By David Arome
Children under five account for nearly 31 million of the Nigerian population, with 1 in every 3 struggling with a malnutrition crisis. Malnutrition continues to expose them to risks that jeopardise their ability to survive and thrive.
Shuaibu’s short battle with malnutrition
Just after giving birth in January 2025, Zainab Lawal, the mother of Shuaibu Lawal, who lived in Kaduna, Kaduna State, Nigeria, passed on. Shortly after, Aliyu’s father’s friend, Jamilu Yahaya, takes over as carer for Shuaibu and her six-month-old baby. His wife, Rihanatu Jamilu, also joined in providing care.
Battling with the very few resources that are not enough for Rahinatu and her baby, adding Shuaibu to the mix stirs up even more hunger in the house.
“It’s quite demanding feeding the two, knowing that I don’t have a job,” Rahinatu explains
Rahinatu struggles to meet the nutritional needs of breastfeeding Shuaibu and her child as the occasion demands. Leaving Shuaibu with inadequate breastmilk threw him into severe acute malnutrition (SAM) and fever that affected his growth.Shuaibu’s sickly condition deteriorated into a swollen belly, pale skin, and puffy eyes.
SAM is a life-threatening condition that occurs as a result of a child not getting enough nutritious food as required and often falling sick with illnesses such as diarrhoea, measles, and malaria. This, in turn, weakens the child and reduces their ability to fight diseases.
In Nigeria, an estimated 2 million children are affected by severe acute malnutrition, with 2 in 10 receiving treatment.
Later, Shuaibu was rushed to the Primary Health Care (PHC) Ungwan Rimi, Kaduna, for treatment. It was at this point that Aleeyah Sani Bello, founder of Nutrition, Empowerment & Education, Sustainable Intervention, Transformation (NEST) Foundation, in one of her visits to the PHC, spotted Shuaibu and took an interest in his case. “His condition was so bad even at the time they came to the PHC, with glaring symptoms of severe acute malnutrition and weakness,” Aleeyah explains.
NEST Foundation provides supplementary nutritional support in the form of Tom Brown to children who are six months and above. Since Shuaibu was less than six months old, falling short of the complementary feeding criteria, Aleeyah connected Rahinatu with a paediatrician. The paediatrician gave a treatment plan and requested that Shuaibu be admitted to the PHC while receiving treatment for proper monitoring.
Aleeyah paid for the laboratory test, leaving the drugs and admission bills, which Lawal Musa, Shuaibu’s father, declined, complaining that he cannot afford the bills.
Rahinatu had no option but to return Shuaibu to the house and revert to herbal medicine. Unfortunately, his health condition keeps deteriorating by the day with malnutrition eating so deeply, and three weeks later, Shuaibu died.
This is one out of the many cases of malnutrition crises that are claiming the lives of children under five in Nigeria.
Fight to Save Her Malnourished Son
Mariam Abubakar, a farmer residing in Baro, Agaie LGA, Niger State, had a similar malnutrition experience with his son, Aliyu Abubakar.
Aliyu was only one year and two months old when malnutrition set in. Mariam was worried because Aliyu, the first child, was not growing as fast as other children of his age.
About 11 million children under five in Nigeria are malnourished, the UNICEF 2024 report reveals.
Although Aliyu received breast milk for three months after birth, his growth was characterised by retardation and sickness. “The breast milk was not enough for him, so I started adding “pap” to complement his feeding,” Mariam said.
“The mothers hardly practise exclusive breastfeeding; rather, they feed the children with pap and herbal concoctions,” Esther Garba, deputy officer in charge, PHC, Baro, said. The worst is that they discard the colostrum, yellowish breastmilk that serves as the first vaccine, believing it is not good for the baby.
Mariam often uses an herbal solution for treatment each time her son feels sick. But the herbal remedy that once healed Aliyu failed to work at times, and Aliyu’s health was not getting any better. Her very good friend Joy Maji, upon a visit, observed the son’s condition and advised Mariam to take Aliyu to the clinic for proper treatment.
