How supplements, good nutrition could reduce Nigeria’s  maternal, infant mortality burden – Experts

The neonatal ward at the Paediatric section of the Mother and Child Centre at Isolo General Hospital, Lagos, has a lot of children. Some are premature and are in incubators, some have low birth weight and are on oxygen, others have jaundice and are on a phototherapy machine.

Some of these children, especially those with low birth weight and those born prematurely, could probably not have been there if their mothers had adequate nutrition and necessary micronutrients supplements during pregnancy.

According to a 2022 Programming Guidance (PG) by the United Nations Children’s Fund (UNICEF) on prevention of malnutrition in women before and during pregnancy and while breastfeeding, it was stated that, Only 38 percent of women receive iron folic acid (IFA) tablets during their pregnancy.

Also, Only 59 percent of pregnant women attend four antenatal care (ANC) visits. Since 2016, WHO recommends eight ANC contacts, which further increases the gap.

The UNICEF PG further stated, each year, 20 million babies suffer from low birth weight (LBW), an early marker of poor maternal and fetal nutrition.

Research has shown that inadequate nutrition can lead to critical health risks to the infant, such as: low birth weight, pre-term delivery, stillbirth and being born small for gestational age.

Poor nutrition can also lead to serious maternal health outcomes and even lead to the death of the mother or her baby.

Experts say many women are not taking the required nutrients as a result of financial instability while others have little knowledge about the right micro nutrients to consume during pregnancy. Also, many women attend antenatal clinics when their pregnancy is in the second or third trimester without taking any supplements before that.

Usually, when women attend antenatal clinics in government owned health facilities in Lagos, some of these micronutrients are given while others are not. The general hospitals for instance give women at every antenatal care (ANC) visit, some iron tablets, vitamin C and folic acid. The medication would not even be enough to last the pregnant woman till her next appointment. Whereas, the primary health care facilities where women attend ANC do not give any medication, rather, women will be referred to the pharmacy to buy them.

Due to lack of enough sensitisation during ANC regarding nutrition and nutrients in both foods and supplements, many women are unaware that Micronutrient deficiencies can have lifelong impacts on a child’s physical, mental, and emotional development.

Asides these, experts also say children born without adequate micronutrients have short stature, Impaired cognitive development, anemia and other micronutrient deficiencies. Such children often end up with fatigue and impaired well-being, impaired productivity and school performance.

According to UNICEF, poor nutrition consequences are also serious for the mother and can lead to anemia, increased risk of hemorrhage, eclampsia, sepsis and other complications during delivery, and even death.

Also, pregnant women who take no Micronutrients supplements are at risk of losing their lives during childbirth, suffer obstructed/prolonged labour and are prone to Eclampsia and pre-eclampsia.

What really are micro and macro nutrients?

Pregnant women have a greater need for all nutrients, macro and micro, to allow the rapid growth and development of their unborn child – and they are more susceptible to the harmful consequences of poor diets and nutrient deficiencies, a medical expert, Dr Francis Ohanyido explained.

There are several major classes of nutrients which can be grouped as either macronutrients or micronutrients.

Macronutrients are carbohydrates, fats, and proteins, and they provide energy; whereas Micronutrients are minerals and vitamins (and are needed in small quantities).

Micronutrients supplements are critical for mothers. Many different vitamins and minerals, including iron and Vitamin A, are known to play an important role for overall good health during pregnancy and while breastfeeding.

Pregnant women in low- and middle-income countries (LMICs) are at increased risk of being deficient in multiple, critically important, micronutrients. 

Multiple micronutrients supplements (MMS) 

Every woman who attend antenatal clinic should be given multiple micronutrient supplements (MMS) at the hospital regardless of whether it is a primary or secondary or tertiary health facility.

MMS contains 15 essential vitamins and minerals for pregnant and nursing women and meets micronutrient requirements that poor diets cannot meet.

According to the United Nations International Multiple Micronutrient Antenatal Preparation Multiple Micronutrient Supplementation (UNIMMAP MMS), the 15 components of MMS are; Vitamins: A, C, D, E, B1 (thiamine), B2 (riboflavin), B3 (niacin), B6, B12, folic acid. Others are; Minerals: iron, zinc, iodine, copper, and selenium.

“Every woman who attend antenatal clinic should be given multiple micronutrient supplements (MMS) at the hospital regardless of whether it is a primary or secondary or tertiary health facility,” Ohanyido who is the Country Director of Vitamin Angels suggested.

Beyond supplements, Dr Ohanyido further explained, “The more colourful our food is, the better because we are more likely to get more nutrition from the various options. We should avoid eating only white food. Our food should be cooked with fortified salt as well. Pregnant women should eat orange coloured potatoes as it is said to contain a lot of Vitamin A.”

A research in Imo State 

In a research published by eight authors from the Department of Nutrition and Dietetics, Imo State University and Department of Pediatrics, Nnamdi Azikiwe University in 2017, it was discovered that deficiencies in micronutrients are prevalent and may occur among women of child bearing age.

A study was conducted on 222 mother-child pairs from two health centers in Umuna, Orlu Local Government Area, Imo State to assess the impact of micronutrients supplementation during pregnancy on birth weight of infants.

The result showed that 59.5% of the mothers were between 26-35 years. Married women were 98.2%, 54.1% were traders, 66.7% had secondary education, 76.1% had less than 3 children and 85.1% earned between ₦5,000-₦20,000 monthly.

About 89% attended antenatal visit, 61.7% commenced micronutrient supplementation in second trimester while none had prenatal supplementation. Folic acid (98.2%), Vitamin C (94.6%) and vitamin B complex (83.8%) were the supplements taken once daily by the mothers while ferrous sulphate (83.8%) and multivitamin (82%) were taken 3 times daily. 

Less than half (23.9%) of the mothers gave birth to macrosomic (>4.0kg) babies while 9.0% gave birth to low weight (<2.5kg) babies. The result also showed that the mothers were not taking Omega 3, Zinc, Vitamin A and Calcium supplements. There was a significant (P<0.05) difference between supplement intake and birth weight.

The authors, Amadi Joy, Iwuoha Stephanie and six others concluded that MMS in pregnant women may help in improving the birth weight of infants. The experts opined that, nutrition education on the importance of micronutrients supplementation before and during pregnancy should be taught to women of child bearing age.

Meanwhile, Dr Ohanyido calls on the federal and state government to ensure MMS is incorporated in health facilities for pregnant women and children to reduce the incidence of maternal mortality and childhood-related illnesses associated with lack of nutrition.

Beyond pregnancy

After birth, micronutrient deficiencies can have lifelong impacts on a child’s physical, mental, and emotional development.

Poor nutrition in the first 1,000 days can cause irreversible damage to a child’s growing brain, affecting their ability to do well in school. It can also set the stage for future issues such as obesity, diabetes, and other chronic diseases which can lead to a lifetime of health problems.

In a report by Healthy mothers, healthy babies consortium, “Children in Nigeria are not spared from the high incidence and prevalence of deficiencies of multiple micronutrients especially during the period of complementary feeding when breastfeeding alone can no longer sustain their nutritional needs. They are often fed with poor and inadequate complementary foods at this time.”