At 17 months, Abdul Mugiz weighed 5.0kg with a Mid Upper Arm Circumference of 10.5cm. Abdul Mugiz was not just underweight, he was acutely malnourished.
Mugiz’s condition was so severe that the community labeled him a “spirit child,” a term in some parts of Ghana that entails deep misconceptions about health and illness. Spirit children are believed to be evil and not fit to live in society. They are usually ostracised from their communities or killed and buried in secrecy.
“The baby and I were stigmatized. I feared for my baby’s life. I started locking him up in the room whenever I had an errand to run,” revealed Abdul Mugiz’s mother, Salimu Sumani.
Mugiz’s fate changed one day, when he was accidentally discovered by community health nurses at the Karaga Health Centre, who were on a routine medical outreach programme.
The plight of Abdul Mugiz highlights a broader crisis in the Karaga District, where child malnutrition has become a pervasive issue.
At the Karaga Hospital, two-year-old Rauf Abukari, was on admission. He looked distressed and had swollen feet.
Medical personnel at the facility disclosed that Abdul Rauf was suffering from bilateral pitting edema also known as kwashiorkor, a severe acute form of malnutrition. Pitting edema is caused by excess fluid build-up in the body. The condition causes swelling; when pressure is applied to the swollen area, a “pit”, or indentation, will remain.
Although it can affect any part of the body, pitting edema usually occurs in legs, feet, and ankles.
“We see these cases often, especially during the harvesting season when caregivers leave children under the care of their siblings,” explained Ayese Aganeyeriba, a dietician at the Karaga District Hospital.
According to health personnel at the Karaga Health Center, there is an increase in the number of malnutrition cases reported at the facility.
“In the last two years alone, we recorded two hundred and forty cases of stunting in this facility (Karaga Health Center), out of which we have successfully treated and discharged one hundred and forty one cases. We have more than 90 active cases, but almost all of them are out patients,” said Nakoja Banyala, a Senior Public Health Officer at the Karaga Health Center.
The situation in Karaga is a reflection of the state of affairs in the Northern region, where malnutrition remains higher than the national average.
According to the Ghana Demographic Health Survey 2022, the national average figure for stunting is 17.5 percent, but in the Northern Region, the figure stands at 29.6. Moreover, 14 percent of children in the Northern Region are underweight, up from the national average of 12.3 percent. In terms of wasting, the national average figure stands at 6 percent, while the Northern Region averages 7.8 percent.
Despite these numbers, stakeholders say, the situation has improved significantly over the last decade. They attribute the high number of cases reported at facilities in the district to increased public awareness about the phenomenon of malnutrition.
“We used to record malnutrition-related infant deaths, but no child has died of malnutrition in this area in the last three years,” a Senior Public Health Officer at the Karaga Health Center, Nakoja Banyala explained. Additionally, as a result of intense public awareness and medical outreach, more cases are identified and treated.
The 2020 Comprehensive Food Security and Vulnerability Analysis (CFSVA) survey, conducted by the Ghana Statistical Service (GSS), puts Karaga District as the second highest food insecure District in Ghana, with 75.9 percent of the population classified as food insecure.
“This (food insecurity) makes Karaga more vulnerable to malnutrition,” explained Porbilla Ofosu-Apea, Health and Nutrition Officer at the UNICEF field office in Tamale.
UNICEF, in collaboration with the Ghana Health Service and the World Food Programme, have initiated several programmes to address the root causes of the issue and to treat malnourished children. These include public health awareness campaigns, organising food exhibitions, capacity building for health personnel and the provision of Therapeutic Food also known as plumpy nuts
.
The Northern Regional Director of Health, Dr. said, sensitization remains a key feature in the campaign addressing the canker of malnutrition in the Northern Region, especially Karaga. The goal of this initiative, he explained, is to address long-held myths around child nutrition. The campaign also seeks to encourage households to leverage on locally available food to prepare nutritious meals or what health officials call “four star meals” for children. A four star diet in Ghana refers to a balanced meal of staples, legumes, fruits and vegetables, and animal protein.
Since 2010, UNICEF, the World Food Programme (WFP), the Ghana Health Service and other partners, have implemented the Community Based Management of Acute Malnutrition (CMAM) project in Karaga. With funding from the French government, the CMAM initiative was not only designed to treat malnutrition but also to empower families with knowledge about proper nutrition, feeding practices, and the importance of a balanced diet.
Through workshops and outreach programs, health workers engage with mothers and caregivers, equipping them with the tools they need to combat malnutrition within their households. Part of the CMAM initiative entailed capacity building for health personnel in the target communities.
Mugis and Abdul Rauf are currently on a Ready to Use Therapeutic Food (RUTF) otherwise known as Plumpy’Nut. After a few weeks on the plumpy nut, Mugis, who was labeled a spirit child due to his malnourished body, now weighs 7.8Kg and has a MUAC of 12.5cm. Abdul Rauf is expected to recover fully, thanks to the same treatment regime.
Despite this glimmer of hope for children in Karaga there is the need for more efforts to address lingering gaps and find sustainable ways of ending malnutrition. Ghana, having signed onto the United Nations Sustainable Development Goals, is mandated to commit more resources towards attaining SDG 2.2, which seeks to end all forms of malnutrition, including achieving targets on stunting and wasting in children under 5 years of age by 2030.
Untreated malnutrition could cause significant and permanent physical and mental damage in children, potentially leaving them with lifelong disabilities. Prioritising the treatment of malnutrition is therefore as important as every effort that aims to ensure the socioeconomic development of the country.