breastfeeding for their babies within one hour of birth, as recommended by World Health Organisation (WHO).
Infants aged 0-5 months, who are not breastfed have a seven fold risk of death from diarrhea and pneumonia, compared with infants who are exclusively breastfed (Lancet, 2005). Prompt breastfeeding reduces neonatal mortality by 44 per cent.
However, breast-feeding ensures that babies get the nourishment that they need. Human milk contains the proper amounts of carbohydrates, protein, vitamins and minerals for babies.
Breast feeding has several advantages over bottle feeding (Shelov, 1993). It improves the growth and development, health and survival of infants. It has also been described as the best form of preventive medicine, as it reduces the risk of early-life diseases and obesity

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The situation of mothers
Studies have revealed a high level of micronutrient deficiency in adult women in Nigeria. There are Iron deficiency anemia (12.7 per cent) and anemia in pregnancy (19.9 per cent). Good maternal nutrition is critical for the nutrition of future generations.
Sustainable Development Goals (SDGs) has noted that an indicator of women’s dietary diversity reflects the nutritional quality of food intake.

Poor funding of nutrition interventions and over-reliance on donor agencies:
In 2014, for instance, only 50 per cent of funds budgeted for the scale-up of nutrition were released. The low budget allocation and release lead to over-reliance on donor agencies for funding to implement nutritional interventions.
Consequently, the sustainability of these interventions is not certain.

Government policies and programme
The government has set up the National Committee on Food and Nutrition (NCFN) as an institutional arrangement to coordinate and provide leadership, with the view to articulating a comprehensive policy and actions that could effectively reduce malnutrition considerably or eliminate it in Nigeria. NCFN has led effort aimed at the fortification of staple foods with Vitamin A, so that children would naturally consume vitamin A in their food. This resulted in Vitamin A fortification of 70 per cent sugar, 100 per cent wheat flour, and 55 per cent vegetable oil sold on the market.
Nigeria is also fortifying wheat flour with iron, thereby helping to protect children and mother’s physical and mental health.

Recommended nutrition priorities
Nigerian government, through the Federal Ministry of Health, has identified nutrition-specific and nutrition-sensitive interventions in the five-year coasted health sector National Strategic Plan of Action on Nutrition (NSPAN) 2014-2019. The plan was adopted at the 57th National Council on Health (NCH) meeting held in October 2014, by representatives from the 36 states.