Will a supplement pill help protect Nigerian women and children from anemia during pregnancy?

“I am five months pregnant and I can tell you that I sometimes struggle with a balanced diet. It does not occur to me to add fruits and vegetables to my diet as prices of local foodstuffs have skyrocketed in recent times,” said 34-year-old Ashia Yusuf from Lagos. VaccinesWork.

To tackle the risks of anemia in pregnant women and children under five, Nelson called for the rollout of Multiple Micronutrient Supplement (MMS), a small pill containing 15 vitamins and minerals.

The latest report from the Nigerian National Bureau of Statistics (NBS) shows that food inflation in the country rose to 40.01% as of March 2024, again up from 37.92% in February 2024. According to the NBS’s year-on-year rise in food inflation was driven by a rise in prices of items like garri, millet, bread, yam tuber, dried fish, sardine, palm oil, vegetable oil, beef, coconut, watermelon and others.

In January 2024, NBS showed that the average price of 1 kg of local rice was 1,021.79 naira (approximately US$0.75), almost double the January 2023 price of 514.83 naira (US$0.37) . The price of boneless beef rose by 37% in the same period, while loose kidney beans became 64% more expensive. Meanwhile, the World Bank reports that an estimated 87 million Nigerians – almost 40% – live below the poverty line.

Ashia Yusuf is one of them. “The nurses at Ifako General Hospital in Lagos, Nigeria always advise me to eat a balanced diet and include fruits and vegetables in my diet so that my body gets the nutrients it needs for both myself and my unborn child. But due to the current state of the economy, I cannot afford them as my family and I are now struggling to eat twice a day,” she said.

Risk of anemia

Pregnancy significantly increases the calories and micronutrients a woman’s body needs, explains Dr. Francis Ohanyido, a physician and consultant with the nonprofit Vitamin Angels in Nigeria.

Ohanyido fears that the number of cases of anemia and other diseases linked to deficiencies among pregnant women could rise due to food inflation, as women like Yusuf find it more difficult to access dietary sources of key micronutrients such as vitamins A, C, D, E and B1 (thiamine), B2 (riboflavin), B3 (niacin), B6, B12 and folic acid, and minerals such as iron, zinc, iodine, copper and selenium.

Inadequate nutrition can lead to anemia in mothers, confirmed Chito Nelson, former head of the Food and Nutrition Department of the Federal Ministry of Budget and Economic Planning, during a February event on multiple micronutrient supplementation (MMS), organized by Civil Society- Scaling. Up Nutrition in Nigeria (CS-SUNN) in Abuja.

Anemia can cause increased morbidity and fetal mortality, as well as preterm labor, intrauterine growth retardation, congenital malformations and reduced immunocompetence, Nelson said.

Pregnant women, meanwhile, may experience breathing difficulties, fainting, fatigue, heart palpitations and sleep problems, and are at increased risk of developing perinatal infections, preeclampsia, complications during labor and even death and cognitive impairment after delivery.

MMS, a catch-up pill

To tackle the risks of anemia in pregnant women and children under five, Nelson called for the rollout of Multiple Micronutrient Supplement (MMS), a small pill containing 15 vitamins and minerals. “MMS has 20 years of research [behind it]providing clear evidence that it is safe and more effective than IFAs at preventing adverse birth outcomes,” said Nelson.

IFAs stands for iron and folic acid supplements, which are routinely given to pregnant women in Nigeria. But Nelson points out that the 2018 Nigeria Demographic and Health Survey (NDHS) found that 58% of women of childbearing age and 68% of children under the age of five had anemia, pointing to shortcomings in that approach.

To address this, the Nigerian government in January 2021 approved MMS as a safe and cost-effective way to meet micronutrient needs for women during pregnancy. The Federal Ministry of Health has approved the nationwide rollout of MMS in its updated National Guidelines for the Prevention and Control of Micronutrient Deficiencies in Nigeria.

Nutrition and immunity

Nutritional deficiencies can pose several health risks, including making the body much more vulnerable to infectious diseases. In fact, malnutrition contributes to an estimated 45% of deaths among children under five in lower-income countries, with most of these deaths due to disease.

Where malnutrition is widespread, the same disease can cause far greater damage than elsewhere. For example, measles is expected to kill about 1 in 1,000 unvaccinated but otherwise healthy children. However, in deprived settings, mortality rates of 15% have been recorded due to the virus.

This means that providing both vaccinations and nutritional supplements is especially important in difficult economic conditions. A review article released last year by Gavi and the Eleanor Crook Foundation examined the potential for integrated delivery of both life-saving interventions.

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Costs of the transition

Seven states in Nigeria have adopted these guidelines at the national level and committed to transition from IFAS to MMS, said Yadika Charles, nutrition officer at UNICEF. VaccinesWork.

“Plateau, Kwara, Katsina, Jigawa, Gombe, Adamawa and Borno states have committed to roll out MMS. Four states have released six hundred million naira as part of the Match Child Nutrition Fund,” he disclosed.

It will cost Nigeria $26.5 million to procure enough MMS to effectively tackle anemia in pregnant women and children under five, Charles said. “To be realistic, we aim for 60% of pregnant women in Nigeria to have access to MMS within three years.”

In any case, the switch may come too late for Ashia Yusuf, she said in Lagos VaccinesWork that she had never heard of MMS. “It would be great if the Lagos State Government would consider switching to MMS,” she said, freshly caught up. “Most pregnant women [I know] also have difficulty eating healthy.”

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