Hyper Prevalence of Malnutrition in Nigerian Context

Health Organization, 462 million adults are underweight, while 1.9 billion adults are overweight and obese. In children under 5 years of age, 155 million are stunted, 52 million are wasted, 17 million are severely wasted and 41 million are obese. Globally, there is hunger and malnutrition ravaging the world with a current estimated value of 1 in 9 people out of the 820 million people who are hungry or malnourished. Thus, the study found that Nigeria is one of the African countries listed among the 20 countries responsible for 80% of global malnutrition. The finding of the study also revealed that over the years, two main types of malnutrition have been identified in Nigerian children: protein-energy malnutrition and micronutrient malnutrition. The study discovered that the causes of malnutrition and food insecurity in Nigeria are multidimensional and include very poor infant and young child breastfeeding or feeding practices, which contribute to high rates of illness and poor nutrition among children under 2 years. The study discovered that young children with protein energy malnutrition suffer from brain atrophy; a shrinking of brain cells due to a lack of nutrients. The findings of the study revealed that stunted children earn as much as 20% less than their counterparts, and that today’s malnutrition could potentially cost the global economy $125 billion. The study concludes that nutrition is not only significant for increasing economic outcomes of individuals; it is important for nations’ economic development, especially for a developing country like Nigeria. Based on the findings, the study recommends that the National Health and Nutrition Survey (HANS), and the Federal Ministry of Health should liaise to produce foods that are rich in nutritive contents.


Introduction
Diet is the number one risk factor for disease in the world; carrying a superior risk of ill health than smoking or drinking alcohol Mills, et al. [1]. According to the World Health Organization of nutrition for growth, development and advancement is globally recognized, universal efforts in battling hunger and malnutrition have not really been achieved on a global scale [3,4]. Globally, there is hunger and malnutrition ravaging the world with a current estimated value of 1 in 9 people out of the 820 million people who are hungry or undernourished. A study conducted by [4] states that there has been a perpetual increase in these figures since 2015, especially in Africa, West Asia and Latin America. Similarly, approximately 113 million people across 53 countries experience acute hunger, as a result of conflict and food insecurity, climate shocks and economic instability [5]. However, more than onethird of the world's adult population is overweight or obese, with growing trends over the past twenty years Ng, et al. [6]. it. [7] emphasises that countries affected by conflict or other forms of fragility are at a higher risk for malnutrition. Moreover, it further illustrates that in 2016, 1.8 billion people (24% of the world's population) were living in fragile or extremely delicate countries.
This digit is projected to grow to 2.3 billion people by 2030 and 3.3 billion by 2050. International Food Policy Research Institute, [8] notes that the prevalence of stunting or restricted growth among children under five years reduced to 23.8% from 36.9% between 1990 and 2015. Nonetheless, the Food and Agricultural Organization of the United Nations [9] indicated that in 2017, the number of undernourished people increased from 777 million to 815 million between 2015 and in 2016, about 155 million children below the age of 5 were too short for their age. Furthermore, approximately 52 million did not weigh enough for their height while about 41 million was overweight. Previous researches like Black, et al. [8,10], and [11] indicated that malnutrition is connected to nearly half of all deaths among children under the age of five.
On the contrary, more than 28 million adults and children in the United Kingdom (UK) are overweight or obese, which is catalysing a diet related health problem with escalating rates of noncommunicable diseases, including type 2 diabetes, cardiovascular disease and certain forms of cancer [12]. The treatment of obesity and its consequences in England alone currently costs the NHS £16 billion every year, the majority of which is spent on type 2 diabetes, [13]. This is more than the £13. 6 billion per year spent on the fire and police services combined. The wider economic toll of obesity and related conditions is estimated to be the equivalent of 3% of the GDP Dobbs, et al. [14].

