First 1,000 Days: Nigeria’s approach to tackling child malnutrition

BY ABIEMWENSE MORU

A two-year-old child from rural Adamawa survived severe malnutrition last year, thanks to a timely nutrition intervention.

This case highlights the precarious line be- tween life and death for children facing food insecurity across Nigeria.

According to the 2023 National Nutrition and Health Survey, 37 per cent of Nigerian children under five are stunted, 7 per cent suffer from wasting, and 22 per cent are underweight, emphasising the urgent need for strengthened nutrition interventions.

Dr Ben Ojewola, consultant paediatrician at Isolo General Hospital, explained that inadequate and suboptimal breastfeeding practices are major contributors to child malnutrition.

He added that this, in turn, drives high infant mortality across Nigeria and neighbouring African countries.

He noted that food insecurity restricts mothers’ dietary intake, limiting their ability to produce sufficient breast milk, which adversely affects children’s growth, immunity, and cognitive development.

Citing the World Health Organisation (WHO), Ojewola clarified that exclusive breastfeeding involves feeding infants only breast milk for the first six months, with exceptions made solely for medically necessary vitamins, medications, or oral rehydration solutions.

He lamented that economic hardships, rising inflation, and escalating food costs often prevent mothers from practising exclusive breastfeeding.

Consequently, he urged urgent interventions to protect child health and ensure early life nutrition for all infants.

He further emphasised that breastfeeding is not only a vital survival tool, especially in humanitarian and crisis settings, but also a strategic investment in national development. Mothers were encouraged to adhere strictly to WHO breastfeeding recommendations.

Supporting this perspective, Oncologist Dr Tolulope Okunowo, managing partner at MercyWay Medical Centre, added that stress, anxiety, and strenuous labour can reduce milk production, forcing mothers to rely on formula feeding, which increases malnutrition risks.

Okunowo advised mothers to prioritise rest and proper nutrition, highlighting that exclusive breastfeeding also functions as an effective family planning method, temporarily inhibiting conception and improving maternal-child health outcomes.

She further advocated for supportive breastfeeding initiatives in hospitals, workplaces, and communities, stressing that exclusive breastfeeding strengthens mother-child bonding, promotes cognitive and physical development, and improves overall child health and well-being in the long term.

In Adamawa, the Civil Society—Scaling Up Nutrition in Nigeria (CS-SUNN), has urged the state government to invest N9 billion in child nutrition, leveraging counterpart funding to double the impact.

Mr Sodangi Chindo, Chairman of CSSUNN’s Steering Committee, noted that such an approach could allow Adamawa to access double-value funding opportunities, effectively reducing required expenditure from N18 billion to N9 billion, while extending malnutrition interventions across the state.

He described malnutrition as a public health crisis in Adamawa, with stunting at 48.6 per cent, wasting at seven per cent, and underweight prevalence at 32.5 per cent.

These figures threaten child survival, educational attainment, future workforce productivity, and overall economic development.

Chindo stressed that timely investments in maternal and child nutrition, especially during the critical first 1,000 days from conception to a child’s second birthday, yield huge returns in health outcomes, cognitive development, and national productivity across generations.

It is worth noting that CS-SUNN, with support from UNICEF, is implementing a project to scale up quality nutrition services in Adamawa, aligned with the Adamawa State Multisectoral Plan of Action for Food and Nutrition (ASMPFAN).

Chindo called for the full operationalisation of ASMPFAN, strengthened monitoring systems, and improved coordination down to Local Government Areas (LGAs), ensuring interventions reach even the most vulnerable communities effectively and efficiently.

He further urged sustainable domestic financing, timely release of allocated funds, and proper utilisation of nutrition budgets across sectors to ensure maternal and child nutrition interventions are implemented consistently and produce measurable results.

In addition, he recommended extending paid maternity leave from three to six months to encourage exclusive breastfeeding, reduce child malnutrition, and improve both infant survival and maternal health.

Chindo also appealed to the media to prioritise evidence-based nutrition reporting, holding government and stakeholders accountable for budget commitments, programme implementation, and tangible impact on child nutrition.

He encouraged private sector investment in food fortification, affordable nutritious foods, and the adoption of breastfeeding friendly workplace policies, which could strengthen nutrition outcomes and reduce early-life malnutrition risks nationwide.

Civil society organisations were urged to sustain advocacy efforts, mobilise communities, and align interventions with state nutrition priorities, ensuring collective action complements government programmes.

Similarly, in Benue, CS-SUNN highlighted alarming malnutrition indicators despite the state’s reputation as the “Food Basket of the Nation”.

Mr Sunday Okoronkwo, CS-SUNN Executive Secretary, reported that 25.3 per cent of children are stunted, 6.7 per cent suffer from wasting, and 13.6 per cent are underweight, threatening survival, cognitive development, and future workforce productivity.

He emphasised that investing in maternal and child nutrition is not merely a social intervention but a strategic economic choice, as malnutrition erodes human capital and sup- presses lifetime earnings.

Okoronkwo reiterated the importance of the first 1,000 days as a critical window for interventions that yield high returns in health, cognition, and long-term productivity.

