For parents, seeing their child’s first smile, watching their initial wobbly steps, and hearing their child begin to form words are all precious milestones as they grow up. But for children living in countries facing some of the worst crises in the world—like Nigeria, Afghanistan, Syria and Yemen—precious moments are put at risk because children don’t have access to one of life’s basic necessities: nutritious food.

Fifty million children worldwide suffer from acute malnutrition every year. Even though treatment is available, accessing it is challenging. Lack of access to treatment is caused for a number of reasons. In northeast Nigeria, drought and conflict have created massive food shortages leaving parents without access to provide nutritious food for their toddlers about to take their first steps. 

Nutrition Coordinator Dr Mohamed Kassim has been working for the IRC’s malnutrition response in Nigeria since 2016, supporting thousands of families. We spoke with him about the basic causes of malnutrition, the challenging contexts of conflict and climate, and how the IRC is finding sustainable ways to end child hunger in northeast Nigeria.

Last year, the IRC treated 161,000 children under 5 worldwide for severe acute malnutrition. The IRC treated 57,522 children under 5 for acute malnutrition in Nigeria alone.

What is malnutrition and how is it different from hunger?

Malnutrition is caused by a lack of nutrients, either as a result of a poor diet or problems absorbing nutrients from food. It isn’t just hunger. It’s a life-threatening condition that can rob children of the opportunity to live full and healthy lives.

In northeast Nigeria, the IRC works with mothers and their young children who have been identified as undernourished. “When we are looking for malnutrition in children, we start from when the mother is pregnant, to the time the child is delivered, and all the way to when a child reaches up to 5 years old,” Dr Kassim explains.

Mrs Rhoda Rufus, Stabilization center assistant, takes the arm measurement of baby Muhammad Ali, 10 months whilst been carried by his mother, Hafast Muhammad at Mashamari Stabilization center, Jere, Borno, Nigeria
MUAC tape is a tool used to identify whether a child may be malnourished. The tape, similar to a sewing measuring tape, is used to measure the circumference of a child’s mid-upper arm. If the score indicates malnourishment, then the IRC teams are able to refer the child for further treatment.
Photo: KC Nwakalor

“If a mother is malnourished herself and underweight when she delivers her baby, this may lead to her child becoming malnourished,” says Dr Kassim. “That is the first component of what causes malnutrition in a child.”

Dr Kassim describes how malnutrition causes fat and muscle tissue to waste away. The team is able to make quick analysis based on the height and weight of a child. 

Other symptoms include changes to skin and hair. “Dermatosis is where the skin starts peeling off,” explains Dr Kassim. “Hairs become very brittle and might change colour.” 

“Children with malnutrition are more vulnerable to infections and illnesses because their immune system becomes low,” says Dr Kassim. If malnutrition is not treated quickly, it may impair a child’s ability to learn for the rest of their lives. 

Why are children unable to access nutritious food?

Conflict and drought

In northeast Nigeria, drought and conflict have created massive food shortages. When people become displaced, parents struggle to provide food because “they no longer have a consistent supply of food,” Dr Kassim explains. “When livelihoods are depleted, there is food insecurity”.

Family portrait of Muhammad Ahmad (husband), 38, Bilikisu Ahmad (Wife), 29, and their children, Aisha, 6 (white & blue patterned Hijab), Fati (Brown Hijab),8 and baby Abba, 3, at their home in Maiduguri, Borno, Nigeria
Bilkisu and her husband Muhammad were forced to leave their farm due to conflict. Today, the family of five lives and farms in Maiduguri, but the lack of rain has caused the crops to dry up. Since moving, Bilkisu and her youngest daughter are supported by the IRC’s services.
Photo: KC Nwakalor

Cultural norms

“There are also cultural practices that may hinder what a child is fed.” Dr Kassim says that there are taboos around what to feed children in some communities. “Some mothers believe that breast milk is not adequate for the baby's growth and that they must feed their babies other traditional foods. Some believe that colostrum, the first milk produced after mothers deliver, is not good for the baby and they must discard it and not give it to the baby. In fact, this milk is nutritious and good for the newborn.”

“Some mothers encounter unplanned pregnancy while breastfeeding very young infants. Some believe that the breast milk of expectant mothers is not good for the child. There is a general perception that it causes diarrhoea. Many mothers take the advice and terminate lactation prematurely.”

“At the IRC in Nigeria, it's recommended that children are exclusively breastfed for six months after delivery,” Dr Kassim explains. “When this is not practised, it can contribute to the development of malnutrition later in life or as the child grows.” 

