Combating malnutrition in Somaliland
By Bismarck Swangin
HARGEISA, 19 March 2014 – When two year old Yusuf Hashi was admitted to the nutrition Stabilization Centre at Hargeisa Hospital, Somaliland, he weighed just over eight kilogrammes – half the weight of a healthy toddler. After five days of feeding and management by the nutrition staff, which included fortified milk, Oral Rehydration Salts and antibiotics, he began to show signs of progress,
“I have seen a lot of improvement. When he was admitted, he had to be fed through a tube but now he can drink fluids directly,” said Yusuf’s mother, Zeinab Ali Hussein.
The little boy was diagnosed with generalized oedema, an abnormal swelling of tissue that, in children, is caused by severe acute malnutrition. He was also suffering from diarrhoea, anaemia and fever – all of which were successfully controlled in the hospital.
Yusuf is Zeinab’s eleventh child. She says the family lost all its livestock during the drought in 2011 and survives on the meagre earnings of her husband who is a primary school teacher.
“Many children are malnourished because there is not enough food to eat around the house,” said Awale Abdullahi, a Supervisor at the nutrition Stabilization Centre. “At the same time, ignorance is a factor. From birth, babies are given water and food rather than being breastfed. When the young mothers go out to search for firewood or water, they leave their children behind, often for hours, and the children suffer as a result.”
Abdullahi says they receive several cases of acutely malnourished children at the Stabilization centre in Hargeisa Hospital each week. The stabilisation centre admits severely malnourished children under five with medical complication such as vomiting, fever, malaria, diarrhoea. The children are referred from the Outpatient Therapeutic Centres (OTPs) based at Maternal and Child Health Centres in the rural areas, as well as mobile centres that visit villages to screen children for malnutrition,
In Somaliland UNICEF supports four Stabilization centres, 66 static OTPs and 372 other OTPs that are covered by mobile teams.
Once discharged the children attend an outpatient therapeutic centre for follow up care close to their home. Here, along with other malnourished children who do not have complications requiring inpatient treatment, they are given a package of nutrition services to ensure the inclusion of treatment, promotion and prevention known as the Basic Nutrition Services Package.
The BNSP includes the management of acute malnutrition, micronutrient support, infant and young child feeding, maternal nutrition, deworming, promotion of appropriate food fortification, monitoring and surveillance, the prevention and management of common childhood illnesses as well as immunizations.
This includes managing acute malnutrition through providing nutritious peanut-based paste, vaccinations, and micronutrients such as Vitamin A and deworming tablets.
In addition mothers attend health and nutrition education sessions where they learn the importance of exclusive breastfeeding for infants from birth to six months, and the type of foods that should be introduced after six months. They are also taught how to prevent diarrhoea, through improving hygiene standards, cooking with clean safe water, and washing hands as well as how to treat common childhood illnesses.
“We explain to mothers that malnutrition can be managed with proper diet, hygiene and sanitation,” said Abdullahi.
The Director for Nutrition at Somaliland’s Ministry of Health, Dr Ahmed Jama says poor nutrition remains a recurrent problem. Many children become sick due to the lack of essential vitamins and minerals known as micronutrients such as iron, vitamin A and Zinc. There are plans to introduce a blend of micronutrients in powder form which should be added to food for children under 2 years.
“With all these efforts, we can say that we are on track to address malnutrition,” Dr Jama said.
There are 200,000 acutely malnourished children in Somalia including 50,000 who are so severely malnourished they are at risk of death. It’s hoped that this Basic Nutrition Services Package being operationalized across Somalia by UNICEF with support from partners including the European Commission will go some way to stopping this crisis and allowing children like Yusuf to grow and thrive.