Mariam yielded to her friend’s advice and trekked for 3 km to Baro Primary Healthcare Center. On reaching the clinic, the nurse examined Aliyu, took his vitals, and used Mid-Upper Arm Circumference (MAUC) to check for malnutrition, and a laboratory test was carried out. After a while, the nurse disclosed the test result that Aliyu has malaria and severe acute malnutrition.
According to the World Health Organization, infants and children of 6–59 months are diagnosed with SAM if the MUAC reading is less than 115 mm, falling within the red zone of the MUAC tape.
The nurse prescribed drugs and advised her to augment Aliyu’s feeding with nutritious foods, such as locally sourced and made Tom Brown. Tom Brown is a therapeutic food designed to rehabilitate malnourished children back to health.
“I was only able to get the drug but could not make the local Tom Brown because of financial constraints,” Mariam said.
Though Aliyu later recovered with financial support from Mariam’s uncle, it took a long while before he caught up with his agemate.
Like Aliyu, many under five, especially those in rural communities, are battling with a similar malnutritional crisis.
Saving Yusuf
“I always admire seeing young children growing to catch up with their age,” said Fatima Mohammed, a mother of three in the Ekosa community, Agaie LGA, Niger State. The opposite depicts the reality of his 3-year-old malnourished child, Yusuf Mohammed.
Fatima explains that at age 2, Yusuf often falls sick with symptoms of a high body temperature, vomiting, and frequent stool. This leads to her frequent visits to the primary healthcare centre (PHC) Ekosa for treatment.
During one of the visits to the PHC, Yusuf’s appearance raised the community health extension worker’s (CHEW) suspicion of malaria and diarrhoea. Further examination and laboratory tests were conducted, confirming the suspected cases.
The CHEW prescribed antimalarial drugs and oral rehydration therapy (ORT) for use in Aliyu’s treatment. “It took a while for Yusuf to fully recover after giving him the prescribed drugs,” Mariam exclaims with excitement.
Barely three weeks after recovery, Yusuf started emaciating with loss of weight, struggling to stand, and was physically inactive as before. Fatima got so disturbed by Aliyu’s condition.
In a bid to know the underlying cause, Mariam took Yusuf to the same PHC for diagnosis and treatment. At this point, the CHEW uses the MUAC and confirms to Fatima that Yusuf is suffering from severe acute malnutrition (SAM). Fatima’s countenance was altered, but the CHEW advised her to incorporate protein and vegetables into Yusuf’s food to ensure the quick recovery of his son.
“Moderate to acute malnutrition is the most common form of malnutrition in the Ekosa community,” Esther said.
“The turning point for Yusuf’s recovery was the adherence to the CHEW advice and nutritional health counsel at the PHC,” Fatima said.
Burden of Malnutrition
“Malnutrition is not a short-term problem but a long-term one, as children are the ones who suffer the most,” Aleeyah said. The persistent threat of stunting, wasting, and overweight—the three manifestations of malnutrition—hinders children’s development. This burden exposes them to lifelong consequences, including impaired cognitive development. It can manifest as delayed language acquisition, reduced problem-solving abilities, and difficulty excelling in school, ultimately limiting their future earning potential.
“Malnutrition is not just that a child is not getting the right nutrition; while that is a typical thing, there are many underlying factors that encompass the impact of this,” Uju Onuorah, nutritionist and research associate at Nutrition Drive for Healthy Diet Initiative (NDDI) Africa, explains.
Drivers of Malnutrition Among Children Under-Five
Many factors drive the malnutrition crisis in Nigeria, with poverty taking the lead. Nigeria ranks among the 20 hotspot countries that account for 65% of the 181 million children globally facing severe food poverty. “Due to poverty, many households cannot afford basic nutritional diets for their children. The poverty level is still on the high side in many homes,”Dr Elizabeth Ojochebo Dangana, a lecturer in the Department of Human Physiology at Prince Abubakar Audu University, Anyigba, Kogi State, explains.
