Ghana will not attain Millennium Development Goals 4 and 5 and some of the fundamental reasons are our inability to provide sufficient and quality food for our children and the poor state of nutrition of our pregnant mothers. Fifty-five per cent of childhood deaths have underlying malnutrition and 70 per cent of pregnant mothers are anaemic.
Why should a country like Ghana not be able to provide sufficient and quality food for all its children and also ensure that anaemia in pregnancy is dealt with adequately.
It is simply because nobody cares enough to want to tackle the problem. It falls through the cracks all the time, but it will continue to haunt all of us as a country.
Since the onset of the Ghana Demographic Health Survey (GDHS) from 1988, there has been very little improvement in the nutritional status of our children under five years of age.
Categories of malnutrition
Malnutrition is divided into four categories; stunting, where children are short for age and is an index of long standing or chronic food shortage in the short life of the child.
The GDHS has shown figures of 34 per cent in 1988, 33 per cent in 1993, 31 per cent in 1998, 35 per cent in 2003 and 28 per cent in 2008. The figures show there has been no sustainable attempt to ensure that all Ghanaian children get enough food to eat. Many children still go to sleep on an empty stomach.
Underweight signifies low weight for age. It is also an index of poor nutrition. The data shows better improvement but still the percentages are high enough to be worrying. In 1988, underweight was 23 per cent, remained at 23 per cent in 1993, dropped to 20 per cent in 1998, then to 18 per cent in 2003 and in 2008 it came down to 14 per cent.
The third category is wasting. This category represents recent failure to receive adequate nutrition or maybe the result of recent illness. It is the acute manifestation of malnutrition.
That data has been erratic, nine per cent in 1988, 14 per cent in 1993, 10 per cent in 1998, eight per cent in 2003 and nine per cent in 2008.
The fourth category is childhood obesity which though previously unrecognised, has climbed to five per cent.
Marginal improvement
The 2011 Multiple Indicator Cluster Survey, which represents a mid-term review, showed marginal improvement but again not significant enough;
Stunting dropped from 28 per cent in 2008 to 22.8 per cent.
Underweight from 14 per cent in 2008 to 13.4 per cent.
Wasting from nine per cent in 2008 to 6.2 per cent.
The results show that in 2008, 51 per cent of Ghanaian children had some nutritional deficiency while five per cent were over nourished. In 2011, the figure dropped to 42.4 per cent with still five per cent over nourished.
In real terms, this means that 1.59 million Ghanaian children in the under five-year group have inadequate and poor food consumption while 187,500 are overfed or obese (children under five make up 15 per cent of Ghana’s population).
Essence of nutrition
Nutrition is important in the general well-being of any human being because it must provide the right balance of all the components of food, carbohydrates, fats and protein, vitamins, minerals and antioxidants. The absence of any in the right quantity provides a platform for many affectations.
These children do not only have stunted, became short, thin or both, but their mental development is compromised to the extent that they are unable to comprehend even very minimal tasks. There is poor development of their memory lanes that have a severe impact on their cognitive capacity or ability.
In addition, their physical capacity to do work is also seriously hampered such that they are tired even before they have begun to do work in their adolescents and adult life. The coup de grace is that their entire immune system is so affected that on their own, the body is unable to fight any diseases, infections, or cancers.
As if that was not enough, it fuels into the Baker’s hypothesis that states that poor maternal nutrition invariably leads to poor child nutrition which is the recipe for most of the non-communicable diseases in later life. This may help explain the exponential growth of non communicable diseases among Ghanaians. Hypertension has climbed from 1:50 to 1:2, Diabetes from 1:100 to 1:10 over a period of 50-60 years and cancers are increasing at a frightening rate.
Deaths from bacterial infections which with the help of antibiotics must be confined to history still occurs with great alacrity, not to mention the fact that fake and substandard drugs still are a huge problem in Ghana. Deaths from malaria among children and pregnant women are still too high because of the poor immune development from malnutrition.
Ghana, despite the twin track disease burden, now has a fast developing twin track malnutrition burden.
