By DAVID ADENUGA
FUNDING of Ready-To-Use Therapeutic Food (RUTF) has continued to decline in Bauchi State eve seen as more children are left vulnerable to acute malnutrition that has ravaged the state before the intervention of the United Nations Children Emergency Fund (UNICEF). Between January and May alone, at least 10 children have died of acute malnutrition, and the Community-based Management of Acute Malnutrition (CMAM) centres set up by UNICEF were out of stock. DAVID ADENUGA, who visited several centres, including the Bauchi State Primary Health Care Development Agency (BSPHDA), reports
COMMUNITY-BASED Management of Acute Malnutrition (CMAM) centres in Bauchi State have been frequently out of Ready-to-Use Therapeutic Foods (RUTF) due to lack of funds. But many parents accuse the state government of misplaced priority because of the little importance it places on children’s lives.
In Bauchi, malnourished children are constantly at greater risk, especially now that the state government shows less commitment to CMAM.
Under CMAM, children who are six months to five years old suffering from acute malnutrition are given RUTF for about two months.
The pilot programme of CMAM was introduced in Nigeria in 2009 by United Nations Children Emergency Fund (UNICEF) in 12 northern states where the scourge has remained endemic.
The governments of the affected states are meant to support UNICEF intervention with counterpart funding.
But despite the huge budgetary allocation earmarked for RUTF by the Bauchi government, only a paltry amount is being released for its procurement.
A breakdown of the releases obtained from the Bauchi State Primary HealthCare Development Agency (BSPHDA) showed that only N20 million was released out of N400 million budgeted for RUTF in 2020.That is paltry five per cent of the expected funding.
According to UNICEF, only 890 cartons of RUTF were procured with N20 million by the state government, while 2,387 cartons were provided by the agency at the cost of N54 million.
In 2019, The UN agency procured 10,000 cartons of RUTF at the cost of N270 million but there was no counterpart funding from the government.
Furthermore, 15,000 cartons estimated at N375 million were provided by the agency in 2018 also with no counterpart funding from the government.
Yet CMAN is just one out of multiple interventions of the agency, which include Infant Young Child Breastfeeding (IYCF) and others.
Between 2018-2020, about 600,000 children have been treated for Severe Acute Malnutrition (SAM) by the agency in the state.
The Director, Planning and Research of BSPHDA, Ibrahim Sabo Jama’re, claimed that of N110 million allocated for RUTF in 2018, the government released only N5.8 million. And in 2019, of the N90 million allocated, it released N20 million. But the agency has not been transparent with its spending. For instance, the number of RUTF cartons it procured with the amount released were not made available to the public.
Visits by this reporter to five CMAM centres in the state showed non-availability of the therapeutic foods. The centres include Baima PHC in Warji LG, Miri PHC in Bauchi LG, Bununu in Tafawa -Balewa, Madara PHC in Katagum and Gamawa Township Maternity.
At the Miri Health Centre, a health worker, who spoke in confidence to The Nation, said the therapeutic foods have been out of stock for almost a month.
He blamed the state government for the shortfall saying: ”When we contacted the state Nutrition Officer, he said they have written a memo for approval for additional supply from UNICEF but up till now, we are yet to receive supplies.”
He added that the centre has resorted to teaching nursing mothers how to prepare the locally made RUTF popularly known as ‘tamowa,’ which is made of groundnut and other nutrition supplements.
A health care worker at the Bununu Primary Health Centre in Tafawa Balewa Local Government Area disclosed that RUTF has been out of stock for three weeks.
The official said about five children have died since 2020 at the Bununu Centre, adding that the situation is so bad that at times mothers come to queue at his house complaining of RUTF stockouts.
A similar case was recorded in Baima PHC in Warji, where another health care worker, who also spoke under the condition of anonymity said RUTF is already out of stock.
Gamawa C-MAN Centre in Town Maternity also suffers the same predicament. A worker complained that RUTF has been out of stock for almost four weeks, leaving them in a helpless situation. The source added that about three children died last year at the centre.
Consequences of RUTF underfunding by government
Hajara Salamatu (not real name), a mother of two, lost her precious child to acute malnutrition. Her son died after being diagnosed with diarrhoea. The diarrhoea was so severe that her child had lost so much weight before being taken to the Miri CMAM Centre, where it was discovered that he was malnourished.
She said all efforts to save him proved abortive even after she contacted government officials to intervene.
“’My son died in October last year after we rushed him to Miri centre which is where children from Bauchi Local Government access the commodity but unfortunately, it was not on ground. Children are dying because of the inability of the government to take responsibility,” she said.
Salamatu is one in the long list of mothers in the state who in recent times have lost their children to acute malnutrition due to the non-availability of therapeutic foods.
Data obtained from United Nations Children Funds, UNICEF, in Bauchi, showed that 17,315 children (1.3 per cent) suffer from Severe Acute Malnutrition (SAM) in the state.
Moderate Acute Malnutrition stands at 109,217 which (8.2 per cent) stunting falls at 607,352 (45.6%) while exclusive breastfeeding for one in five children is at 21 per cent.
Furthermore, UNICEF had predicted that about 300,000 children in the Northeast were likely to die of acute malnutrition in 2021. They are Bauchi, Adamawa, Gombe, Plateau and Taraba, some of which has been ravaged by insurgency over the years. The UN body also predicted that over 800,000 children in the region were likely to suffer from acute malnutrition in the course of the year.
