Kicking malnutrition out of Ghana

Ghana prides itself as a middle-income country with a Gross Domestic Product (GDP) of $1650, according to the World Development Index 2012.

The country also claims it has achieved Millennium Development Goal 1, which is to halve poverty, well ahead of 2015. However, the human development index and social development fall way out of the league of middle-income countries.

One such indicator is the proportion of children under 5 who are malnourished. We may be a Middle income country but not a middle-income society.

Ever since Dr Cecil Williams described malnutrition and named it kwashiorkor in the Princess Marie Louise Hospital in Accra in the 1920s, the effort to rid our children of this burden has yielded some results but painfully not enough and is rather too slow.

After independence, the Nutrition Unit was created by Prof. Fred Sai in the Ministry of Health, at the instance of the First President of the Republic of Ghana, to coordinate the fight against malnutrition. Ghana’s population has increased more than four fold in the 56 years post-independence, compounding the problem.

Children under five constitute 15 per cent of the population and those up to 15 years make up 44 per cent. Ghana therefore has a significant dependent population for which government policies must be geared to support.

The fight against malnutrition is also a fight against all childhood diseases that are capable of tipping an otherwise healthy child into malnutrition and across all age groups. The diseases include malaria, diarrhoea diseases predominantly from unsafe water, worm infestations, and upper respiratory tract infections and, of course, good quality and quantity of food.

The statistics are not complementary at our stage of development. The increasing Gini co-efficient, which is an assessment of the disparity and inequity in our society, explains the difficulty.

As a country, we can ensure that every child eats well because there is so much in Ghana, a lot of which is allowed to go to waste.  Proper and effective governance is what may be needed to get the appropriate responses. We have let many of our children down.

The problem

Malnutrition is a multi-sectoral issue, with the MOH of Health as the co-ordinating ministry and also in charge of the prevention, promotion and treatment of diseases.  The Ministry of Food and Agriculture justifies food security and food prices;  Ministry of Works, Housing and Water Resources providing safe and clean water for the communities;  Ministry of Local Government and Rural Development in charge of sanitation and food hygiene; Ministry of Environment;  Science and Technology guaranteeing clean air; Ministry of Children, Gender and Social Welfare overseeing the wellbeing of children and their mothers and the Ministry of Education seeing  to the provision of education.

The need for an inter-ministerial approach to solving the problem cannot be overemphasised.

The current policy of the MOH is exclusive breastfeeding for the first six months, for all newborn babies. Worthy, though, is the issue of maternal nutrition status, which is a problem we must confront.

With almost 59 per cent of women in the reproductive age group, and being anaemic even at the time of labour is undesirable.  Cultural norms still allow the mother not to be fed on highly nutritious supplements till she has delivered because of the fear of difficult childbirth if the child becomes big. The current policy of supervised childbirth must be able to deal with that situation but it must be discussed explicitly.

Of what benefit is all the antenatal care if it does not cure the high rate of anaemia before labour. The quality of these interventions must be seriously looked at in order to tackle head-on this unfortunate and devastating menace.

After the standard four antenatal visits, no pregnant woman must be anaemic unless the mother does not take the prescribed iron and folic acid tablets and does not act on all the nutritional advice. Who can best deal with such recalcitrant mothers?

The proposal is for queenmothers to be partners in this bold attempt to improve the lives of pregnant and lactating mothers. If queenmothers are supported to hold meetings with pregnant and lactating mothers at which wellbeing issues are discussed, attendance to antenatal and postnatal clinics, and adherence to good practices reviewed, it might reduce the proportion of defaulters.

It is the period between six months and three years when weaning has taken place and supplementary feed is provided that tips many children into malnutrition. It is also the most critical period, in addition to the nine months in the womb and the six months breastfeeding period (the critical 45 months).

If malnutrition is not reversed by age three, the effects become irreversible. It is for this reason that as a country, we must do everything possible to ensure that no child attains the age of three with any nutritional deficit that will impair the individuals’ full development and contribution to the greater good of the country.

It cannot and must not be seen as a parental or family problem but a huge national issue which, as stated, must be tackled holistically. One child that falls victim to this avoidable problem will forever be an indictment on the country and all of us Ghanaians.

Solution

There must be a concerted effort to rid this country of malnutrition. It is a combination of ignorance and lack of resources and injudicious use of the meagre resources. The health of a mother is superior and everything must be done to ensure that a mothers’ health, in particular their nutritional health, is given the needed support within the family and in the country. The nutritional status of the unborn child and the first six months of life is a reflection of the mother’s health.

The health of the critical period from six months to three years defines the life and output of every child in Ghana and the rest of the world and whatever happens, no child should have a nutritional deficit by the end of the third year.

The MOH, together with some development partners, is treating the severely malnourished with a plumpy nut product which is given in the hospital. The moderately malnourished are brought into hospital every day and are fed with food provided by the hospital and cooked by the mothers of the sick children.

Many of the hospitals do not have enough money to provide adequate food and supplementary feeding is not captured under the National Health Insurance programme. These children, even with the best intentions, are not getting enough to eat.

Vitamilk Foundation, launched on Monday,  September 30, is stepping on the plate to lift the Ghanaian child by providing three of the 125mls vitamilk Champ initially to every moderately malnourished child in Princess Marie Louis Hospital daily in order to assess the  impact before extending it to other feeding centres.

It shall also create the platform for donations to provide in addition to the Vitamilk, appropriate and highly nutritious Ghanaian food to the moderately malnourished. There is so much in Ghana that no child under five years must go to bed hungry. It will also help to resolve the problem of unsafe water for communities.

This is a call for help to feed Ghanaian children before they become unproductive and noncontributory to the growth and sustenance of the Ghanaian economy. The appeal is to all Ghanaians, school children from privileged backgrounds, all the numerous private schools in Ghana, corporate Ghana, development partners, all and sundry, to contribute and become nutrition icons.

By Professor  Agyeman Badu Akosa/Daily Graphic/Ghana
The writer is the Executive Chairman of Vitamilk Foundation. email:[email protected]