As a country of great inequality, five per cent of the children under five (187,500) have been overfed and are obese with all its consequences on heart and kidney functions and early death, while 42.4 per cent are under fed.
Anaemia in pregnancy is a proxy for nutritional status and figures of 59 per cent of women in fertile age group and 70 per cent among pregnant women and 62 per cent in breast feeding are serious and unfortunate.
Consequences of malnutrition
The level of malnutrition and the consequences thereof in children and pregnant women must be heralded and drummed into the fabric of the nation. It is at the centre of the poor educational standards of many rural and peri-urban children; school dropouts in primary schools, poor Basic Education Certificate Examination (BECE) results with zero pass rate in some communities, the huge numbers that graduate from Junior High School (JHS) and cannot go beyond and are left to the ravages of the Ghanaian economy.
It is known in nutrition circles that the first 1,000 days of a child’s life is the most critical and this period includes the nine months in the mother’s womb and up to two years of age.
Beyond the 1,000 days most of the effects are irreversible even though it is fair to believe that continued malnutrition beyond two years, deepens and worsens the problem.
The poor immune status means the body cannot fight diseases. The poor mental development means intelligent quotient, cognitive development and creativity and imagination are all compromised.
The physical incapacity means that such persons are incapable of work to any significant value.
If 1.59 million Ghanaian children in every five-year cohort are in this category and will grow to become adolescents and adults, then we have a formidable task as we seem to have now with many years of failure to tackle the problem. So what can be done now? A stitch in time saves nine.
Options
a. Ghana must recognise malnutrition as a huge multi-sectoral problem and set up a Malnutrition Task Force involving the Ministries of Health, Food and Agriculture, Trade and Industry, Gender, Children and Social Protection and civil society organisations to really focus on the problem.
b.Create a Malnutrition Day to raise the national consciousness of the problem.
c. Create food banks that can be used at the Nutritional Rehabilitation Centres of the Ghana Health Service for weekly rations of blended maize, groundnut and beans (weanimix).
d. Educate boys and girls in schools about the importance of nutrition.
e. Educate women in the productive age group on the importance of nutrition.
f. Make nutrition education an important component of couples counselling prior to marriage.
g.Make nutrition education an important component of antenatal and postnatal education.
h.Reimburse hospitals, clinics and Nutritional Rehabilitation Centres for therapeutic feeding.
It is as much a nation’s problem as it is a parental problem and Ghana as a party country to all the international conventions and protocols on the Rights of Children and Nutrition that indicate that the government will step in when there are parental issues. The Ghana School Feeding Programme with all its issues comes a shade too late to ameliorate the problem.
Ghana must make childhood and maternal nutrition a priority in national discourse.
Child Malnutrition Foundation formerly known as Vitamilk Foundation has stepped onto the malnutrition platform to create awareness and capitalise on the issues for appropriate solution.
It has entered the fray of the moderately malnourished child and is working with the Ghana Health Service through the Nutritional Rehabilitation Centres in Accra. It will then move into the Greater Accra Region and then upscale to Central Region and then the Northern, Upper East and Upper West before going nationwide. Its byline is Lifting the Ghanaian Child and it intends to set up a National Malnutrition Fund to be managed by a Board of Trustees from supporting institutions.
It has started a fundraising campaign targeting all staff of the security agencies in Ghana (Armed Forces, Police Service, Fire Service, Prison Service, Immigration and Ghana Revenue Authority), others are the members of the associations of recognized professional bodies (doctors, lawyers, architects, pharmacists, bankers, engineers, surveyors and planners, nurses and teachers), as well as orthodox churches (Anglicans, Methodists, Presbyterians and Catholics to begin with), chamber of commerce, mines and telecommunications and some selected private schools.
The Malnutrition Fund will be used to procure maize, beans and groundnuts from the Grains Commission or Buffer Stock Company of the Ministry of Food and Agriculture and provide weekly food rations for the children.
Child Malnutrition Foundation is supported by Gentle Giant Company Limited, the importers of Vitamilk.
• The writer is the Executive Chairman, Child Malnutrition Foundation and a former Director General of the Ghana Health Service
