Malnutrition in COVID-19 times
The story of Athari Adigazidi, technical health agent and midwife at the Toukra health centre
In Chad, a vast country at the heart of the Sahel and one of the least developed countries in the world, the man-made and natural crises have left almost 8.8 million people, half of its population, breathless. Food insecurity and malnutrition, population movements and health emergencies linked to cyclical epidemics of cholera, measles, Hepatitis E, meningitis and polio are the first three obstacles on the road to recovery, recovery and socio-economic success (HNO/HRP 2020). According to the latest figures, one child in eight dies before his or her fifth birthday and the prevalence of global acute malnutrition stagnates at 12.9% (SMART 2019). It is in such a fragile context that the COVID-19 pandemic has infiltrated the daily life of Chad since March 2020, upsetting the ordinary and imposing new rules.
Health centres, already under pressure due to a shortage of equipment and staff, and among assembly sites with a high risk of contamination, had to introduce procedures very quickly to minimize the spread of the coronavirus.
"We installed hand washing devices at the entrance to the health centre and forced patients to wear masks while maintaining the 2-metre physical distance. Now screening for malnutrition is done by measuring only the gill circumference and looking for oedema, not the child's height and weight. We have received packs of bracelets and each bracelet is used just once and is disinfected with javélisé water. Regarding the care, we have established a bi-weekly follow-up of the children, whereas before we used to do it every week," explains Athari Adigazidi, technical health agent and midwife at the Toukra health centre.
This centre is one of 39 offering acute malnutrition management services (Ambulatory Nutritional Units (UNA)) in the city of N'Djamena and cares for around 350 children suffering from severe acute malnutrition (SAM) per month. In a country where 53% of deaths of children under 5 years of age are caused by malnutrition, the work of Athari and her colleagues is proving to be very effective
Essential without or with a deadly virus that goes around the world. For this reason, UNICEF Chad, thanks to the financial support of the Civil Protection and Humanitarian Aid of the European Union, continues to work alongside the government in the prevention and care of malnourished children even in times of global pandemic. At the national level, with the support of ECHO, 530 agents were recently trained on the protocol for the management of severe acute malnutrition in times of COVID-19. Health centres have been equipped with communication materials to raise awareness on preventive hygiene and infant and young child feeding measures.
Athari, in her 5th year of service in the Toukra health centre, has chosen to save the lives of mothers and children who could live in better conditions if prevention became a common practice in the field of maternal and child health to the detriment of harmful practices. Atari fights every day to inform mothers about the vital importance of pre- and post-natal consultations, exclusive breastfeeding, and HIV testing at the beginning of pregnancy. "In April 2020, I received an HIV-positive mother and her child who showed signs of malnutrition. Little Elise (fictitious name), sick with malaria and with severe diarrhoea, was barely 5 months old", Athari tells us. Often the HIV status is a secret that the person keeps until death, as social stigma would prevent her from living a normal life. "It is thanks to the regular monitoring of her child that Chantal (mother's fictitious name) gained confidence and, little by little, the courage to tell me her story. I quickly advised her to have her child tested to find out his HIV status, because children born to HIV-positive mothers need to be tested early to ensure better care.
Chad's Practical Guide to the Prevention of Mother-to-Child Transmission of HIV and AIDS Care recommends that, if possible, paediatric screening should be carried out at 6 weeks of birth for early diagnosis of the infection. Otherwise, HIV serology should be carried out at 9 months, 12 months and 18 months. Treatment should then be initiated if the child's serology is positive.
Day after day, Elise regains weight and joy returns. If she is tested in time and followed up regularly, she could celebrate her 5th birthday.