Parts of Nigeria, precisely the Northeast and Northwest, are the worst hit, accounting for nearly 5.4 million malnutrition cases among children under five. This lingering malnutrition crisis impedes achieving the Zero Hunger target by 2030. “Until we solve the problem of child food poverty, the issue of malnutrition will persist,” said Solomon Idowu, a nutritionist at Africa Youth Growth Foundation, Niger State.
Malnutrition is the most severe consequence of food insecurity among children under five. Insurgency and insecurity in food-producing parts of Nigeria, such as Niger, Benue, and other northern states, are fuelling child malnutrition. Farmers are afraid to go to their farms for fear of attacks, while many have been displaced from their ancestral lands. This security crisis has driven up food prices, making it difficult for families, especially mothers, to afford nutritious meals, thereby deepening hunger and malnutrition. “For a child to grow well, it must be fed with an adequate, balanced diet,” Dr Elizabeth noted.
At the local level, which forms an integral part of the interventions, nutrition is not well integrated into the primary healthcare system. The health facilities are not provided with the necessary resources and equipment to help manage malnourished children. Often, there is either a stockout or absence of therapeutic foods, weighing equipment, and even MUAC tapes to check severe acute malnutrition. “This shortfall limits access to nutritional health services and proper monitoring and treatment of malnutrition,” Uju stressed.
The impacts of climate change are mounting every day, with glaring evidence of drought, flooding, and shifting rainfall patterns. The resultant effect of a drop in crop yield is rising food prices. Crop yields in sub-Saharan Africa, including Nigeria, are predicted to drop by 22% by 2050 due to climate change, as well as a projected population of 262.9 and 401.3 million in 2030 and 2050, respectively. “Soaring prices make it so difficult for families to feed twice a day; talk more of providing for the children. This makes it challenging to meet the nutritional needs of the under-five children, worsening the malnutrition crisis,” Dr Elizabeth added.
Funding and Policy Implementation Gaps
The staggering health budget of between 4 and 6% every year is grossly inadequate and falls below the 15% recommended target set by the Abuja Declaration of April 20, 2001. This is not enough to fund health programmes, including nutrition interventions. Nigeria has never met this target since the declaration, with the highest allocation being 6.23% in 2012. Trend analysis in 20 years (2001-2021) of budgetary allocation to the health sector stands at an average of 5.05%, with a shortfall of 9.95%.
Another glaring problem is the over-reliance on external funding and donations. Most nutrition-focused programmes in Nigeria and other parts of Africa are largely funded by international organisations such as USAID, UNICEF, the World Bank, and the Gates Foundation. The end of the funding cycle signifies the end of the programme or intervention. A classic example is the recent closure of the USAID-funded programme. “It took everyone by surprise, as no one saw it coming,” Aleeyah said.
More than 90% of USAID-funded programmes globally have been halted, including its therapeutic feeding programme across Nigeria, leaving children with malnutrition without treatment. USAID funds 50% of the global therapeutic foods used in the treatment of malnutrition in children.
Nutrition Policy
The National Policy on Food and Nutrition (NPFN) is a strategic blueprint for tackling malnutrition and promoting food security for all, in line with global best practices and the Sustainable Development Goals. The policy was first adopted in 2016 and later updated in 2021. The NPFN provides a comprehensive framework for addressing food and nutrition insecurity in Nigeria.
According to the policy document, it is expected to achieve the following indicators by 2025:
- Reduce hunger and malnutrition by 50%.
- Reduce stunting rate among children under five to 18%
- Reduce childhood wasting, including severe acute malnutrition, to 10%.
- Increase the exclusive breastfeeding rate to 65%
- Increase the percentage of children aged six months for appropriate complementary feeding to 40%
However, the statistics are not looking good, as stunting has increased from 37% in 2018 to 40% in 2023. Despite this policy framework being in place, implementation remains abysmal. The gap is further widened by the underfunding of nutrition programmes and the lack of political will. “What we are seeing in reality does not complement the policy,” Aleeyah noted.
