By Madeleine Logan

A programme in Ghana that mobilizes healers, healthcare workers and the community is proving a powerful ally in the fight against malnutrition.

GBULLUNG, Ghana, 1 May 2013 - When Hamdan’s face and body swelled up, his mother Ramatu did not know what was wrong with him.

In this part of northern Ghana, many parents believe that symptoms of illness in their children signify a curse from the gods or punishment from ancestors. Children are taken to traditional healers for spiritual intervention, rather than for medical care.

But a neighbour who saw the boy told Ramatu to take her son to the local clinic. The nurses there diagnosed Hamdan with severe acute malnutrition. They gave Ramatu a week’s supply of Plumpy’nut for therapeutic feeding, and taught her how to make nutritious food to treat severe malnourishment.   

“After two weeks, he’s looking better,” Ramatu says. “The swelling has gone down.”

A new approach

The clinic is part of a project called Community Management of Acute Malnutrition (CMAM), led by the Ghana Health Service, with support from UNICEF and the Canadian International Development Agency (CIDA). Under the programme, specially trained health workers and volunteers are sent out into communities to identify acutely malnourished children and refer them to local health centres. After initial treatment is provided at the health centre, mothers learn to care for their children at home.

Every Tuesday a malnutrition clinic is held at the Gbullung health centre.  Mothers are given a week’s supply of silver sachets filled with soft Plumpy’nut paste, which doesn’t need preparation or refrigeration.
Community health nurse Rashida Alhassan says the Plumpy’nut “works like magic”.

Nurses also teach mothers to prepare nutritious flour called weanimix, made from corn or millet with pounded soybeans or groundnuts. This is prepared as porridge and fed to children along with their daily Plumpy’nut ration.

In 2012, the Gbullung clinic recorded a cure rate of more than 85 per cent.

Accessible treatment

Malnutrition is associated with more than half of all childhood deaths worldwide, predominantly a result of poor child-feeding practices, food shortages or poor access to adequate sanitation and healthcare. In Ghana, 13 per cent of children under age 5 are moderately or severely underweight, according to the most recent data.

Clement Adams, a UNICEF Ghana nutrition officer, says that before the introduction of CMAM, many malnourished children in the country’s Northern Region had little access to treatment. There were only five nutrition rehabilitation centres spread across the region’s 20 districts, and hospitals are difficult to reach for many families.

Those who did seek distant medical care often dropped out. It was too big a burden for families to have women away from home, where they are relied upon to support the household and care for the rest of the family.
Although children suffering from medical complications like hypothermia, hypoglycemia or severe dehydration are still sent for inpatient care at hospitals, CMAM has brought treatment for malnourished children directly into the home.

Changing attitudes

In communities like Gbullung, CMAM has also helped change attitudes about healthcare. 

To promote the understanding of malnutrition as a medical rather than a spiritual issue, UNICEF sponsored health workers to educate traditional healers about the causes of malnutrition and the new community-based treatment programme.

“We encouraged the soothsayers to continue to do the spiritual healing, but we asked them to also send the parents to the CMAM clinics,” Mr. Adams says. “We urged them that the child must also take Plumpy’nut.”

The focus is also on educating parents on prevention of malnutrition through proper infant and young child feeding. Community theatre, radio messages and house-to-house visits by health workers and volunteers are all part of UNICEF’s awareness campaign to encourage good feeding practices.

“This includes promoting exclusive breastfeeding, how to introduce food at 6 months of age, how many meals are needed a day and what foods are best for small children,” Mr. Adams explains.

At the same time, they are careful not to interfere with traditional practices.

“We don’t speak out against seeking spiritual assistance,” he says. “But we ask families to do both traditional healing as well as taking the Plumpy’nut. It’s such a huge belief – you can’t get over it overnight. But we’re making some inroads.”

Eventually, the support of traditional healers may prove to be the best asset in fighting malnutrition across the region.

“Mothers who are referred by the healers are happy to take the Plumpy’nut,” Mr. Adams says. “And as people see more children being healed at the clinic, the word spreads.” 



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© © UNICEF Ghana/2013
Ramatu brought her son Hamdan to a local health centre where he was diagnosed with severe acute malnutrition and given a programme of treatment. Local outreach has helped many families in northern Ghana have access to care.

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