In this report by SADE OGUNTOLA, experts warn that the spike in COVID-19 cases risk disrupting nutrition, immunisation and other health services, thereby further worsening nutritional status of children.
Children evoke strong emotions in most of us. Those with children may be worried about their welfare. Children are at very low direct risk from COVID-19, but they are at heightened risk of exploitation, violence and abuse when schools are closed and social services are interrupted due to health emergencies. And, they are at very high risk of malnutrition and starvation.
Unfortunately, COVID-19 has become a double-edged sword for the poor; either to die from coronavirus or from hunger. The accompanying lockdown has contributed to under nutrition in vulnerable groups, particularly children.
Prior research has shown that malnutrition in children can lead to both physical and mental problems as the child grow older. Even more, malnutrition and HIV/AIDs may make children worst hit by COVID-19 because it weakens people’s immune systems.
According to United Nations Children’s Fund (UNICEF), Nigeria currently has over 2 million children that are under 5 suffering from Severe Acute Malnutrition (SAM) largely caused by a significant imbalance between nutritional intake and individual needs.
Unfortunately, “The high rate of malnutrition, HIV/AIDs and cholera among children in Africa may make them more vulnerable to COVID-19 pandemic, which is gradually spreading in the region,” said World Health Organisation’s Regional Director for Africa, Dr Matshidiso Moeti.
In addition, the closure of schools also eliminates access to school-based nutrition programmes, driving malnutrition rates upwards, a hidden impact of COVID-19 among children and young people said UNICEF Executive Director, Henrietta Fore.
Fore declared: “We know that, in any crisis, the young and the most vulnerable suffer disproportionately. This pandemic is no different. It is our responsibility to prevent suffering, save lives and protect the health of every child.”
Unfortunately, COVID-19 has the potential to overwhelm fragile health systems in low- and middle-income countries and undermine many of the gains made in child survival, health, nutrition and development over the last several decades.
Fore, UNICEF Executive Director, stated: “Prior to the COVID-19 crisis, 32 per cent of children worldwide with pneumonia symptoms were not being taken to a health provider. What will happen when COVID-19 hits in full force? We’re already seeing disruptions in immunization services, threatening outbreaks of diseases for which there already exists a vaccine, such as polio, measles and cholera.
“Many more newborns, children, young people and pregnant mothers could be lost to non-coronavirus related causes if national healthcare systems, already under great strain, become completely overwhelmed.
“Likewise, many nutrition programmes are disrupted or suspended, as are community programmes for the early detection and treatment of undernourished children. We need to act now to preserve and strengthen health and food systems in every country around the world.”
Moreover, Professor Fatai Fehintola, head, Department of Clinical Pharmacology, University College Hospital (UCH), Ibadan stated that individuals withstand some infections when you eat an adequate balanced diet,
“A well-nourished person stands a better chance with infections, including COVID-19 than somebody who is malnourished if you look at it from that angle and what constitutes proper nutrition includes all these things that we call supplements; micronutrients, vitamins and so on,” he declared.
Dr Babatunde Ogunbosi, a consultant paediatrician, University College Hospital (UCH), Ibadan, said although children that are malnourished stand a higher risk of coming down with many infections, a lot of things about children and COVID-19 is still not known.
“We know that COVID-19 is not very common in children; we also know that the disease is not as severe in children as in adults. Why this is so we really don’t know. Part of the postulate is that the immune response that adults generate is so excessive and that is what contributes to the severity of the disease in them.”
According to Dr Ogunbosi, children hardly get bad complications of COVID-19 like adults except such children have chronic diseases like cancer, sickle cell disease and asthma that can easily tell on their immune reserves.
However, he declared that the possible impact of malnutrition on the severity of COVID 19 is not established for now.
“Places, where COVID-19 has been more established and widespread, are not in areas where malnutrition is very rampant. However, one or two studies say that impaired nutritional status was not particularly associated with poor outcome of its severe disease.
“There has been some documentation of it even worse in obese children; so we are not too sure of what the picture is in malnutrition because in places where they have severe malnutrition.
“One can anticipate that those that have malnutrition would probably have multiple outcomes from COVID-19. We can only postulate but we are not sure.”
Nonetheless, Dr Ogunbosi declared the possibility of malnutrition incidence increasing in children due to poor access to food and other health services for child care like immunization during the lockdown period.
He declared, “We might see a lot of malnutrition after all these has settled. And that has happened every time there has been a recession and issues like this. So we should anticipate a lot of child health issues.”
President, Nutrition Society of Nigeria (NSN), Dr Bartholomew Brai in a brief by society stated that COVID-19 was a challenge to addressing the high burden of malnutrition in Nigeria, including the school feeding programme for school-age children in public schools and community management of acute malnutrition.
Dr Brai said that ensure adequate nutrition during the pandemic and to reduce post COVID-19 burden and severity of malnutrition effectively in babies, mothers should exclusive breastfeed and continued breastfeeding their babies up to the age of 24 months.
Even mothers in isolation, he said should be encouraged to express their breast milk using a dedicated breast pump and hand hygiene and disinfection of the pump and other utensils to feed their babies.
For school-aged children, especially those in public schools and benefitting from existing school feeding programmes, he advised that parents provide an extra meal per day for these children where they are capable during this COVID-19 lockdown period.
”The lockdown offers the opportunity to reinforce health-promoting lifestyle including diet, sleep (about eight hours daily) and physical activity, especially for adolescents and adults,” Dr Brai added.
The increase in food price hikes, he said parents should tackle by selecting alternative foods to replace usual food items.
He declared: “Cocoyam or sweet potato can be purchased instead of yam, white beans may be the alternative to red variety, low priced fish or edible insects may be alternative animal food.”
Though transmission of COVID-19 infection through food is not likely, he said still proper food hygiene should be maintained.
“Handwashing should be observed after returning home, and before preparing or eating food. Food items should be washed thoroughly under running water or using vinegar.”
The NSN president asked that government and other stakeholders make efforts to provide food and nutrition support to indigent households, intensify community management of acute malnutrition and similar ongoing interventions, and scale up existing social protection programmes especially for the older population.