CS-SUNN, supported by UNICEF, is implementing the “Increased Investment in Nutrition to Scale Up Quality Nutrition Services” project in Benue, strengthening financing and expanding nutrition services for maximum impact.

Advocacy priorities include sustainable domestic financing, leveraging innovative funding mechanisms such as the Child Nutrition Fund, and ensuring timely release and efficient utilisation of nutrition budgets across multiple sectors.

Okoronkwo also recommended extending paid maternity leave from three to six months in the public sector to improve exclusive breastfeeding, maternal health, and child survival outcomes, aligning with global best practices.

In Bauchi State, authorities introduced Small Quantity Lipid-Based Nutrient Supplements (SQ-LNS) for children aged six to 23 months, complementing breastfeeding and ensuring daily nutrient intake for healthy growth.

Dr Rilwanu Mohammed, Executive Chairman of Bauchi State Primary Healthcare Board, explained that SQ-LNS bridges nutrient gaps, addresses micronutrient deficiencies, and prevents stunting before malnutrition becomes severe, offering a preventive alternative to Ready-to-Use Therapeutic Food (RUTF).

Mohammed commended UNICEF for supplying the supplements and highlighted training for health personnel to ensure proper administration, alongside continued breastfeeding and complementary feeding practices.

The State Nutrition Officer, Abubakar Saleh, added that SQ-LNS is made from local ingredients such as groundnut, cereal, pulses, milk powder, vegetable oil, vitamins, and minerals, making it affordable, acceptable, and nutritionally adequate for children.

Each sachet represents a daily dose, mixed with complementary foods, and is not a substitute for breast milk.

In Katsina, the International Red Cross donated 4,117 cartons containing 600,500 packs of RUTF to support children suffering from severe acute malnutrition.

Mr Bala Abdullahi-Hussaini, Secretary of the state Red Cross branch, said LGAs including Bindawa, Zango, and Kankia had benefited.

Complementary programmes on peace- building, youth empowerment, and cholera response further expanded the organisation’s impact. COVID-19 sensitisation and diphtheria awareness campaigns reached over 500,000 residents, demonstrating the broad benefits integrated health, nutrition, and community resilience initiatives.

In Kogi, Women Affairs Commissioner Mrs Acharu Okpanachi noted that proper nutrition enhances cognitive development, strengthens immunity, and provides a foundation for lifelong health, urging caregivers to prioritise child feeding practices.

She emphasised that diets rich in iron, protein, and vitamins improve school performance, emotional well-being, and overall development, while malnutrition contributes to stunted growth, learning delays, and long-term disabilities.

Mrs Mary Aiyesimi, Director of Nutrition in Kogi, stressed that early-life nutrition lays the foundation for health, learning, and productive adulthood, advocating exclusive breastfeeding and proper complementary feeding.

Nutritionists Funmilola Alapo and Shaibu Mohammed reinforced that exclusive breastfeeding, timely complementary feeding, hygiene, and responsive feeding practices are essential to healthy child development.

Government officials such as Mr Bolarinwa Ogundusi and Mr Abubakar Musa insist that nutrition is the bedrock of child development, urging consistent, nutritious dietary habits to ensure optimal growth and future productivity.

At the national level, the Federal Government called on stakeholders to align Nigeria’s food and nutrition policies with research, current realities, and global best practices.

Dr Deborah Odoh, Permanent Secretary of the Ministry of Budget and Economic Planning, noted that the revised National Policy on Food and Nutrition (NPFN) is critical for identifying gaps, addressing challenges, and leveraging opportunities to improve nutrition outcomes nationwide.

The framework incorporates a multisectoral action plan, enhanced coordination at national and state levels, and improved data systems for evidence-based decision-making, with a focus on vulnerable populations and children.

Mrs Uju Anwuka, Senior Special Assistant to the President on Public Health, emphasised that policies must reach communities and households to bridge the gap between policy intentions and actual impact.

Clementina Okoro, Director of Food and Nutrition, said the revision reflects the Federal Government’s Renewed Hope Agenda, demonstrating commitment to reducing malnutrition, strengthening food systems, and promoting national productivity through improved nutrition outcomes.

Also, UNICEF Nigeria’s Chief of Nutrition, Ms Nemat Hajeebhoy, highlighted the importance of shifting from opinion-based to evidence-informed policies.

She said this is critical to addressing stunting, declining breastfeeding, severe acute malnutrition, and limited access to life-saving interventions nationwide.

Other stakeholders, including the Aliko Dangote Foundation, National Assembly, Nigeria Governors’ Forum, Nutrition Society of Nigeria, and state budget commissioners, reaffirmed their commitment to the revised policy, which addresses both undernutrition and overnutrition.

They described the NPFN revision as crucial for unlocking Nigeria’s potential, providing a robust framework for reducing malnutrition, strengthening food systems, and achieving sustainable health and development outcomes for children over the next decade.

With multi-sector collaboration, evidence informed policy, civil society engagement, and targeted nutrition interventions, Nigeria aims to curb malnutrition, enhance early-life development, and secure a healthier, more productive generation of children.