Literature Review
A report by the Food and Agriculture Organization of the United Nations [16] indicates that more than 14% of the population in developing countries were undernourished in the period between 2011 and 2013. Malnutrition includes both nutrient deficiencies and excesses and is defined by the World Food Programme (WFP) as "a state in which the physical function of an individual is diminished or weakened to the point where the person can no longer maintain normal or adequate bodily performance processes such as growth, pregnancy, lactation, physical work, and resistance to and recovering from disease" [17]. Additionally, [18] states that malnutrition frequently begins at conception, and child malnutrition is connected to poverty, low levels of education, and poor access to health services, including reproductive health and family planning.
Furthermore, the World Health Organization, [2] states that malnutrition occurs due to an imbalance in the body, whereby the nutrients required by the body and the amount used by the body do not balance. Additionally, it stipulated that there are several forms of malnutrition and these include two broad categories namely under nutrition and over nutrition. Under nutrition manifests as wasting or low weight for height (acute malnutrition), stunting or low height for age (chronic malnutrition), underweight or low weight for age, and mineral and vitamin deficiencies or excessiveness.
While over nutrition includes overweight, obesity and dietrelated non-communicable diseases (NCDs) such as diabetes mellitus, heart disease, some forms of cancer and stroke.
In the 21 st century, malnutrition in children has three main strands. The first is the continuing plague of undernutrition.
Despite its reduction in many parts of the world, undernutrition is still depriving many children of the energy and nutrients they need to grow well and is connected to the deaths of children from 6 months to under 5 of age each year [19]. The second strand is hidden hunger. This is as a result of the deficiencies in essential vitamins and minerals such as vitamins A and B, iron and zinc. It is often unseen, and often ignored; hidden hunger robs children of their health and vitality and even their lives. The third strand is overweight, which is also called obesity in its more severe form.
It was formally regarded as a condition of the rich, overweight now afflicts more and more children, even in underdeveloped and developing countries. It is has also been considered as a threat to stimulating a rise in diet-related noncommunicable diseases (NCDs) later in life; such as heart disease, which is the leading cause of death worldwide [20]. The smallest or least advantaged are the most likely to suffer from malnutrition and its longstanding consequences. A research report by Hancock, et al. [22] states that the most deprived white children measured across England in 2012-2013 were on average more than a centimetre shorter in height by the age of 10 years than the least deprived children. These children are not likely to catch up growth losses from their early years. Obese children in England are more than twice as likely to live in the most deprived areas compared with comfortable areas and this gap is increasing over time [23]. Poor children are also more likely than wealthy children

Perspectives on Malnutrition in Nigeria
Over the years, two main types of malnutrition have been identified in Nigerian children: (1) protein-energy malnutrition and (2) micronutrient malnutrition. The protein-energy malnutrition is common among the preschool children and constitutes a major public health problem in the country. "Stunting" is usually defined as low height for age, however, it is a deficit of linear growth and failure to reach genetic potential that reflects long term and cumulative effects of inadequate dietary intake and poor health conditions [25]. Succinctly, underweight is low weight for age, stunting (low height for age) and wasting (low weight for height) are all manifestations of under nutrition. All these expose the child to health risks and in their severe forms; they constitute a threat to the child's survival [26]. wasting, 24% underweight, and 42% of children stunted [27]. As at 2008, prevalence of underweight had declined to 23% and stunting had reduced to 41% but wasting increased to 14% (NDHS, 2008).

