Overcoming the odds

"When she arrived here, I was afraid she wouldn't make it," says Dr Zoumana Diallo. "She wasn't even moving. She had serious anemia."

Indeed, little Maya's red blood cell count was seven times lower than it should be, the result of a severe and untreated case of malaria.

"I was scared of losing her," remembers her mother, Aminata Cissé. "She was sleeping all the time and she wasn't playing. She didn't even have the energy to cry."

Aminata had good reason to worry - she lives in a conflict-affected area 135 kilometers away from the nearest hospital, and buses only run to Timbuktu town once a week. She consulted both a community health center and a reference health center before she was told to head to the regional hospital in Timbuktu.

By then, Maya, 12 months old, had already had three blood transfusions, but due to undiagnosed malaria, still wasn't any better.

At the Timbuktu regional hospital, Dr Diallo instructed the nurses at the nutrition ward to run a thorough diagnosis and start Maya on a new course of treatment. The regional hospital has additional testing and diagnosing capacity, and nurses and pediatricians quickly detected her dire combination of conditions: severe acute malnutrition (SAM), anemia, and malaria. Maya was given two additional blood transfusions to increase her red blood cell count and put on artemisinin to treat her malaria. Finally, she was given F75 therapeutic milk, a low-protein milk-based formula which stabilizes the condition of children suffering from SAM and who have lost their appetite.

Maya’s condition was particularly weak. "She couldn't even drink the entire first dose of milk," Dr Diallo remembers.

But by the third dose of milk, her appetite was coming back - voraciously. Three days after being admitted to the hospital, little Maya has already gained half a kilo, and is becoming bubbly, laughing as she reaches up to her mother’s earlobe to play with a glinting earring.

"I'm very happy with the treatment here," says Aminata. After weeks of worry and insomnia, her daughter is finally showing signs of recovery. 

At 20 years old, Aminata is a young mother, and Maya is already her third child. She's also pregnant with her fourth. When girls are married off during adolescence - which is the case of 53% of women in Mali - their children are at higher risk of malnutrition and disease. In addition, close pregnancies can affect children's health, particularly when breastfeeding is interrupted early. UNICEF recommends exclusive breastfeeding for the first six months, then complementary feeding with foods rich in nutrients such as vitamins, minerals, essential lipids, and protein, while continuing breastfeeding until age two.

"I wasn't producing enough breastmilk," says Aminata. "Maybe because I wasn't eating enough myself. And I didn't know anything about malnutrition. I didn't even know it was an illness."

Maya isn’t the only child suffering from SAM currently at the hospital. This year, the regional hospital has even more cases than usual: 33 children were admitted for treatment in the first two months of 2020, more than double the number of cases of the previous year. Increasing insecurity in the region, which makes it difficult for families to access farms and markets, has aggravated food insecurity. Aminata's husband is a farmer, but with an extended family to take care of, ensuring nutritious food for the entire family is becoming more and more of a challenge.

Other childhood illnesses also compound the situation: high numbers of cases of respiratory infections and malaria have recently been recorded in the region.

“Key to ensuring children do not fall back in severe acute malnutrition is nutrition education”

Timbuktu is already the region of Mali with the highest rate of severe acute malnutrition. At 2.5% of children affected, it is above the emergency threshold of the World Health Organization. SAM is a life-threatening condition, but also perfectly curable if diagnosed on time and treated completely. In 2019, UNICEF supported the treatment of over 135,000 children suffering from SAM in Mali.

One of the funds that allow UNICEF to treat as many children are the Global Humanitarian Thematic Funds - flexible funds that allow UNICEF to provide support where it is needed most, particularly in fast-moving humanitarian contexts.

Before parents and children are discharged from the nutrition ward, healthcare workers conduct sensitization sessions on good nutrition practices, including how to prevent malnutrition using affordable and locally available products.

“Key to ensuring children do not fall back into severe acute malnutrition is nutrition education,” explains Kounindiou Dolo, Health and Nutrition Specialist at UNICEF’s office in Timbuktu. “Simple and highly efficient gestures, like birth spacing, exclusive breastfeeding for the first six months, and handwashing with clean water and soap, can go a long way in preventing future cases.”

Maya still has some time to go before being discharged. Dr Diallo’s team will soon conduct an appetite test and see if she can be put on outpatient treatment. Then, he’d like to see her reach her target weight of 6.7kg.

But she's on the right path. She's also got some new toys - animals and trucks made from the carton box of ready-to-use therapeutic food. Just seeing them makes her shriek with joy.

It's a level of energy that she hasn't had in months.