The project’s chairman of “Little Steps, Big Steps: Tackling Malaria and Malnutrition among Pregnant Women and Under-5 Children in Lagos, Oyo and Ogun States, and Rotary Past District Governor, Mr Adeniji Raji, in this interview with SADE OGUNTOLA expressed concerns about the increasing incidence of teenage pregnancies and its contribution to malnutrition and malaria communities.
WHAT is the “Little Steps, Big Help” project about? What is it intended to achieve?
“Little Steps, Big Help, Tackling Malaria and Malnutrition in Mothers and Infants Under Age 5” addresses the dual health challenge of malaria and malnutrition in Lagos, Oyo, and Ogun states. From 2019 to 2021, we had a project on reducing maternal and child mortality and morbidity in Lagos, Ogun, and Oyo states. During that project, we had community dialogues where we found that many mothers were having preterm babies, and there were other issues associated with malaria and malnourishment. After its conclusion, we knew malaria and malnutrition were key issues in those states.
Now, Nigeria has the highest burden of malaria in Africa. Nigeria also accounts for 31 percent of global deaths due to malaria. Beside polio, which we have now overcome, malaria is next because the number of people dying from malaria and malnutrition, particularly children under five, is high. Oyo State alone accounts for almost 38 percent of malnourished children; they are either stunted or wasted. Stunting in children is when a child is too short for their age. “Wasting” in children refers to a condition where a child is significantly underweight for their height.
At a recent community outreach in Lagos for selected nursing mothers with severely malnourished children at Iwaya Primary Health Centre, we had a food demonstration to teach the mothers how to prepare Nigerian dishes for their children using local food materials. In Lagos State, 100 severely malnourished children are selected, 20 children each from the five LGAs in Lagos State. We shall give nutrients to each child for eight weeks and observe their progress from severely malnourished to nourished children.
This project in Lagos State will use about 16,800 sachets of nutrients provided by the project. This is also ongoing in both Oyo and Ogun States.
Why the choice of malaria and malnutrition in children below five and pregnant women? Why are the men excluded?
Our action group is the Rotary Action Group for Reproductive Maternal and Child Health. Its focus is on mothers, women, and children under five. We also know that the dual challenge of malaria and malnutrition affects mothers and children more than men. It has grave consequences. Malaria in pregnancy can lead to preterm birth, stillbirth, miscarriage, and anaemia in the woman. It can potentially affect the cognitive development of the unborn child.
What was the baseline finding at the onset of this project in these states?
We looked at the malaria prevalence in these states. However, Oyo State has a higher prevalence of malaria and malnutrition; thus, 60 percent of our effort in this project is devoted to Oyo State. So, we are addressing 15 local governments and 96 primary health centres in Oyo State. First, we trained over 455 health workers on what to do to address the two issues in Lagos, Ogun, and Oyo states. Additionally, 81 community health workers are yet to be trained.
Secondly, we are also conducting community outreach on the dangers of malaria, its causes, its prevention, and then testing those who show positive signs of malaria using the rapid diagnostic test (RDT) kits. And those found to test positive for malaria, if it’s not complicated, are given medicine to take care of the malaria. Again, the malnutrition status of children at these outreaches is assessed using muaptapes and weighing scales. If they are malnourished, depending on their status, they are given nutrients or referred to the state’s nutrition focal person to take care of them.
Besides that, there were outreaches for pregnant women (ANC) where talks were about what they need to do when they are pregnant, when they have had their babies, and breastfeeding their babies exclusively for six months. The breast milk is then complemented with local foods thereafter. Besides that, we also give medicines, Intermittent Preventive Treatment (IPTp), to help prevent malaria in pregnancy. Also, we demonstrated to them how to set up and use the mosquito nets they were given. Many people get the mosquito nets, and they don’t use them. In this programme, we are distributing about 15,000 mosquito nets in the three states. But Oyo State gets the largest number, 8,700; Ogun, 3,200; and Lagos, 3,100.
Thirdly, we’re also supplying malaria drugs and equipment like weighing scales and RDT kits for these primary healthcare centres. Then the last part is a media campaign. Jingles on the radio in Yoruba, English, and Pidgin talk about malaria and malnutrition. Besides that, we also have publications in newspapers and 2,000 posters that we gave to be pasted on their PHC boards. So, people can see what malaria is, how to prevent malaria, treat their children when they are born, and also breastfeed them. The printed fliers about malaria and malnutrition are given out during these outreach programmes.