Nutrition-Focused Programs and Interventions
Programmes such as Accelerating Nutrition Results in Nigeria Project 2.0, a World Bank-sponsored initiative running in 21 states, focus on increasing the utilisation of high-quality, cost-effective nutrition services for pregnant and lactating women, adolescent girls, and children under five. This programme provides essential nutrients, including vitamin A, micronutrient powder, deworming, zinc/ORS, iron-folic acid, and Maternal, Infant, and Young Child Nutrition (MIYCN) counselling.
Similarly, the Ready-to-Use Therapeutic Food (RUTF) programme, implemented through state governments and UNICEF, provides specially formulated, energy-dense pastes designed to treat acute malnutrition in children. RUTFs are packed with essential nutrients and do not require refrigeration or cooking.
An investigative report by Zubaida Baba Ibrahim and Aaron Bawala of the Nigerian Health Watch reveals stockouts and diversion of RUTF from health facilities into local markets in northern Nigeria, where malnutrition is endemic. This is alarming as the malnutrition crisis continues to surge in the region. Malnourished children need to be protected and given adequate, nutritious food to recover and catch up with their peers.
While these interventions are currently being implemented across some of the states, malnutrition is still gripping many children. “Intervention should be designed not just to solve the malnutrition problem but to solve the underlying causes. And this beckons for coordinated efforts from the government, funding partners, and communities to scale up workable plans tailored toward addressing the root causes of malnutrition,” Uju stressed. Most of the interventions are targeted specifically to cover a certain number of children under five, leaving a bulk of them behind, increasing their vulnerability to malnutrition.
Sustainability Challenges
The sustainability of nutrition-focused interventions or programmes remains a big challenge in Nigeria. “But it is important to look at it from the angle of how it serves the community beyond the intervention life cycle,” Uju noted. In designing a sustainability action plan, it is important to factor in diversity across communities. This is necessary because what works for one community may not work for another community.
“The sustainability of these programmes depends largely on community involvement and ownership. It should be streamlined to the reality of local communities, to what they can easily afford, and sourced locally for use,” Solomon said.
Oftentimes, the sustainability plan is just archived without implementation. This lapse widens the malnutrition crisis among children under five and exposes them to severe complications. “Intervention should not just be the one that works, but be sustained beyond the end of the project cycle,” Uju stressed.
Beyond Maternal Education
While there is growing interest in maternal education, there is also an urgent need to focus on paternal education and involvement, which can equally influence the nutritional well-being of children under five. “All of this forms an interconnected web that can shape a child’s nutrition and, if neglected, lead to malnutrition,” Uju noted.
A study established that when a mother has a low level of education, it affects her feeding habits and, by extension, the dietary patterns of her child. “So, there is a very strong correlation between maternal education and child nutrition outcomes,” she added.
“Beyond maternal education, which is important to help improve the malnutrition status of children under five, men should not be left out of nutrition discussions,” Uju emphasised. Government and nutrition-focused organisations can really look at practical ways to integrate men into the whole nutrition discourse. It’s important because ensuring a child’s healthy growth begins with informed families, not just informed mothers.
Call to Action
Research is the gateway to understanding the problem deeply and proffering solutions. “Through research, you can identify what works, refine programmes, and align them with the realities on the ground. Turning research findings into actionable policies is key to tackling child malnutrition effectively,” Alaayah noted.
Dr Elizabeth added, “Preventive measures are better off when it comes to child malnutrition. Yet, responses have remained largely curative and reactive, fixing the damage after it’s done.” The moment calls for bold policy reforms, health budget increases, stronger community education, and early nutrition investments that stop hunger before it starts.
Investing in the health of children is investing in the nation’s future. Every child deserves the chance to survive, grow, and thrive.
Credit Statement: This work was produced as a result of a grant provided by the Wits Centre for Journalism’s African Investigative Journalism Conference.