Similar trends were reported by the 2001-2003 Nigerian Food
Consumption and Nutrition Survey (NFCNS). The study reported 9% wasting, 25% underweight, and 42% stunting, with significant variations across rural and urban areas, geopolitical zones, and agro-ecological zones Maziya-Dixon, et al. [28]. The study also shows that the prevalence of stunting was lowest in the southeast at 16%; it reached 18% in the south and 55% in the northwest of Nigeria. The result further shows that among the states, stunting was highest among children in Kebbi (61%). The 2003 report of NDHS also indicates that among the rural children (43% stunted) were disadvantaged compared to urban children (29% stunted).
Children living in the Northwest geopolitical zone stood out as being particularly underprivileged at 55% compared to 43 % in the Northeast zone, 31% in North Central, 25% in the Southwest, 21% in the South-South, and 20 % in the Southeast. The Multiple Indicator Cluster Survey (MICS), reported that there was a decrease in the prevalence of malnutrition in Nigeria with 34 % of children under five stunted, 31 % underweight, and 16% wasted, while about 15% of children had low birth (at less than 2,500 grams at birth) [29].
It is obvious from the 2013 NDHS that the proportion of children who are stunted has been decreasing over the years. However, the degree of wasting has worsened, indicating a more recent nutritional deficiency among children in the country. Prevalence of stunting decreased to 37%, with a higher concentration among rural children (43%) than urban (26%). Nevertheless, there has been an increase in the proportion of children underweight (29 %) and the proportion wasting (18%) [30]. It is graphically clear based on the data from these different studies that, malnutrition of children under five has been a consistent problem in Nigeria over time, with just little improvement reported despite its escalation in the country. Malnutrition contributed to 53% of deaths among children under five in Nigeria, and levels of wasting and stunting are still very high [31].

Empirical Review
Malnutrition is a global public health problem in both children and adults universally [2]. Annually, malnutrition claims the lives of 3 million children under age five and costs the global economy billions of dollars in lost productivity and health care costs. However those losses are almost entirely preventable. A large body of scientific evidence like [32][33][34] show that improving nutrition during the critical 1,000 day period from a woman's pregnancy to her child's second birthday has the potential to save lives, help millions of children to fully develop and deliver greater economic prosperity. Furthermore, Shrimpton, et al. [35] stated that malnutrition is currently an important global problem; as it affects all people despite the geography, socioeconomic status, sex and gender, overlapping households, communities and countries.
In addition, anyone can experience malnutrition but the most susceptible groups affected are children, adolescents, women, as well as people who are immunecompromised, or facing the challenges of poverty.
Young malnourished children are affected by compromised immune systems by yielding to infectious diseases and are prone to cognitive development delays; damaging long term psychological and intellectual development effects, as well as mental and physical development that are compromised due to stunting [10,36]. A malnutrition cycle exists in populations experiencing chronic under nutrition and in this cycle, the nutritional requirements are not met in pregnant women. Thus, infants born to these mothers are of low birth weight, are unable to reach their full growth potential and may therefore be stunted, susceptible to infections, illness, and mortality early in life. The cycle is worsened when low birth weight females grow into malnourished children and adults, and are therefore more likely to give birth to infants of low birth weight as well [37]. Malnutrition is not just a health issue but also affects the global burden of malnutrition socially, economically, developmentally and medically, affecting individuals, their families and communities with serious and long lasting consequences [2].
It is very significant that malnutrition is addressed in children as it manifestations and symptoms begin to appear in the first 2 years of life [35]. Overlapping with the mental development and growth periods in children, protein energy malnutrition (PEM) is said to be a problem at the ages of 6 months to 2 years. Therefore, this age and period is considered a window period during which it is essential to prevent or manage acute and chronic malnutrition [38]. Furthermore, children less than 5 years of age have a disease burden of 35% Black, et al. [10]. In 2008, 8.8 million global deaths in children less than 5 years old were due to underweight, of which 93% occurred in Africa and Asia. Walton, et al. [39] stated that approximately one in every seven children faces mortality before their fifth birthday in Sub Saharan Africa (SSA) due to malnutrition.
Nigeria is the most populous nation in Africa and has a population of almost 186 million people in 2016 UNICEF [40]. With a high fertility rate of 5.38 children per woman, the population is growing at an annual rate of 2.6 percent, escalating and worsening overcrowded conditions. Hence, by 2050, Nigeria's population is expected to grow to an astounding 440 million, which will make it the third most populous country in the world, after India and China (Population Reference Bureau, 2013). A report by the Nigeria Federal Ministry of Health [41] states that scarcity of resources and land in rural areas has resulted in Nigeria having one of the highest urban growth rates in the world at 4.1 percent. Furthermore, out of the 157 countries in progress toward meeting the Sustainable Development Goals (SDGs), Nigeria ranks 145th Sachs, et al. [42].
Malnutrition in childhood and pregnancy has many adverse consequences for child survival and longstanding wellbeing. It also has extensive consequences for human capital, economic productivity, and national development generally. These consequences of malnutrition should be a significant concern for policy makers in Nigeria, which has the highest number of children under 5 years with chronic malnutrition (stunting or low height for age) in SubSaharan Africa at more than 11.7 million, according to the Demographic and Health Survey National Population Commission and ICF International [43]. According to the World

