Niger: tackling moderate malnutrition
SAHEL: Number of underfives who suffer from wasting (acute malnutrition): 1.5 million
The adults are chatting in hushed voices under white sheeting, but the children are making so much noise that it is easy to forget that most of them are malnourished. Most cases of acute malnutrition are treated in centres like this one, which is known as a CRENAM, a French acronym for a nutritional feeding centre for children with moderate malnutrition.
In Niger, more than 800 CRENAM look after more than 400,000 children every year. It is one of the largest programmes of its kind in the world. Once a fortnight, mothers receive two rations of fortified flour, a mix of maize, soya, oil and sugar. The first ration (three kilograms) is known as the “treatment” ration and is set aside for the malnourished child. The second (six kilograms) is known as the “protection” ration and is given to the child and his or her siblings – at least those who are under five – because a mother can hardly give food to one of her children without feeding the others. As soon as they get their share of fortified flour, some mothers start giving it to their children immediately.
The nurse, Moussa Bahari, is often too busy to remind them that this food, like cereals, must be made into a “porridge” and that it is only for children under five. But he can hardly get across with them: he is aware that some families have traveled up to 40 kilometers to get here and that the children are hungry. In the queue, some small children are sleeping in their mothers’ arms, but it is not due to the heat. Malnutrition has made them weak and drowsy. He takes great pleasure, however, in the fact that the majority (more than 85%) of malnourished children in this CRENAM, which treats around 250 monthly, will be fit again within two to three months.
One child in every 10, however, will not see the treatment through because his or her mother will stop coming for reasons that often remain unclear. What happens to those who do not follow the treatment to the end? No one knows for sure, but it is feared that their nutrition situation continues to deteriorate. That is where the real challenge lies: retaining all malnourished children until they get better. In Niger, fortified supplementary foods are helping hundreds of thousands of malnourished children to pull through.In the case of “non-responsive” children, those who do not reach their target weight or who continue to lose weight despite everything, parents are urged to seek further help in a CRENI, an intensive nutrition rehabilitation programme, where all means will be taken to save them.
It is not always easy convincing parents to give the go ahead. "Intensive care" requires mothers to be by the side of their child for up to two weeks. “Mothers tell us that they have to work in the fields or that they have to cook for their husband,” says nurse Moussa Bahari. They are caught in a tragic situation: poor and unable to say “no” to their husbands, they must keep working – even when their children’s survival hangs in the balance.
The victim of this situation is all too often a fragile and vulnerable boy or girl under the age of two who will first have come to someone’s attention in a CRENAM. For these children who go from moderate to severe malnutrition, time is of the essence.
by Michel Arseneault