In northern Nigeria, malnutrition is a leading driver of high child mortality rate. This is worsened by poverty, climate change, insecurity, and limited access to healthcare. Although the government adopted a multi-sector policy to tackle the crisis, weak implementation has rendered it largely ineffective 25 years after. KINGSLEY JEREMIAH explores this escalating crisis across some northern states and its impact on the region’s most vulnerable population, mostly children.

At the paediatric ward of Ahmad Sani Yariman Bakura Specialist Hospital in Gusau, Zamfara State, Fatima (surname withheld) sat silently beside her frail eight-month-old daughter, Mariam, but her mind was on Abdul, her two-year-old son, who had died days earlier. Desperate to save them from malnutrition, Fatima had rushed both children to the hospital. Abdul, severely malnourished and barely breathing, was admitted first.

In addition to stunting and underweight, diagnosis revealed he had a congenital heart defect. Doctors did what they could. He was placed on medication and discharged to a Primary Health Care (PHC) centre for outpatient care. But within a week, his condition deteriorated, and he was back in the hospital.

At the same time, Mariam contracted measles. Her malnourished body had no strength to fight it. She was admitted as well, leaving Fatima to watch both children struggle for life. Then, Abdul died. Fatima couldn’t even go home to bury him. Her husband took the boy’s body back to their village alone, while she stayed behind to look after Mariam.

“We see cases like this every day. The death rate is around 35 per cent, far above normal,” Head of the Nutrition Unit at the hospital, Nefisat Sani, said, adding that most parents delay coming to the hospital because they can’t afford treatment and when they finally do, it’s often too late.

Fatima’s pain is shared by thousands of mothers across northern Nigeria, especially Northeast and Northwest zones. Soaring food prices, insecurity that keeps farmers from their fields, and rising poverty have turned hunger into a death sentence. From 28 million in 2019, the United Nations World Food Programme put food insecure Nigerians at 100 million in 2024.

A week after Abdul died, another tragedy unfolded. Ummi (surname withheld) brought her four-month-old daughter to the hospital. The baby, weighing just 2.2 kilogrammes, less than the average newborn, was fighting to live. Ummi had developed mastitis, a breast infection that left her unable to nurse. She couldn’t afford formula. By the time she got to the hospital, her baby was too frail. The infant died within a day of admission.

The Guardian learnt that cases of malnutrition usually spark when during the planting season, leaving many families with little to survive. But Sani insisted that the crisis is “no longer just a seasonal issue but an economic crisis.”

Bandit attacks had forced farmers like Dambata Abdulmuminu to flee his village in Gidangoga. He now lives in Maru, Zamfara State, trying to rebuild his life. But when his daughter fell critically ill, he had to beg for help to get her to the hospital. “I’ve already lost two children. I couldn’t lose another,” he said.

Zamfara has over 697 PHCs, many running Outpatient Therapeutic Programmes (OTPs) for malnourished children. Each centre sees about 100 cases daily. The system is overwhelmed, and resources are over stretched. Although agencies like the United Nations Children’s Fund (UNICEF) provide support, the need far outweighs the help.

In another ward at the specialist hospital, 19-year-old Asmau sat beside her malnourished infant, while her 43-year-old mother, Shefahatu Suleiman, nursed her own one-year-old child. This is her 11th child. Both women had children fighting for life in the same hospital ward.

“I never imagined I’d face this kind of suffering,” Shefahatu said. Despite raising 11 children, she admitted she knew little about family planning. “I heard about it, but never tried. When I breastfeed, I don’t get pregnant, so I never saw the need.”

Now, watching the health of her youngest child deteriorate, she’s reconsidering to “try it when my child recovers, but only if my husband agrees.” Her baby is one of 250,000 children in Nigeria suffering from Severe Acute Malnutrition (SAM), according to UNICEF. One in every 10 of those children could die without intervention.

