Stunt: Predisposing Nigeria’s future to low IQ

Nigeria has the highest number of stunted children under age five in sub-Saharan Africa. Experts in this report by Sade Oguntola say that Nigeria risks raising more adults with low IQ.

The death of their mother deprived Hassan and Hussein the benefit of breastfeeding and motherly care. The twins, at two years, although plumy, have the height of a year old child.

“That they are alive today is a miracle. I thank all the people that supported me in taken care of them,” Hawawu Musa, their grandmother said with a smiling face. “They did not develop well; they were only feeding on infant formula.”

In August, 2015, health workers diagnosed Hassan and Hussein who lived with their grandmother that sell local cheese at Gaa-Ayegbade, a suburb in Ibapara East Local Government Area of Oyo State, as having severe acute malnutrition.

Six months after the children started on soya based enriched complementary food and guinea corn; the babies who hardly could sit are now walking and eating other foods adults take.

Abigail, now two years and three months, also is a victim of malnutrition. The mother started to give her pap, amala and ewudu and other adult diets when she was a month old because she refused taking breast milk.

Amina, Abigail’s mother who had her when she was 19 years old did not go for antenatal care all through her pregnancy. This contributed to her ill health after Abigail’s birth and inability to properly initiate breastfeeding.

Abigail at one was unable to sit or walk. Respite came her way when she was referred for treatment and her mother commenced her on soya based enriched complementary food that is prepared at Oyo State Nutritional Rehabilitation Centre, Oni and Son’s Children Hospital, Ibadan, Oyo State.

Sadly, Hassan, Hussein and Abigail are few of the children that the soya based enriched complementary food had saved from the jaws of death due to malnutrition.

Malnutrition comes in many forms – including stunted growth, wasting, underweight and vulnerability to infection among those who do not get enough food, and obesity, heart disease, diabetes and cancer risks in people who are overweight or whose blood contains too much sugar, salt, fat or cholesterol.

Globally, an estimated 25 per cent of children under the age of five are stunted, which means they are shorter than normal for their age. But in Nigeria, nearly 43 per cent of children across all socio-economic classes are stunted.

“Stunting does not just happen; it takes a long time to show. It affects the child’s mental capacity and not just that the child is short for his age. It leaves children ill-prepared to take maximum advantage of learning opportunities in school,” said UNICEF Nutrition Specialist, Mrs Ada Ezeogu.

In South Western Nigeria, stunting is the biggest form of malnutrition. “We are losing a lot of potentials due to stunting. This is not just about food or poverty alone, its causes are many including lack of variety in diet, poor maternal health and unsanitary environment,” Ezeogu said.

But children with the highest level of malnutrition in South Western Nigeria are between six and 11 months. This tallies with the period that complementary feeding is started and suggestive that the quality of complementary feeding given was poor, Ezeogu said.

Approximately 20 per cent of stunting begins in the womb, with a mother who herself is malnourished and is not getting enough of the nutrition she needs to support her baby’s growth and development during pregnancy.

The effects of stunting last a lifetime: impaired brain development, lower IQ, weakened immune systems, and greater risk of serious diseases like diabetes and cancer later in life.

Reports have it that stunting reduces IQ scores by between five and 11 points. When children are stunted at an early age, they risk reduced productivity over time — poor education results in jobs with low earnings.

This in turn has an impact on their communities and their countries’ economies, costing countries billions of naira every year in lost productivity and holding back worldwide economic development that could benefit everyone.

Though stunting is irreversible, it is also preventable. The first two years of life is a window of opportunity that Oyo State is capitalising on to stem the problem.

“Initially, we were considering the under five children. But, we now concentrate on children right from conception till age two because if the damage is done at this age bracket, little can be done to reverse the effect,” Dr Adijat Alarape, Oyo State Nutrition Officer, said.

Although the 2013 National Demographic Health Survey puts stunting in Oyo State at 27.2 per cent, she said this had dropped to 20.5 per cent based on the SMART survey done in 2015.

However, Alarape said: “it is still higher than the average prevalence for South West Nigeria, put at 17.5 per cent.”

So, how was this achieved? According to Alarape, exclusive breastfeeding was promoted and health workers were trained to ensure that it is promoted at all health facilities in the state.

Soya based enriched complementary food was compounded at the State nutrition rehabilitation centres  as well as three Infant and Young Child Feeding (IYCF) model local governments, Egbeda, Ona Ara and Iseyin, established all with the support of UNICEF as part of efforts to stem malnutrition.

According to Alarape, “In the IYCF local government councils, we screen and manage children with severe malnutrition. We use the Soya based enriched complementary food.

“There was an 11-month-old child in Ibarapa that we managed with the Soya based enriched complementary food. Within six months of management, the child who was wasted and unable to sit could do so.”

However, she said lack of budget line for nutrition, unavailability of regular logistics for follow-up visits and dearth of staff were challenges against stemming malnutrition.