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EASTERN AND SOUTHERN AFRICA feature story for Madagascar

Outpatient Treatment Improves Lives of Severely Malnourished Children in Madagascar

© UNICEF Madagascar/2010/Nouria

A health worker gives a woman a supply of ready-to-eat therapeutic food, at a UNICEF-supported health centre in Anjira. Her twin two-year-olds were critically malnourished two months ago and will continue treatment at home.

September 2010, Anjira, Madagascar: On a dry, hot Monday morning in the village of Anjira, in southern Madagascar’s arid Androy region, 2-year-old twins Fanja and Sambeavy wait outside a UNICEF-supported basic health centre. They have come to receive treatment for severe acute malnutrition. Their mother, Soavinily, carries a third infant in her arms. The family has travelled more than 5 kilometres from their village, Andraketalahy, to be here.

A little over a month ago, Fanja and Sambeavy were critically ill, suffering from severe acute malnutrition with medical complications. The head of the Anjira health centre, Dr. Jean Marc Andriakotonindriana, referred them to the intensive care unit at the hospital in the town of Tsihombe, more than 30 kilometres away. Fanja and her brother spent 10 days there before being transferred to the Anjira clinic for outpatient treatment. Now, every Monday, they return to Anjira for a weekly assessment of their recovery and to receive their supply of ready-to-eat therapeutic food to take home.

For Fanja, this is not the first time she has battled with severe acute malnutrition. She had already been diagnosed in January 2010, and received treatment to ensure her recovery. But in August she was diagnosed again, this time along with her twin brother: evidence of the chronic food insecurity that plagues large parts of southern Madagascar.

In 2009, a lack of rain in the region caused widespread crop failure and a devastating nutrition crisis that communities are still recovering from. This year, the harvest in many areas has not been much better. Soavinily and her husband have not been able to grow enough manioc (cassava), maize and beans to feed the family. If they can, they raise and sell chickens to earn money and buy food in the market, allowing the family to eat dried manioc and beans twice a day. If not, a diet of cactus fruit and crushed manioc leaves must suffice.

To help reach other children like Fanja and Sambeavy, in families that continue to struggle to find enough to eat, UNICEF is supporting the integration of services to treat and monitor severe acute malnutrition without medical complications in basic health centres across those areas most affected by food insecurity. When severe acute malnutrition is identified early, children can often be treated at home with ready-to-use therapeutic food, in addition to attending regular check-ups at an outpatient clinic, such as the one in Anjira.

To ensure the clinics are fully operational, UNICEF is training medical staff, like Dr. Andriakotonindriana, to diagnose and treat cases of severe acute malnutrition. Community health workers are trained to identify potential cases, refer them to the nearest health centre, and to provide regular supervision of outpatient treatments taken at home.

As a result, thousands more children are now being reached with life-saving interventions at home and in health centres nearer their communities, ensuring wider access to treatment and fast recovery for those reached.

Beyond these basic health centres, the only place where children can get specialized help is at intensive inpatient treatment units in hospitals, like the unit in Tsihombe. These hospitals accept only the most critical cases of severe acute malnutrition in which medical complications are evident. To help ensure the adequate treatment of children in these units, UNICEF has provided drugs and therapeutic milk and helped train medical staff.

In Anjira, 35 children were treated for severe acute malnutrition in March. Since then, a small harvest has led to a drop in this number, but when this limited food runs out there will be little left to eat, and health workers are concerned that the number of severely undernourished children will increase again.

For those children who receive treatment, it is the parents’ responsibility to ensure their continued recovery. “The improvement of the children’s health is dependent on the parents,” said Dr. Andriakotonindriana. “If they follow the advice we give them, their children will get better.”

Soavinily knows this, and her commitment means that Fanja and Sambeavy are making a good recovery. She has given birth to nine children, but only six have survived. “I can only trust myself to improve life,” she said, acknowledging her responsibility as a mother. “My stay at the emergency nutrition ward in Tsihombe not only saved the twins’ lives, but also helped me learn how to breastfeed properly and so look after my youngest child better.”

For Fanja and Sambeavy, the future holds some hope, and in southern Madagascar, where food insecurity is a constant menace, UNICEF continues to support the development of health services that help women like Soavinily give their children a better chance in life.