In 1933, British pediatrician Cicely Williams identified a malnutrition syndrome called kwashiorkor while working in what is now Ghana. She observed the condition primarily in children aged six months to four years who were weaned early due to the birth of another child. These children exhibited symptoms like swelling in their hands and feet, failure to gain weight, and severe skin changes. The condition, linked to poor-quality diets, resulted in the death of four out of the five children she initially described. Since then, the mortality rate from kwashiorkor and other severe forms of malnutrition in children has remained distressingly high, with between 20% to 30% of affected children dying, regardless of where they receive care. In some cases, this number can rise to as much as 50%.
Other forms of severe acute malnutrition, as classified by the World Health Organization (WHO), include marasmus and marasmic-kwashiorkor. Children suffering from these conditions are the epitome of childhood misery. Those with kwashiorkor appear wasted, with little muscle mass, swollen legs and feet, and hair that thins and falls out easily. Their skin is often affected by cracks, fissures, scaling, ulcers, and infections. Children with marasmus, on the other hand, exhibit severe wasting and have a prematurely aged appearance but no swelling. Marasmic-kwashiorkor presents a combination of symptoms from both kwashiorkor and marasmus, with severe skin issues adding to the suffering.
Children with severe acute malnutrition are highly susceptible to infections, which are often the immediate cause of death. However, surviving this critical period comes with long-term consequences. Research shows that children who recover from malnutrition tend to have smaller head sizes and lower intelligence compared to their peers. This developmental lag persists into adolescence, along with shorter stature and smaller pelvic sizes for females, leading to potential complications during childbirth, such as obstructed labor.
Severe acute malnutrition was not commonly seen in Nigeria until the civil war, during which hunger was used as a weapon of war. Thousands of children were affected, displaying swollen legs, wasted bodies, and despair etched on their faces. They died by the thousands, and malnutrition became the face of Nigeria’s civil war. Following the war, kwashiorkor and severe malnutrition cases diminished as food supplies and hope were restored. For a time, kwashiorkor was a rare condition, primarily seen by a few doctors. However, in the mid-1980s, the condition returned with a vengeance. Economic policies like the Structural Adjustment Programme led to a renewed rise in malnutrition, with swollen feet and wasted bodies once again filling hospital wards. Although there were brief improvements in the economy, kwashiorkor persisted in the background.
By the 2020s, kwashiorkor has made a full return to Nigeria. Only about 20% of children aged 0-23 months receive the minimum acceptable nutrition. WHO and UNICEF estimate that about two million children in Nigeria suffer from severe acute malnutrition, with northern states being the worst affected. Sadly, only a small fraction of these children receives the necessary treatment, and the mortality rate remains high, particularly in communities where cases go unrecorded.
In the past, international health experts have emphasized that poverty is the root cause of protein-energy malnutrition, now called severe acute malnutrition. Malnutrition follows poverty, and as poverty escalates in Nigeria, the prevalence of wasted bodies and swollen legs increases. This is especially true in the wake of widespread corruption, economic mismanagement, and insecurity, which have disrupted local food supplies. Recent events like the COVID-19 pandemic and the Russia-Ukraine war have further exacerbated food shortages and inflation, pulling even middle-class families into malnutrition.
The cycle of malnutrition, poverty, sickness, and death continues to plague Nigerian children. Malnutrition is responsible for nearly 45% of child deaths in Nigeria. Those who survive are often left with long-term physical and cognitive impairments that prevent them from reaching their full potential, keeping them trapped in a cycle of poverty. Girls who grow up malnourished are more likely to suffer from complications during childbirth, while both boys and girls are less likely to excel physically or use sports as a route out of poverty.
Efforts are being made to manage malnutrition through programs like UNICEF’s Community-based Management of Acute Malnutrition, particularly in northern Nigeria. This program involves weekly visits to health centers, where severely malnourished children are treated with Ready-To-Use Therapeutic Foods. However, prevention remains crucial. Encouraging exclusive breastfeeding, improving complementary feeding practices, and ensuring access to immunization and healthcare are all key to reducing malnutrition rates.
Ultimately, addressing poverty is essential to eradicating severe acute malnutrition in Nigeria. The country’s escalating poverty rates, fueled by corruption, have kept malnutrition alive. It’s not just about providing food but ensuring that economic policies and public resources are managed effectively to create a stable, food-secure future for Nigeria’s children.