For these children, severe weight loss, stunting, underweight conditions and frailty are common along with weakened immune systems and other diseases like measles, bronchopneumonia, and tuberculosis, as well as complications such as fever, chronic diarrhea, vomiting, and swollen feet.

In Shefahatu’s village, most women give birth at home without skilled care. Only 13 per cent of pregnant women in Zamfara receive such care. Immunisation rates are alarmingly low, with Penta 3 coverage at just 9.6 per cent. Over 60 per cent of children are out of school. Early marriage and poverty trap girls like Asmau in cycles of hardship, repeating generations of suffering.

Across Nigeria, the broader picture is disturbing as 40 per cent of children under five are stunted; nearly half live in poverty, and more than two million children have never been vaccinated.

At the Dr. Karima Primarya Health Centre in Tudun Wada, Gusau, hundreds of mothers sat on bare floor, their malnourished children cradled in their arms.
“It’s been so hard feeding my baby,” one of the mothers, Sadau Tahiru, told The Guardian, adding: “Everything is too expensive. I came here for treatment, and maybe food from the UNICEF team.”

In 2001, Nigeria launched the National Food and Nutrition Policy and repackaged it in 2016 with the ambitious goal of achieving optimal nutrition by 2025. Nearly 25 years on, that vision remains unfulfilled.

The policy outlined bold objectives – improve food security at all levels, reduce undernutrition in children and women, tackle micronutrient deficiencies, integrate nutrition education, support vulnerable groups, curb diet-related diseases, embed nutrition in government planning, and build strong systems for monitoring, early warning, and social protection.

Yet today, with millions of children malnourished, the plan reads more like a forgotten promise than a national priority.
From 2021 to 2024, the number of children affected by severe malnutrition in Nigeria rose sharply by 145 per cent. In 2021 and 2022, cases were around 2.2 million and 1.7 million but by 2023 and 2024, the situation worsened to 4.4 million and 5.4 million. The National Demographic and Health Survey showed that between 2018 and 2023, child malnutrition in Nigeria worsened, with stunting rising from 37 per cent to 40 per cent, wasting from seven per cent to eight per cent and underweight prevalence from 22 per cent to 27 per cent while overweight rates declined slightly from two per to one per cent, indicating that there’s persistent and deepening challenges in combating malnutrition among children aged six to 59 months.

Indeed, data from the Integrated Food Security Phase Classification (IPC) estimated that nearly 5.4 million children aged 0-59 months in northwest and northeast Nigeria are suffering from acute malnutrition and will likely continue suffering through 2025. This includes about 1.8 million cases of Severe Acute Malnutrition (SAM) and 3.6 million cases of Moderate Acute Malnutrition (MAM). Additionally, approximately 787,000 pregnant and breastfeeding women are acutely malnourished. The figure for malnutrition is however lower in north central.

A Professor of Public Health Nutrition, Ignatius Onimawo, had said Nigeria is not on track in achieving the target.Onimawo said the issue with Nigeria not meeting these policies lies in its tendency to develop strong policies that are not always implemented comprehensively, and as a result, the desired outcomes remain elusive.

JUST like in Zamfara, the burden of malnutrition in Sokoto is critical, especially at the Usmanu Danfodiyo University Teaching Hospital (UDUTH), where severe cases flood the 668 primary healthcare centres and 43 secondary hospitals across the state.

Consultant Paediatrician at the hospital, Prof. Tahir Yusuf, said seven out of every 10 children admitted to the hospital are diagnosed with malnutrition.
In April, 18-month-old Yakubu was rushed to UDUTH with fever, vomiting, and diarrhea. His mother never imagined she would leave without her child.
“We suspected malnutrition,” said Yusuf. “But without prompt lab tests, we couldn’t confirm it.”

The family, already struggling financially, couldn’t afford the N10, 000 ($6) needed for tests. After hours of waiting, Yusuf paid for them out of his pocket. The results revealed critically low potassium levels, a condition that could have been treated if diagnosed early.

