Central Mindanao leading the way in the treatment of severe malnutrition
by Angela Travis
Maguindanao, Mindanao, Philippines. 7 September 2011 - In June 2011, one and a half year old Fahad was brought to a rural health centre in Datu Piang, Maguindanao. The youngest of six, Fahad had recently suffered from measles and also had diarrhea exacerbated by the recent floods that contaminated water supplies.
Fahad’s large, sunken eyes stared blankly at the health workers around him, as they started to measure and examine him. They found that his upper arm circumference was only 8cm – a sign of severe, acute malnutrition. His mother had delayed bringing him to the centre because ‘many children in the barangay looked like he does’. Fahad was admitted into the government’s community-based management of acute malnutrition programme or CMAM, and immediately began to improve. Today he is hardly recognizable – a normal looking, lively 2 year old.
The CMAM programme has been running in Central Mindanao since December 2009, and is supported by UNICEF, Save the Children and ACF. It was started in response to a nutritional assessment carried out in the area that showed 10% of children under 5 were suffering from acute malnutrition. UNICEF working with partners began assessing and treating children, and the programme now has a remarkable success rate.
“Without any intervention, a child suffering from severe acute malnutrition has a 50-70% chance of dying. With this programme, which is based on UNICEF’s global experience with CMAM, we are recording a 90% survival rate,’ said Zambrano.
Mothers register their children for check-up in the Datu Odin Sinsuat regional health unit. Copyright UNICEF/2011/Philippines/Ty
The programme involves community screening and an out-patient programme that is administered by municipal health workers and volunteers of the rural health units (RHUs). Mothers bring their children each week, on a specific day to be weighed and measured and the children are given special peanut based RUTF (Ready-to-Use Therapeutic Food) to eat whilst in the clinic. As long as the child has appetite and is able to eat the food, the mother is given enough packs for a week, and strict instructions on how to administer it. Mothers are also counselled on breastfeeding, nutritious complementary foods as well as other best childcare practices. Any child that cannot eat or has other complications is admitted to the stabilisation centre in the hospital.
At Dinaig Municipal Hospital we meet Datu Ali. The baby’s sunken eyes watch his mother keenly, as she fans the air to try and cool him and keep the flies away. His hands and feet look and feel like a newborn baby - small, delicate with saggy skin. But this little boy is 7 months old and has been admitted with severe acute malnutrition. Luckily for him this government hospital has a stabilisation centre – one of only 2 in the region - and trained staff who know how to treat his condition. Whilst we are there he is given a pack of therapeutic food and begins sucking and eating the special food. It’s a good sign that he is alert and responsive, and Doctor Sally Bataclan, the programme manager, is confident that he should be discharged soon.
7 month old Datu Ali was brought to the Dinaig stabilization center in for severe acute malnutrition. Copyright UNICEF/2011/Philippines/Arcayan
Datu Ali’s mother is tired, and worried about her other 5 children who are still at home. She explains that the family are poor, and when the floods hit Cotabato area last July, the family had to move to an evacuation centre. She was given a free donation of powdered milk, intended for older children, and gave it to her son. He developed diarrhea and became dehydrated and ended up in the hospital. Dr Paul Zambrano, UNICEF Nutrition Specialist, explained: ‘Children like Datu Ali, who are not breastfed and are already malnourished are in a precarious condition. It only takes one bout of diarrhea, or a viral infection like measles to take them to a life-threatening stage. The good news is, he is now responding well to the treatment ’.
Chief Nurse Nursia Ismael, confirms the programme’s success, as she shows us her book of cases admitted into the stabilisation centre at the hospital:“Of 119 cases admitted, we are pleased to say 94% were cured or referred back to the out-patient programme. In the twenty years that I’ve worked here, this is a very positive programme for our hospital,” she said, smiling proudly. “We are grateful to UNICEF for supporting this programme, because it is really working. We can see the results,’ commented the Dept. of Health Secretary for ARMM, Dr Kadil Jojo Sinolinding. The CMAM programme in Central Mindanao is currently the only one in the Philippines, and UNICEF is now working to develop a national policy that can make this treatment available to all children in the Philippines who need it.
‘Amazingly if a child presented with symptoms of severe acute malnutrition in a hospital in Metro Manila, they may well receive treatment that can kill them. That’s because a child in this condition has a body that is shutting down, and will not sustain large amounts of fluids or medicines, commonly administered by doctors that are not familiar with the CMAM protocol. The treatment programme is specially developed just for this condition, and we hope it will become a standard protocol for every health centre in the Philippines’ said Dr Rayco-Solon, UNICEF’s nutrition specialist in Manila.
Back in Maguindano, we receive good news that Datu Ali has been discharged from the hospital, and will now be monitored through the outpatient care programme. That’s another success that can be added to Chief Nurse Ismael’s record book.