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Thursday, May 23, 2024

Like Carbonated Drinks, Like Local Beverages: The Health Costs Of Sugar-Sweetened Beverages On Malnourished Children In Conflict-Torn Communities

By: Anibe Idajili
The risk of insufficient prenatal, newborn, and young child nutrition is believed to be higher in populations affected by armed conflict. Yet, these children are fed cheap, nutritionally inferior diets that are high in sugars, salt, and calories while being deficient in micronutrients.
This is the case for three-year-old malnourished Rafayat from the conflict-affected Bangi community in Niger State, whose mother, Fatima Umar, feeds her with just fish and kunu, a local sugary beverage. The little girl already shows signs of Severe Acute Malnutrition (SAM), including pneumonia, developmental delays, and diarrhea.
Like Rafayat, seventeen-month-old Aminatu has been diagnosed with severe acute malnutrition and is admitted to the children’s ward of the Kontagora General Hospital. She was identified by a community health worker during a visit to Farin Shinge village, a community once besieged by armed bandits on January 15, 2022. Aminatu had not been exclusively breastfed because her mother suffered low milk supply occasioned by stress and so the little girl had developed respiratory and intestinal infections due to malnutrition. Her mother, who had lost her small shop to the attacks, began feeding Aminatu with sugar-sweetened kunu aya and pap at just three months in the hopes that it would replace breast milk. The mother’s feeding choice for her child has been influenced by a number of things, including the views and cultural traditions of friends and family.
“Aminatu is my 9th child and I have no idea how this happened. I don’t make enough milk to feed her exclusively, but I still give her a lot of kunu and pap. Every woman around here gives their kids that, including those who breastfeed,” Zainab Aliyu said.
Photo Credit – Anibe Idajili
Sadly, Rafayat and Aminatu’s parents are just two of over three billion people worldwide who cannot afford a healthy meal. In Nigeria, they are two of the two million children that are severely undernourished, making up 14.3% of all such children worldwide. The statistics are even more dismal in northern Nigeria with over half of all children stunted. For example, in Niger State, according to the state’s policy on food and nutrition, the under-5 mortality rate is unacceptably high at 123 per 1,000 live births, and malnutrition is the underlying cause of 53% of these deaths.
In Nigeria’s northern region, the current spike in severe acute malnutrition cases, according to UNICEF in 2022, is attributable to a rise in insecurity. For instance, between 2019 and 2020, bandit conflicts in Niger State displaced at least 150,000 people from over 30 communities. Unfortunately, the State’s nutrition response to emergencies has been inadequate due to financial, technical, and logistics constraints, resulting in high cases of child malnutrition and increased demand for ready-to-use therapeutic food for children. More regrettably, conflicts have forced parents out of their farms, making them turn to buying their malnourished children affordable sugar-sweetened drinks like carbonated drinks, kankarar kwame (iced baobab juice), kunu zaki (millet drink), kuni tsamiya (tamarind juice), and zobo drink (hibiscus tea).
Empty calories
Although these locally produced beverages, which are unregulated and exempt from sales tax, may contain only small amounts of micronutrients, according to Dr. Ocholi Okutepa of Kontagora General Hospital, their high added sugar content and unnatural drug-like urges create a vicious cycle where consumption rises and nutritional levels fall. He says more sugars may have the ability to replace the micronutrient content of a diet by increasing the quantity of “empty calories” and energy consumed. Sugars may give energy right away, but they don’t help kids produce their own.
“We occasionally suggest modifying conventional dishes to make a meal more acceptable for a malnourished child in addition to Ready to Use Therapeutic Foods (RUTFs). For example, for children who are malnourished, carbohydrates with a little oil and sugar can be a healthy supplementary food. Little amounts of sugar can be added to the meals of SAM-affected children since they need energy. However, excessive consumption of added sugars may result in a condition known as “internal starvation” (via leptin and insulin resistance), which could make a malnourished child’s hunger signals more intense,” says Dr. Okutepa.
Due to their association with a number of health issues, including metabolic abnormalities and early mortality, added sugars should not be consumed by children under the age of two, according to numerous studies. The basis for this insistence is the fact that children are susceptible to the same physical effects of too much added sugar, just like adults. Tessy Umeh, a nutritionist in Minna, notes that many parents are unaware that added sugars, which are frequently included in juices and other local beverages, cause a brief spike in energy that is quickly followed by a feeling of low energy. They contain a lot of empty calories, she claims, which can also lead to weight gain and insulin resistance.
