Addressing Nigeria's Triple Burden of Malnutrition
Nigeria continues to face high rates of chronic childhood undernutrition, micronutrient deficiency, and overweight / obesity: otherwise known as the triple burden of malnutrition. The culprit? Poor dietary quality.
According to a recent policy research brief from the Feed the Future Innovation Lab’s Nigeria Agricultural Policy Project , 36.8 percent of Nigerian children under the age of five suffered from stunting in 2018. Micronutrient deficiencies, particularly anemia caused by iron deficiencies, remain widespread among young children and women; in fact, anemia rates rose significantly in urban areas between 2010 and 2018. At the same time, both overweight and obesity among Nigerian adults has also risen rapidly in both rural and urban areas, leading to increased non-communicable diseases like type-2 diabetes and cardiovascular disease.
Behind these grim figures lies poor diets, which the brief highlights as a “universal problem” throughout Nigeria. While availability of calories has risen hand-in-hand with economic growth and increased staple crop production since the 1980s, the average diet in Nigeria lacks overall diversity. Both urban and rural households of all income levels get too many of their calories from staple foods, like grains and starchy roots and tubers, and too few from fruits and vegetables, meat, fish, and dairy products, and pulses. A recommended healthy diet suggests that about one-third of a person’s daily caloric intake should come from staple foods. In Nigeria, urban households rely on staple foods for between 52 and 67 percent of their daily calories; these numbers are even higher for rural households, between 60 and 76 percent.
The brief also reports that where higher dietary diversity does exist, it appears to be driven mainly by increased consumption of fats and sugars, particularly those found in ultra-processed foods. This trend contributes to overweight and obesity – the third arm of the burden of malnutrition – and is a particular problem in urban areas. In fact, urban households on average consume three times the recommended amount of fats and sugars.
Agricultural seasonality appears to not play as large a role in dietary diversity as may be expected, according to the findings. Only around one-third of farm households’ diets comes from their own production, suggesting that rural food availability does not rely as much on household harvest cycles but rather on purchased foods. Patterns in urban areas showed similar findings, with no distinct seasonal variations in food group consumption.
These findings carry some important policy implications. Focusing efforts on increasing access to and consumption of high-quality, diverse diets will be more effective than simply addressing the physical outcomes of malnutrition (such as child stunting). While nutrition-specific interventions such as food fortification are important, they are not enough to improve dietary quality in the long term. In order to do so, policymakers will need to address the root causes of poor dietary quality, including poverty and food insecurity.
Nutrition-sensitive agriculture programs have shown promise in improving households’ dietary quality and diversity. Such policies include promotion of home vegetable gardens and small-scale livestock and aquaculture production. However, questions remain as to the scalability and long-term success of such interventions.
Of more potential promise, the brief suggests, are broader agricultural and trade policies. Agriculture provides the main source of income for rural households, particularly poor households, and accounted for around 36 percent of the country’s total employment in 2019. In addition, Nigeria imports significant quantities of wheat, rice, fish, and milk but bans imports of beef, pork, poultry, and eggs. The brief points out that agriculture- and trade-related policies, such as these import bans, as well as production incentives and subsidies for or taxes on production, can significantly impact incomes, food prices, and food availability. Policymakers and researchers will need to work together to determine the impact of such policies on dietary quality and diversity.
Finally, a food systems framework is needed to address Nigeria’s food and nutrition policies from both a policy and a research perspective. Such a framework would look not only at agricultural production but also at food trade and transport, food processing, and food services and retail. As Nigeria’s economy continues to grow, the off-farm food system, including food processing and retail, will account for more and more of the country’s GDP and will help to shape food access, availability, and preferences. Taking the broader perspective to ensure that food systems as a whole promote healthy, diverse diets is a key step in reducing Nigeria’s triple burden of malnutrition.