Another government policy deprives 60% of Nigerian children under the age of five lifesaving Vitamin A supplements, leaving them prone to blindness and other illnesses.

By Chikezie Omeje

In March when Moses Jato’s daughter turned six-month-old, he took her along with his wife to the Federal Staff Hospital, Abuja, where she was born, to receive Vitamin A supplement.

That same day, Jato’s wife completed six-month exclusive breastfeeding of the daughter. Being their first child, they had ensured that the baby received all the vaccines listed in the immunisation card given to them by the hospital.

The hospital did not have Vitamin A and the family was told that it might be available by April or May.

Jato and his wife were disappointed. They needed to give their daughter the Vitamin A supplement to boost her immunity against childhood killer diseases such as measles, diarrhoea, among others. Jato’s daughter had just been introduced to complementary feeding.

Reaching six-month without any illness was an important development milestone for his daughter and Jato was ever willing to do whatever it took to give his daughter this essential child-survival intervention.

From Federal Staff Hospital, he drove his family to Area 2 Family Clinic which is reputable for always having all the government-approved vaccines.

Unfortunately, the Area 2 Family Clinic also did not have Vitamin A supplements.  Jato then visited several other health facilities and pharmacy stores in Abuja in search of Vitamin A to give his daughter.

After almost a month of fruitless search for the supplements, when his daughter developed cough and catarrh, Jato was apprehensive.

“Maybe if my daughter had taken the Vitamin A, she wouldn’t have had a cough,” Jato, a civil servant, told www.icirnigeria.org last week.  “Her immunity would have been strong enough to resist a cough”.

Jato’s plight is typical of the experience of many parents. And it may explain why out of an estimated 7.4 million babies born annually in Nigerian, a significant proportion of them do not survive to celebrate their fifth birthday.

According to the Ministry of Health, World Health Organisation, WHO, and the United Nations Children’s Fund, UNICEF, 2,300 Nigerian children under the age of five years die every day to causes that are largely preventable.

Eunice Nzekwe, a nursing mother is going through similar trauma over her son. Her child is yet to receive vitamin A supplements almost nine months after birth.

Nzekwe who had her son in a private clinic in Abuja said the hospital had kept telling her that Vitamin A supplements are out of stock.

Under the Revised Expanded Programme on Immunisation, a baby is supposed to receive the first Vitamin A dosage at six-month of age and subsequently gets it at an interval of six months until the age of five.

Vitamin A is an essential micronutrient for child development, which prevents certain childhood illnesses.

According to the World Health Organisation, WHO, Vitamin A deficiency is the leading cause of preventable blindness in children and increases the risk of disease and death from severe infections.

Vitamin A deficient children are more vulnerable to infection and have reduced immunity to fight common childhood diseases, such as measles, diarrhoea and acute respiratory infections.

It is estimated by the WHO that increasing vitamin A intake can decrease childhood mortality from these illnesses by 23 per cent, or nearly a quarter of childhood deaths

WHO classifies Vitamin A deficiency as a public health problem and also listed Nigeria as one of the countries with a high burden of Vitamin A deficiency.

According to the world body, an estimated 190 million children globally under the age of five are affected by vitamin A deficiency. It estimates that 250,000 to 500,000 vitamin A deficient children become blind every year, half of them dying within 12 months of losing their sight.

WHO also estimates that In Africa, Vitamin A deficiency alone is responsible for almost 6 per cent of child deaths under the age of five years.

Vitamin A deficiency is prevalent in Africa and Asia. UNICEF notes that in 2013, sub-Saharan Africa had the highest rates of 48 per cent and South Asia with 44 per cent.

Being a high-risk country for Vitamin A deficiency, Nigeria adopted the global recommendation of giving Vitamin A supplements to children under the age of five, starting when a baby turns six-month-old. Although children can receive Vitamin A from foods and fortified foods, supplements have proven to be an effective intervention.

WHO notes that the impact of single supplementation on childhood mortality is as great if not greater than that of any one vaccine – and it costs only a cent a dose.

Despite the relatively cheap price of Vitamin A, this essential micronutrient for child survival has not been readily available for Nigerian children.

Investigations by www.icirnigeria.org showed that the scarcity of Vitamin A is mainly caused by a government policy that restricts it supply to health facilities to only twice in a year.

Vitamin A is only given to children under the age of five in Nigeria in May and November during the Maternal, Newborn and Child Health, MNCH Week, which is celebrated twice every year.

The Executive Secretary of FCT Primary Health Care Development Board, Rilwanu Mohammed said government decided to stop giving health facilities Vitamin A except during MNCH week to prevent its misuse.

“We found out they are misusing it. They are giving it to adults and selling it,” Mohammed said.

Mohammed explained that government decided that it was better to supply Vitamin A only during the MNCH Week to ensure that only children within the age of five are given, pointing out that two annual doses of high-potency supplements are adequate for addressing the adverse effects associated with vitamin A deficiency.

However, this government policy has had a negative effect on the uptake of vitamin A.

The National Nutrition and Health Survey, NNHS 2015, by the National Bureau of Statistics, showed that only about 42 per cent of the children aged between 6 to 59 months received vitamin A supplement which means that still three in five Nigerian children do not receive adequate levels of supplementation and are at risk of Vitamin A deficiency.

This 42 per cent coverage in Vitamin A supplementation is far below the UNICF’s threshold of 70 per cent for a country to expect to observe reductions in child mortality.

The North East and North West regions of the country had the lowest coverage of 15% each while only the South West reached the threshold of 70% coverage. Based on NNHS 2015, the situation is particularly critical in Gombe, Sokoto, Taraba, Yobe and Zamfara, where less than one child in ten reported having received vitamin A supplement.

Checks by www.icirnigeria.org showed that chaotic implementation of MNCH Week is mostly responsible for the low coverage of Vitamin A. For example, the last time the Federal Capital Territory, FCT had MNCH Week was in June 2016, missing on the November observation.

The www.icirnigeria.org also discovered that 896,000 doses of Vitamin A meant for the MNCH week in FCT for last year are still stored in the office of FCT Primary Health Care Development Board and will expire by August this year.

Mohammed said health facilities are only given the Vitamin A during MNCH week except in areas that record outbreak of measles.

He, however, said the doses would be used for MNCH week, which has been scheduled to start on May 8 if government releases fund for the programme.

He explained that the last November MNCH week was not held due to lack of money.

“We can’t do without certain logistics support,” Mohammed said. “We don’t have money at all, we can’t go out. We can’t service our vehicles. Area councils have no money to do it”.

It was learnt that the primary health board had requested only N4 million to carry out the last November MNCH week but the FCT administration failed to approve the request, resulting in the cancellation of the campaign.

Unlike the polio campaigns in which health workers go to homes to immunise eligible children, Vitamin A is only given at the health facilities during the MNCH week. But due to poor publicity, many parents are hardly aware of the week to take their children to a health centre to receive Vitamin A.

Since 1998, Nigeria has been getting a supply of Vitamin A supplements through the Vitamin A Global Initiative, led by UNICEF and WHO, but the poor administration of this life-saving supplement has denied an overwhelming number of children this benefit.