Journey to recovery from severe acute malnutrition in Papua New Guinea
MOUNT HAGEN, Papua New Guinea, 16 February 2016 – Two-year old Elijah Issac manages a weak smile as he is fed milk through a feeding tube in the Paediatric Ward of Mount Hagen Hospital.
His mother, Betty, is beaming with pride, happy that her son is being fed.
“My son stopped eating earlier this month after he was sick with diarrhoea and his body became swollen. When he was admitted to the hospital seven days ago, he wasn’t eating anything so the nurses started feeding him this milk and now I can see a change in his body every day. The swelling in his skin is going down, his eyes are clearer and his face which was thin and drawn is starting to fill out. I am very happy,” Betty says.
Elijah has Severe Acute Malnutrition (SAM) and has had persistent diarrhoea since October 2015 during the time the El Nino induced drought was at its peak severely affecting water sources and food gardens in the Western Highlands province. He lost weight rapidly from diarrhoea and also suffered from malnutrition-related oedema – a condition which occurs when fluids build up improperly in human tissue causing abnormal swelling in parts of the body as the body lacks certain nutrients. This nutritional disorder is most often seen in regions experiencing famine. Despite being treated at a local clinic near his home with oral rehydration solution, Elijah’s condition worsened.
At the hospital, Elijah drinks small feeds of therapeutic milk, F75, eight times a day and his recovery is clearly visible. The therapeutic milk is part of UNICEF’s support to the management of SAM cases in Papua New Guinea.
“We have been in the hospital for seven days and my boy is feeding on this milk everyday through a tube and I can already see many good changes in him. I’m very happy. Now I know that if any of my other children are sick with diarrhoea, I have to take them to the hospital quickly,” Betty says with a shy smile.
Betty is still not sure why Elijah became very sick while her older five-year-old son remains healthy.
“I feed my children the same food. We cannot afford meat or fish from the shops so I feed my children food from our garden like sweet potatoes and greens most of the time. Elijah became very sick and now I have to stay with him in the hospital while my husband is at home with our older son,” she adds.
Many factors may have contributed to Elijah’s illness. While Elijah is fully immunised for his age, his mother gave birth to him at home, a mere 30-minutes’ drive away from the hospital because she couldn’t find a vehicle in time to take her to the hospital. Betty exclusively breastfed her son for only three months before she introduced other foods although her child was not quite ready for them.
Now heavily pregnant at seven months with her third child, Betty continued to breastfeed Elijah in the early months of her pregnancy, unaware that she had fallen pregnant again and that all the nutrients from the food she ate was being absorbed by the unborn child. The El Nino induced drought dried up Betty’s food garden and they had very little to eat. At the same time general water and sanitation hygiene practices deteriorated due to the lack of water. Betty admits that handwashing at critical times – before preparing food, after using the toilet and after changing her baby – was no longer a priority during the drought because they needed the water for cooking and drinking and could not afford to waste any of it.
Unfortunately, Elijah’s story is not uncommon in Papua New Guinea. Close to 45 per cent of children in the country under the age of five are undernourished and stunted – shorter than the average for their age. As a result they face poor brain development, low productivity as adults and risk poor achievement to reach their full potential in life.
UNICEF is supporting the Government of Papua New Guinea to address SAM by reinforcing the capacity of the provincial hospitals, district health centres and communities to identify children with SAM so they receive timely care.
In mid 2014, UNICEF introduced SAM management interventions and trained 90 health workers from 15 provincial hospitals to detect and treat SAM cases.
As part of this support UNICEF also supplies Ready to Use Therapeutic Foods (RUTF) to hospitals. These are high protein, nutrient and energy-dense food such as micro nutrient milk and plumpy nut paste that contain all the nutrients required for a growing child and are easily digestible promoting fast rehabilitation in malnourished children.
More than 800 children have been treated with RUTF in the Mt. Hagen Hospital since the program began in 2014 with the hospital witnessing a reduction in the number of admissions as well as the length of time a malnourished child is kept in the ward. With UNICEF’s support, SAM management has contributed to a reduction of child mortality from more than 18 per cent in 2011 to less than 10 per cent in three major hospitals - including Mt. Hagen Hospital.
There still remains many challenges to overcome. Two days after talking to Betty, Elijah’s oedema stopped subsiding because his mother started feeding him other foods like sweet potatoes and bread even though she was advised not to give him other foods apart from the therapeutic milk until he was well recovered. Unfortunately, this means that Elijah will now be required to stay longer in the hospital to allow for a full recovery. It also means that the longer she stays in the hospital with her son, the less care she is able to give to her five-year-old son who remains in the village with his father.