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In Sudan, mothers learn how to keep their children healthy

By Alastair Beach

A community-based approach helps mothers in a West Darfur displacement camp treat and prevent malnutrition.

EL GENEINA, West Darfur, Sudan, 27 October 2015 – Inside a camp for internally displaced people in El Geneina, capital of West Darfur state, a group of 12 young mothers sit with their children on woven stools in a thatch-roofed hut that serves as a meeting space.

On the walls are posters giving advice on child health – from tips on breastfeeding to the drinks that parents should avoid giving their children. Nutritionist Fatima Abdel Rahman is leading today’s discussion.

Pointing to a poster, she directs the mothers’ attention to a picture of a cup of water with a large red cross through it. Fatima asks the mothers, “What does this photo mean to you?”

© UNICEF Sudan/2015/Omer
Mothers gather for an information session on malnutrition, in a camp for displaced people in Sudan's West Darfur state.

One of the young women replies: “It means that we should not give water to our children when they are babies.”

Her answer is correct, and Fatima moves on to the next picture.

Vital services

The session is one of the weekly discussions that happen as part of a UNICEF-supported programme on community-based management of acute malnutriton, or CMAM for short.

Here in Ardamata Camp, housing more than 17,000 people displaced from their homes, around 60 per cent of whom are children, the CMAM programme – which is implemented by NGO partner Concern Worldwide – is providing vital services to children under 5 who are either suffering from or at risk of acute malnutrition.

Like all CMAM initiatives, the Ardamata programme uses four key components, each intended to enable the community to help tackle child malnutrition themselves.

First, there is community mobilization. Some 17 volunteers within the community, trained in the use of arm measurement, reach out to families in the camp and try to identify boys and girls who may be suffering from malnutrition, through measurement of the mid-upper arm circumference (known as MUAC).

Then there are two nutritional programmes – the Supplementary Feeding Programme (SFP) and Outpatient Therapeutic Programme (OTP).

The SFP provides food rations only for children who are moderately malnourished. For more severe cases, OTP offers home-based treatment, but only if the child is suffering no additional maladies as a result of their malnutrition.

For the cases that require it, CMAM provides in-patient care for the most severely malnourished children who have also developed medical complications.

In addition, there is an important educational component to the CMAM programme. Once a week, Fatima and the other health workers at the Ardamata centre lead discussions on a certain nutritional topic. The discussions range from advice on exclusive breastfeeding to lessons on diarrhoea control, and are regularly repeated to ensure the message is spread as widely as possible.

The sessions are a crucial element of the programme, according to Fatima.

“The main cause of malnutrition is that mothers don’t know what type of food to give their children,” she says. “After birth, many women just give their children anything to eat or drink. Sometimes they give them water; sometimes dates or honey. This varies within neighbourhoods, localities and states.”

In South Darfur, for instance, there is a tradition by which Koranic verses are written on a board using a special kind of ink, Fatima explains.

“The verses are then washed off with water, which is then given to sick children,” she says. “A child is not able to deal with this, and it creates complications.”

After each weekly discussion at the CMAM programme, the health workers approach each child and measure their mid-upper arm circumference to check the level of malnutrition. Each boy and girl is then weighed to see whether there has been any change since previous sessions.

“I cannot eat while my child has no food”

Kubra Ahmed is one of the mothers who attends the CMAM programme. Her daughter Sana’, 2 and a half years old, became sick recently after Kubra stopped breastfeeding her.

After the girl developed diarrhoea, Kubra took her to hospital, where staff told her the child was malnourished. As a result, they referred her to the Ardamata CMAM programme.

“This service is really good, as it really helps to inform and guide us the mothers,” says Kubra, 21. “When my child becomes ill, I also become ill, because I get so worried. I cannot eat if my child is not eating.”

Sana’ is currently being provided with super cereal, a product containing soya beans, corn, sugar and dried milk, which is given to children with moderate malnutrition.

The treatment is working. When Kubra first enrolled Sana’ in the CMAM programme some four weeks ago, she weighed 8.1 kg (17.8 lb). She has since gained an additional kilo, she is progressing well, and her MUAC measurement is edging in the right direction.

“When Sana’ became sick, I was very afraid,” Kubra says. “She is my first child, and I thought maybe soon she would not be alive.”

Malnutrition remains persistently high in Sudan, with global acute malnutrition levels at 16.3 per cent, which is above the standard emergency threshold of 15 per cent. The Darfur region and other conflict-affected areas have some of the country’s highest rates of acute malnutrition.

A key programmatic focus of the UNICEF Country Office is the delivery of an integrated package of interventions for the survival and development of children at a household level, especially the most vulnerable, such as IDPs and refugees. UNICEF Sudan’s CMAM programme in Ardamata camp plays a vital role in meeting this goal.



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