According to UNICEF 2017, Nigeria has the third highest infant mortality rate in the world. Many factors have been identified including acute respiratory infections, infectious diseases and malnutrition. Of these factors, malnutrition is associated with about 50% of all deaths among children (Rice et al., 2000). This reveals that malnutrition, especially resulting from low rates of exclusive breastfeeding and inadequate dietary intake is a major contributor to the high infant mortality rate.

 

In addition, indices of nutritional status among children under-five years are poor. According to UNICEF, the rate of stunting or chronic malnutrition among children under five years is 37%, rate of wasting is 18% and the rate of underweight is 29%. These rates are indicators of the public health burden of malnutrition in Nigeria as the nutritional status of children under five years is an indicator of the nutritional status of the Nigerian population.

 

Adequate nutrition plays a critical role in ensuring child survival and preventing short and long-term consequences of malnutrition.Short term consequences include: increased susceptibility to infections, increased severity of infections, increased duration of infections, increased morbidity, disability and mortality. Long-term consequences include reduced cognitive ability, reduced economic productivity and increased risk of obesity and chronic diseases in adulthood.

 

Recommendations for improving child survival include: exclusive breastfeeding for the first six months of life, continued breastfeeding until the child’s second birthday, adequate complementary feeding after six months in addition to immunization. However, not all children in Nigeria have adequate access to the factors listed above. The rate of exclusive breastfeeding in Nigeria is 25% (NNHS, 2014), which is just half of the global target by World Health Organization.Children who are breastfed exclusively for the first six months, have fewer ear infections respiratory illnesses, diarrhea and hospitalizations.

A number of challenges confront the Nigerian nutrition system. They include: inadequate funding for nutrition programs in the national budget,ineffective coordination of nutrition activities and actors at the national and sub-national levels,lack of visibility of nutrition issues, translation and effective dissemination of research for evidence to spur decision making and changes in policy (CS-SUNN, 2018).

 

Therefore, there is the urgent need to tackle malnutrition at all levels. UNICEF conceptual framework of malnutrition explains the levels- basic (political factor, economic structure), underlying(inadequate access to food, inadequate care, insufficient health services),and immediate (inadequate dietary intake, disease) at which different factors interact to culminate in malnutrition in children (UNICEF 1990).

 

Nutritional status must be addressed throughout the lifecycle especially before conception.Previous interventions have focused on improvement in nutrition during pregnancy, but evidence has shown that improving the nutritional status of the girls and women prior to conception has a larger effect on the nutritional status of the infant (King, 2016). Therefore, interventions to improve infant and child nutritional status should focus on improving nutritional status of women prior to conception. 

This should involve nutrition education especially for secondary schools and higher institutions in addition to intensive nutrition counseling for intending couples. 

 

The period of adolescence and the pre-pregnancy period are windows of opportunity to address the nutritional status of girls and young women to secure the nutritional status of infants during pregnancy and post-partum. This should also incorporate programs on girl education and women empowerment since research has shown that the risk of child malnutrition is lower among mothers with higher levels of education. These interventions should be institutionalized within the health care system especially primary health centers, schools, government hospitals and other mediums for targeting this group and for effectiveness.

 

The first 1000 days of life from conception to the child’s second birthday is a critical period in the growth and development of the child. Nutritional assault or compromised nutrition during this period can lead to irreversible deficiencies or disorders with long-term consequences. Therefore, interventions targeting pregnant women to ensure adequate food access and adequate food intake will go a long way in improving birth outcomes.

 

Another window of opportunity is the period from 2years till five years where minimum changes can be effected in the nutritional status for catch-up growth in the child. Beyond this point, little can be done to address long-term nutritional status.

 

Furthermore, there is the need for intersectoral cooperation to address infant and child malnutrition sincemalnutrition is multi-factorial and multi-faceted and must be addressed from various perspectives.Multi-sectoral interventions are required in the place of interventions taking place in silos where one sector acts independently of the other. In addition,at the household and community level, fathers and grandparents should be mobilized to provide a social network for the mother and to support breastfeeding and adequate nutrition as part of adequate child care practices.

 

There is also the need to allocate more resources in the national and state budgets for nutrition and health promotion activities. Policy makers should advocate for more funds for evidence and context-based interventions to improve the nutritional and health status of the Nigerian population

 

Public-private partnership should also be incorporated into efforts to address malnutrition. This may include providing food industries incentives- favorable policiesand tax environment for the production of nutrient-dense, culturally acceptable and affordable foods via collaboration with food industries. This can go a long way to make these foods available and affordable to the target population.

 

Empowering states and local governments by providing adequate funds while giving them the autonomy of implementing context-based nutrition programs in addition to national programs will also improve effectiveness. Incentivizing nutrition activities especially at the grassroots in communities or at the primary health centers can also improve enrollment and participation in nutrition activities which will also help reduce malnutrition rates.

 

In conclusion, addressing infant and child malnutrition is an urgent priority and all relevant stakeholders must be involved in combating the ugly trend with the ultimate goal of improving the health status of the Nigerian population.

 

References

Civil Society Scaling Up Nutrition in Nigeria (2018). Partnership for Improving Nigeria Nutrition Systems. (Cited November 4, 2018). http://cs-sunn.org/pinns/

King J.C. (2016). A Summary of Pathways or Mechanisms Linking Preconception Maternal Nutrition with Birth Outcomes. The Journal of Nutrition.146(7): 1437S–1444S.

National Nutrition and Health Surveys (2014). National Bureau of Statistics, Federal Government of Nigeria.

Rice A.L., Sacco L., Hyder A. and Black R.E. Malnutrition as an Underlying Cause of Childhood Deaths Associated with Infectious Diseases in Developing Countries. World Health Organization Bulletin.2000; 78(10): 1207–1221. 

United Nations Children’s Fund (2017). Levels and Trends in Child Mortality. (Cited November 4, 2018).https://data.unicef.org/resources/levels-trends-child-mortality-2017/

United Nations Children’s Fund (1990). UNICEF Conceptual Framework of the Determinants of Child Undernutrition. (Cited November 4, 2018) https://www.unicef.org/nutrition/files/Unicef_Nutrition_Strategy.pdf

Infant and Child Mortality in Nigeria: How Far from The Millennium Development Goals? 

http://epc2010.princeton.edu/papers/100020

United Nations Children’s Fund.Malnutrition Rates in Children Under Five Years

https://www.unicef.org/nigeria/factsheets_NUTRITION_low.pdf