Strengthening Maternal, Infant, and Under-five Children Nutrition Services in Nigerian Primary Health Care Centers
Good nutrition is an essential component of good health. Adequate nutrition is vital for growth and development, building a strong immune system, preventing, and managing chronic diseases such as diabetes and heart disease.
More than one million children aged five and under die every year in Nigeria; over a third of these deaths are related to malnutrition. This is inexcusable. It is well established in medical literature that maternal nutrition is a key determinant of infants and under-five children nutritional status. Indeed, it has been settled empirically that children of malnourished mothers are at greater risk of mental impairment, stunted growth, infectious diseases, and death [1].
Maternal nutritional needs have been divided into preconception, antenatal, and postnatal needs [3]. The preconception needs include information and education on adequate nutrition, counselling, iron, and folic acid supplementation, and energy- and nutrient-dense food supplementation.
Care consists of counselling about physical activity, increasing daily energy and protein intake, oral folic acid and iron supplementation, and general micronutrient supplementation for antenatal needs.
Postnatally, the focus turns to general counselling on adequate nutrition and continued iron and folic acid supplementation.
Therefore, the mother’s nutritional status is inseparable from that of the infant and under-five child.
Why Primary Health Centers?
Primary healthcare centers are the first point of contact for individuals at the grassroots level seeking healthcare services. They play a crucial role in promoting and supporting maternal, infant, and under-five children’s nutrition services.
However, in many low- and middle-income countries, like Nigeria, these centers lack the resources, knowledge, and skills to provide adequate nutrition services.
In most countries, health systems and services live or die by the presence or absence of effective networks that reach the community and rural levels. In Nigeria – as in many developing countries – health programs as basic as child immunizations are not universally available.
For many, secondary and tertiary hospital-based care is too costly and thus available to only a few. It is from the backdrop that the concept of primary healthcare became attractive in the early 1970s; the concept of “integrated planning, improved coverage, and increased emphasis on participation at the community level” [2].
While it is understandable that one should approach a health center when one is down, with say malaria, it is not common at all to approach a health center for nutrition-related challenges. These challenges are pernicious and are only suspected when remediation is either an emergency or an impossibility.
It is at the primary healthcare centers that the battle for adequate nutrition would be won or lost.
Why have PHCs Failed in What appears a Simple Role?
Conventionally, people trained to become primary healthcare workers tend to be selected from the community they would eventually serve. This means that the pool of the well-educated is limited. Those who are chosen tend to not have formal education beyond the primary level – they may even be entirely illiterate.
Now, many recommendations regarding mother, infant, and under-five children nutrition exist. The primary health care worker is expected to learn all this – which is in addition to other duties that they had hitherto performed. This has begged the question: are the expectations on the health worker realistic? Are they simply overloaded with too much expected of them? Coupled with the small impact of nutrition-related activities, the following arose as accounting reasons.
First, primary health workers are indeed labored already by curative work that leaves no time or mental strength for them to pursue preventive or promotional work – such as nutrition. For many, hunger is synonymous with nutrition. After an exhausting day working on delivering babies or stabilizing delirious children, it would be a little odd – and perhaps, mildly irritating – if a mother comes in with a child seeking medical attention for “hunger.”
Second, primary health workers are often not guided on precisely what they need to do to promote nutrition. That is, their training in relation to nutrition may be inadequate or even inappropriate. This is why for them nutrition may, wrongly, be a problem related to food and food alone.
How PHCs Can Do Better
There is science-backed evidence on what works (UNICEF, 2022). It is clear therefore that the continued struggle to have mothers and children with the right nutritional scorecard is not one of knowledge. The requisite knowledge is available.
The issue is how to funnel this knowledge from where it is generated to where it must be utilized. In this, primary health workers may be trained to, first, appreciate nutrition as important as any other curative activity that takes place in their centers. Only this way can they translate this appreciation to mothers who would eventually carry out recommendations.
Next, the exact knowledge of what to do in a variety of scenarios (for it to function best, it must not be “one-size-fits-all”). It must be geographical and time-specific and must be taught to health workers. Their enthusiasm to pass on nutrition information must be matched by their possession of the right information.
Also, nutrition must get the attention that it deserves. If the primary health care workers are already overloaded by their current duties without nutrition having to be added, new workers must be recruited and trained to competently share the workload.
Preventable child deaths are a scourge to any health system worthy of the name, strengthening the capabilities of PHCs would stem these numbers. Science says so; we must now do so.