Healthcare

“The other cause of malnutrition is common illnesses that could be prevented through immunisation," says Dr Kassim. "If that doesn't happen and the child gets sick, feeding becomes a challenge, then that gravitates into malnutrition.” 

If a baby doesn’t receive its vaccinations for preventable illnesses, the risk of them becoming sick is higher. This can contribute to many risks to the baby's health. Children who have not received all their vaccinations have a higher chance of suffering from malnutrition.

Hussiena Ibrahim Ali, 20, breastfeeds her baby, Bello Ibrahim, 7 days old, few hours after their child naming ceremony at her home in Gwoza, Borno, Nigeria
Twenty-year-old Hussiena Ibrahim breastfeeds her baby, Bello Ibrahim, just 7 days old. The IRC advocates for exclusive breastfeeding for six months after a baby is delivered to ensure they get the nutrients needed for a strong start to life.
Photo: KC Nwakalor

What is the IRC doing to treat and prevent malnutrition in young children? 

The IRC is working to both prevent and treat malnutrition in children.  Here are some of the ways our teams are doing this important work in Nigeria:

Stabilisation centres

The IRC currently runs five inpatient stabilisation centres in Nigeria for more severe cases across three states. “These are for quite sick children,” Dr Kassim explains. “We admit mothers and children for at least one week. Then we transition them to the outpatient programme for another six to 12 weeks.” 

All five centres combined can accommodate 160 children. “Children with severe acute malnutrition with medical complications come with various underlying issues,” says Dr Kassim. “They can be treated for hypoglycemia (low blood sugar levels), shock, serious infection, worms, malaria, skin ulcers, measles, ear infections, meningitis, anaemia, Tuberculosis, low body temperature, micronutrient deficiencies, dehydration, persistent diarrhoea and eye infections.” 

Portrait of Naima*, her son Hadi*, 2yrs 4 months, was discharged after spending 28 days at Mashamari Stablization center, Jere, Borno, Nigeria
Naima* and her son, Hadi*, spent 28 days being treated at the IRC’s Mashamari Stabilisation Centre in Jere, Borno, Nigeria.

Photo: KC Nwakalor

The outpatient programme is for children who come for treatment for the day but go home. For less severe cases, the IRC runs a "targeted supplementary feeding programme", tailored services where children are offered ready-to-use supplementary food and mothers are counselled on best feeding practices. “The IRC monitors a child’s progress until they are fully recovered,” explains Dr Kassim.

Training and education within the community

The IRC also works closely with local communities and leaders to strengthen health systems that prevent malnutrition in young children. “We've empowered groups of mothers in the various communities we support,” says Dr Kassim, “They are given training on how to use the MUAC tape [for mid-upper arm circumference measurement] used for assessing malnutrition in children and refer cases for further evaluation.” By empowering women, the IRC is able to reach more mothers and babies. “For those not educated to read, we've given them the colour coded tape. So they know a certain colour means malnutrition.”

Hauwa Mustapha, 30, interacts with other women during mother-mother session within their community at Sulubri, Maiduguri, Borno, Nigeria
Community based exclusive breastfeeding advocate Hauwa Mustapha speaks to other mothers about the benefits of exclusive breastfeeding, educating them on healthy, locally-sourced foods to avoid severe acute malnutrition in their children and other best practices in looking after newborns.

Photo: KC Nwakalor

Mentoring community groups involves training, coaching and guidance on the best nutrition practices so that the members can learn and start influencing the attitudes of other community members. 

“It made a lot of difference because children are now getting referred on time which will bring a better outcome in terms of the treatment,” says Dr Kassim.

“If the referral is delayed, it will take longer to treat the child and use more resources and time. The faster the child gets treated, the less complications.” 

Working with parents

The IRC is also working with fathers. “They have a lot of influence on the family’s decision making,” explains Dr Kassim, “so we are trying to see how we can get them involved through the mentoring communication groups that we have.” 

“By bringing men on board through the men-to-men committees, there was great change and more women are able to take their children to the stabilisation centre for treatment and care.”

Portrait of Ibrahim Ali, 24 and his baby, Bello Ibrahim, 7 days old, few hours after his child’s naming ceremony at his home in Gwoza, Borno, Nigeria
Ibrahim smiles at his baby, Bello Ibrahim, a few hours after his child’s naming ceremony at his home in Gwoza, Borno, Nigeria. The IRC supported baby Bello’s mother Hussiena throughout her pregnancy.
Photo: KC Nwakalor

Through strengthening community systems, the IRC aims for nutrition work to eventually be run solely at a community or state level.