Communities unite to overcome childhood malnutrition

With support from UNICEF Australia, Irish Aid, and Czech Republic, training on early detection and treatment is averting the long-term impacts of early childhood malnutrition in Kratie province.

Youra Soeum and Jesse Lee Gray
Ms. Phai Sokhim, 22, takes a moment to relax in a hammock with her two-and-a-half-year-old daughter, Solina, after her treatement Dar Health Center. She holds a micronutrient-dense ‘cure’ cookie that is so crucial for Lina’s treatment for malnourishment.
UNICEF Cambodia/2022/Nick Sells
23 May 2022

"I knew my daughter, Solina, was smaller than the other children her age, but I didn't know how serious it was until our village health screening last month. The Deputy Village Chief told me that Dar Health Centre could help her get healthy and strong again, so I brought her in as soon as I could."

Phai Sokhim, 22, is a housewife from Kratie province in North-East Cambodia. She is the mother of two-and-a-half-year-old Solina, and seven months pregnant with her second child. Following the Deputy Village Chief’s advice, she visited the center and was shocked to learn that her daughter was suffering from severe acute malnutrition (SAM). The center's health staff also explained to her the many causes for malnourishment such as not eating enough variety of nutritious foods and over-reliance on unhealthy foods, like instant noodles. Other causes are related to water sources and hygiene practices. Drinking unclean water and not washing hands properly before eating, especially after using the toilet, can lead to diarrhea, dehydration and, ultimately, malnutrition.

Seeing improvement in her daughter's health and in her own knowledge about raising healthy kids, Phai Sokhim has been returning to the health center every week. 

Ms. Sem Chanthou, 38, talks to a mother and child about the results of their health and nutrition assessment at Dar Health Centre, in Kratie Province.
UNICEF Cambodia/2022/Nick Sells
Ms. Sem Chanthou, 38, talks to a mother and child about the results of their health and nutrition assessment at Dar Health Centre, in Kratie Province.

Ms. Sem Chanthou, the manager of Dar Health Centre in Kratie Province, is not surprised to see how Phai immediately turned her attention to her family's nutrition, growth, and overall health. In the nine years since she has worked here, she's seen a lot of positive change.

"It used to be much more common to see skinny children in the surrounding communities, and cases would turn fatal more often. Since I received UNICEF training on how to identify and treat severe childhood malnutrition, severe cases have gone down and almost all cases lead to complete recovery”, she says. 


In addition to the training, thanks to the support from UNICEF Australia, Irish Aid, and the Czech Republic Dar Health Centre in Kratie Province is equipped with the right tools to conduct nutrition screening, a steady supply of therapeutic feeding products to treat children with SAM, as well as educational material like posters on breastfeeding used to counsel mothers. 


Since 2020, UNICEF Cambodia, with the support of UNICEF Australia, Irish Aid, and the Czech Republic, has been working in eight of Cambodia's most underserved provinces to increase the capacity of healthcare staff to identify, assess and treat early-stage SAM and to upskill sub-national staff, like Sokhim's village chief, to help recognize malnutrition cases and refer them to local health centres providing services. In parallel, participating health centres receive supplies to treat SAM and budget to provide direct financial support to caretakers during the treatment period. Working with trained healthcare workers and key sub-national staff, UNICEF also oversees quarterly integrated health and nutrition outreach to the most remote villages where families can receive nutrition assessment and counseling, growth monitoring, and referrals for SAM treatment. These most recent interventions build on lessons learned and best practices from the previous UNICEF Australia-funded IECD project  and are part of comprehensive and integrated early childhood development (IECD) interventions through health facilities, communities and school platforms. 

"Every time we visit children and parents for routine and COVID-19 vaccination, we bring along our assessment equipment - wood scales, height/length measurement - and we use a set formula to calculate whether the child is at the right height and weight," Chanthou shared. 

Ms. Sem Chanthou, 38, drops in on Ms. Phai Sokhim, 22, and her two-and-a-half-year-old daughter, Solina during one of their regular weekly visits to Dar Health Centre where Lina is undergoing treatment for malnutrition.
UNICEF Cambodia/2022/Nick Sells
Ms. Sem Chanthou, 38, drops in on Ms. Phai Sokhim, 22, and her two-and-a-half-year-old daughter, Solina during one of their regular weekly visits to Dar Health Centre where Lina is undergoing treatment for malnutrition.

The other pillar of the programme's success is education. Chanthou explained,

"From the very beginning, I make sure parents understand what malnutrition means- not just for today but the far-reaching consequences for their children's future. I simply say 'Your child is underweight. If it continues, they won't grow as they should. They may stay small, often be sick, and will likely struggle to learn well in school." 

Once she sees they've understood the seriousness, she quickly assures them that it's not too late to fix it. "I urge them to bring their child to the health center and receive free weekly treatment for one or two months. I always make it very clear that the treatment won't cost them anything because most people we see don't have the means to pay for specialized healthcare services. I also tell them about the travel stipend we provide to families in need to offset the costs to attend these weekly appointments." 

Sokhim receives 10,000 Riel (about $2.50) each time she brings Lina in. She always puts a little of this stipend money aside to ensure Lina is getting the right mix of nutritious ingredients in her diet, like green and yellow vegetables. The rest goes to cover the gas that her husband or her mother use when they drive her to the weekly appointments. No matter what, she never misses her follow-up appointments for Lina and her antenatal check-ups. 
 

Ms. Phai Sokhim, 22, comforts her two-and-a-half-year-old daughter, Solina, at Dar Health Center as she is measured during a regular weekly check-up during her treatment for malnourishment.
UNICEF Cambodia/2022/Nick Sells
Ms. Phai Sokhim, 22, comforts her two-and-a-half-year-old daughter, Solina, at Dar Health Center as she is measured during a regular weekly check-up during her treatment for malnourishment.

Lina has been receiving the medicinal BP 100 cookies used to treat SAM for almost a month now. Every week, she comes with her mother to be weighed, measured and given a fresh supply of energy, protein and micro-nutrient-dense BP 100 which helps supplement her daily diet during her recovery. As Lina gets treated in the safe hands of the nurses, her mother uses the time to talk to the health staff to learn more about nutrition, which she now knows is vital knowledge for her, her daughter and her unborn baby.  

Lina's appetite is getting better by the day. She is putting on weight and starting to enjoy the food her mom cooks for her.

"I’m very happy to see Lina eating well and getting stronger. She can walk without falling and plays joyfully with other children around our house.”

Lina needs to continue the treatment for at least another month, but Sokhim is determined that she will be strong enough to enter pre-school at the end of 2022, when she turns three years old.

Phai Sokhim, 22, feeds her two-and-a-half-year-old daughter, Solina, in their home in Ta Ngoun Village, Dar Commune, Kratie District, Kratie Province
UNICEF Cambodia/2022/Nick Sells
Phai Sokhim, 22, feeds her two-and-a-half-year-old daughter, Solina, in their home in Ta Ngoun Village, Dar Commune, Kratie District, Kratie Province

Sokhim hopes that this programme will continue in her community and expand to support other underserved communities, “so all of Cambodia’s children will grow likes shoots of bamboo, healthy and strong for the country’s future.”

An upcoming nationwide social behaviour change campaign aims to do just that, by reaching even more parents with nutrition knowledge and creating more awareness of healthcare services through the existing outreach network of healthcare workers and community leaders. The campaign’s SMS messaging and takeaway tools will go a long way toward ensuring that even the most remote and hard to reach communities can give their children the best start in life and are equally nurtured at home, school and throughout the community.