Theoretical Framework
This study is anchored on two theories, which include the Hardeman, et al. [46]. This is why there is a connection between the study and the theory; since it is health related within theoretical postulations.

Methodology
The study uses secondary data such as significant texts, journals, newspapers, official publications, historical documents and the Internet. However, the research was strictly limited to available or recorded information about malnutrition, its prevalence, effects and impacts on the Nigeria economy that can be found in scholarly journals, books and the internet. The study adopts content analysis as its method of analysis, whereby the existing literature will be considered for the analysis.

Findings and Discussion
Based on the stated research questions, the findings and discussions are purely based on the research questions. The questions are discussed as follows:

RQ1: What are the Factors or Causes of Hyper Prevalence of Malnutrition in Nigeria?
The causes of malnutrition and food insecurity in Nigeria are multidimensional and include very poor infant and young child breastfeeding or feeding practices, which contribute to high rates of illness and poor nutrition among children under 2 years; lack of access to healthcare, water, and sanitation; armed conflict,

Consequently, the UN Office for the Coordination of Humanitarian
Affairs (2014) stated that Nigeria has the second highest acute malnutrition burden in the world, with an estimated 3.78 million children suffering from wasting.

RQ2: What are the Mental and Intellectual Effects of Hyper Prevalence of Malnutrition in Nigeria of Under Five Children?
The growth of the brain, including neurodevelopment begins in the womb within one week of conception. During this period of rapid growth, protein and energy (from carbohydrates and fat sources) are extremely important. A lack of these nutrients can have very damaging effects. Fuglestad, et al. [49] showed a higher occurrence of brain abnormalities at two years of age among children affected by foetal under nutrition. Furthermore, studies of young children with protein energy malnutrition alsoindicated brain atrophy; a shrinking of brain cells due to a lack of nutrients Blaack, et al. [10]. In addition, inadequate calories have continue to affect children's brain growth and enlargement immediately in the first months after birth, which was supposed to be a time of fast neurodevelopment, including the establishment of the parts of the brain fundamental for memory (the hippocampal-prefrontal connections Fuglestad, et al. [49]. The deficiency of iron also complicates the growth period of a child. Iron deficiency before two to three years of age may results in intense and possibly permanent myelin (fatty lipids and lipoproteins, which surround the axon of a nerve) changes Fuglestad, et al. [48]. Iron also facilitates the production of neurotransmitters -the chemicals that pass messages between neurons, and it is involved in the function of neuroreceptors, which receive the neurotransmitters' messages Jukes, et al. [50]. According to Allen [51], emergent evidence suggests that maternal iron deficiency in pregnancy reduces foetal iron stores, perhaps into the first year of life. This leads to greater risk of damages in future mental and physical development. to other biological processes that affect brain development, including DNA and RNA synthesis and the metabolism of protein, carbohydrates and fat Prado, et al. [51]. Additionally, Hamadani, et al. [59] stated that although the results of studies on the impact of zinc supplementation on cognitive outcomes are inconsistent, there appears to be a relationship between zinc deficiency and children's cognitive and motor development, including among low birth weight children Folate is prerequisite during initial foetal development to prevent neural tube defects and make sure that the neural tube forms accurately to create the brain and spinal cord.
Iron folate supplementation is also significant for pregnant and breastfeeding mothers to prevent iron deficiency anaemia Black, [10]. Vitamin B12 and folate works together to produce red blood cells. Black [10] further stated that the deficiencies in both could affect brain development in infants. Like iron, vitamin B12 is also essential to the myelination process. Neurological symptoms of vitamin B12 deficiency appear to affect the central nervous system and in severe cases cause brain atrophy.