“We started treatment right away, but it was too late. Yakubu died from something entirely preventable,” he said. For Yusuf, it’s a devastating but familiar outcome, insisting that the development is the human cost of delayed care.

In the children’s ward, young and older mothers sat silently by their children’s beds, watching and waiting. The still air is broken only by the hum of ceiling fans and the low voices of medical staff.

One child fortunate to survive was 22-month-old Aisha (surname withheld). She arrived at UDUTH with a persistent fever, cough, swollen feet, and chronic diarrhea. Doctors diagnosed her with severe acute malnutrition and bronchopneumonia. Further tests revealed she also had tuberculosis.
Aisha’s condition gradually improved. Within two weeks, she began eating again. The hospital started her on anti-TB medication, and her mother received counselling on proper feeding and care.

In Kebbi, Cultural Norms Put Children’s Lives At Risk
AS in other parts of northern Nigeria, malnutrition affects roughly six in every 10 children in Kebbi State. But beyond poverty and poor healthcare access, harmful cultural practices further endanger children’s lives in the state.

Former Kebbi State Nutrition Officer at the Ministry of Health, Beatrice Kwere, spent her career confronting these issues. For her, the malnutrition is not just a matter of food scarcity, it’s a deeper problem rooted in tradition and misinformation, how food is prepared, what gets sold and preserved for family consumption and who grants permission for a child to be taken to the hospital.

“The problem isn’t just a lack of food. It’s about mindset and knowledge gaps,” she said. In northern Kebbi, it’s common for families to sell off nutrient-rich foods like eggs and watermelons for income, while mothers and children starve or get millet porridge, nono and overcooked vegetables that have lost most of their nutritional value. In contrast, families in southern Kebbi lightly cook vegetables, preserving more nutrients.

“In many northern households, watery porridges are the norm. They fill the stomach but offer little nutritional value,” Kwere explained. As a nutrition officer, she used ready-to-use therapeutic foods (RUTF) provided through donors to treat severe acute malnutrition (SAM) and taught caregivers how to make nutritious porridge for less severe cases. But cultural barriers often delayed care.

“Mothers sometimes need permission from male relatives before seeking medical help. That delay has cost lives,” she said. Kwere estimated that 20 to 30 per cent of paediatric admissions in Kebbi are linked to malnutrition, often worsened by infections that require antibiotics. She warned that entrenched traditions and ignorance continue to undermine efforts.

“Without culturally sensitive education and community-based interventions, we’ll keep losing children to preventable causes,” she said.

IN Borno State, Prof. Garba Ashiru has dedicated his life to fighting malnutrition. He serves as Chief Consultant and National Technical Lead for the Inpatient Therapeutic Feeding Centre at the University of Maiduguri Teaching Hospital.

“The burden of malnutrition across northern Nigeria hasn’t changed much in decades. In some places, it’s getting worse. This isn’t just a medical emergency, it’s a social disaster,” Ashiru said. In the state, nearly six in 10 children under five are stunted, meaning they have been undernourished for a long time.

“Some children are already malnourished before they are even born,” he said. Drawing from the 2023–2024 National Health Survey and the 2023 National Food Consumption and Nutrition Survey, Ashiru identified states like Zamfara, Borno, Jigawa, Katsina, and Kano as stuck in a cycle of chronic malnutrition. He stressed that stunting, if not addressed within the first 1,000 days of life –including during pregnancy – has irreversible effects.

“Stunting doesn’t just affect physical growth. It stunts brain development too,” he explained. Ashiru also warned about a spike in severe acute malnutrition, which is often triggered by sudden food shortages. While many children can be managed at outpatient centres, about 15 per cent arrive with life-threatening complications requiring hospital admission.

“These are the ones we fear most. Without urgent treatment, up to one in every three or four may die,” he noted. For Ashiru, malnutrition must be addressed as a social issue and not just a health problem.

