Recently, a survey on Protein-Energy Malnutrition (PEM) was conducted by yours truly across all the tertiary health institutions within the North-Western states of Nigeria – Kaduna, Kano, Katsina, Jigawa, Zamfara, Sokoto, and Kebbi – and which will be made available on this platform soon. While the results represent only certain section of the region (dominant and most populous), it gives a broader picture of the entire Northern Nigeria on the issue of PEM. Protein-Energy Malnutrition is one of the most worrying public health problems in many developing countries, Nigeria inclusive. It’s a wide spread deficiency disease among children of low socio economic class. In Nigeria, nearly one-third (1/3) of the children under the age of five barely survives that age bracket as a result of PEM, of those that did, only a fraction does so without impaired growth and, perhaps, mental retardation.
The extreme forms of PEM are diseases known as Kwashiokor and Marasmus. According to Cicelly Williams, Kwashiokor represents the sickness which a child develops when the next baby is born and the elder one gets deprived of breast milk. It represents the imbalance between protein and carbohydrate. Marasmus on the other hand, is a Greek word that means “waste”. Generally, not only children deprived breast milk are likely target of PEM, anyone deprived of rich foods consistently becomes predisposed. Though PEM is a characteristic of children under five, no particular age group is immune to its attack. In adults for instance, PEM manifests in the form of weight loss, anemia, reduced subcutaneous fat, general lethargy, inability to cope with demanding activities, delay in wound healing and edema. In its acute manifestation, PEM occurs due to the mother’s inability to transmit nutrients to the fetus and her shortfall in lactating, subsequently. Severity of PEM can be attributed to the proportionality of growth failure. Mathematically, it’s expressed as follows: weight loss per age/weight of normal children. To have grade 1 PEM, the weight loss must be between 11% – 25%. For grade 2 PEM, it’s between 26% – 40%, while grade 3 consists of any weight loss above 40%.
Though causes of PEM varies with environment and orientation, there are standard criteria for assessing what usually prompts its outbreak. Generally, Nigeria’s food are known to be of low nutritive richness. Traditionally (Particularly in Northern Nigeria), children’s foods are characterized by low protein, low energy density, and high bulk. Pap from maize (koko) is believed to be of no nutritive importance. It’s widely established that cereal-based diets have lower nutritive value than animal based ones. The cereals that constitute the bulk of Northern Nigeria’s children’s foods pre and post weaning are maize and guinea corn; unfortunately, the protein content of these foods is very poor. Lysine and tryptophan are indispensable to the growth of young children – two amino acids that are essentially absent in maize and guinea corn. Traditional northern Nigeria’s weaning foods as well as feeding practices predispose the Northern Nigerian child to the attack of Malnutrition, growth retardation, infection and high mortality. Complementing breast milk with cereal meals that are very low in protein and energy density do not in any way help the child growth rate.
One basic predisposing factor to PEM is knowledge deficit. Going by the literacy level of northern Nigeria (very low), one would had expected nothing different to what is being practiced. Additionally, the traditional rural practice of most Northern states – premature termination of females’ education is a great hindrance. Besides, many of such women always end up becoming housewives in a more obsolete manner at the expense of their illustrious education.
However, in some relatively established and literate societies, the issue is much better, though not satisfactory. Knowledge is the key component life wheels upon. From health to humanity. Lifestyle to decision making, religion to socialization. When you’ve deficit of anything knowledge, you become vulnerable to every exploitation and resistant to new meaningful ideas. Such is the complication of knowledge deficit that had penetrated the broad boundaries of Northern Nigeria. Women, children, men, adults, Muslims, Christians, traditional worshippers are all victims of knowledge deficit horrors.
Institutionalized traditional settings of Northern Nigeria do not help matters. Placing utmost priority on the male education above that of the female is something I’m yet to fathom. There are also the groups that still view Western education as a taboo and or not necessary. Regrettably, such groups are either ignorant of their faiths or mischievous tools that are against societal betterment via political foul play. Lack of purchasing power of women is another factor. There’s hardly any society that survives without empowering its women. Such is the importance of women education that societal success, in part, depends on it.
