Nourishing the future: How UNICEF is providing nutrition care in Sokoto State

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26-month old Sabira Sanusi eats a Ready to Use Therapeutic Food at Dantassako IDP Camp CMAM centre. Sabira is one of the many children receiving treatment for malnutrition from the UNICEF-operated centre in Sokoto State. Photo credit: Nigeria Health Watch

According to the 2018 National Nutrition and Health Survey, Sokoto State is one of the four states with the highest prevalence of malnutrition among children six to 59 months in the country. With a prevalence of 8.4%, only Zamfara (10.3%) Katsina (9.2%) and Jigawa (8.5) are worse off. Nigeria is currently battling child malnutrition amidst many other health challenges such as maternal mortality. According to UNICEF, about two million children in the country are suffering from severe acute malnutrition, with more than 80% without access to the needed treatment.

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Image credit: Nigeria Health Watch

Fourteen-month-old Khadija Sani plays around on her mother’s leg in a small, three room building in Dantassako Internally Displaced Persons (IDP) camp in Goronyo Local Government Area of Sokoto State. The building serves as a Community Management of Acute Malnutrition (CMAM) centre where children from the camp and surrounding villages who are malnourished are assessed and treated. It’s Khadija’s fifth visit and her mum cannot hide her joy in the progress her daughter has made. ‘’Six weeks ago, I never thought she would survive. She had high fever and diarrhoea and was thin,’’ said Sadiya Sani as she feeds Khadija with the Ready to Use Therapeutic Food (RUTF) in her hand. The CMAM centre is one of 15 operated by the United Nations Children Fund (UNICEF) in Sokoto State according to Ijanada Aliyu, the state nutrition supervisor for UNICEF. The Centre’s Officer-in-Charge, Surajo Umar, says not less than 40 children receive treatment from the centre every week.

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Image credit: Nigeria Health Watch

In a makeshift tent outside the building, several women sit with their children waiting to be called inside. They are either on a follow-up visit or coming for the first time to register their children. Volunteers work to organise the women into the two categories. One person after another, the women and their children are called into the first room of the building, where the weight and arm circumference of the children are measured. Here also, newcomers are given enrolment cards. ‘’We use the arm circumference to determine those that are really malnourished and together with the weight, evaluate the progress of those on treatment,’’ said Dr. Ikenna Isu, UNICEF’s senior LGA supervisor, who is on a supervisory visit to the centre. As each woman comes out of the room with her child, Ige Ahmad, an elderly volunteer, leads them to the handwashing station. Here, every woman washes her hands and those of her child with soap under running water while Ahmad provides guidance. ‘’For your children to be healthy, you must make sure that you always wash your hands before feeding them’’, a smiling Ahmad says repeatedly to almost every woman.

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Women and their children sit in a makeshift tent outside the centre before they are called in to take their childrens’ weight and arm circumference. Photo credit: Nigeria Health Watch

The women, in groups of two or three, sit on mats in front of the second room. Volunteers go round to distribute a sachet of RUTF and watch as they feed their children in what is known as “appetite test”. The essence of the test is to understand a child’s appetite strength and willingness to eat. It is particularly important for children who are coming to the centre for the first time. For children who are already on treatment, it is more of a routine to make them relaxed. Rejection or inability of a child to eat the RUTF suggests the possibility of other complications aside malnutrition. In such cases, the child will be referred to one of UNICEF’s stabilisation centres for further assessment and treatment according to Umar.
In the second room, a staff of the centre takes history of new children and assesses the progress of those already on RUTF using readings taken and recorded on each child’s card in the first room. Here, new complaints by mothers such as diarrhoea and fever are noted, and treatment provided before they are sent to the third and final room, where individual counselling takes place and new RUTF sachets are given to the women.

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Before giving their children RUTF, every woman washes her hand and those of her child with soap and running water at the handwashing station in the CMAM centre. Photo credit: Nigeria Health Watch

