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Addressing the Double Burden of Malnutrition in Nigeria

July 10th, 2019

The Double Burden of Malnutrition is a key issue in global health. Choices International, working with national health authorities and nutrition platforms, wants to know how this issue is perceived and addressed on a national level. To answer that question, Semnen Lambert, masters student in International Public Health at the Vrije University Amsterdam and coming from Nigeria, did her internship at Choices. Here is what she found.

While being a medical doctor coming from conventional medicine which focuses on disease treatment, I have always had an interest in preventive medicine. Even more so, now the current epidemiological transition with top 10 causes of death being Non-Communicable Diseases (NCDs) such as diabetes, heart diseases and cancers, calls for more emphasis to be put on prevention. I wrote my masters project on the Double Burden of Malnutrition (DBM) which includes the co-existence of overnutrition such as for overweight and obesity; undernutrition such as wasting, stunting and micro-deficiencies, and diet-related NCDs on an individual, community or population level. The DBM is increasingly becoming prevalent in especially low- and- middle- income countries (LMICs). Tackling this problem will be essential in achieving the Sustainable Development Goals (SDG) 2.2, to end malnutrition and all its forms by 2030. Therefore, the aim of my study was to give recommendations to the Choices International Foundation on their advisory work on tackling the DBM in Nigeria, which is my home country. My main research question was: How do international organizations influence the development of the DBM policies in Nigeria?

I did a policy analysis of international organizations including WHO, FAO, World Bank, WFP and Global Panel on Agriculture and Food systems on the DBM policies recommendations in comparison with the current food and nutrition policy in Nigeria. The result from the policy analysis showed that the international organizations all had an elaborate set of integrated policy recommendations on addressing the DBM. Furthermore,  it showed that some DBM policies recommended by international organizations for national policy-making were excluded in the food and nutrition policy in Nigeria. Consequently, I did a further exploration by interviewing stakeholders involved in the development of food and nutrition policies in Nigeria on policies excluded that are relevant to the Choices International Foundation. I interviewed ten stakeholders from different sectors: Government, Non-Governmental Organizations (NGOs), the scientific community and private sectors. Overall, the results of my study showed that the food and nutrition policy in Nigeria mostly had strategies towards addressing undernutrition and lacked specific strategies for overnutrition and diet-related NCDs. To tackle the DBM, undernutrition, overnutrition and diet-related NCDs all need to be addressed. As a result, there is a need for a comprehensive integrated strategy in Nigeria that addresses all these forms of malnutrition. However, many malnutrition problems are context specific which is indicated by the differences in translation of international policies into national policies. Hence, recommendations were given to the Choices International Foundation based on lessons learnt in this study as strategies to tackle the DBM in Nigeria. These recommendations are (1) Inclusion of specific strategies for preventing overnutrition and diet-related NCDs in the food and nutrition policy such as front of pack labelling, reformulation policy and marketing regulations. (2) Creating awareness on the importance of prioritizing the growing prevalence of the DBM in Nigeria, both the government and consumers should be educated using strategies such as social marketing campaigns, behavioural change programs and dietary diversification taking into account local foods. (3) The government should leverage on the SUN Business Network operating in Nigeria to increase the degree of involvement of food companies in the development and implementation of food and nutrition policy in Nigeria. (4) Increase of sustainable investment in nutrition activities, especially by the government with additional funding from the development partners and private sectors. (5) Improvement of multi-sectoral coordination for nutrition activities. (6) Strengthen the monitoring, regulation and evaluation systems for capacity building to facilitate the implementation of food and nutrition policies and regulations. (7) Improvement of data collection and frequency to enable the development of well-informed food and nutrition policies.