A larger percentage of Northern Nigeria’s women are mostly full time house wives and belongs to the low socio-economic class. Making it much difficult for them to afford foods that are highly nutritious for themselves and their children (because the husbands mostly doesn’t care). Even those that can afford, negligence and lack of nutritional information, atimes, lead them into feeding themselves with less nutrients rich foods.
Access to clean drinking water is a major contributing factor to malnutrition. In a region with abundance of water sources and lacking in safe domestic water, it will be safe to say, either the government fails in its responsibility of providing basic human needs or individuals deem it not necessary to learn how to provide safe domestic water locally (could be both, anyway). Whichever angle one decides to look at it from, fact is, lack of safe water (drinking and other purposes) is hampering individuals’ growth and general health status. In a body that comprises 70% water, not having a safe one for children will seriously affect their immunity, making them susceptible to various kinds of microorganisms attacks. One life lost is a life too many.
There’s also the issue of non accessibility to health care facilities especially in the rural areas where malnourished children (and even adults) are evidently visible. In many instances it usually starts from certain disease conditions, and because health care aren’t accessible (even where they’re, human resources – skilled and committed workers – are highly deficient), couple with lack of foods rich in nutrients, people’s immunity are brought to the lowest rank. Many doesn’t usually recover from such shattering situations and mostly end up losing their lives. For those that are lucky to remain alive, they hardly return to their normal physique, mental alertness, and normal growth rate unless where timely and appropriate interventions are provided. In most cases, children are taken to tertiary health facilities at the terminal end of the condition hoping for miracle where none exists.
To bring an end to this menace, collective efforts must be employed. Everyone has a role to play. From the government, community, individuals and NGOs. First, I think, the purchasing power of women must be addressed deeply. Women must be empowered technically, technologically, business wise and, above all, educationally. Many women end up in homes where their husbands hardly give any priority to the kind of foods they and their children eat nor the nutritive value. But when you’ve a woman that is literate in many fronts and financially stable, she’ll needs no one to tell her what she wants for the child and how best to gets it. Any small scale business is a good starting point for ambitious women.
Breastfeeding promotions through campaigns and awareness creation are essential elements in ensuring overall participation and compliance. There are lot of women who see breastfeeding as punishment rather than being fancy. While it may not be fancy, the overall health nature of your child may largely depends on it. Breastfeeding guide is an important concept that requires strict adherence. From the type of exclusive breastfeeding (EBF) one intends to do, child positioning during feeding, identifying breast and nipples problems, to when and how to wean/terminate the breast feeding all contribute in determining the success of a breastfeeding session. It’s highly recommendable to incorporate these guides into the antenatal schedules and to discuss them immediately after every successful delivery.
The need to create public awareness on what PEM is and its grave dangers amongst the populace cannot be hushed up. It’s quite unfortunate that many among the populace aren’t aware of what PEM is as well as its complications. Creating awareness will go a long way in curtailing this intimidating condition. Health policies are as good as dead in this part of the world. Government must wake up to its responsibility of ensuring adequate and equitable health provisions for all. Clean drinking water must be made available to everyone. There’s the need for NGOs and other community groups to educate the people on local ways of purifying water. The sources are there, local purification processes should be encouraged, especially in rural areas.
The need to teach women how to prepare local nutritive foods is enormous. Ground nut, beans crayfish, palm oil, milk, soya beans, fish, egg are all local foods that can be used to prepare highly nutritious delicacies for children and adults alike. Even the cereal meals can be made nutritious by combining with protein rich foods like the ones mentioned above. Government and other organizations can help in providing subsidized packaged foods rich in nutrients for local consumption especially at hospitals.
Environmental sanitation is a key element in enhancing immunity which inturn fights malnutrition attacks. At individual and community levels, we all should ensure adequate cleanliness and that of our neighborhoods. On a final note, education is one tool necessary for achieving lot. Women education, at least secondary level, should be encouraged in all societies. Abrupt termination of women education for early marriage should be discouraged in totality. And where the marriage becomes necessary, it shouldn’t, in anyway, results to termination of education as both can be achieved successfully as proved in many instances. That will give women the liberty to plan their homes structurally and raise their children educationally through perfect, aside natural tendencies, health status.