In the crowded backyard of Dogon-Azare Primary Health Care Centre in Potiskum, Yobe state, Maman Umar sat on a weathered bench, her eyes tired and filled with worry. She gently coaxed her 22-month-old son, Adamu, to swallow his food supplements, as other patients shuffled in and out of the waiting tents at the health clinic’s Outpatient Therapeutic Programme (OTP) section.
The 25-year-old mother of six, who earns a living by selling locally made spaghetti, let out a deep sigh. Adamu, her youngest child, had been battling unexplained weight loss since a recent measles outbreak. His eyes were dull, his cheekbones sunken, and his belly swollen— signs of the malnutrition that had ravaged his small body.
This is not Maman Umar’s first visit to the clinic. In October 2023, when Adamu was 10 months old, she had brought him in for a routine immunisation, only to be told that he was suffering from Severe Acute Malnutrition (SAM).
“He began losing weight and developed a high fever, with measles. That is why I brought him here,” Umar said as she cradled her son, persuading him to finish eating his sachet supplement – Ready-to-Use Therapeutic Food (RuTF), an initial treatment given to children suspected of malnutrition at the clinic.
“If Umar doesn’t finish his RuTF and doesn’t breastfeed properly, it is a sign of low appetite and essentially a sign of acute malnourishment,’’ health worker Aminu Haruna told Pluboard as he quietly drew out his Mid-Upper Arm Circumference (MUAC) tape, a rapid assessment tool for acute malnutrition to measure Adamu’s arm. The child measures 10 centimetres.
“Anything less than 12.5 centimetres falls under the red zone and indicates severe malnutrition,” Haruna added.
Experiencing two episodes of her child’s malnutrition diagnosis within a year has been shocking for Aisha. However, her situation reflects a broader crisis in northeast Nigeria where children and even mothers face various levels of malnutrition.
Humanitarian experts have attributed this situation to social-economic deprivation and the decade-long activities of armed groups, which have ravaged livelihoods in the region and exacerbated hunger to record levels.
In 2017, the United Nation’s World Food Programme estimated that among the three war-ravaged states of Borno, Adamawa, and Yobe, Yobe had the highest number of malnutrition cases in Nigeria with 517,000 persons at 11.4% people who are food insecure.
The state is projected in 2024 to have some 510,000 children under five years who are acutely malnourished. They include 171,000 severely underweight, according to a Yobe State Nutrition Brief document for June 2024.
Government data sourced by Pluboard shows in Dogon-Azare Health Centre in the capital Potiskum alone, a total of 348 new cases of SAM patients were recorded in six months, with June—which falls during the infamous “Lean Season”, or Dry Season — having the highest number at 63% or 18% of all cases.
“Yobe State currently faces an alarming nutrition crisis due to prolonged socioeconomic deprivation and armed conflict. The situation is particularly dire for children in remote wards of Geidam and Gujba, which border the Niger Republic,” said Babagana Makinta, a nutrition and health officer working with Action Against Hunger, (ACF), providing humanitarian aid to health facilities in at least seven LGAs in Yobe state.
“We are trying to strengthen the system, we are not bringing anything new,’’ Mr Makinta added. “We do just identification, like training and other things, and we try to train them on the gaps we identified. These are the main things that we are doing.’’
Pluboard understands that in Potiskum, ACF, an international nonprofit organisation provides health facilities with support for care such as delivery of drugs and service support to SAM patients both with and without complications. However, only Moderate Acute Malnutrition (MAM) cases are supported by the UN-WFP.
Moderate Malnutrition
Last year, Fatima Hassan, a 30-year-old mother, noticed that her seven-month-old son, Hashim, was losing weight after suffering from diphtheria, a rare but severe bacterial illness. Weighing less than 6.8 kg, Hashim’s health deteriorated with sores in his mouth.
Hashim made a remarkable recovery after receiving RuTF paste, which gave him the essential nutrients he needed to regain his health. His weight increased, and his cheeks began to fill out.
In July, the mother of three brought Hashim —now looking healthier — to the Dogon-Azare health facility for a follow-up care. The child’s weight had increased to 8.3 kg and his MAUC arm size was 12 centimetres, which is in the yellow zone.
Yusuf Ibrahim, a health worker under the WFP Targeted Supplementary Feeding Programme, stationed at the Moderate OTP centre, said Hashim’s arm size falls slightly below the green zone, indicating that he needs continued monitoring and support.
He said the boy would continue to receive close monitoring and assistance under the MAM programme to ensure his full recovery. The mother would be given 15 sachets of RuTF for eight weeks before her son will be discharged.
According to data gathered from the centre, a total of 1,872 new cases of mild-malnourished children were recorded between January and July, with June and July having the highest figures at 379 and 424, respectively.
The “Lean Season” Scourge
The Lean Season in Nigeria is a critical period that significantly impacts agriculture and malnutrition across the country. Typically occurring between the planting season and the harvest, this phase can extend from June to September.
Food security experts say food reserves from the previous harvest have been exhausted, resulting in increased scarcity and rising food costs.
“This period is marked by a gap between the previous harvest’s end and the next one’s onset. During this time, food prices rose, and many households, particularly in rural areas, faced challenges getting food during the lean season. This calls for the need for tailored interventions,” Azeez Salawu, a food expert, said in an interview with Pluboard.
To address these shortfalls, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), in its 2024 Humanitarian Response Plan Northeast Nigeria sought a donation of US$306 million to address the urgent needs of 2.8 million affected people in the most severe need and to prevent a further deterioration in conditions in Borno, Adamawa, and Yobe states.
