Zara Ishaku, 35, had difficulty lactating, a condition that encompasses low milk supply, engorgement, sore nipples, plugged ducts and latch problems, after having her second surviving child in September last year. She had already lost four children to severe acute malnutrition, a life-threatening condition characterised by an extremely low weight-for-height ratio and/or the occurrence of bilateral pitting edema, typically caused by inadequate intake of energy, protein, and other essential nutrients.
The situation caused her family a great deal of trauma. “Losing four of my babies to malnutrition due to my inability to breastfeed was so traumatic for my family. My husband, who was the breadwinner of the family, barely made enough money to cater to our basic needs, including food,” she told the <em>Catholic Herald.</em>
Since experiencing breastfeeding difficulties with her first child born in Borgozo, a village located 90 kms away from Maiduguri, the capital of Borno in the northeastern region of Nigeria in 2013, Zara then tragically lost four of her children, one after another, all under the age of 6 months. Only her last two children have survived.
She originally practiced mixed feeding with pap—a staple food made from fermented maize, millet, water, guinea corn, and other locally available options without the addition of breast milk, and when her babies showed signs of sickness, instead of taking them to the hospital, she administered locally-made herbal concoctions—a common practice in rural parts of Nigeria where medical facilities are mostly far away and difficult to reach.
Ishaku’s infant feeding practice changed when she encountered a team of community mobilisers from the partnership of Catholic Relief Services (CRS) and the Justice Development and Peace Commission (JDPC), a Catholic group dedicated to reducing infant mortality through its Management of Nutritionally At-Risk Mothers and Infants (MAMI) project based in Nigeria’s northeast region.
Malnutrition has remained a leading cause of death of children under five in Nigeria. A <a href="https://www.unicef.org/nigeria/press-releases/1-3-children-nigeria-experiences-severe-child-food-poverty-due-conflict-climate">report released</a> by UNICEF in June last year estimated that around 11 million Nigerian children are facing severe food poverty. Shockingly, nearly half of all deaths in this age group can be linked to undernutrition.
In sub-Saharan Africa, it is a major health concern, contributing to a high burden of child mortality. It is the second leading cause of death among children, just after malaria. Children in the region are more than 14 times more <a href="https://www.afro.who.int/health-topics/child-health">likely to die before the age of 5</a> than children in developed regions.
Nigeria <a href="https://punchng.com/nigeria-must-address-malnutrition-2400-children-die-daily-unicef/">loses</a> approximately 2,400 children to malnutrition each day, UNICEF <a href="file:///Users/apple/Desktop/CRS%20MAMI%20PROJECT/Nigerian%20children%20suffer%20from%20the%20effects%20of%20malnutrition%20than%20the%20global%20average.">say</a>s, which is more than the global average.
<a>Part of the problem is that the majority of</a> mothers who breastfeed exclusively often <a href="https://www.unicef.org/parenting/food-nutrition/breastfeeding-positions">suffer from undernourishment</a>. This is linked to a variety of factors, including poor dietary habits, insufficient meals, lack of formal education, poverty, lack of advice on exclusive breastfeeding during antenatal care and lack of support from their husbands.
Other contributing factors, including the ongoing <a href="https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-023-00513-0#:~:text=Malnutrition%20is%20caused%20by%20a,20%2C21%2C22%5D.">armed conflict</a>, insecurity, recurrent droughts, and flooding, <a href="https://www.mdpi.com/2076-0760/11/2/59#:~:text=With%20a%20score%20of%2029.2,the%20success%20of%20the%20SDGs.">have severely impacted food security</a>. Rising food prices driven by inflation and tumbling crude oil prices make it increasingly difficult for many households in Nigeria to access nutritious meals.
The UN emphasises that children require proper nutrition at the right time to reach their full potential. The most crucial period for ensuring good nutrition occurs <a href="https://www.unicef.org/nutrition/early-childhood-nutrition#:~:text=The%20most%20critical%20time%20for,safe%20and%20nutritious%20food%20source.">during the first 1,000 days</a>, starting from pregnancy and extending to a child's second birthday.
David Jankoli<strong>, </strong>Community-based Management of Acute Malnutrition (CMAM) and MAMI Officer with the JDPC in Borno State, says inadequate maternal nutrition during this period could lead to insufficient infant feeding, which can lead to childhood malnutrition and developmental restrictions.
“If an infant is malnourished at six months, it indicates that something has gone wrong during the exclusive breastfeeding period. A child who is well-cared for from birth to six months should not experience malnutrition by that age.”
The MAMI project launched as a pilot initiative in March 2024 and operated for six months in Benisheikh, the headquarters of the Kaga district in Borno State, targeting infants aged up up six months. It is the first time the CRS, in partnership with the JDPC, is focusing specifically on malnutrition in infants, particularly emphasising breastfeeding for new mothers and their babies in Nigeria.
Previously, CRS collaborated with partners on initiatives like the CMAM, focusing on children between six and 59 months in the<strong> </strong>Northeast in Kaga, Magumeri Gubio, and Jere districts of Borno in 2017.
“Our experience in actively identifying and managing malnutrition among children aged six to 59 months revealed a troubling gap. After conducting screenings, we encountered over 1,000 cases that required follow-up.” Said David.
