Child Malnutrition in Nigeria

In recent years, a combination of increased food prices, slowing agricultural growth, and a rapidly rising population have put pressure on Nigeria’s domestic food security. According to IFPRI’s Nigeria Strategy Support Program (NSSP), the average share of income spent on food within the country rose from 45 percent in 2007 to 80 percent in 2008 as a result of the global spike in food prices.

These challenges pose a particular threat to children. A new NSSP project paper states that in 2013, a study conducted by the Nigeria Demographic Health Survey (NDHS) found that more than two out of every five children in Nigeria were stunted due to chronic malnutrition; the rate of stunting was higher in rural areas (45 percent of children compared to 31 percent in urban areas).

According to the NSSP paper, poverty and a lack of awareness of proper nutrition and child feeding practices appear to be at the root of child malnutrition in Nigeria. Using a sample from rural Kwara State in the North Central geopolitical zone, the paper looks at the nutrition status, food consumption patterns, determinants of malnutrition, dietary diversity, and knowledge of micronutrients and biofortification among rural populations.

Kwara State is one of the ten poorest states in Nigeria; over 70 percent of the population lives on less than US$1 per day. In addition, 19.1 percent of children were stunted and 12.1 percent of children were underweight in 2007. Agricultural production is mainly conducted by smallholder farmers with limited farm mechanization, inputs, or technology. The main crops grow in the region include cassava, cowpeas, groundnut, melon, maize, okra, pepper, rice, sorghum, yam, and some leafy vegetables.

The state is located midway between the cereal-based food systems of northern Nigeria and the root-based food systems of the southern and western parts of the country and thus is characterized by a variety of dietary practices. According to research cited in the paper, the most commonly consumed foods in the region are yams, rice, and maize; cowpeas, meat, and fish are consumed in smaller quantities, suggesting that starches and cereals play a larger role in households’ diets than proteins. The study also finds that 65.5 percent of the rural population in Kwara State is food-insecure. A 2011 study found that the prevalence of child stunting, underweight, and wasting was 23.6 percent, 22 percent, and 14.2 percent, respectively; these figures are comparable with Nigeria’s national averages.

Of the 414 households sampled by the study, almost 60 percent were farming households; most households own livestock for sale and for household use. Farm assets are generally limited to basic tools, as agricultural mechanization in the state (and in rural Nigeria in general) is low. In terms of sanitation, only eight households have running water in their homes, but most households have access to other sources of water, such as public taps or protected wells. However, toilet and refuse disposal facilities are inadequate in the state, with 84 percent of households using poor facilities.

Twenty-three percent of the children surveyed have low dietary diversity. Only 24.8 percent of infants are exclusively breastfeed from birth through six months, and only 4.8 percent of children are breastfeed to 24 months. The reasons given for not breastfeeding ranged from health (for example, some women did not produce enough milk) to culture (for example, some ethnic groups in the region traditionally do not breastfeed). The most food most commonly given to young children to supplement breast milk is pap, a corn-based gruel; very few children under the age of five consume eggs, milk, or fruits.

The study found a widespread lack of understanding regarding the nutritional benefits of many food items, particularly regarding the role of micronutrients in overall health and disease prevention. In addition, less than 20 percent of the study households were familiar with the concept of fortified foods, despite a 2002 law requiring the fortification of certain staple foods (such as flour, salt, and vegetable oils). New federal nutrition initiatives have focused on providing micronutrient-fortified powders; however, 97 percent of the households surveyed in Kwara State were not aware of these powders. In addition, only 23 households out of 414 consumed powdered Moringa, a highly nutritious plant native to the area that can be used as a proxy for these micronutrient powders.

In addition to a lack of awareness of these available products, many study households do not have easy access to fortified food items, as there are no supermarkets in any of the surveyed villages. Local markets were found to have several brands of fortified foods, but these markets only operate on designated days.

The study did find that the biofortification of crops is gaining ground with farmers in Kwara State, particularly biofortified cassava. Farmers who have adopted this new cassava variety have been enthusiastic about expanding acreage and passing the variety on to neighboring farms. Their main concern regarding biofortified crops remains market acceptance.

Overall, the study finds that a range of socioeconomic, demographic, and public health factors contribute to child malnutrition in Kwara State, and in rural Nigeria in general. The authors suggest that there is an urgent need for more frequent, comprehensive surveys of national food consumption and nutrition in order to truly gauge populations’ consumption and understanding of important micronutrients; these surveys should include cultural groupings to determine how interventions can be targeted to different ethnic groups to address traditional practices. The government also needs to increase its efforts to educate people, particularly poor and remote populations, about proper child feeding practices and fortified food products; this will include better advertising, labeling, and packaging of fortified foods so that poorly educated households can recognize them and make more informed nutrition choices.

By: Sara Gustafson, IFPRI

Photo credit:Albert González Farran, UNAMID