Real lives

Real lives


Reaching children in remote southwest Madagascar

Tilda with children
© UNICEF Madagascar/2011/Corbett
Tilda Rainivomalala waits outside the basic health centre in Itampolo. Communities like Itampolo are hard to reach, but UNICEF is working to strengthen community-based screening mechanisms to detect malnutrition among children under five.

By Christina Corbett

ITAMPOLO and ANDROKA, Madagascar, 9 September 2011 - It is 7.30 am in the village of Itampolo, on Madagascar’s remote south west coast. Outside the village health centre, 35 year old Tilda Rainivomalala is among a group of women and children waiting in the shade of a mango tree. Tilda has 10 children, and today she has brought 1-year-old Mahatratse and 4-year-old Momoni to the health centre to be screened for malnutrition.

“The community health worker in the village told us about the screening,” says Tilda and I came because I want to know more about my children’s health.” Malnutrition is a permanent challenge for Madagascar.

The country ranks sixth globally among countries with the worst malnutrition rates, with 50 per cent of under-five year-olds suffering from stunted growth. In the semi-arid south, where unreliable rainfall or flooding often damages harvests, the situation is punctuated by repeated peaks of acute malnutrition, particularly during the annual lean season when food supplies are limited.

At the health centre in Itampolo, nearly 600 children are expected to be screened as part of a UNICEF-supported Plumpy’doz distribution campaign that is targeting 20,000 of Madagascar’s most vulnerable children in some of the most remote villages in the south.

Preventing malnutrition

Children showing signs of malnutrition will receive further treatment, while those aged between 6 and 36 months, who are not yet showing signs of malnutrition will be enrolled in a scheme in which they will receive two months’ supply of Plumpy’doz, a supplementary food rich in vitamins and minerals, designed to help prevent malnutrition in children.

Child having MUAC measurement taken
© UNICEF Madagascar/2011/Corbett
Community health worker, Francoise Soamaniry takes the measurement of 1-year-old Fairson's mid-upper arm circumference. The measurement is an indicator of a child's nutritional status.

"Before a child starts to show signs of malnutrition there will already be a significant lack of vitamins and minerals in their diet," explains UNICEF nutritionist, Dr Leonide Rasoahenikaja. "The Plumpy'doz provides these vitamins and minerals and so can prevent that child from becoming malnourished. Used as a supplement to other food, Plumpy'doz completes a child's nutritional intake, and helps the child grow and develop immunity to disease."

For 32 year old mother of six, Voatiana Vaha, the opportunity to provide her children with such care is essential. “The biggest problem we face here is finding enough money. I don’t have land to farm, so I have to find money in other ways,” explains Voatiana.

“I buy fish from the fishermen here and sell it on to other buyers. When the sea is calm I can earn some money, but when it is rough the fishermen don’t go out and I have nothing to sell, and cannot buy enough food for my family.”

Reaching the most vulnerable

In southern Madagascar, reaching communities isolated by distance and a lack of roads is challenging; but in order to address the country’s high malnutrition rates, UNICEF is targeting the most vulnerable children in these hard to reach areas. By tackling food insecurity, improving water and sanitation, and by supporting health services, UNICEF is working to prevent the nutritional situation from worsening, and the Plumpy’doz distribution campaign forms part of this wider strategy to reduce malnutrition rates.

Identifying children with malnutrition early on is a key part of this work. In April 2011, UNICEF worked with its partners to screen around 260,000 children across southern Madagascar to ensure the early detection and adequate treatment of severe acute malnutrition. However, ongoing political instability and economic decline in Madagascar means that many specialist nutritional centres are increasingly short of skilled staff, and of the therapeutic food and milk used to treat malnutrition – making UNICEF’s work critical.

“UNICEF is calling for more support from the international community to ensure that this essential programme for child survival and development can continue in a context where the socio-political crisis is deeply impacting on the functioning of the health system,” says UNICEF Representative in Madagascar, Bruno Maes."



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