The challenges of pregnancy, birth and mothering could be frustrating for the average woman particularly if she is living in Low- and Middle-Income Countries (LMICs), like Nigeria.

One of such challenges is the risk of being deficient in multiple, critical micronutrients like Vitamins A, C, D, E, B1 (thiamine), B2 (riboflavin), B3 (niacin), B6, B12, folic acid and Minerals: iron, zinc, iodine, copper, and selenium.

The World Health Organization (WHO) revealed that micronutrient deficiencies can cause several serious health issues; a lack of iron, folate and vitamins B12 and A, for instance, can lead to anaemia, a condition in which there is a reduced number of red blood cells or haemoglobin concentration, causing fatigue, weakness, shortage of breath and dizziness.

Inadequate nutrition can lead to serious maternal health outcomes and even to the death of the mother and her baby, the country director, Vitamin Angels, Nigeria, Dr Francis Ohanyido told LEADERSHIP, adding that globally, many women lack access to nutritious diets, quality health and nutrition services.

Ohanyido stated that 170 million women, representing one in 10 women of reproductive age are underweight and 570 million women, representing one in three women of reproductive age are anemic; Worst still, only 38 per cent of women receive more than 90 Iron Folic Acid (IFA) tablets during their pregnancy.

“The implication of this, is that malnourished women with severe anemia are two times likely to die during or shortly after childbirth, and if the baby survives, can have lifelong impacts on the baby’s physical, mental, and emotional development.



“A malnourished pregnant woman could suffer from impaired cognitive development, anemia and other micronutrient deficiencies, fatigue and impaired well-being, impaired productivity, ostructed/prolonged labour, eclampsia and pre-eclampsia and maternal mortality.

“The consequences for infants and children are low birthweight, small-for-gestational age, pre-term birth, stillbirth, spina bifida, congenital defects, child mortality and morbidity, poor post-natal physical and cognitive growth and development,” the country director stated.

The Nigerian situation

Implementation research consultant, Vitamin Angels, Nigeria, Dr. Yinka Obanewa said WHO estimated that approximately 300 million children globally had anemia in 2011; of this number, children in Africa aged six to 59 months have the highest burden of anemia, estimated at approximately 62 per cent.

Obanewa stated that 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. They are often fed with poor and inadequate complementary foods at this time, he added.

Putting a figure to it, the United Nations Children’s Fund (UNICEF) stated that Nigeria has the second highest burden of stunted children in the world, with a National prevalence rate of 32 per cent of children under five. An estimated two million children in Nigeria suffer from severe acute malnutrition (SAM), but only two out of every 10 children affected is currently reached with treatment, the organisation stated, while disclosing that seven per cent of women of childbearing age also suffer from acute malnutrition.

“We are at that point in Nigeria where it is important that nutrition becomes at the front burner of national discussions, Ohanyido stated, adding that one sure way the country can tackle malnutrition during pregnancy is through the National roll out of Multiple Micronutrient Supplement (MMS).

MMS: a silver bullet

Ohanyido said several studies have showed that whatever a pregnant woman takes for the first 1000 days of life, (that is from conception to two years of a child), had an impact on the child’s health, hence the need for pregnant women to take in adequate nutrition.

While nutrition is crucial to the health of pregnant women and their babies, the country director disclosed that it is sad to know that a lot of pregnant women in Nigeria are poor and could not afford to eat adequate food. To help this set of women, Ohanyido stated that Nigeria should embark on a national roll out of the Multiple Micronutrient Supplement (MMS).

MMS is a formulation of multi vitamin for pregnant women as identified by the United Nations that should help pregnant women to have a better value in terms of nutrition for themselves and their children.

Ohanyido, at a 2-day Media Engagement and Capacity Building Workshop on Multiple Micronutrient Supplement in Pregnancy, said several studies have showed that MMS has significant benefits compared to Iron and Folic Acid (IFA), as it contains 15 micronutrients, including IFA.

He stated that before 2020, global policy guidance recommended use of IFA, adding that with the introduction of MMS, several studies support switching from IFA to MMS, especially for women with poor diets.

“The reason for that is because MMS contains 15 essential vitamins and minerals for pregnant and nursing women and meets micronutrient requirements that poor diets cannot meet. It contains vitamin A, vitamin D, vitamin E, Vitamin C, Thiamin, Riboflavin, Niacin, Vitamin B6, Folic Acid, Vitamin B12, copper, Iodine, Iron, Selenium and Zinc, which help to improve maternal nutrition and reduce the risk of adverse birth outcomes.





“In fact, MMS provides even greater benefit for anemic women and underweight women compared to IFA. Findings of a study carried out to assess the effects of MMS compared with IFA in Indonesia showed that early infant mortality of babies whose mothers are undernourished was reduced by 25 per cent with MMS. Even greater results for babies of anemic women, with reduction of infant mortality by 38 per cent and risk of Low Birth Weight (LBW) decreased by 33 per cent with MMS.

“Additionally, it reduces the risk of female infant mortality in the first six months by 15 per cent. More so, it is cost effective and safe,” he revealed.

He disclosed that transitioning from IFA to MMS can avert between seven to 28 million additional infant deaths and disabilities across 132 LMICs, adding that scaling up MMS to 90 per cent coverage is projected to contribute to huge human capital gains for all babies born per year across 132 LMICs.

The country director revealed that the Nigerian government, in January 2021, approved MMS and micronutrient powder in the Micronutrient Deficiency Control Guideline, which is a policy document that regulate supplements given to women and children.

However, it is not yet operational, Ohanyido said, while calling on critical stakeholders, including the media to advocate for the rollout of MMS in the country, to avert maternal and child mortality in Nigeria.

The country director also advocated that MMS should be included in a package of antenatal maternal nutrition interventions, adding that, “Iron and Folic Acid given at primary healthcare level are free. We are advocating that government should replace them with MMS which contains 15 micronutrients. The price differential between MMS and IFA is not much, it is cost effective, so the transition from IFA supplementation to MMS should be something that we should not break sweat about. It is something that can be done, if there is political will.”

While government resources may be lean, Ohanyido averred that the lives of women and children should be their top priority and if the country is going to achieve its demographic dividend, then the future of the country, must be preserved.

“Our social sector has suffered; our primary healthcare for example is almost comatose; most Nigerians are paying everything out-of-pocket. We need a comprehensive health package of care for Nigerians that are covered by health insurance, so that the average Nigerians should be able to get quality healthcare services and pregnant women should be able to get MMS and other things to enough them go through pregnancy and come out successfully,” he explained.



https://leadership.ng/adopting-mms-to-reverse-maternal-child-mortality-in-nigeria/