By Martha Agas
Mrs Khadijat Abubakar, from the Maiadiko community like most pregnant women experienced food aversion which threatened her health with that of her baby. She experienced weakness and was cautioned on her health status during her Antenatal Care (ANC) session at the Primary Health Centre (PHC) in Rayfield. She was educated on the dangers of lacking key nutrients which can cause anaemia, pre-eclampsia and also lead to stillbirth, low birth weight and delay in development for children.
“I have been attending ANC in this clinic, I have learnt a lot and we are taught the kind of food to eat in our condition and how to make them. There are some foods I do not like eating, but with the health talks they do in the clinic, I endure eating them because of their nutritional value to me and my baby, “ she said.
Similarly, Mrs Nancy Stephen, who attends ANC at PHC Bukuru says she looks forward to coming to the clinic for the ‘food demonstration` organised weekly for them. She admitted that she usually washes vegetables after slicing them, but learnt that the appropriate way is washing it with salt before slicing. She has also learnt how to ensure she eats a balanced diet.
“Through the food demonstration I know what to eat to increase my blood level such as vegetables and fruits, because I was told that i do not have enough blood in my system and taught the foods to eat to increase that, for my health and that of my baby. I advise women to follow all the procedures given to them at the clinic,“ she said.
This is the similar story of women in the 100 health facilities implementing the three -year Accelerating Nutrition Results in Nigeria (ANRiN) project in Plateau. Its component includes providing increased knowledge to pregnant women on nutrition, for their well-being and of their babies, which is critical in improving maternal health in the state.
Maternal health has posed concerns following the records on high mortality rate across the globe especially in Africa. According to UNICEF, Nigeria`s 40 million women of child bearing age, which is between 15 and 49 years, suffer disproportionately high levels of health issues surrounding birth, which has contributed to 10 per cent of global deaths for pregnant women.
Reports from WHO says that between 2005 and 2015, an estimate of over 600,000 maternal deaths and no less than 900,000 maternal near miss deaths occurred in Nigeria, which is threatening its achievement of the SDG target of reducing global maternal ratio to less than 70 per 100,000 live births by 2030.
Experts say social cultural factors such as age, religion, traditions, education, socio economic status and societal construction of gender are major determinants of maternal health outcomes in Nigeria, but the magnitude of its effect varies in different regions of the country.
Nigeria is estimated to have maternal mortality of 512 deaths per 100,000 live births, with the northern region as the highest contributor to the statistics.
Observers say that insecurity has further aggravated the already backward region in maternal health. Following the worsening situation, stakeholders have called for more concerted efforts by both the government and non-governmental organisations to find lasting solutions.
Many intervention programmes are being implemented in the region, and reports indicate some improvement in some states on maternal health and one of such states is Plateau.
There are indications that the state has recorded improvement in maternal health and a decrease in maternal mortality. The State Reproductive Health Coordinator, Mrs Hannatu Dung, revealed that maternal mortality has reduced as obtained from recent data from the Nigeria Obstetrics Quality Assurance platform.
“In 2020 maternal mortality was 64 per cent and in 2021, it reduced to 33 per cent, while it (Nigeria Obstetrics Quality Assurance platform) has data of only January to May in 2022 which is 3 per cent,“ she said. She explained that even though the data was mostly collated in the facilities, it is evident that efforts being made are yielding results.
Food demonstration component of the ANRiN project
With a maternal mortality rate of Plateau at 905/100,00 live births, the state is implementing the ANRiN project in 100 health centres across its 17 local governments.
Launched in 2021, the project objective is to increase the utilisation of quality cost effective nutrition services among pregnant and lactating women, adolescent girls and children under five years, which according to Nigeria Demographic and Health Survey 2018 (NDHS), 58 per cent of women age 15 to 49 years are anaemic.
Nutrition is critical to women of reproductive age as its chronic deficiency which they are vulnerable to, is a major risk factor for adverse birth outcomes. According to 2018 NDHS`s report, the proportion of women who consume five or more food groups is lower in the northern zones, with the lowest at 47 per cent in the north central zone. In addressing this situation, the project supports counselling of pregnant women on improving their nutrition practices and overall health outcomes, using food demonstrations at the weekly ANC sessions in addition to the provision of Iron Folic Acid (IFA).
The food demonstration involves disseminating nutritional information to the pregnant women, through preparing meals and explaining the procedures, while also using recipes that are accessible and affordable to them in the area, of which they get to taste. The demonstrator also discusses the different food classes and how they can be used to ensure balance diet.