He explained this new effort gives special attention to children under six months, a demographic that has often been overlooked. “Our experience in actively identifying and managing malnutrition among children aged six to 59 months revealed a troubling gap. After conducting screenings, we encountered over 1,000 cases that required follow-up.”
“During these follow-ups, we observed that infants around six to seven-months-old continued to suffer from malnutrition within the community. If an infant is malnourished by six months, it indicates issues with exclusive breastfeeding practices. Ideally, a well-cared-for child from zero to six months should not be malnourished at this age.”
The MAMI program began with the identification of community volunteers in Benisheikh, with only three selected after a screening exercise and were trained on the MAMI approach. Training was also provided for health workers within the community’s primary health care and the general hospital in collaboration.
Jankoli says training for healthcare workers was important, as the program requires referrals to medical facilities in Benisheikh. “MAMI is not just a one method of approach, it also necessitates referrals to hospitals whenever necessary. To address this, we involved those who work at health facilities and trained them alongside our community mobilisers.”
“After completing the training, we proceeded with mapping and identifying our project participants[beneficiaries] in the designated locations. Initially, we planned to work with just 30 participants, but, as we assessed the situation, we realised the need to expand our target group to 50.”
Nigerian children <a href="https://dataphyte.com/latest-reports/economy/child-malnutrition-likely-to-soar-amid-nigerias-inflation/">suffer more severe effects of malnutrition</a> compared to the global average. Approximately 6.5% of children under five in Nigeria suffer from wasting, which exceeds the global average of 4.6 per cent. A staggering 31.5 per cent of Nigerian children experience stunting, significantly higher than the global average of 19.9 per cent, with malnutrition leading to tragic outcomes, the child mortality rate is 11.7 per cent, stands above the global average of 3.7 per cent.
Global child rights observatory, UNICEF, <a href="https://www.unicef.org/nigeria/nutrition">says</a> that Nigeria’s northern region has recorded an unprecedented surge in children who are affected by the two forms of malnutrition – stunting and wasting.
Last year, Global Hunger Index, a tool <a href="https://www.globalhungerindex.org/methodology.html">designed</a> to comprehensively measure and track hunger at global, regional, and national levels, reflecting multiple dimensions of hunger over time, <a href="https://www.globalhungerindex.org/nigeria.html">ranked the country 110th out of 127</a> countries with a score of 28.8, indicating a serious level of hunger.
Wilson Kipkoech, emergency coordinator with the CRS, says the aim for the MAMI project is to address this issue by focusing on maternal health, nutrition, and infant feeding practices, “thereby filling these critical gaps”.
“By doing so, it not only provides immediate support but also helps reduce the incidence of severe and moderate acute malnutrition in the long run. Essentially, it operates as both a preventive and curative measure; mothers receive rehabilitation to boost their milk production, enabling them to maintain six months of exclusive breastfeeding.”
The Catholic group conducted research among families across Benisheikh, showing the presence of malnourished children, highlighting the urgent need to address the vulnerabilities of these families, particularly those living in Internally Displaced Persons (IDPs), who have been forcefully evicted from their homes and villages by banditry attacks and the longstanding Boko Haram insurgency.
They recognised the need to support lactating mothers with infants under six months. “This also involves understanding and addressing cultural beliefs and barriers that hinder mothers from practicing exclusive breastfeeding effectively.”
“So, it's more or less preventive and also curative because the mothers are able to be rehabilitated, and produce more milk, and they would sustain a continuous six months of exclusive breastfeeding,” Wilson told the <em>Catholic Herald.</em>
Ishaku’s understanding of breastfeeding has undergone a remarkable transformation, evolving from limited knowledge to a solid grasp of how to prevent breast engorgement, address low milk supply, and ensure proper latch and positioning for a smoother breastfeeding experience.
“The knowledge I gained has made a lot of difference in my baby. I used to face challenges like breast engorgement, and my grandmother often discouraged me from exclusively breastfeeding my children. But the MAMI project opened my eyes to the vital importance of exclusive breastfeeding for my 7-month-old. He now looks very healthy and rarely gets sick, unlike my previous babies who didn’t survive.”
She and her husband were forcibly displaced from their village of Borgozo, a rustic town in Borno, in 2015. She is currently living in the magistrate camp in Benisheikh, one of the IDP camps where the catholic organisations implemented the MAMI project with her husband, a peasant farmer.
The initiative is set to expand the MAMI project into Sokoto, located in Nigeria’s Northwest region, with a goal of reaching 200 infants. “Our experiences in Kaga were highly encouraging, and based on the insights we gained there, we are now moving forward and scaling our efforts in Sokoto,” said Jankoli “Initially, we aimed to assist 50 children under five, but now we’ve increased our target to 200.”
<em><a href="https://x.com/thevalentineben">Valentine Benjamin</a> is a Nigeria-based travel journalist and documentary filmmaker with interests in social justice and global health issues across sub-Saharan Africa.</em>
<em>(MAMI participants, including Zara, after a group session at the Low-cost IDP Camp, Benisheikh, Kaga local government area of Borno State, Nigeria | Photo credit: Dorathy Okaba/CRS)</em>