“In the end, these sugars may have an impact on the children’s quality of life and lifespan. For this reason, I frequently urge parents to limit their children’s exposure to added sugars. Parents who are financially impacted by conflict may find complete elimination of added sugars from their children’s diets economically impractical, but they shouldn’t be regarded as a regular dietary staple,” says Umeh.
Unregulated and untaxed
Around a year ago, the Nigerian government imposed an excise tax of N10 per litre on all non-alcoholic, carbonated, and sugar-sweetened beverages. Many concerned citizens believe the implementation of the tax will deter people from taking too much carbonated beverages, which have detrimental effects on their health, in a nation that, according to statistics from Statista, is the largest consumer of soft drinks.
Local-beverages Photo credit – Anibe Idajili
Local beverages are sadly overlooked by the authorities imposing taxes, although carrying the same health dangers as carbonated drinks. While millions of Nigerians consume traditional beverages, they are typically untaxed and do not follow accepted standards for food safety, unlike carbonated beverages. In Nigeria, these locally manufactured microbially fermented beverages include kunu, zobo, pito and burukutu, nono, tiger nut milk, and soymilk. These beverages may also be produced with sugar added to sweeten them.
The State Nutrition Committee is one of the many nutrition-focused initiatives run by the Niger State Government; however, none of them particularly addresses the necessity for defining acceptable safe limits for the intake of local drinks. According to the state’s policy on food and nutrition, the goal is to reduce childhood wasting from 7.3% in 2015 to 3% by 2025 and the percentage of under-five stunted children from 38% to 20% by that time. Yet, there is still a problem with severe acute malnutrition made worse by the intake of drinks with added sugar, particularly in communities where there have been armed conflicts.
Children pay the price
The Team Lead of Youths in Justice Health and Sustainable Social Inclusion, Shedrack Muaazu, attributes parents’ use of sugar-sweetened traditional beverages for children with SAM to a lack of government intervention, poor feeding practices, inadequate supplemental feeding, large family size, and low socioeconomic status. Nonetheless, he recommends providing mothers in conflict-affected areas with information about nutrition free of added sugars, affordable diets, and breastfeeding practices in order to prevent and treat childhood malnutrition.
“Aside from literacy, there is a need for standardization with respect to the production criteria for the regulation of these traditional beverages’ production and sale. It should also be mandatory for producers and sellers to obtain licenses and complete basic food safety training. Training resources in the target person’s language may be employed, and the fees of these must be very reasonable or subsidized,” stressed Muazu.
Fatima Aliyu, who oversees the Kontagora Local Government Secretariat’s Emergency Unit, states: “With my experience working with conflict victims, I know that SAM is the most deadly type of malnutrition and that, if unmanaged, it can result in death. Sadly, I understand how easy it is for parents in financial difficulty to simply give their kids inexpensive, sweet stuff to eat instead of nutritious meals.”
“Healthy diets that prevent deficiency symptoms and long-term nutrition-related health issues are what these children actually need. The government is making its best effort. We receive funding to provide emergency relief items for bandit victims and survivors, including food. But this only lasts a short while; after that, families are left to provide for their food needs. Unfortunately, not all mothers have the financial means to provide their children with wholesome meals free of added sugars,” Aliyu further explains.
“We must remember that children’s risk for poor health outcomes can be considerably increased by the lack of extensive restrictions for the majority of local beverages. And in children who are already malnourished, consuming too much sugar might result in nutrient deficiencies. I am aware of the financial burden that armed conflicts place on families, but instilling in young children a liking for unsweetened foods will help them develop better eating habits and reduce their risk of developing chronic illnesses,” Umeh concludes.


This report was supported by Gatefield Impact under the Pro-Health Policy Journalism Fellowship. 


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