“I am married to a farmer, so I do not rest. We work, all day on the farm and walk long distances.
“I worry about a few things about my pregnancy now. The first is my health. And second is fulfilling everything that is needed for the baby.
“When food is served, I am happy if my family eats before me. If I am hungry, I keep it to myself, because I run the house,” said six-month pregnant Aisha from Kano State.
Like Aisha, many pregnant women in low-income countries, including Nigeria, are poorly fed and work under harsh weather conditions, which usually predispose them to anaemia. They believe in the primitive saying that “the woman can eat the leftovers. If there are no leftovers, she can survive that too.”
The World Health Organisation (WHO) Global Anaemia Report for 2021 shows that 29.9 per cent of women of child-bearing age (15 to 49) were anaemic in 2019, while 38.8 per cent of children aged 6 to 59 months suffered anaemia, with 60.2 per cent prevalence among children aged 6 to 59 months in the African region.
Anaemia remains a major public health concern, particularly, in sub-Saharan Africa (SSA), where it is one of the causes of maternal death. The most common cause of maternal anaemia is iron deficiency or malnutrition. According to the 2018 Nigerian Demographic Health Survey, the prevalence of anaemia was high among pregnant women. It was pegged at 61.8 per cent, with 62.6 per cent underweight women; whereas, the risk of anaemia was found to be 2 per cent less likely among women who took minimum adequate diet, compared to those who did not.
It has also been established by experts that inadequate nutrition can lead to critical health risks to the infant, such as low birth weight, pre-term delivery, being born small for gestational age. Poor nutrition can also lead to serious maternal health outcomes and even to the death of the mother or her baby.
Analysing the impacts of malnutrition on mothers and infants, UNICEF recently affirmed that poor diets and poor care services aggravate women’s risk of illness, death and poor pregnancy outcomes. The agency added that poor diets also put babies at risk of undernutrition in early childhood (including wasting, stunting and micronutrient deficiencies) with long-term negative consequences for school readiness, enrolment and learning performance
MMS as benchmark
Experts have emphasised the importance of micronutrients for pregnant women and infants, in order to curb the incidence of malnutrition and iron folic acid (IFA) deficiency. Accordingly, due to the increased need for various vitamins and minerals during pregnancy, WHO has stated that IFA formulations may also include other vitamins and minerals in Multiple Micronutrients Supplements (MMS). This has since established MMS as the gold standard for micronutrient supplements, although compliance rate is still very low.
Multiple Micronutrient Supplement (MMS) is a formulation of multivitamins designed to help pregnant women to enjoy better nutrition that will benefit them and their babies. Micronutrients, often referred to as vitamins and minerals, are vital to healthy development, disease prevention, and wellbeing, especially of pregnant women and their babies. According to WHO, there is evidence suggesting that, with MMS, there may be a decreased risk of low birth weight and small-for-gestational-age in comparison to IFA supplementation alone.
Also, in an exclusive chat with a Consultant Public Health Physician, Dr Francis Ohanyido, he rated the benefits of MMS over IFA. According to him, beyond the fact that MMS contains 15 micronutrients in comparison to the mere two in IFA, evidence-based findings have shown that it can adequately nourish pregnant women and drastically reduce mortality from postpartum haemorrhage. Essentially, it sufficiently beefs up women’s nutritional needs in pregnancy.
Ohanyido mentioned some of the advantages of MMS over IFA to include reduction of stillbirth and reduction of small for gestational age, as well as other advantages for the child in terms of good health, for the first 1000 days of life.
According to him, “MMS helps reduce the issues around infection because if the mother is doing well, it also passes to the child, in terms of quality outcomes of the child. MMS also helps give supplementation in terms of the nutrient level for the mother that has gone through pregnancy.
“It has been observed that a lot of women going through pregnancy in Nigeria, especially in sub-communities, are malnourished. So it’s very important that we introduce MMS and pull it out in a way that is accessible to pregnant woman in any community in Nigeria.”
Ohanyido, who is also the country director of Vitamin Angels, an NGO involved in micronutrients advocacy, in partnership with states and federal governments, emphasised the need for government to prioritise the health of its citizens by investing in the procurement of MMS. He noted that MMS has been proven to have better outcomes on maternal and infants health, particularly decreasing mortality rate, compared to the existing IFA in most antenatal and post natal facilities.
He also commended the Federal Ministry of Health for launching the MMS policy in 2021, along with that of the micronutrient powder. He, however, lamented the slow implementation of the policy, which he described as hanging between the decision of stakeholders and government.
Ohanyido said, “The first part of the intervention is that there is a policy; now, what is left is for stakeholders and government to begin to chart a common course in terms of making sure the MMS is available. MMS will gradually replace IFA, but the speed will be dependent on how much government is willing, how much partners are willing to put into that to make sure that it’s accessible to pregnant women in Nigeria. It’s something that is a no-brainer; that is the direction we should be going – although we are not saying ‘stop giving IFA’ because it is a lifesaver.”
Expressing optimism over the timely and gradual implementation of MMS in Nigeria, Ohanyido remarked that countries like Indonesia and Haiti are already enjoying the dividends of the intervention. He urged stakeholders and governments to urgently tap into the invaluable resources of MMS for the huge health benefits it promises for the populace. He also noted that its production cost is at parity with IFA, stressing that the nation will procure at a larger scale, which makes it an economical intervention,
“Transition from IFA to MMS shouldn’t be something that we should break sweat over, because it’s something that can be done. I know that resources are lean, but I think, as a country, we need to prioritise where we put our money. The lives of women and children should be top priority. And if we’re going to achieve the demographic dividend, it is those places we should be putting the money because those are the future of the country.
“Our primary healthcare, for example, is almost comatose. Our health system is making people pay everything from out of pocket. If anybody is challenged health-wise, most Nigerians use money from their pockets and if the money they are asking is so high, the only thing left is for the person to go and die. This shows why most Nigerians are looking for solutions because they know they cannot afford hospital bills”, he said.