RQ3: What are the Impacts of Hyper Prevalence of Malnutrition on the Future of the Nigeria Economy?
According to Save the Child [60] the benefits of good nutrition  [61] stated that the same review discovered that less severe stunting in Brazil and Guatemala was associated with higher adult incomes among both men and women. Furthermore, models using proof from across these longitudinal studies, combined with evidence on the relationship between education and earnings taken from 51 countries, have estimated that children who are stunted at age five earn 22% less than their non stunted counterparts. In addition, data from the same study has been used to evaluate that individuals who were not stunted in early childhood were more likely, by 28 percentage points to work in higher paying skilled labour or white collar work and earned as much as 66% more as adults Hoddinott, et al. [62].
Part of the impact of malnutrition on earnings may be because of the influence on children's physical development. Very importantly, the latest evidence suggests that it is actual learning and the acquisition of skills that matter most, not just the number of years spent in school Hanushek, et al. [63]. This is another reason why early childhood development, boosted by good nutrition, is very vital. Hence, children need to start school ready to learn, rather than struggling to understand what the teacher is trying to teach and impart. Therefore, according to Currie, et al. [64] given the significance of cognitive and educational outcomes on wages, this is likely to be a key pathway that links nutrition to later economic wellbeing.
In actual fact, nutrition's relationships with cognitive and educational development may be the most important pathway in terms of its impacts on wages. Save the Child [59] reported that the economic impacts of malnutrition are larger for those working in more skilled jobs than for those in manual jobs. Baird, et al. [65] showed that among those working for wages or operating small businesses as adults, those who had received an intervention to improve nutrition as children worked on average five extra hours per week, and earned 20% more than those who didn't. These impacts were much larger than increases seen for farm workers.

Conclusion
Diet is the number one risk factor for disease in the world; carrying a superior risk of ill health than smoking or drinking alcohol. According to the World Health Organization, 462 million adults are underweight, while 1.9 billion adults are overweight and obese. In children under 5 years of age, 155 million are stunted, 52 million are wasted, 17 million are severely wasted and 41 million are obese. Globally, there is hunger and malnutrition ravaging the world with a current estimated value of 1 in 9 people out of the 820 million people who are hungry or undernourished. Thus, the study found that presently Nigeria is one of the African countries listed among the 20 countries responsible for 80% of global malnutrition. The finding of the study also revealed that over the years, two main types of malnutrition have been identified in Nigerian children: protein-energy malnutrition and micronutrient malnutrition. The study discovered that the causes of malnutrition and food insecurity in Nigeria are multidimensional and include very poor infant and young child breastfeeding or feeding practices, which contribute to high rates of illness and poor nutrition among children under 2 years. The study discovered that young children with protein energy malnutrition suffer from brain atrophy; a shrinking of brain cells due to a lack of nutrients. The findings of the study revealed that stunted children earn as much as 20% less than their counterparts, and that today's malnutrition could potentially cost the global economy $125 billion. The study concludes that nutrition is not only significant for increasing economic outcomes of individuals; it is important for nations' economic development, especially for a developing country like Nigeria.

Recommendations
Based on the findings, the following recommendations are put forward:

1.
Since the study discovered that Nigeria is one of the African countries listed among the 20 countries responsible for 80% global malnutrition, the study recommends that the National Health and Nutrition Survey (HANS), and the Federal Ministry of Health should liaise to produce foods that are rich in nutritive contents.

The study recommends that breast feeding mothers should
be educated on the significance of proper child breast feeding.
This will boost the immune system of the children and reduce illness.
The Federal Government of Nigeria (FGN) should invest in nutrition programmes that will reduce protein energy malnutrition in order to control the rate at, which children suffer from brain astrophy.