In conclusion, the main challenge in Nigeria is not the policies but the implementation of these policies, mainly due to inadequate funding. That said, International organizations should consider the cost implication of recommended DBM policies, especially in LMICs. This will ensure easier national adaptation of these recommended policies in low-income settings. Overall, improvement of nutrition is not only essential to achieving the SDG 2.2, elimination of malnutrition and all its forms. It plays an integral role in sustainable development, at least 12 of the 17 SDGs include indicators that are relevant to nutrition. Thus, it is important to reach global nutrition targets for global sustainable development.

Comment on this article

Comments on this article

Mondine Isaac - 11 07 2019

Weldone, I’m proud of you! Your conclusion is not bad, you’ve done a great work, I most attest to that but let me drawn your attention to this point. Sometimes it’s not the implementation is the major challenge, sometimes is the funds as you’ve mentioned earlier. Secondly the government need to fathom how important to implement such policies. Thirdly the government need to know what value/effects will the policies have to economic growth of the Nation

Wadzii - 11 07 2019

So informative! Well researched. Saw a problem and found a possible solution! Way to go !

John Giovanni - 11 07 2019

This research is a good one. It is about time Malnutrition getting the attention it deserves.

Stella fom - 11 07 2019

Nice one Dr Sem

Ayuk jefferson - 11 07 2019

I am immensely pleased with your work on DBM. Coming from Nigeria, in schools we were mostly taught of diseases that are due to under nutrition which is because the common Nigerian only thinks about under nutrition as a problem not over nutrition. I agree with your recommendation that making the masses aware of on the problem of not just under nutrition but also over nutrition would go a long way in solving the DBM. From my perspective, I think diet diversification should be prioritized as majority of the population on Nigeria are on carbohydrates based diet which we all know when consumed overly leads to metabolic and cardiovascular diseases

Stella fom - 11 07 2019

Nice one Dr Sem

Osakue Moses Osama - 11 07 2019

This is a beautiful and quite timely. With the increase in NCDs like cancer, diabetes, heart diseases etc in Nigeria and Africa by extension, it has become very important and as a matter of fact, an emergency for serious emphasis to be placed on nutrition. I strongly believe that if this recommendations are collectively adopted and implemented to the later, millions of lives would have been saved. I lost a loved one recently to one of the NCDs (which in most times are incurable). Preventive rather than curative measures should be strongly emphasized.

Mona Vasquez - 11 07 2019

Such an interesting topic! Thanks for shared it! It’s a great work to acknowledge the I mportance of key organizations/stakeholders such transnationals, NGOs, etc. and their role in policies to improve for example: nutrition.

Mafeng Danke - 12 07 2019

Wonderful research Dr Sem!!
I am highly impressed, Malnutrition needs to be tackled in Nigeria and the world at large.

Arc Ritgak Paul - 12 07 2019

the article supports one of the sustainable development goals, (SDG) which is one of the major issue that we face in Nigeria as a developing country, it’s a good research keep it up. success.

Daniel - 12 07 2019

Informative dear,  I feel implementation is the major challenge not fund

Benny Dung - 12 07 2019

Quite an impressive analysis… It was informative too, as it is interesting to know that part of the problem is overnutrition. However, it is rather unfortunate that implementation has been our greatest challenge in Nigeria. Beautiful policies may well exist, but the problem will then be the adequate implementation, without which we may not see any head way in curbing the problem.
We are however hopeful that with researches like this, we will surely make remarkable progress.

Sunday Agbo - 18 07 2019

Thanks shining a light on such an important topic which doesn’t get nearly the level of attention it deserves given its huge influence on our health, wellbeing and consequently, our economy.

Your snapshot article is really informative and I like that you’ve touched on all the major topics concerning DBM. Particularly the link with health, over nutrition (often overlooked), mechanism to resolve it and sustainability.

I do feel implementation is the key issue though. The lack of a desire and robust mechanism in politics to resolve this further adds to the cost of implementing it. Given that Nigeria does have the variety of nutrition, public awareness via implementation I feel can go a long way.

Awesome article Sem, I hope it plays key role in changing attitudes.

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