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Simple rules of hygiene help reduce malnutrition among Somali children

UNICEF/ Pflanz
© UNICEF Somalia/ 2011/ Mike Pflanz
Safiyo Abdullah is being shown proper techniques for handwashing

By Mike Pflanz

BOSSASO, Puntland, 28 Nov 2011 – A series of laminated A4 pictures are stuck on the wall of the room where two dozen mothers sit with their babies, many so young they are still breastfeeding.

On the posters are crude but colourful drawings showing a girl walking past rubbish, flies swarming around food on a table, a collection of tatty water containers and a woman’s dirty hand.

They may be basic, but these pictures are powerful weapons on the frontline of the battle against the world’s leading contributors to childhood death: malnutrition and diarrhea.

Sustained efforts have been made to treat malnutrition. Relief agencies distribute food and clinics and hospitals provide emergency supplements to the most severe cases.

But alongside this, an innovative new approach is trying to restrict one of the main reasons that people – children especially – fall victim to malnutrition in the first place. 

Supported by UNICEF, with UKaid funding, there is a new focus on improving basic hygiene and sanitation in Somalia’s family homes.

“It’s simple,” says Abdihakim Olad Salebon, a nutrition expert from Bossaso General Hospital, seconded to the scheme to work with communities here in Puntland, a semi-autonomous region in northern Somalia.

“If a child’s environment is clean, if the water they drink and the food they eat is prepared properly, infants are breast-fed correctly, and if their body is clean and their parents are alert, the risks of getting diarrhoea and other illnesses are much, much lower.

“There, you have one of the strongest ways to prevent malnutrition.”

Yet these simple practices, and the boost they give to better health, are not widely understood in Somalia, prompting gatherings like that in the meeting hall with the laminated A4 posters, led by UNICEF’s Somali partner organisations.

One by one, mothers come to the front and choose from a second set of pictures – food covered with a plate, a child drinking from a clean container, hands being washed – and stick these solutions over their matching problems up on the wall. 

UNICEF/ Pflanz
© UNICEF Somalia/ 2011/ Mike Pflanz
Hawa Mohamed gives her 18-month-old son clean water from supplies she keeps separate from washing water, after health workers in Bossaso explained that this can help avoid illnesses.

“Before we started this programme two years ago, it was a very different situation,” said Mohamed Ali Nur, a village elder who volunteers as a ‘hygiene promoter’ for people living nearby.

“Children used to go to the nearest open area to defecate, there were no toilets. Rubbish was all over the place, drinking water was not treated. Every day, children were sick with diarrhoea, which causes malnutrition.”

Out along the sandy lanes which weave through the 100 Bush camp for people who have fled to Bossaso’s relative safety from problems elsewhere in Somalia, Mohamed is conducting house to house visits.

At Safiyo Abdullah’s tin-walled home, a new stone-built toilet stands in a corner. Cooking pots and pans gleam where they have been washed after lunch. One of her daughters is scrubbing clothes using water kept separate from that used for drinking.

Safiyo, 25 and pregnant with her eighth child, shows how Mohamed taught her to wash her hands properly, using soap and clean water, thoroughly scrubbing twice.

“No-one had told me about this before people like Mohamed started showing us,” she said. “Before, the children were sick a lot, with diarrhoea. Now, it is something rare, and I can say it is only because of these new practices.” 

Deeper into the camp, Hawa Mohamed proudly shows where she keeps her chlorine-treated drinking water, and tells how she warns her children not to go near the dumpsite over near the beach.

“Both of my children were severely malnourished in the past,” she said. Fatuma, her 2-year-old daughter, was even hospitalised because of the condition in January.

“I have come to know that it is because this is a dirty place, where there are flies and they can bring germs to our food and water if we do not take care. Now I am telling so many other mothers about what I have learned.”

It is not just keeping her home clean that Hawa has learned. One aspect of the approach is to encourage mothers to breastfeed their babies exclusively for their first six months, and then to continue with supplementary food until age two.

“I did not know about this before, I used to use bottles, or water even though I boiled it, to feed my children when they were babies.”

She pulled her youngest child, a four-week-old son, to her and began feeding him. “See, it is not difficult,” she says with a smile. “This too, I am telling other mothers.”

There are plans to expand this fresh approach, integrating activities to improve nutrition with those focused on clean water, sanitation and hygiene, across UNICEF’s activities in Somalia.



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