Every country in the world is affected by one or more forms of malnutrition, making it one of the greatest global health challenge.
In Cross River, the scourge of malnutrition is no news, especially in Edim Otop, in Calabar South and many other areas in the state, where children are seen with tiny legs, protruded stomachs and pale looking hairs and eyes.
These children may not be considered severely malnourished, but merely looking at them, it is clear that something needs to be done to help them regain the appropriate weight, height and nutrients they require.
On a visit to one of the Primary Healthcare Centres (PHC) in Calabar, many of the women and children that came to access healthcare were simply malnourished.
Malnutrition is an unhealthy condition caused by not eating enough food or healthy food and which results to stunting, underweight, overweight/obesity and the exposure to many diseases such as kwashiorkor, marasmus and so on.
An attendant who preferred to be anonymous, said they attend to different kinds of people every day, mostly women and children and most of their challenges are connected to poor or inadequate feeding.
"We attend to women and children every day and when you look at them, you just know that they are not feeding well and are deficient of some important nutrients and vitamins."
"It is more painful when I see malnourished pregnant women because they are easily exposed to other conditions not good for them.
"The least we do is educate them on the right foods to eat and distribute available supplements, such as folic acid, ferrous sulphate and vitamin B complex," she said.
In 2021, the Government of Cross River introduced the Active Search Strategy which was the use of a large network of community tracers and health workers in rescuing and treating malnourished children in the state.
The search helped in the discovery of over 234 severely malnourished children living in remote parts of the state as well as the capital.
The then Commissioner for Health, Dr Betta Edu said Gov. Ben Ayade had directed that victims of malnutrition in the state be given urgent medical attention free and their families supported to sustain care
She added that severe malnutrition among children in the state was a serious issue aggravated by ignorance, cultural beliefs, poor government policies and the poor economy of the state and nation.
While this initiative could be considered laudable, the big questions are: how sustainable was it? What is the state government doing about the root causes of malnutrition rather than being reactive?
Mrs Vickie Emah-Emah, Founder, Neighborhood Care Well Foundation,
one of the NGOs fighting malnutrition among children said many families in the state are not able to feed well.
Emah-Emah said that there was high level of food insecurity due to the poor economy of the state.
According to her, there is also the problem of many hard to reach areas in the state, especially the creeks where the people survived mostly on what they have locally but are deficient in other nutrients
"Looking at the access and availability of food, good nutrition is difficult; I have seen sickly and wasted children die during our field works as a result of malnutrition and exposure to disease and mosquito infested environments.
"The result is that they get infected by malaria parasite and other health conditions and because they already have weak immune systems, they die even before healthcare services get to them.
"What my foundation does is to ensure that no matter the project we embark upon to support children, there is always a nutrition component.
"We have also assisted over 3,000 women who are among the most vulnerable groups, with income generating activities and grants for start-ups to enable them help their households.
"However, one of the major challenges is poor data. For instance, if Cross River had done a nutrition needs assessment, we will have credible data to work with, but without data, you can't do much," she asserted.
According to the National Nutrition and Health Survey (NNHS) 2018, each year, about one million Nigerian children die before their fifth birthday and malnutrition contributes to nearly half of these deaths.
The survey also shows that although acute malnutrition levels are below the critical levels in Nigeria with Global Acute Malnutrition (GAM) rate of 7.2 per cent, the case loads are high given the population of the country and challenges of insecurity in some parts, including food deficit.
Although, these nutritional surveys provide relevant information about states like Cross River, it is mainly periodic and does not give information on the levels and causes of under five year old malnutrition, especially in the rural areas.
It should, however, be noted that the Federal Government in 2016 introduced a strategy called the Agriculture Sector Food and Nutrition Strategy 2016 to 2025, with the aim of reducing malnutrition in the nation.
The strategy has eight thematic concerns which include improving food security at the national, community and household levels: To significantly reduce under-nutrition, including micro nutrients deficiency disorders among infants, children, adolescents and women of reproductive age.
It also aims to increase the knowledge of nutrition among the populace and integrate nutrition education into agricultural formal and informal trainings, among others.
Mr Julius Adanlawo, an officer in the Nutrition Unit of the Federal Ministry of Agriculture and Rural Development (FMARD), said one of the offshoots of the strategy was the ongoing World Bank assisted Accelerated Nutrition Result in Nigeria, (ANRIN) currently operating in Gombe.
He said with the programme, the Federal Government was looking at using a food based approach to fight malnutrition by providing inputs like bundles of orange, fleshed sweet potato rich in vitamin, among others.
"However, funding has been quite a challenge because the budgets are meagre and the release of the funds is another issue, so we cannot be in all the states at the same time," he said.
Although this 10-year strategy is nearing its expiry period, having gone an 8-year distance so far, Nigerians are really yet to feel its impact as it is practically unknown to many in the country.
Dr Chijioke Osuji, an agro-industry and value chain expert maintained that from the agriculture production point of view, "bio- fortification is possible and being done in some agricultural commodities."
Osuji, however, said that it was in processing that a lot of fortifications and value addition could be done, explaining that the " yellow cassava rich in vitamin A can be blended with the white one that is rich in starch."
According to Osuji, there could also be the addition of different premixes to enhance the micro nutrients of commodities.
"In Nigeria, there is a mandatory inclusion of vitamin A in maize and wheat flour, sugar and in vegetable oil. There is also the mandatory inclusion of iodine to salt for fighting goitre.
"We have many companies in Nigeria carrying out voluntary fortification to enhance consumer's wellbeing and wholesomeness of the food. This is something our government needs to continue to pursue.
"We also need to educate our women who have children especially those who are to be weaned, on complementary foods with protein rich components such as soya beans.
"For many years in Nigeria, soya beans flour has been popular especially among women because it is known to have some good level of health benefits, apart from its high protein content.
"Some people add crayfish and other types of fortifications to their food, but we need to pay more attention to feeding of children," he noted.
Osuji said serving children "eba" and soup in the name of school feeding programme is not an optimised advantage because the child eats "eba" and soup at home.
He advised that in schools, the government should go the extra mile of ensuring that enriched foods that are fortified and made easy to consume and not cumbersome like "eba" and soup or "jollof" rice should be served.
He maintained that the food could be turned to convenient snacks that is very rich, so that it will deliver good nutrient and help reduce malnutrition among children.
"The truth is this, when you have many children malnourished and stunted, it means they will never reach optimum performance in their chosen career because their brain development had been hindered due to poor nutrition.
"It is not a coincident that the most well fed nations are the ones that produce the most Nobel Prize Winners, Olympic gold medalists and inventions, this is because they have higher brain capacity collectively than others.
"We have been discussing nutrition for a long time now, it is time for the Nigerian Nutrition Policy to be reviewed more regularly and its essential components looked into.
"Components like agricultural production, post harvest losses and value addition to allow the researches we have been carrying out for the development of food to come to fruition" he contended.
There are research works that have made efforts to identify and proffer solutions to this silent child killer, government at all levels should pool resources in order to halt the advance of this condition. We need good nutrition as the first line of defence against the impact of diseases.