“Please explain to me what you were taught last week?” Sandra Ishaku, a volunteer who also carries out one-on-one counselling, asks Sani. Ishaku sits at a table with a register of children and a flipchart of local foods in front of her. She explains that every day before screening starts the staff and volunteers at the centre carry out nutrition talks with the women, where basic hygiene and cooking nutritious meals from locally available foods are taught. “We were taught how to keep our environment clean and how to make sure that our children are also clean by regularly bathing them and washing their hands especially before they eat”, Sani narrates to Ishaku. She further explained how different kinds of food which are usually locally available could be used to prepare nutritious meals, using images of foods such as beans, groundnut and moringa on the flipchart as a guide. After some commendation and further counselling from Ishaku, who emphasised that Khadija has made remarkable progress, she issued RUTF that would last a week to Sani. ‘’See you next week,’’ she says with a smile. According to Ishaku, Khadija weighed 4.7kg with Mid Upper Arm Circumference (MUAC) reading of 10.0cm which is 80% of the ideal MUAC reading when she was first brought to the centre. She now weighs 5.8kg and her MUAC measures 11.3cm, about 90% of the ideal reading. “Once she achieves two consecutive MUAC readings of 12.5cm and above which is the ideal for children six to 59months old, we will discharge her,’’ she added.

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Khadija Sani has made remarkable progress since her first visit five weeks ago, according to Sandra Ishaku, a volunteer at the centre. Photo credit: Nigeria Health Watch

Providing nutrition care to displaced persons
The Dantassako IDP camp CMAM centre was established in October 2019 as part of UNICEF’s child nutrition program in Sokoto State. The centre caters for malnourished children who together with their parents have made the IDP camp their home due either to flooding of their respected communities or have been displaced by incessant bandit attacks on their villages. Malnourished children from villages in Goroyon LGA and beyond also receive care from the centre. Among them are two-year-old Musa Ibrahim and his 10-month-old sister, Rakiya Ibrahim, from Kagara village. It’s their first visit to the centre and both Musa and Rakiya, after necessary measurements have been classified as being malnourished by health workers at the centre. According to their mother Amina Ibrahim, Musa was just five months old when she got pregnant with Rakiya, resulting in Musa not being able to be breastfed well. “Both of them have being falling ill intermittently’’ said Ibrahim, adding that she was referred to the centre by a neighbour whose child was also treatment for malnutrition there. After passing the appetite test, Musa and Rakiya are now enrolled to be treated for malnutrition at the centre and will be brought in every week for assessment and RUTF.

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Musa and Rakiya take the appetite test after been classified as malnourished. The test is carried out using RUTF to ascertain a child’s appetite strength and willingness to eat in order to rule out other underlying conditions. Photo credit: Nigeria Health Watch

Can child spacing advocacy help reduce malnutrition?
Musa and Rakiya’s cases highlight why child malnutrition is a condition that could be prevented with better knowledge about child spacing by parents. Had Ibrahim and her husband practiced child spacing through contraceptive use, Musa would have been breastfed enough before Rakiya arrived, and both children would have had better nutritional and health outcomes. This highlights the importance of improved and continuous awareness in communities on the benefits of child spacing by government and advocacy organisations. Availability of family planning commodities at health facilities should be ensured to complement the advocacy. Besides having sessions on basic hygiene and nutritious meals, UNICEF could also include sessions on improving overall child health, such as child spacing. In doing this, they should target both women and their husbands, as the latter are the decision-makers in most homes. The centres could also improve their work by organising nutrition awareness sessions for men either with the women or separately. Instilling the knowledge of adequate nutrition will surely yield better results if both parents attend as men traditionally hold more economic power than women in most households in Nigeria, and particularly in Northern Nigeria.

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Image credit: Nigeria Health Watch

Furthermore, adequate nutrition treatment centres like the ones run by UNICEF should be established by states with high numbers of malnourished children, including Sokoto State. This will complement the efforts of organisations like UNICEF in treating the children and reach mothers with the right knowledge on nutrition. This should be followed by implementation of the existing policies that will prevent children from becoming malnourished in the first place. The country’s 2014–2019 National Nutrition Action Plan has explicitly outlined steps to reduce the burden of child malnutrition in Nigeria. These include ensuring maternal nutrition, as malnutrition in mothers could transcend to their children, control of micronutrient deficiency, community management of acute malnutrition among others.
The timeframe of the Plan has elapsed, but the policies in the action plan should continue to be implemented to ensure that children like Khadija, Musa and Rakiya have a good start in their lives. They should not be left to suffer from the debilitating scourge of malnutrition which could stifle their physical, emotional and cognitive growth.

What measures are your state putting in place to tackle malnutrition? Please let us know in the comment section below, or on our social media platforms, @nighealthwatch on Twitter or @nigeriahealthwatch on Facebook and Instagram.

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We use informed advocacy and communication to influence health policy and seek better health and access to healthcare in Nigeria. nigeriahealthwatch.com

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