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Angola’s new war: The struggle against malnutrition

© UNICEF Angola/2005
A child suffering from malnutrition and malaria, who is being treated in the Caala therapeutic centre’s pediatric ward. In April alone, 74 children were checked in to the centre.

By Macarena Aguilar

CAALA, Angola, 25 May 2005 – Five-year-old Sipiriano Sangaripo is a poignant example of what many children face in Angola, which is still recovering from the effects of a long and brutal civil war.

When Sipriano first arrived at the Caala therapeutic nutrition centre 10 days ago, he suffered from acute malnutrition and weighed barely 8.5 kg. His condition is still serious, but is gradually improving – he now weighs 9.5 kg and can sit up in bed unassisted.

Of the 74 children admitted to the centre in April, 19 children died and 19 others were taken away by their parents without finishing their course of treatment.

“Since mid-March we haven’t had any therapeutic milk to properly treat the children,” says an anguished Rosa de Carvallo, Provincial Nutrition Supervisor. “We tried to replace the proper therapeutic milk with fat milk mixed with oil and sugar but the effect is not the same. So after waiting weeks for (Angola’s capital city) Luanda to send the therapeutic milk, we had to ask UNICEF to help us urgently.”

Not strong enough to eat – or to smile

Sipiriano’s father, Tito Joao, sits patiently at his bedside hoping for the best. His mother is back home in Cuima, a village 50 km away, caring for his six other siblings.

Tito Joao tells of how frightened and confused he was when, after noticing Sipiriano’s body get slimmer and slimmer, it suddenly begun to swell. The child’s hands and feet were bursting from the liquid that his protein-free body could no longer absorb. “This is a typical reaction of a child suffering chronic malnourishment,” explains Rosa. “Some reach a point where they even start shrinking.”

© UNICEF Angola/2005
Sipiriano Sangaripo, 5, on his tenth day of treatment for malnutrition. When he arrived at the centre Sipiriano weighed only 8.5 kg.

Sipiriano’s tiny hands have been carefully bandaged to prevent him from tearing out the feeding tubes that run from his nose into his throat and digestive system. He is still far from having enough strength to eat normally, let alone to smile.  

“Last year, it was agreed with the government that UNICEF would gradually cease providing therapeutic milk to the feeding centres in order to begin the transfer of responsibility to the Ministry of Health. Unfortunately, for some reason, the Ministry was unable to purchase the milk,” says Rosa. In response, UNICEF Angola, with financial support from the Italian Government, imported 6.2 tons of therapeutic milk which is currently being distributed nationally.

A bold strategy to revitalize health centres

Angola’s recovery from its 27-year long war may be on track but one look at Sipiriano and his helpless father suggests that it is still costing too many young, innocent lives.

Most children arrive at the therapeutic centres in appalling condition from untreated illnesses, including acute malaria, diarrhoea, measles and even tuberculosis. Parents often wait too long before they seek help and have no basic knowledge of how to detect early symptoms for some of the most common diseases.

Therapeutic centres have long been Angola’s response to malnutrition. Supported by UNICEF since 2001, there are still 26 centres running throughout the country, treating an average of 1,000 young patients every month.  Sadly, at least 20 per cent of these children die. A further 25 per cent are taken home before completing the treatment, with the outcome very much in doubt.

“These percentages are still very high and worrying,” explains UNICEF Nutrition Officer Mercedes Diaz. “But it is critical to understand that the root of the problem lies in the lack of access to primary health care, the poor quality of the service and the abysmally low levels of education among the population.”

UNICEF is supporting the Ministry of Health with a bold strategy to revitalize and strengthen health centres at the municipal level through training personnel in planning, management and quality service delivery.  “To fight malnutrition you need to invest 80 per cent in prevention and 20 per cent in treatment,” says Mercedes. “The intention is to reduce the bridge between the community and the health service and have a real impact on child mortality.”

When asked about the fate of the 19 children that never finished the treatment last month at the Caala centre, Rosa de Carvallo looks dismayed: “Most of them will have died back in their homes and those that didn’t will probably come back in a similar or worse condition.” Luckily, Sipiriano Sangaripo will not be one of them.



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