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In Mali, using play to help treat malnutrition


By Hector Calderon

In an area of Mali with a high prevalence of chronic malnutrition, a cognitive stimulation programme is being used alongside traditional interventions to promote recovery. In the process, it’s also helping to strengthen families. 

SIKASSO, Mali, 7 November 2014 – Sitting on his mother's lap, 2-year-old Lamine casts a twinkle in her direction then throws himself backwards. He knows she will catch his head with her hand. She always does. Both of them giggle.

''We haven't always been like this,'' says his 38-year-old mother, Mariam Coulibaly. “The medicine that really worked was play.”

The pair are graduates of a new UNICEF-supported initiative in Mali that aims to tackle malnutrition's impact not only on the body but also on children's cognitive development.

Mali has an overall prevalence of stunting of 28 per cent among children under 5 years old. In Sikasso, the rate is even higher – 33 per cent. This level has scarcely changed for years.

“The first 1,000 days of a child's life are very important for his or her brain architecture,” says Fabio Manno, Education Specialist at UNICEF Mali. “We know also that providing exclusively nutritional supplementation is not enough. These children need development for the brain – a benefit that will pay off by helping their recovery but also much later when they start school.”

In Sikasso, UNICEF has begun complementing its standard methods for fighting malnutrition (screening, diagnosis and treatment) with supporting a cognitive stimulation programme implemented through Handicap International, in collaboration with local health officials. “This intervention, called Care for Child Development, gives hope of survival, growth and development to the most vulnerable children in Mali,” Mr. Manno says. “It enables caregivers to do age-appropriate communication and play activities with children in order to boost their development and reinforce attachment.”

Creating fun

In a small building adjacent to the malnutrition ward at the local referral hospital, play is the order of the day. Mats have been laid on the floor, one wall is almost entirely covered by a mirror and the centre of the room is dominated by simple, brightly coloured toys for all to use – bricks, bowls, and pop-up boxes.

But in poor Malian families, toys are a luxury. Staff make a point of showing parents how to create items of fun: a rattle made from pebbles in an empty bottle, a flower made from strips of coloured paper threaded through a straw. They explain to parents that an ordinary household item, like a wooden spoon, can provide valuable stimulation.

© UNICEF Video
"Playing saves the children," says Mariam Coulibaly. "Games help them learn to crawl, learn to walk, and games make them happy."

Hamidou Sanogo, 44, is having at least as much fun as his daughter, 27-month-old Habibatou, who was admitted the previous week with severe acute malnutrition and malaria. Father and daughter, watched over by mum Mariam, 28, have discovered the joys of a pink pop-up box featuring characters that spring unexpectedly from beneath different-coloured lids.

Mr. Sanogo, a farmer from a village 50 kilometres away, casts a glimpse of pride in his wife's direction: It's suddenly become clear that Habibatou has worked out how to predict which character will pop up next.

“We are having great fun,” he says. “I have never spent so much time with my daughter since she was born.”

Habibatou still has scars on her legs and arms from Kwashiorkor - the form of severe acute malnourishment than confined her to hospital. She remains physically weak, but her success with the pop-up box is evidence that she has turned a corner on the road to recovery.

“She was so weak just two days ago,” says Mariam. “We were really worried. We were so worried that my husband decided to stay with me here in town, rather than go back to the village during Habibatou's treatment.”

Speeding up recovery

Dr Aoua Traoré, head of the children's unit, admits that she and referral hospital staff were initially skeptical of the programme, but are now convinced.

“With stimulation games, the child's recovery is speeded up. Children with severe acute malnutrition used to be admitted for 10 days. Now we can cut that period to six days. The impact is remarkable.”

Play is supervised by social worker Ami Coulibaly. She gets to know the children at the centre and carries out home visits once they have been discharged.

“I look at the parenting skills. Sometimes you find that the mother has become a little cut off from her baby, as a result of the passivity you find in malnourished children,” she says. “In cases like that, I try to help to reawaken the contact between the two, encouraging the mother to imitate the baby's sounds and grimaces.”

Lamine's mum, Mariam, was an avid pupil. Lamine now has a homemade rattle – the soft-drink bottle filled with pebbles – and Mariam is unembarrassed about imitating her son's gurgles and cooing. In a culture where public displays of affection remain rare, even dad Boubacar, 38, spontaneously demands a cuddle from his son when he arrives home from work.

Mariam says she has learned a lot. ''Lamine is my fifth child, but he was different from the others,” she says. “The pregnancy was much more difficult. He was sickly when he was tiny. He had an incarcerated hernia, which required an operation. Afterwards, he never seemed to grow strong.

“But I was busy with my business, selling flip-flops on the market. Then the rainy season meant my husband and I were busy in the field,” she says. “Meanwhile, Lamine was just getting weaker. Fortunately a neighbour whose own child had just been treated for malnutrition recognized the symptoms and sent me to the referral hospital. Now Lamine is strong and cheerful. We all are! I hope he will now stay lively and happy so that one day he can go to school.”

She giggles, and so does he.



UNICEF Photgraphy: Early child survival

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