Additionally, we have introduced the Community Birth Attendants (CBA). More than 50 percent of deliveries in Nigeria are by traditional birth attendants. Many programmes always exclude them. In this project, we have included them in our outreach to the community. This inclusiveness helps the CBAs to know the rudiments of pregnancy and management and child delivery as well as the need to manage malaria in pregnancy. This relationship with PHC staff, for instance, if something is beyond their capability, they have recourse to the nurses from the primary healthcare centre in their vicinity. So, we want to build that relationship between them so that referral of cases they cannot handle is made easy. At the outreach with the community birth attendants, mosquito nets and IPT tablets are given to the pregnant women.
How many children and women have you reached through this project?
We have had over 27 outreaches. Usually, we have between 200 and 300 people at each of these outreaches. We have reached approximately 5,400 women and children with malaria information, nutrition information, and probably drugs. Many times, of every 200 women that are tested, about 28 or more will test positive for malaria. Also, when there are cases of severely malnourished children, we advise the parents on what to give the child.
Emphasis is also made on the need for environmental cleanliness to prevent mosquito breeding around their homes, how to use the mosquito nets, and that if they have signs of fever, they should go to the nearest primary health centre to get tested and treated appropriately. Right now, we’re in 27 local governments and 165 primary health centres in the three states. And then we are also linking the traditional birth attendants with the PHCs.
Can you relate some of the success stories of this project?
Well, the success stories have been that people are getting informed about malaria, and they are taking the right precautions. Mothers also now know how to use our local food items to make nourishing food for their children. A woman, for instance, claims that she always feeds her child noodles. But noodles have a lot of salt. So it’s not good for the child. Many times, it’s not for economic reasons that children are not given the right food, but it’s just ignorance of what needs to be done. However, in the next few months, we are having a mid-term evaluation to see the project’s impacts and what the issues are.
Before this programme started, a baseline study of a few selected primary health centres was done. Data were not available on PHCs. However, with our intervention, records are being kept properly with the state M&E Officers. We also do spot checks to assess the quality of care they give.
President Trump recently made some pronouncements on U. S donor-funded programmes. What is your opinion regarding the withdrawal of these funds, particularly in Nigeria’s fight against malaria?
You will recall that USAID gave Nigeria 2.3 million dollars towards the end of last year to fight malaria. I don’t know where that money went. We now have to take our lives in our own hands. And you know also the Ministry of Health, because of USAID’s withdrawal from the system, has increased the health budget by $200 million. So that’s also going to compensate for that.
Besides, this year, the federal government also plans to do what we call seasonal malaria chemotherapy (SMC). This is done during the rainy season to give children under five medications for preventing malaria. The Federal government plans to address 30 million people. So, the government is also addressing those issues. So it’s also a call to action for us because we have the resources. So, we should be able to do it.
Can you recall any particular incident that made you perturbed in this project aimed at reducing ill health and deaths due to malaria and malnutrition?
Well, the most pathetic one I saw was in Ogun State. There was a young lady, maybe 19 years old, with a child. She also had an injured hand, maybe from an accident. She doesn’t even have money to go to the right hospital for the treatment of the hand. If she’s not careful, she might lose the hand. I had to give her money. So, you find quite a few adolescent pregnancies, some who are neither married nor able to take care of themselves and their babies because they lack enough family support. That particular lady was living with her mom, who also was not well off to be able to look after her and look after the child. When we visited the state authorities, I did mention that there’s a high preponderance of teenage pregnancies in the state. They are malnourished, and their babies would be malnourished.
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What are those factors you think are contributing to cases of malaria and malnutrition in those communities where you work?
Well, the first is sanitation. Mosquitoes breed where there are pools of water and things like clogged drainages in the environment. So mosquitoes have a field day to breed. Poor personal hygiene is also involved in many of the cases. People are given mosquito nets, but they hardly use them or use them for other things for different reasons. Mosquito nets cost about N3,000 each. Many families cannot afford that. Also, the cost of delivery is the reason many women go to traditional birth attendants. So those are some of the reasons why malaria persists: because people don’t go to where they can get treatment. Some, after a diagnosis of malaria at the primary healthcare centre, turn to herbs because they lack resources for the medicine and the medicine is not available in the pharmacy.
Also, malnutrition, for instance, is due to a lack of knowledge on how to make food nutritious. What is the combination of foods, even at minimum cost, they can put together for a nutritious meal? Many times, the mother herself is also malnourished. The mother is also not feeding well, and that reflects on the child as well. So this cycle of poverty can also make people have malnourished children.
and then