Currently, an estimated 2.5 million Nigerian children under five have severe acute malnutrition. The country still has the highest burden of stunting in Africa and is still the second-highest in the world next to India.
The country’s current nationwide childhood under-nutrition indicator stands at 37 per cent stunting, 7 per cent wasting and 23 percent underweight, according to Nigeria Health and Demographic Survey (NDHS, 2018).
On a visit to Baima PHC in Warji, our reporter had a chance encounter with Aishatu Mustapha, a mother whose daughter, Miriam Gudu, died from acute malnutrition last year. Aishatu said her daughter was only 24 months when death dealt her a heavy blow.
The mother said having given birth to the child at the maternity ward of the PHC, her growth started deteriorating with severe wasting because she did not observe exclusive breastfeeding in the first six months.
When asked why she failed to observe exclusive breastfeeding, she said she underwent an operation during delivery that affected her.
“Up till now, I feel disturbed by her death but there is nothing I can do. I couldn’t get any assistance to save my daughter’s life,” she said.
Aside from Aishatu, Adama Garuba also has her own terrible story to tell. Narrating how she lost her daughter to acute malnutrition, she told The Nation that though she gave birth to twins only one of them survived. The female twin was said to have died when she was barely seven months old.
Speaking at the Madara PHC in Katagum Local Government Area, Adama said her twin daughter died at the time she started getting RUTF and it was not sufficient because it went out of stock.
Records also made available to this reporter by the Civil Society Legislative Advocacy Centre (CISLAC) showed that in 2019, about 94 children died from acute malnutrition. However, in the year 2020 the number drastically reduced to 15.
But the State Primary Health Care Centre disputed the figures, saying that the death rate is not as high compared to its records. It said it has only recorded 28 deaths so far in the last three years.
According to data made available by the state Deputy Nutrition officer, Abubakar Saleh, as of 2018, only 13 children died from acute malnutrition while 4,034 were cured.
He added that in 2019, only five deaths were recorded while 1,474 were cured, in 2020, six deaths were recorded with 261 cured while between January to May of 2021 10 deaths were already recorded.
The inadequacies of RUTF contributing to deaths among malnourished children is a clear violation of Article 24 (1) and (2) (b) and (c) of the United Nations Convention on the Rights of the Child (1989) .
The state government also violates Article 14 (1) of the African Charter on the Rights and Welfare of the Child both to which Nigeria is a signatory though the Child Right Acts is yet to be domesticated in Bauchi.
Article 24 (1) and (2) (b) and (c) of the United Nations Convention on the Rights of the Child (1989) states: “States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.”
In a phone interview with this reporter, the Co-Chairman of the Civil Society Scaling-Up Nutrition in Nigeria (CS-SUNN), Sodangi Chindo, said UNICEF has been the saving grace for the state government; otherwise things would have gone from bad to worse.
Suggesting solutions, he said: “It’s quite unfortunate that children are dying from malnutrition, but if the government can take up the Infant Young Child Breastfeeding program, (IYCF), that we are agitating for, and also nutrition corners in Primary Health care. You know we have 1MPHC per ward, if we can have a nutrition corner across the LGAs in 1 MPHC, we will be having 323 IYCF corners and that 323 will go a long way in sensitising women and Ii am telling you if there is proper education, we might not need RUTF.”
The Executive Director of the Civil Society Legislative Advocacy Centre (CISLAC), Auwal Musa Rafsanja, expressed concern over the “unwillingness” of the state government to release funds allocated for the procurement of RUTF) in the state for the treatment of SAM.
In a WhatsApp message, he said: “We noticed with great concern the unwillingness of the state government to release funds allocated for the procurement of Ready-To-Use- Therapeutic-Food (RUTF) in the state for the treatment of Severe Acute malnutrition.”
Rafsanja also expressed concern over the non-domestication of the Child Rights Acts (CRA) in Bauchi.
The nutrition officer in Katagum Rabi’u Haruna said one of the reasons why mothers do not engage in exclusive breastfeeding is due to the belief that only breast milk cannot satisfy the hunger of a baby hence the need for supplements.
Another reason, he said, is the rejection of colostrum by mothers because they believe it is contaminated milk.
“Some women don’t know breast milk contains all essential nutrients. If only they know breast milk is enough but instead they get rid of it because they believe the yellowish substance in it makes it contaminated milk but we are still enlightening them during CMAN and antenatal,” he said.
‘RUTF procurement is unsustainable’
The Chairman, BSPHDA, Dr. Rilwan Mohammed, said the procurement of RUTF was not sustainable.
According to him, the government is looking at preventive measures in tackling acute malnutrition rather than being reactive since it has not been able to meet up with its counterpart financial obligation to UNICEF.
One of the measures, he said, is providing mothers with weaning foods which they can give their children to augment breastfeeding.
”We only have 21 C-MAN centres in just 9 out of 20 local government areas. We are only managing because RUTF is too expensive. To get the money to buy it is another problem. It’s actually supplied by UNICEF but it has not been forthcoming because we have not been able to meet up with counterpart funding,” Mohammed said.
This investigation is supported by the John D. and Catherine T. MacArthur Foundation and the International Centre for Investigative Reporting.