“There’s a saying: Malnutrition is a social problem masquerading as a medical condition. It stems from poverty, broken food systems, lack of clean water, and weak social protection.

“While Nigeria has developed strategic plans and policies to tackle malnutrition, implementation remains weak. Key ministries – agriculture, education, water resources, and social welfare – must collaborate more meaningfully.

“In practice, less than 15 per cent of interventions come from the agricultural sector, even though it’s central to food production. Health-led responses alone won’t solve this,” he said.

Insecurity and displacement also complicate recovery efforts. Millions in states like Zamfara, Sokoto, Katsina and Borno have been driven off their land by insurgency and banditry. Even when communities return, their livelihoods are rarely restored.

In Borno, climate change has compounded the crisis. Flooding has destroyed farmlands, wiped out harvests, and spread waterborne diseases. Environmental shocks are now triggering humanitarian emergencies in already fragile regions.

“When insecurity, natural disasters, and economic hardship collide, malnutrition surges,” Ashiru submitted.

IN northern Nigeria, “farming is a pride,” but this rings hollow for many residents today. As farmlands turn arid with erratic rainfall, insecurity has forced thousands of farmers off their lands, robbing them of their livelihoods. The once-proud farming communities now depend heavily on food aid. The recent withdrawal of support from USAID has dealt a further blow to critical health, nutrition, and education interventions.

Médecins Sans Frontières (MSF) reports that the Northwest region is grappling with more than 500,000 cases of severe acute malnutrition. In 2023 alone, 854 children admitted to its facilities died within 48 hours of arrival.
“We’re deeply concerned given the seriousness of the humanitarian crisis in this region, home to around 50 million people,” Head of MSF’s Nigeria Mission, Abdullahi Mohammed Ali, said.

He noted that the levels of malnutrition and disease outbreaks are catastrophic in the context of persistent and relentless violence. MSF, he disclosed, treated 170,000 children in Zamfara, Kebbi, Sokoto, Katsina, and Kano states for severe acute malnutrition last year, a 14 per cent increase from the previous year.

During a recent food distribution to farmers, Abdul Bala Gusua, a representative of the A.U.G Foundation, said that humanitarian support has become essential as deepening insecurity fuels poverty and fear.

“Farmers can no longer access their land. Aid is no longer optional; it’s critical,” he said. Zamfara State’s Commissioner for Agriculture, Yau Gamji, is optimistic that the Community Protection Guards (CPG) initiative introduced by the state could be a turning point. The state-led programme recruits local residents, trains them, and equips them to defend farmlands and farming communities.

“These guards are the eyes and ears of their communities. They monitor threats, respond quickly, and ensure farmers can return to work,” Gamji said. With overstretched government forces and limited policing, the CPGs are seen as an essential layer of protection in rural areas.

Meanwhile, Nigeria’s inflation crisis is compounding food insecurity. Starting at nine per cent in 2015, inflation peaked at 27 per cent in 2020, dropped briefly, then soared again to 28.92 percent in 2023 and reached 34.8 per cent in 2024.

However, the inflation rate dropped to 24.48 per cent in January 2025, following a rebase of the Consumer Price Index (CPI) by the National Bureau of Statistics (NBS), 23.18 per cent in February 2025 and went to 24.23 per cent in March 2025.

The NBS reports that the average daily cost of a healthy diet rose from N473 in December 2022 to N786 by the same month in 2023. By April 2024, it climbed to N1,035 per adult per day, rose to N1,265 in July, and reached N1,371 in October.

AT Gidandawa Primary School in Bungudu, both teachers and pupils struggle to communicate in English, but that’s not the biggest concern. The spotlight is on the Reading and Numeracy Activity (RANA), a programme aimed at improving literacy and numeracy in public primary schools and Integrated Qur’anic Schools (IQS). Yet, even the top students selected by teachers struggled to construct complete sentences.

