Malnutrition: Cognitive functions of Nigerian children under threat

As pregnancy and infancy are most important periods for brain development, mothers and babies need good nutrition to lay the foundation for the child’s future cognitive, motor and social skills, school success and productivity, writes ALEXANDER CHIEJINA.

It’s hard to believe, but a child’s future can be determined years before he/she even reaches the fifth birthday. As a father of three, I see unlimited potential when I look at my kids. But for many children, this is not the case,” Rajiv Shah, administrator, United States Agency for International Development (USAID), revealed in ‘Save the Children-State of the World’s Mothers 2012 Report.’

Shah continued: “Good nutrition during the critical 1,000-day window from pregnancy to a child’s second birthday is crucial to developing a child’s cognitive capacity and physical growth. Ensuring a child receives adequate nutrition during this window can yield dividends for a lifetime, as a well-nourished child will perform better in school, more effectively fight off disease and even earn more as an adult.”

The issue of malnutrition has continued to remain a key health challenge in developing economies, including Nigeria, remaining an underlying cause of child deaths annually. While millions of Nigerian children under the age of five survive, they suffer lifelong physical and cognitive impairments as a result of inadequate nutrients needed early in their lives when their growing bodies and minds were most vulnerable; the negative effects of malnutrition are largely irreversible.

However, children with restricted brain development in early life are at risk for later neurological problems, poor school achievement, early school dropout, low-skilled employment and poor care of their own children, thereby contributing to the cycle of poverty, according to ‘State of the World’s Mothers 2012 Report.’

A major cause of concern is the July 2013 report by the Federal Ministry of Health that reveals that 41 percent of Nigerian children under age five are stunted as a result of malnutrition. The report, which is in tandem with the last National Demographic and Health Survey (NDHS) conducted across the states of the Federation, shows acute malnutrition level as high as 53 percent in the North-West, 49 percent in the North-East, and 22 percent in the South-East.

Confirming this report, The State of the World’s Mothers 2012 Report released in 2013 put stunting rate in Nigerian children – age five – who are moderately or severely stunted at 40 percent or more.

These figures make Nigeria one of the six countries globally that account for half of all child deaths from malnutrition, and presents a major obstacle to attainment of Millennium Development Goals (specifically goals 1, 4, and 5) in the country, which is less than 12 months away.

Stunting refers to a child that is too short for his/her age. While this condition is caused by poor diet and frequent infections, delayed motor development, impaired cognitive function and poor school performance, which are effects of stunting, are largely irreversible.

Speaking with BusinessDay, Chris Isokpunwu, deputy director/head of nutrition, Federal Ministry of Health, says malnutrition is one of the underlying cause of under-five mortality rate in Nigeria, contributing 53 percent of infant mortality.

While blaming malnutrition on low level of exclusive breast feeding of Nigerian children under the first six-months of life, Isokpunwu urges mothers to scale up nutrition before pregnancy and during pregnancy till age two of a child’s life in order to empower their mental development.

“Exclusive breast feeding rate is 13 percent in Nigeria while early initiation of complementary feeding before the age of six-months is 76.1 percent. Focus on nutrition in the first 1000 days is a foundation for good health in adulthood and prevents nutrition-related non-communicable diseases that emerge in adulthood,” Isokpunwu explains.

Ngozi Nnam, president, Nutrition Society of Nigeria (NSN), explains that a child that did not get enough nutrition in the first 1000 days is destroyed for life, as it determines what a child would become in life academically and health-wise.

Nnam, a professor of public health nutrition, University of Nigeria (UNN), reveals that malnourished children lack 13.5 percent of intelligence quotient (IQ), pointing out that if a pregnant woman is malnourished, the child’s certain important brain parts would be irreversibly deformed for life.

“First 1000 days of life is one of the periods of growth spurt when cells, tissues and organs are developed and bones are formed. It is a period of rapid brain development.

“Up to 70 percent of brain development happens during pregnancy. 15 percent of a child’s bran develops during the first year of life, with the brain almost completely developed by the second birthday. Some nutrients are needed for proper brain development – protein, iron, folate, iodine, some fatty acids from fat and carbohydrates.

“At least 50 brain neurotransmitters are affected by the intake of nutrients in the first 1,000 days. Inability to provide adequate nutrients for proper development reduces IQ by 13.5 points and the effect is irreversible.

“Inadequate supply of nutrients during the first 1,000 days leads to stunted growth and predisposes a child to chronic diseases in adulthood. These chronic illnesses include diabetes, heart disease and obesity,” Nnam says.

Addressing malnutrition, nutrition experts believe is critical, as it costs many developing nations an estimated 2 to 3 percent of their Gross Domestic Product (GDP) annually extends the cycle of poverty, and impedes economic growth. In contrast, well-nourished children perform better in school and grow up to earn considerably more on average than those who were malnourished as children.

The fifth report on World Nutrition Situation which reveals that stunting affects 147 million pre-school children in developing countries, with Nigeria believed to be home to 10 million of such children, calls for urgent steps to address the current challenge.

No doubt, there is need to invest in proven, low-cost solutions to save children’s lives and prevent stunting. Knowledge of nutrition and proper utilisation of locally available nutritious foods should be employed to reduce the growing danger of malnutrition in the country.

Ebenezer Ojofeitimi, Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile Ife, believes that nutrition counselling should be an important component of health services, and when properly done, can help reduce the undesirable effects of ignorance and faulty practices.

While training and re-training of qualified healthcare staff so that they can effectively undertake health and nutrition education should receive priority, Ojofeitimi notes that the use of micro-nutrient supplements like vitamin A and zinc supplements, iodised salt, should be encouraged even as exclusive breast feeding should be promoted as it has been proven to have an impact on the nutrition and health of children and mothers.

“At present, there is no specific data that shows the prevalence of various nutritional in the country. Mapping various nutrition into different zones, gender, and age will help in allocating resources and manpower to pressing ones like infant and maternal mortality. Promotion of adequate infant and young child feeding practices should go beyond health information; it should be through practical demonstration in all health facilities.

“Most of the health programme on PHC have been on vertical line and some of them are ‘Top –down’ approach with very little local initiative and participation. This should be changed to ‘bottom-up’ approach with full participation of the community at the initiation of any health programme that will be executed in the community.

“Private sector involvement in the prevention of nutritional-related diseases in Nigeria is very limited. They should be involved at the community level at all cost,” he concludes.