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How micronutrient deficiency ruins Nigerian children

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… Several defects could be avoided through antenatal care, exclusive breastfeeding, experts say

• Vivian and her baby
• Vivian and her baby

When 29 year old Vivian brought Andy, her 16-month-old boy to Medway hospital Obalende few weeks back, he appeared very thin and pale as a withered grass. His body size looked like that of a 5- month-old. His head appeared larger than his body, with sparse hair and dry skin.
According to Vivian, nothing was wrong with Andy, “I breastfed him for one year, after 6 months, I started giving him other foods. I give him all the food we eat; fufu, eba, rice, still he is just getting lean. At his age, he couldn’t talk properly and he can’t walk. He will just be gazing at you or be crying”, she said.
After series of tests, Andy’s condition was traced to micro cystic anaemia, caused by vitamin B12 and iron deficiency. According to the Medical Director Medway hospital, Dr. Tuyi Mebawon, Andy’s mum who is HIV positive, had anaemia and Vitamin B12 deficiency while she was pregnant. This caused the child’s deficiency despite him being breastfed exclusively. B12 deficiency can cause developmental delay in toddlers, hypotonia, tremor, seizures, failure to thrive, reduced IQ, and mental retardation, he explained.
The doctors then placed him on treatment consisting of B vitamins, iron supplement and other nutritional support. Few weeks later, Andy became fully recovered, his weight tremendously improved and he is now attempting to speak.
Another similar incident occurred at the outpatient Paediatric ward, LUTH Lagos. 34 year old single mother Rita has just been told that her 28-day old baby boy has to be operated immediately because he has spinal cord defect that will cause serious development issue in future. The spinal bifida was accompanied by hydrocephalus, another condition resulting in excessive accumulation of fluid in the brain. This problem was traced to the mother’s inability to take enough folic acid and vitamins while pregnant.
According to Rita, few days ago, her baby had developed a seizure and very high temperature while at home. She immediately took him to a maternity home, ‘Saint Mary’s maternity home Agege’ where she was referred to LUTH for further check-up. At LUTH, series of tests were done before the doctor finally gave her the report showing that the baby had spinal bifida with hydrocephalus and required immediate surgery and shunt.
“Over my dead body!” Rita, shocked at the report, retorted. “But how can my son have such a disease when it is not in my family? My enemies have done their worse”.
One of the attending nurses who overheard her immediately lashed back at her, accusing her of being responsible for her son’s predicament.
“Why are you calling your enemies now? Are you not the one responsible for your son’s problem?” the nurse said. The bewildered Rita did not understand how she could be responsible for her son’s sickness.
“Me? Responsible for my son’s sickness? How?” she asked.
The nurse replied: “Did you take all your folic acid and vitamins when you were pregnant? Were you not given some folic acid during your antenatal?”
Rita, still puzzled, quickly responded: “I don’t know if I was given folic acid o! But I know I took all the drugs they gave me, I did not cause my son’s sickness!”
Nurse: “you people will always lie. Even when you did not take your drugs you will say you did. You better go and look for money for the operation otherwise your son’s head will grow bigger and bigger and his problem will be worse”
Rita took her baby and walked out of the hospital premises in tears. When National Mirror correspondent accosted her, she insisted she took all the drugs given to her. “I have to go and meet my pastor. My enemies have done something to my baby. How can my little baby have such disease when it is not in my family?” she said.
According to the analysis by a senior paediatrician at LUTH, Dr. Moyin Omidiji, the risk of having a baby with spina bifida, hydrocephalus or other neural tube defect is normally avoided if the mother had taken enough folic acid right from the first month of conception.
“The spine and neural tube of a foetus develops during the first few months of pregnancy so if the mother is deficient in folic acid at that time, something might go wrong resulting in these defects. While a mother may claim she took her folic acid, it depends on how early she started taking them. Folic acid is needed for the development of the baby’s brain. That is why it is good for pregnant women to start antenatal very early so their Pact Cell Volume (PCV) or blood level will be checked. If her blood level is low, that is an indication that she has anaemia and folic acid deficiency”, he said.
Micro nutrients such as folic acids, B-vitamins and Iron are very important for infants from conception to age 2 because this is the period the infant’s brain develops, the National President, Paediatric Association of Nigeria, Prof. Adebiyi Olowu, said.
“Adequate nutrition during this period will enable a child have improved brain and physical development, proper immune system to fight off infections and disease, and sharper mental abilities.”
Micronutrient deficiency is a silent hunger and the major cause of malnutrition among children in Nigeria, explained Head Nutrition Federal ministry of health (FMOH), Dr. Chris Isokpunwu.
“These micronutrients are vitamins and minerals such as vitamin A, Iron, Folic Acid, Iodine and Zinc, most of which are not made in the body, or made only in insufficient amounts. They are required in small quantities to ensure normal metabolism, growth and physical well being”, he said.
Of these, he described iron deficiency as most prominent, with over two billion people being anaemic globally. He said the reason for micronutrient malnourishment is intake of monotonous diets high in starch and sugar and low in vitamins and minerals.
Other reasons, according to him, include low intake of animal source foods, low prevalence of breastfeeding, low micronutrient density of complementary foods, pregnancy and lactation, chronic infection (e.g. tuberculosis, malaria and HIV/AIDS).
Many children in Nigeria may not look sick or thin yet, they are suffering from one or more micronutrient deficiency, explained a UNICEF nutrition expert, Arjan De Wagt, during a workshop on malnutrition held in Calabar recently. According to him, vitamin and mineral deficiency account for over 50 million disability adjustment years.
“Iodine deficiency leads to poor growth, stunting, mental retardation, and cretinism. Malnutrition in Nigeria is not exactly as a result of lack of food lack of proper diet. Even the rich are affected because they too do not know the right thing to feed their children. Many of them do not know that exclusive breastfeeding in the first six months will prevent illnesses”, he said.
Dr. Isokpunwu however said that interventions such as fortification (increasing the content of essential micronutrients-vitamins and minerals) of staple and complimentary foods, is one way to prevent micro nutrient deficiency. He said that the effects of malnourishment such as stunting, underweight and wasting could be corrected over time with food fortification.
“For instance, vitamin A fortified food, will decrease all causes of mortality in children aged between 6 months and 5 years by 23 percent,” he said

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