Responding to every need

“I was in total despair,” remembers Boureima Kanitao. “I was mentally prepared to lose my child.”

Boureima’s second daughter, six-month-old Aissata Kanitao, had stopped moving. Only a day earlier, she had still been crying. But as she got sicker and sicker, she even lost her ability to cry. She was running a high fever, had diarrhea, and had ulcers lining the inside of her mouth. Her appetite had completely vanished, and her weight had drastically dropped to 4.4.kg – much too little for a baby her age.

Her mother, 20-year-old Amissetou Maiga, could not stop crying. Her first child had also had malnutrition, but nothing as severe as this. She was so worried about Aissata that she herself got sick.

“She just didn’t know what to do,” remembers Mariam Diarra Keita, the nurse in charge of nutrition at the community health center in downtown Mopti, ASCOTAMB Mossinkore.

Aissata was suffering from severe acute malnutrition with medical complications. Due to her grave state, she was first admitted to the nutrition ward, or URENI, of the Reference Health Center of Mopti town, where her condition was stabilized through F-75 therapeutic milk, a milk which is low in proteins and calories but helps improve a child’s metabolism until her appetite is back. She was also given antibiotics to treat her medical complications

“After the treatment had started, Aissata started looking more alive,” her mother says. “She was starting to move around again, she even wanted to play again. I was so happy, I finally stopped crying!”

“It gave me so much hope when I took her in my arms and saw her moving again.”

“It gave me so much hope when I took her in my arms and saw her moving again,” father Boureima adds on.

After ten days of treatment with therapeutic milk, during which her mother and grandmother never left her side, Aissata was found ready to be discharged and begin outpatient treatment through the Mossinkore Community Health Center. There, she was put on ready-to-use therapeutic food, a nutrient-rich peanut-based paste which can easily be administered at home by parents themselves.

Aissata’s first taste of therapeutic food was memorable, her mother says: she was so hungry, she didn’t want to stop eating. By then, her weight had gone up to 5.1kg – still far from her target weight, but in the safe zone.

UNICEF supplies therapeutic milk and ready-to-use therapeutic foods to all health districts in Mali thanks to support from partners like the European Union’s humanitarian aid. Once delivered to the health districts, the products are then delivered to community health centers by motorcycles, public buses, and even tricycles, based on an estimation of needs. 

In 2019, support from the EU’s humanitarian aid has helped UNICEF and its principal partner, the Ministry of Health, treat more than 22,000 children suffering from severe acute malnutrition.

But the needs remain huge. In the URENI where Aissata was first admitted, 17 cases of children with SAM with complications are being followed up, including dire cases which have come from more than 100 kilometers away. Meanwhile, in the community health center, Mariam is following over 50 children.

“We have noticed an increase in admissions,” confirms Cheikh Arouna Diarra, the Technical Director of the Mossinkore Community Health Center.

“One of the factors is that it is the rainy season, and with the increase in the number of malaria cases the frequency of malnutrition increases. The other is that there are a lot of displaced persons who are currently arriving in Mopti, and the nutritional status of their children is already precarious.”

Indeed, increased displacement and barriers in accessing food and healthcare while on the move are becoming serious issues in Mopti, where the security situation has rapidly deteriorated in the last two years.

But beyond responding to urgent needs, it is critical to scale up prevention efforts, including promoting exclusive breastfeeding for the first six months and dietary diversity after, handwashing with soap. Lack of hygiene can lead to diarrhea, which is one of the leading causes of child mortality in Mali.

“Children with diarrhea have a harder time correctly absorbing nutrients,” explains Seydou Amara Dicko, Nutrition Officer at UNICEF Mopti. “This puts them at risk of acute malnutrition. Good hygiene and breastfeeding practices can go a long way in preventing malnutrition.”

Believing Aissata needed to be well hydrated, Amissetou used to give her water while breastfeeding, something she now understands may have contributed to her daughter’s diarrhea. But Amissetou had early pregnancies and did not know much about feeding practices at the time.

Surrounded by the calm blue walls of the health center, little Aissata is measured by Mariam with Seydou’s help. She now weighs 5.7kg. A usual course of treatment on ready-to-use therapeutic food lasts between 6 and 8 weeks, but Mariam has hopes Aissata will hit her target weight before then.

The trick will then be to ensure varied and nutritious food at home, so she won’t ever have to return to the health center.