EASTERN AND SOUTHERN AFRICA feature story for Madagascar

© UNICEF Madagascar/2009/Mullard

Vaha Noeline holds her 14-month-old child Vole Mariah, who has recently recovered from severe malnutrition, in Amboasary District. WFP, working with UNICEF, has now provided the family with food rations.


AMBOASARY, Southern Madagascar, July 2009 - Fourteen month old Vole Mariah laughs as she excitedly toddles about in her local health centre, waiting to be weighed as part of her nutrition follow-up programme. Only two months earlier, Vole Mariah was very different.  She could not move or communicate, and suffered from diarrhoea, vomiting and swelling of the body – all because of severe acute malnutrition.

Her mother Vaha Noeline, 24, recounts the traumatic experience. “As a family, we usually feed ourselves with what we grow on a small piece of land close to our house. It isn’t enough to last all year, so my husband also works on the local sisal plantation and earns 34,000 Ariary a month [around US$ 18]. Combined with our crops, that can feed our family of five.”

But this year the rain didn’t fall, and the insects ate the crops.  At the same time, the plantation owners stopped hiring workers, so there was no income for Vaha Noeline’s family.  The entire family grew thinner, so much so that Vaha Noeline could no longer produce milk for her infant.

“When my baby became very weak, I carried her for an hour to the basic health centre in the nearest town, Amboasary,” Vaha Noeline recalls. “The doctor told me that she was badly malnourished, and that she needed to go to the hospital immediately for treatment.  My friends told me it was no use, that Vole was so sick that she would die. But the doctor reassured me that they could try to save her.”

Once admitted to the malnutrition ward of the local hospital, Vole Mariah received special therapeutic milk formula F-75 and treatment for her diarrhoea and vomiting.  After a few days, she showed signs of improvement.  She then received another special kind of therapeutic milk formula called F-100.

“It really was a miracle,” Vaha Noeline says, smiling as she remembers. “After just three days, she started making sounds again. After a week, she was moving in the bed. A few days after, she was walking and crawling around and laughing.” Vole Mariah was discharged from the hospital, but kept on a programme to ensure that she reached the recommended weight for her age.

This follow-up included rations of Ready-to-use Therapeutic Food (RUTF) packets - a mixture of ground peanuts and oil, fortified with vitamins, minerals, milk powder and sugar requiring no preparation - that the health centre gave to Vaha Noeline to administer to her daughter several times each day. 

“I came back here to the health centre every Wednesday because I really understood how important it was for my daughter,” she says. “Even when I was sick last week, I asked my friend to bring her because I didn’t want her to miss an appointment.”

Vaha Noeline also received a ‘protection ration’ for her family provided by the World Food Programme and distributed in coordination with UNICEF.  This allows the family to feed themselves and avoid the temptation of using the RUTF supply to appease other family members during the period of the food crisis.

In addition, the family received a kit composed of buckets, cups, a jerry can, soap and water purification liquid to help prevent diarrhoea and other waterborne diseases which exacerbate malnutrition problems.

After eating RUTF for seven weeks, her daughter reached the recommended weight for a child of her height.  Vaha Noeline is grateful for the help her daughter received, but at the same time concerned about the future. “I never want this to happen again to any of my children, and pray that we will have enough food to keep us all healthy.”

UNICEF works with the World Food Programme and Catholic Relief Services to provide live-saving treatment to children suffering from severe acute malnutrition throughout Madagascar.