The dilemma of childhood malnutrition in Ghana

Malnutrition, a deficiency caused by poor diet in term of undernutrition and over nutrition is a significant global health concern. This deficiency is prevalence among children, especially in the Sub Saharan Africa.

The Sustainable Development Goal (SDG) two talks about ending all forms of hunger and malnutrition by 2030, specifically among children and the more vulnerable. The United Nations Convention on the Rights of the Child also clearly states that good nutrition should be regarded as a fundamental human right.

But according to the United Nations Children's Fund (UNICEF), the World is far from a World without malnutrition”.

Signs and symptoms of Child Malnutrition

Mr Abdul Aziz Mohammed is the Principal Dietitian at the Cape Coast Teaching Hospital (CCTH). He explained that child malnutrition could occur when the child is either getting more than the nutrients required or less of the nutrients required.

However, he said in Africa and especially in Ghana, the problem had been under nutrition where children do not get the required nutrients for utmost growth.

Symptoms of malnutrition in a child may include faltering growth, changes in behaviour, such as being unusually irritable, slow or anxious, low energy levels and tiring more easily than other children. Other signs are big and shinny stomach, change in skin colour, tiny legs among others.

Childhood Malnutrition in Ghana

Ghana still experiences a malnutrition burden among its under-five population although there had been some improvement. The Ghana Statistical Service (GSS), Ghana Health Service (GHS) and ICF International estimates that nearly 19 percent of children under five years are stunted. They stressed however, that the levels of stunting were higher for children in rural areas, from poorly educated mothers, and those living in poor households.

According to the Ghana Demographic and Health Survey, the national prevalence of under-five overweight increased slightly from 2.5 Percent in 2011 to 2.6 percent in 2011. Similarly, the national prevalence of under-five stunting stood at 18.8 percent as of 2014, though less than the developing country average of 25 percent, the figure still present cause to worry.

According to Mr Mohammed, childhood Malnutrition is endemic in the Central Region where most of the cases were recorded in the fishing communities.

“Here in Cape Coast and in the Central Region, the malnutrition cases, usually comes from the fishing communities such as Elmina, Ekon, Moree and the rest but they have a lot of fish”, he lamented.

He added that his facility recorded on the average over ten malnourished cases monthly some of who were severe.

Madam Rachael Affe Asabo Mensah is the Nutrition Officer of the GHS in the Central Region. She admits that childhood malnutrition is one of the major issues the Service was battling with and says, it called for a collective effort to address it.

Why childhood malnutrition

First, Mr Mohammed mentioned poverty and said in most cases, children suffer from malnutrition simply because their parents do not have the money to feed them well.

He also spoke about lack of education and awareness on the subject of nutrition among the general population saying ” you do not have to be rich for you to take very good care of your child”.

He added that there are some who have the money but are not able to choose the right foods for their children.

“Children needs more protein in other to grow but in the households, they are served less of such protein compared to the adults. You can have people who are very educated but are not educated in the subject of nutrition”, he added

Another reason he cited was neglect or lack of parental care. Mr Mohammed expressed worry about the practice where parents especially those in rural communities leave the care of their children to the older siblings.

When you go to some rural communities, you will realise that a ten year old or seven year old is the one taking care of his/ her two or three year old sibling. So whatever that child will eat is dependent on what the ten year old will buy”, he stated.

“A child who is about four or five years is left on his own to make a decision on what to eat”, he lamented and said that explained why childhood malnutrition is common in rural communities.

Above all, Mr Mohammed said many women did not follow the six months exclusive breastfeeding rule saying “None adherence to exclusive breastfeeding, sets one up for malnutrition”.

Madam Mensah on the other hand, says that the country has not fared well in enforcing the Early initiation feeding policy (the time between when the child is born and when the breast feeding is initiated)

She said as per World Health Organisation (WHO) principle, initiation has to take place within the first thirty minutes after birth.

She said Ghana’s Early initiation as of 2017 stood at 52 percent, something she described as woefully low, while Exclusive breastfeeding is also at 43 percent.

Exclusive breastfeeding, she said had overwhelming benefits for the child, mother and the society as a whole but noted it adherence was poor among Ghanaian mothers.

For instance, she said a child that takes only breast milk for the first six months is protected from various forms of protection because the breast milk is embedded with a lot of immune boosters such that the child is able to fight and withstand infections.

“As the child takes only the breast milk, the child stands a chance of a lower risk of contracting all forms of infections”, she stressed.

Madam Mensah spoke against the introduction of infant formula such as “cerelac” and other foods which she said promote infections ,increases the rate of mortality and leads to malnutrition.

The practice, she lamented had led to increase in childhood obesity with its attendant childhood chronic diseases.

“The system of children is not well developed to digest higher levels of proteins. So if you introduce them to the artificial milk, they tend to develop allergies in later life to other things”, she explained.