In Dogon-Azare Health Centre in Potiskum, SAM and MAM cases typically surge during the Lean Season, data gathered showed.
Mr Makinta of ACF said that Yobe state typically experiences its Lean Season from June to November. During this time, he said caregivers and children often suffer from malnutrition due to the shortage and high cost of food.
The nutrition officer said the Yobe government in May issued a memo informing all primary healthcare centres across the state about the shortage of RuTF. He said the memo directed all OTP centres to provide 14 sachets per week to each child, not the usual 28 thresholds; regardless of their weight or MUAC arm size.
Mr Makinta, who covers Yusufari, Kika, Geidam, and Fune LGAs, and was recently assigned to Potiskum to head nutrition matters, lamented the rising transportation costs, which now reach N100,000 per month for RuTF transport from Potiskum to Damaturu.
Identifying and Treating Malnutrition Cases
Mr Haruna, based at the Dongo-Azare facility, discussed how his organisation handles new malnutrition cases. He said both efforts by parents and identification by community volunteers help to raise awareness.
“Upon arrival at the clinic, children are screened using the MUAC tape. If a child falls within the red margin and has no complications, they are treated at the OTP,’’ he said.
Regarding the treatment plan, he said the facility would administer 14 RuTF sachets, to new cases of SAM patients—with two sachets consumed daily for four weeks. Health talks and counselling on proper nutrition would be provided as part of the care plan.
Blessing Alexander, WFP’s Nutrition officer said their organisation supports the MAM cases before it gets to SAM. She added that due to the shortage of RuTF WFP support facilities across Yobe State provide them with RuSF.
“A child gets to MAM before going to severe acute malnutrition, so we support the facilities by providing them now not with RuTF but with RuSF (Ready-To-Use Supplementary Food) which is similar to RuTF,” she said.
Complications and No Breastmilk Situation
Hauwa Babani, a 20-year-old mother, noticed that her two-year-old son, Muhammed Babani, had a rash on his mouth, weight loss, and a high temperature in June.
Concerned about her son’s health, she took him to the Specialist Hospital in Potiskum, where doctors directed her to the Stabilisation Centre within the facility. After a thorough evaluation, Muhammed was diagnosed with SAM but with complications and was admitted to a bed at the hospital for treatment.
Hauwa, who is a full-time housewife, has been staying at the hospital with her son for the past week, taking care of her son.
“For the past week, we’ve been receiving treatment here,” said the mother of three, as she lay beside Muhammed with a hand fan, gently fanning him to sleep.
She said that her other children never experienced any malnutrition-related complications and that Muhammed has shown signs of improvement and weight gain since their arrival.
With sunken collarbones, Hauwa’s emaciated appearance was evident. She expressed gratitude for the support provided by the facility, especially in the area of feeding her and her son.
Unlike other mothers with children suffering SAM-MAM, Hajara Abudulliahi, a 30-year-old mother, is facing challenges in breastfeeding her 11-month-old twin—boys. She is unable to lactate after giving birth prematurely at six months.
The centre’s midwife, Hafsat Muhazu, told Pluboard that the reasons for Abdullahi’s inability to produce milk for her babies could be due to her not receiving adequate food or a balanced diet during her pregnancy which is an essential case of malnutrition.
The twins were kept in the facility’s special baby care unit and were given artificial milk.
Muhazu said they feed the baby and the mother three meals with normal food every day and also educate them on proper nutrition.
She said, “We give the mother food and children milk. Two hours feeding for the children and for the mother, we give them three square meals. Apart from that, they provide them health education on how to breastfeed. And they give them several breastfeeding techniques for the mothers and more than that.”
Mariya Hamidu, the officer in charge at the stabilisation centre managed and supported by ACF, stated that they receive most of their patients from Bauchi state, possibly due to its proximity to Potiskum.
She said that the centre has a 12-bed capacity and only manages cases related to malnutrition. Additionally, she explained that if they are out of capacity, with patients who have not been discharged, they refer them to the paediatric medical wards which have a 50-bed space located in the facility.
The official also assured that the patients will continue to be managed but will also have to return to the centre’s wards for further treatment and to collect their medication.
“Presently we have patients there, but they come here (centre) for their feeding and treatment,” she said.
Speaking on what the facilities need and lack, the official mentioned that there is a need for additional bed spaces and manpower to ensure proper care for the patients.
She also suggested having three shifts with two nurses and two assistants would enhance productivity. “Currently, there are four nurses, including the official, and two volunteers. However, the volunteers are not always available,” Hamidu said.
She also mentioned the need for more regular therapeutic milk such as F75 and F100 due to the high number of patients. She said, “We need the availability of milk (M10, M100, and M75) and commodities. We’re not short on supply, but more would be appreciated.
The official also highlighted the lack of F75 therapeutic milk and emphasised the issue of transportation of commodities such as RuTF between LGA’s is a major challenge. According to her, “sometimes we face shortages.” She added, “We need to liaise with our base in Damaturu to collect from the state.
Mitigating the Crisis
Muhammad Gana, the state’s health commissioner, told Pluboard that the ministry has already delivered all essential items to the isolation centre. He said there was an ample supply of Ready-to-Use Therapeutic Food (RuTF) across the state’s collection centres.
“I found out from all those who are supposed to be responsible; I mean the management and those who are to ensure that these things are available. They told me they have supplied all the Isolation Centres in Yobe,” he said.
“Again concerning the RuTF, the same people told me they have enough RuTF in their custody, probably when you got there they may have run out of it and they failed to report. All these issues have already been addressed.”
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