Improved knowledge on nutrition according to a report , is one of the cost effective and sustainable methods for lowering cases of anaemia.
The State Nutrition Officer of Plateau, Mrs Lydia Ishaku, said that the women are encouraged during the health talks to do backyard gardening where they can plant foods which they can easily access, to complement their dieting which should consist of each food group.
She said the project had a target of reaching 6,750 pregnant women in the first year, and in 2020/2021 to reach 67,560 women which it all achieved.
“In 2022, 168,750 women were targeted at and we are presently on it, “ she said.
She said that the project has encouraged ANC attendance as revealed during its monthly review meetings, which shows that facilities implementing the project have more attendances compared to the non-implementing PHCs.
The Nutrition Focal Officer for Jos South LGA, Mrs Paula Hata, said that 10 health facilities in the area are implementing the project and are given a monthly stipend of N5,000 for the food demonstration, which is usually augmented by the Officers in Charge (OICs) of the clinic for its success.
“ANRiN gives us N5,000 monthly to conduct the food demonstration. So, we make a roster for the month to ensure a balanced diet for the pregnant women attending ANC every week, and usually give them health talks on the importance of eating healthy for mother and child.
“The roster also incorporates fruits because we encourage them to take fruits and vegetables too, it will help them as pregnant mothers“ she said.
The gains of food demonstration
Attendees of the food demonstration sessions have said that they have learnt many lessons especially on the nutritional values of many foods found in their locality, and processes involved to ensure retention of its contents after cooking.
Also, the management of PHCs implementing the ANRiN project have lauded it for reducing anaemic cases through the food demonstration and free distribution of supplements.
The Deputy Officer-in-Charge (OIC) of Rayfield PHC, Mrs Martha Gusomji, said that the project has been very impactful especially in rural communities. Gusomji, who is the former OIC of Gindiri PHC in Mangu LGA, said that many women in rural areas are constrained by finances to have healthy meals and get supplements.
“This project is of great help to the communities particularly women because many of them experience economic hardship and do not use the supplements or eat nutritious meals, while some maybe because of ignorance.
“The main purpose of this programme is to encourage women to make use of their supplements which are given to them free and have nutritious meals which are needed to assist them in child bearing and breast feeding, “ she said.
Similarly, the OIC of PHC, Central Bukuru, Mrs Monica Akyok, said that the women are always excited to attend the weekly ANC sessions, and it has encouraged the enrolment of those that were not willing to register for the antenatal.
“It has encouraged mothers to come out because it is money that prevent some women from attending antenatal clinic, because you pay money to get few things from the clinic, but since ANRiN started its support, they get free drugs and enjoy meals; they have benefitted from it a lot.
“We also encourage them to eat food that can help them boost their immune system because they need more blood during delivery. Not every facility is implementing this project, I think they should extend it to more facilities,’’ she said.
More gains of ANRiN to community
Experts laud the project for encouraging the adoption of nutritious meals as a lifestyle, and also reaching its host communities through step down talks of its benefits by the pregnant women, to other family members and the community as a whole.
Gusomji says women now understand that they should start preparing for pregnancy right from child bearing age.
Stakeholders say review for more budgetary allocation on reproductive health in the state could be as a result of intervention projects such as ANRiN in the state.
Experts have called for more funding to sustain food demonstration in PHCs, as findings show that many OICs have to augment the paltry sum of the N5,000 monthly allocated to them for the food demonstration.
“Increased funding is needed as N5000 is not sufficient, management augment from their personal funds, “ says the Nutrition focal Officer in Jos South,
She says that the significance of food demonstration cannot be downplayed, as many pregnant women look forward to their ANC sessions where they can also gain knowledge while also enjoying healthy meals.
“Food demonstration is a big thing especially in rural areas. Pregnant women there travel long distances just to get to the clinics where these demonstrations are held to have healthy meals.
Hata also says many reports from the centres indicate that clinics who do not implement the project are abandoned leading to an influx of pregnant women at implementing centres whose officials often get overwhelmed because of the crowd.
Stakeholders have called for its expansion to more facilities especially in rural areas because of its gains. The State Nutrition Officer says the project which is being implemented in only 100 facilities in the state is not sufficient to cater for the needs of pregnant women.
Also, Gusomji says the inclusion of free birth kits to pregnant women in the project will encourage delivery in the facilities and address maternal and neonatal mortality.
“Some women do not see hospital delivery as necessity, they think if a woman can deliver at home, it is alright, but this situation comes with a lot of uncertainties and complications, “ she said.