Other issues Mr Mohammed mentioned include teenage pregnancy as well as other norms and tradition in the society which gave the impression that men and adult would need more of protein.

Preventing Childhood Malnutrition

There are several policies and interventions put forward by the WHO, the Ghana government and the GHS to prevent childhood malnutrition. They cover maternal nutrition, early initiation, Exclusive breastfeeding as well as complementary feeding.

The GHS is currently pursuing “Start Right and Feed Right” policy where from conception, mothers are being encouraged to eat from the four-star diet, (i.e animal flesh or product, plant source protein, fruits and vegetables, carbohydrates). Mothers are also being educated to eat enough to be satisfied and be strong, in that case the baby also grows and develop well.

To prevent malnutrition among children, Mr Mohammed says there is the need to increase education and awareness.

“There are local foods that could substitute the meat, fish and the rest but more education needed”, says Mr Mohammed. He said people needed to be educated to understand that local foods such as kontomire, agushie, beans etc are all good sources of nutrients.

He added that there was the need to educate the citizenry to realise that it was not only when the child is lying down or when the child is shivering that the child is sick, but should seek medical attention when their children develop big and shiny stomach, change skin colour, have tiny legs among others.

Aside from the education, Mr Mohammed says there should be structures in place to prevent children from becoming malnourished. To him, child malnutrition could easily be prevented if the required efforts were put into it.

First he says, there should be mechanisms to ensure that women complied with the six months exclusive breastfeeding. By this, he said there should be policies to help women (i.e) extending the maternity leave to six months to consolidate the six months exclusive breastfeeding. “If you are a woman and you are breastfeeding well, at six months, the child will be very okay”, he said.

Madam Mensah lamented about situations where some institutions did not allow nursing mothers to come to work with their babies and said that compelled them to resort to infant formula.

She therefore called on institutions and agencies to create baby friendly and breastfeeding corners where nursing mothers could sit to comfortably breastfeed their children.

Mr Mohammed however, stressed the need for all health professionals especially community health nurses to be trained in the subject of malnutrition and how to manage it. This, he added would help them spot malnutrition cases in the community and give an intervention.

“If community health nurses are trained very well on the subject of malnutrition and how to manage them, then they can spot these cases and put in an intervention because the more you delay, the worst the child becomes and then, the outcome might not be so good”, he said.

Way-forward

Government needs to do more

The Government of Ghana must work towards strengthening its supervision to ensure that the interventions available were effectively and efficiently implemented to achieve the desired outcomes, says Mr Mohammed.

For Madam Mensah, the nation needs to commit enough financial resources towards the implementation of the available interventions rather than relying on donor support.

“For most of our interventions, it is by donor support that we are able to run them. If the nation can support financially, it will help”, she said.

Child malnutrition according to Madam Mensah, is rising in Ghana because the interventions for managing was non-existent. She said the intervention which was supported by UNICEF has for the past two years ceased.

In that regard, she called for intensified education for people to put in place the preventive measures of early initiation, exclusive breastfeeding and supplementary feeding.

“If the condition comes, there is no product to manage it. The child may linger and survive later in years, become stunted or die”, she stated.

“Two years ago the whole nation run short of vitamin A, an essential vitamin needed to prevent infections in children under five”, Madam Mensah lamented and explained that UNICEF which hitherto was providing the support had stopped.

The government have to put in a lot of resource and make sure that they are used for the intended purposes for the GHS to organise regular outreach programmes at the rural communities to educate the populace in the subject of nutrition.

Madam Mensah said health facilities must be given the needed logistics such as vehicles, motor bikes as well as instruments to be able to carry out their duties effectively.

“As a nation we are to gather information on stunting, we need a particular instrument, but for my Region, we never had these instrument until a programme came and donor support brought in this instrument meanwhile staff are willing to collect”, she bemoaned.

What parents, guardians and families can do

Madam Mensah admonished families to support nursing mothers helping to do other household chores such that the mothers could have enough rest and strength to breastfeed their children stressing that, breast feeding is a peculiar task.

Additionally, she said families need not to pressure or encourage feeding under six month, saying that did not help the baby and the mother but rather mothers encourage the mother to breastfeed.

She advised mothers and families to seek clarification on any information at the health facilities and not fall for the misconceptions being spread around.

Mr Mohammed also advised parents and guardians to make all the efforts to control what their children eat and as such admonished them to desist from giving money to children to buy food.

“Do not leave the child to decide what he/she will eat. It will be best if they could cook at the house. It is always advantageous if you are able to cook in the house, then you control what ever the child eat. It helps a lot in the management of malnutrition”, he said.

What the media can do

Both Madam Mensah and Mr Mohammed believes that the media could help change the narrative by constantly using their platforms to educate the public on the importance of exclusive breastfeeding as well as issues of nutrition.