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…as expert advocates wider MMS provision nationwide
Folic acid, the synthetic form of folate, which is a naturally occurring B vitamin is well known particularly among pregnant women and those planning to conceive. Based on its benefits, manufacturers add it to supplements and fortified foods because it helps produce red blood cells, among other benefits. Folic acid may reduce the risk of preterm birth; it is also important for a range of functions in the body: it helps the body make healthy new red blood cells, for example. Red blood cells carry oxygen throughout the body. If the body does not make enough of these, a person can develop anaemia, leading to fatigue, weakness, and a pale complexion. Without enough folate, a person can also develop a type of anemia called folate deficiency anemia. Consequently, getting enough folate during pregnancy is particularly important because folic acid is crucial for early fetal development, particularly with regard to the spinal cord and because of its importance for health, the United States (U.S.) Food and Drug Administration (FDA) requires manufacturers to add folic acid to enriched bread, pasta, rice, cereals, and other grain products in the U.S. Despite the huge benefits arising from folic acid, more than 20 years of research have provided clear evidence that the benefits of multiple micronutrient supplements (MMS), another micronutrient intervention far surpass the advantages of folic acid. MMS is an antenatal supplement for pregnant women that is proven to enhance maternal nutrition status and, in comparison with iron-folic acid (IFA), further reduces the risk of adverse birth outcomes such as preterm birth, stillbirth, low birth weight, and small for gestational age. Based on the several advantages of MMS, experts in the health sector have admitted that its wider use will benefit Nigerians. Governments at all le should support the implementation of the policy for MMS to be made available nationwide, said Dr. Francis Ohanyindo, a medical expert and Country Director of Vitamins Angel Nigeria, which is the company advocating the introduction of MMS in the country. Vitamin Angels is a public health nonprofit working to address malnutrition by improving maternal & child nutrition in underserved communities worldwide. Vitamins Angel works in various Third World countries to bring the needed nutrition to mothers who may not be able to get access to it easily. The organisation is currently working on making the Nigerian government to recognise the need to add MMS to the nutrients given to pregnant mothers alongside folic acid. Ohanyindo made the call at a recent workshop aimed at sensitizing Nigerian citizens about the importance of getting the necessary nutrients needed by pregnant women which would not only help to improve the health of the mother but also that of the baby. The country director of Vitamin Angels Nigeria stressed that the importance of nutrition in the first 1,000 days of the baby’s life could not be over-emphasised, hence the need for mothers to be able to access the needed nutrients at Primary Health Care (PHC) centres which is the closest health facility to them.
Benefit of MMS
MMS contains a combination of 15 vitamins and minerals, including vitamins A and D, as well as iron and folic acid, or IFA, which are key to strong health for mother and child. The most common prenatal micronutrient supplement was devised by the United Nations and is known as UNIMMAP MMS.
The advocacy to make MMS more widely available has become necessary considering the rise in cases of malnutrition in Nigeria. Available data shows that only 38 per cent of women receive 90+ iron folic acid (IFA) tablets during their pregnancy.
Similarly, only 59 per cent of pregnant women attend four antenatal care (ANC) visits. To address this challenge with a view to boost the number of pregnant women getting folic acid since 2016, World Health Organisation (WHO) recommends eight antenatal clinic (ANC) contacts, which may further close the gap. In addition, the WHO estimated that approximately 300 million children globally had anaemia in 2011. Of this number, children in Africa aged six to 59 months have the highest burden of anaemia, estimated at approximately 62 per cent.” According to Ohanyido, “Children in Nigeria are not spared from the high incidence and prevalence of deficiencies of multiple micronutrients especially during the period of complementary feeding when breastfeeding alone can no longer sustain their nutritional needs.
“In population groups where the prevalence of anaemia among women of reproductive age is above 20 per cent, and mass fortification programmes of staple foods with iron and folic acid are not in place, we need to look at other options of providing the women with the much needed supplements.” “Malnourished women with severe anaemia are twice as likely to die during or shortly after childbirth.” a presentation at the workshop highlighted.
Micronutrients deficiencies
There are various micronutrients deficiency in the country ranging from iron deficiency, folate deficiency, iodine deficiency, vitamin A deficiency to zinc deficiency, amongst others.
Vitamin Angels Nigeria
The Vitamin Angels Nigeria strives to provide a common framework for the coordination of the implementation of the national micronutrient deficiency prevention and control programmes in Nigeria. It also aims to provide directions on effective interventions for Micronutrient Deficiency Control (MNDC) to stakeholders at all levels and promote ef fect ive implement a -tion and delivery of evidence-based and effective micronutrient interventions. In an effort to increase the flow of MMS to be parallel to that of folic acid in the country, Vitamin Angels Nigeria has outlined the consequences of short supply of supplements and the need for it to be mass produced so as to get it to women who need it. “We work directly with local and national organisations, including governments, to reach the most underserved, nutritionally vulnerable populations – pregnant women, infants, and young children – with evidence-based nutrition interventions and technical assistance.” The presentation also outlined some of the consequences of micronutrient deficiency on the child of the mother that did not have access to the necessary nutrients during pregnancy. “Inadequate nutrition can lead to critical health risks to the infant, such as: low birth weight, preterm delivery, being born small for gestational age, amongst other health conditions. Poor nutrition can also lead to serious maternal health outcomes and even to the death of the mother or her baby.” Furthermore, “Micronutrient deficiencies can have lifelong impacts on a child’s physical, mental, and emotional development.”
Impact of Covid-19 on malnutrition
The country director of Vitamin Angels also spoke about the impact COVID-19 had in increasing the rates of malnutrition in mothers and children. It even predicted that it would continue to be on the rise for the next three years if decisive steps are not taken to provide the necessary supplements. “Some women have to suffer the effects of malnutrition during pregnancy for the rest of their lives. They include those that suffer from conditions such as short stature, impaired cognitive development, anaemia and other micronutrient deficiencies, fatigue, impaired wellbeing and impaired productivity in school performance.”
Neglect of womens’ health
Vitamin Angels also blamed the lack of the MMS in the country as a product on the fact that women’s health is not seen as an issue that should be given priority. “Women have to suffer poor services when they go to healthcare facilities. Women often lack available, accessible, and affordable health services and interventions to properly care for their health.” “Policies, guidelines, and programmes regarding women’s nutrition programmes are low priority and lack funding. Women eat last and least in terms of nutritious foods, good quality food is unaffordable to them.”
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