Malnutrition is regarded as a key barrier. It affects cognitive development, impairs learning, and increases the risk of anxiety and learning disabilities. For many children in the region, the malnutrition has derailed their chances at even basic education.

IN 2025, northern states such as Kano (16.50 per cent), Kaduna (16.07 per cent), Borno (15.39 per cent) and Benue (15.09 per cent) allocated the highest proportions of their budgets to healthcare, showing a growing recognition of the urgency needed in the sector. In contrast, southern states like Bayelsa (2.77 per cent), Delta (3.12 per cent), Cross River (4.22 per cent) and Enugu (4.72 per cent) lag behind, raising concerns about deepening regional disparities in health funding.

For the first time, Northwest states of Zamfara, Sokoto, Kaduna, Katsina, Kano, Jigawa and Kebbi, collectively budgeted a record N517 billion for healthcare, averaging 14 per cent of their total expenditures. This marks a significant shift from a decade ago when allocations were nearly half these levels.

Kaduna’s budget history exemplifies this progress. In 2016, only 7.6 per cent of its budget went to health. That figure peaked at 17.8 per cent in 2020 due to the COVID-19 pandemic and has since stabilised around 15 per cent. While these increases are commendable, the bigger challenge remains ensuring the efficient use of funds and tackling malnutrition beyond health.

Nigeria’s 2025 budget for nutrition interventions rose by 33.7 per cent from N127.24 billion in 2024 to N170.01 billion. But with an inflation rate of 24.48 per cent as at January 2025, little can be achieved.

In September 2024, Health Minister, Muhammad Ali Pate, announced that the National Economic Council (NEC) had resolved to prioritise nutrition at all government levels. The current allocation marks a 746 per cent increase from the 2021 budget, reflecting the government’s renewed commitment to addressing malnutrition.

The breakdown of the 2025 interventions saw the Ministry of Water Resources receiving the largest allocation at N182.52 billion, followed by the Ministry of Agriculture with N43.868 billion, and the Ministry of Labour with N10.388 billion. Other allocations include the Secretary to the Government (N2.33 billion), Ministry of Science/Tech (N1.548 billion), Presidency (N850 million), Ministry of Education (N740.3 million), Ministry of Health (N720 million), and the Ministry of Livestock with the smallest allocation at N258.66 million.

UNICEF reports that only two out of every 10 malnourished children are currently reached. To address the crisis, funding must rise significantly to match the scale of the burden.

According to UNICEF, more than $250 million is needed to address urgent needs in Nigeria’s most vulnerable states, including Sokoto, Zamfara, and Katsina. Over $100 million is required for these three states alone to deliver essential services across nutrition, healthcare, WASH, child protection, and education. Without this funding, millions, especially children, remain at risk of malnutrition, disease, and lack of access to critical services.

A Long Road To Recovery But Sustained Action Crucial
WHILE more states are increasing their healthcare allocations, donor support, particularly from UNICEF, remains essential in sustaining hospitals and offering hope. Still, the road to recovery is long.

With Nigeria’s population projected to reach 400 million by 2050, sustainable solutions must address the root causes of poor health outcomes.
“Yesterday, we saw a 16-year-old girl with two children. That means she was likely pregnant at 14. In some countries, child marriage leads to prosecution. This must change,” UNICEF’s Representative in Nigeria, Cristian Munduate said.

“Collective action is vital. Governments, international organisations, and communities must work together to protect girls, invest in education, and challenge harmful practices. Supporting girls’ education is key, not only to reduce teenage pregnancy but also to improve household economies,” she added.

Munduate also emphasised the need to expand healthcare services, strengthen community-based health programmes, scale up nutrition interventions, and promote child spacing as part of a broader strategy to manage rapid population growth.

“Too many women are pressured into continuous childbirth, leading to exhaustion and poverty. We cannot keep bringing children into suffering,” she added.