Nutrition for East Sudan: CMAM in Action
By Philip Moore, UNICEF Consultant
As a fan whirs overhead, circulating the air in the hot, arid environment of Kassala State, Fatima Mohammed sits in the Um al-Gora health clinic with her child, Alawiya. During her consultation, a constant flux of mothers & their children stream through the two rooms of the clinic, many more waiting outside. “My child had diarrhoea and other mothers advised me to come here”, Fatima says. Alawiya looks healthy now, but ten weeks ago when she was first brought here, she was found to be suffering from malnutrition. Treatment was started immediately and she has responded well; now she comes back for monitoring and for food rations.
Alawiya is not alone in her situation. For many children here, their diet consists of cow’s milk and one meal per day. This out-patient care unit in Kassala State, built by UNICEF with funds from the European Commission Humanitarian Aid Office (ECHO), specialises in the treatment of malnutrition, and is part of a state-wide program known as Community Management of Acute Malnutrition (CMAM).
Eastern Sudan, a post-conflict region plagued by drought and described as chronically food insecure, has rates of malnutrition that reach emergency levels. CMAM allows patients to receive treatment at home using special Ready-to-Use Therapeutic Foods (RUTF), such as “Plumpy’Nut”, a high protein, high-energy, peanut-based nutritional supplement. This reduces the burden on hospitals and allows the treatment of a larger number of patients.
CMAM has been in Sudan since 2001, being first implemented in Darfur, but prior to 2009 was limited to the region. “I worked in Darfur, but now here, the nutrition state is worse” says Dr. Mohammed Jalaleldeen, a UNICEF nutrition consultant working in Kassala. With funding from ECHO, UNICEF is working with ministries of health in five states, bringing CMAM to Eastern Sudan.
Prior to the implementation of CMAM, malnourished children were treated along with other in-patients of the hospital. “This led to a mix of illnesses” explains Ahmed Babiker, director of the Nutrition Department for the State Ministry of Health.
Children would often be kept in hospital for one month, which put a great strain on the family as well as staff. Around sixty percent of mothers withdrew their children before the treatment was completed. Since CMAM’s introduction, the default rate - those not completing treatment - has dropped to 27%Since CMAM’s introduction, the default rate - those not completing treatment - has dropped to 27%. As the programme advances, the default rate is expected to reach 15%. “Now mothers are convinced to bring their children to the centres, because they know that they will only be here for two or three days” says Tasabih Abdallah, supervisor of the stabilisation centre at Ed-Damazine hospital. Tasabih was trained by a UNICEF consultant in June 2010.
The roll-out of the CMAM program in Kassala has been very successful. Within six months of its implementation, thirty centres have been established in six localities; fifteen more are planned by the end of the year. By June, 410 members have been trained in its implementation and 1079 children had been treated for malnutrition. “The program has been very well accepted by the community” says Sit Aldar, head of the nutrition team for the State Ministry of Health.
UNICEF provides all of the therapeutic treatment to these centres, as well as equipment and financing the training of staff. “Now there are no problems with the supply of milk and Plumpy’Nut” says Adil Abdallah, a pediatrician in Damazine Hospital. “Whatever we ask for, we receive... UNICEF is a key partner for the ministry of health.” This is possible through funding from ECHO.
However, the roll-out of CMAM faces many challenges. In southern Blue Nile State, the access to several areas is blocked during the rainy season, lasting almost six months, rendering supply, training and monitoring extremely difficult. In Kassala, the situation is similar: “working in six localities, each very far from one another, we need to strengthen our information system” says Sit Aldar. In addition, the success of much of the work in communities depends on that of volunteers, the effort of the federal ministries of health being stretched. “We need a way to encourage them, for example, by more training” he added.
Back in Um al-Gora, having been weighed and measured, Alawiya is being fed a sachet of Plumpy’Nut. Her mother describes how they receive the nutrition supply, drugs and health care at the centre. “This is so important for us, providing care and a medical service” she says. “Before, there was no service available. When my child was ill, there was nothing to give her, so I relied on breast-feeding.”
And the treatment is effective. “Before, my child was not able to walk, but now she can.”