© UNICEF Eritrea/2008

A doctor measures a child’s upper arm circumference to check for malnutrition.


It is 7 a.m. The clinic is already a beehive of activity, a cacophony of colour and chatter as women from all corners of the village converge on the modest building. Amidst the chatter, a child cries, another sneezes, a few women exchange pleasantries. Outside, a tended donkey honks as a two-wheeled scotch car approaches to deliver a woman and her three children. Some come on donkey carts, others on foot. Arriving at the same time is an age-old grandmother with a small child on her back. Looking frail and exhausted, Hawa has walked for two hours from her village Tsawra to bring her granddaughter to the health station. The event is a vitamin A supplementation drive. “I carried the baby and travelled here all the way for the supplementation. I had to help my daughter because she is ill,” she says.

With close to 80 per cent of the population relying on agriculture and pastoralism for their livelihood, the burden of child rearing falls mostly on women, as men are involved with farming and tending to livestock. For many women like Hawa, it is a duty to take the children for vitamin A supplementation and other health services. But even as the health station is bursting at the seams for this campaign, the turnout belies the status of nutrition countrywide.

According to the nutrition surveys conducted by the Ministry of Health, global acute malnutrition among children under age five ranged between 11 per cent and 21 per cent in 2005–2006. This includes micronutrient deficiencies among children under age five: iodine (25 per cent), iron (34 per cent) and vitamin A (42 per cent). Vitamin A deficiency poses a major threat to the health and survival of children and mothers. These effects extend much further than blindness alone: it is now known that the deficiency increases the risk that a child may die from diseases such as measles and diarrhoea, which contribute to over one third of under-five deaths in Eritrea. Vitamin A supplementation provides a highly cost-effective way to improve child survival. Each vitamin capsule, which costs less than 1 Nakfa (0.06 cents), can increase a child’s chances of survival by up to 25 per cent. In fact, in countries where mortality among young children is high, vitamin A supplementation may be the single most cost-effective child survival intervention.

At the health station, the children are given a few drops of vitamin A. Other services are integrated into the campaign, such as screening of malnutrition using mid-upper arm circumference tapes. The services are much appreciated as they cut the number of trips the villagers have to make to the health station. “We see good things happening comparing to the older days. Out of my experience these visits are very helpful,” Hawa says.

Since June 2006, UNICEF has been supporting the Government of Eritrea to implement the twice-yearly vitamin A supplementation campaign, which has been sustaining a high coverage of more than 90 per cent. The campaigns have in the past been integrated with measles and tetanus toxoid vaccination, advocacy campaigns for handwashing and newborn care to maximize outreach to the population. For each campaign, UNICEF procures vitamin A capsules to cover around 400,000 children aged 6–59 months. In order to reach the remotest corners of Eritrea, intensive community mobilization and information campaigns were carried out with UNICEF’s support to inform the communities about the importance of vitamin A supplementation. Donkeys and camels were mobilized to deliver supplies to reach all the targeted children, including in harsh mountainous areas.

To address child malnutrition, UNICEF and the Ministry of Health are providing therapeutic and supplementary feeding services targeting severely and moderately malnourished children. There are presently 53 existing facility-based therapeutic feeding centres countrywide and 61 community-based therapeutic feeding sites in four regions, including Debub. UNICEF and the Ministry of Health are in the process of expanding the number of therapeutic feeding centres as well as supplementary feeding. The Ministry of Health with the support of UNICEF continues to supply required therapeutic and supplementary foods as well as essential drugs.

As Hawa and her granddaughter walk out into the billowing sun to trek back home, the nurse encourages her and other women to spread the word to their neighbours about the benefits of taking children to the clinic. It is only their commitment that would ensure that a whole generation of Eritrean children is saved.