Strengthening nutrition systems to fight against malnutrition in Sierra Leone

Kawaya – After a two-hour drive through a breathtaking tapestry of towering trees and thickets of foliage in Moyamba district, southern Sierra Leone, I arrived at the Kawaya Community Health Post, where Hawa Momodu, Nurse-in-charge of the facility, was getting the monthly nutrition data ready for submission to the District Health Management Team.

Nurse Hawa is one of the unsung heroes stationed at health facilities within communities, working tirelessly under difficult circumstances to rewrite the survival stories of malnourished children by helping them to get critical and immediate lifesaving treatment and other health services.

In Sierra Leone, malnutrition remains a significant threat to the overall health and well-being of children, limiting their potential to learn now and to earn later in life. According to the Sierra Leone National Nutrition Survey 2021 report, 26 per cent of children under five years are stunted, 5 per cent are wasted, and 1 per cent severely wasted. There are more than 60,000 cases of severe acute malnutrition annually among children under five years. These children are at a higher risk of dying, making their early identification, referral and treatment a matter of urgency. Community health workers are at the fore front of this effort and have screened over 100,000 children this year to identify, counsel and refer for treatment at the health facility level as needed.

With thanks to the generous contribution from the United States Agency for International Development (USAID), UNICEF is working with the Ministry of Health and partners to address all forms of malnutrition through preventive and treatment services such as the promotion of infant and young child feeding practices and micronutrient supplementation of children under five years.

UNICEF provided support to strengthen nutrition systems through the operationalization of a nutrition surveillance system to enable early case identification and referral for timely treatment of severely malnourished children across the country. UNICEF also supported the training of 212 health workers, like Nurse Hawa, to identify malnourished children, refer them for timely treatment, and to collect regular and representative primary nutrition data at community and health facility level for strengthening nutrition reporting and decision making.

Jestina Momoh, a Nutritionist at the Moyamba District Health Management Team explained the importance of collecting, analyzing and using nutrition data by saying, “data gives us the power to see the invisible struggles in communities and nutrition surveillance helps us to ensure that no child's hunger goes unnoticed.”

At the end of every month, health workers at the peripheral health units send the data they have collected to the nutritionists and monitoring and evaluation officers at the district health management teams, who in turn verify the data and submit them to the national data centre through the Health Management Information System. This data is a vital part of the nutrition surveillance system as it shows the trend in the nutritional status of individual children and of the collective child population within the communities to inform decision-making and guide quick actions.

“Through our nutrition surveillance efforts, we are upholding our commitment to children's survival and development”, says Dr. Vandana Joshi, UNICEF Chief of Health and Nutrition, “It is the compass guiding our actions, allowing us to detect the early signs of malnutrition and ensuring that every child's journey begins with health and hope”, she adds.

Back at the Kawaya CHP, Hawa recalls the day she identified 19-month-old Samson as severely malnourished. Using the surveillance and referral system, she promptly referred Samson to the In-Patient facility at the Moyamba Government Hospital where he received the therapeutic foods and medical attention that helped him to recover.

"We are more than just health workers; we are champions of change. We save lives and empower our communities to protect our children's futures,” Nurse Hawa reflected on the role of health workers which includes educating families about the importance of breastfeeding, proper hygiene, cultivating family gardens, and feeding nutritious foods to children. Health workers also teach caregivers how to monitor the nutrition status of children 6 – 59 months using the Mid-Upper Arm Circumference (MUAC) tape and to seek help if the child falls within the red zone on the tape. They also encourage families to improve their health seeking behaviours.

Samson’s transformation from frailty to vitality is a testament to the benefits of early detection, referral and intervention, and to the dedication of health workers to use vital nutrition data and systems to save the lives of children in Sierra Leone.