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Medical middlemen catch childhood malnutrition before it becomes life-threatening

UNICEF Somalia/ Pflanz
© UNICEF Somalia/ 2010/ Pflanz
A health worker at the Outpatient Therapeutic Clinic in Hargeisa hands a mother portions of Plumpy’nut food supplement. Severely malnourished children are monitored on a weekly basis and are treated with the high-energy peanut paste.

By Mike Pflanz

HARGEISA, Northwest Somalia “Somaliland”, 20 December 2010 – Salman Haji stood solemnly watching the man in the white coat searching papers spread across the table in the tin-walled hut open to the morning breeze.

Finally, Ali Mayag Muse found the yellow medical card which recorded details of the four-year-old’s last visit to this mobile clinic on the outskirts of Hargeisa, Somaliland’s capital.

“He was improving, but now there are signs again of malnutrition, and of an underlying chronic respiratory illness,” Mr. Muse told Salman’s mother, Hodan Mohamed, as her son struggled to contain a sudden coughing fit. 

Mr. Muse is a supervisor of an innovative scheme to bring health care to people across Somalia who would otherwise struggle to find it. The project is implemented with support from UNICEF, and funding from the European Commission Humanitarian Aid Department (ECHO), UK Department for International Development (DfID), Governments of Italy, Spain, and Denmark, as well as the Italian and French National Committees for UNICEF, and Somalia Common Humanitarian Fund (CHF).

The Outpatient Therapeutic Programme aims to catch children before malnutrition becomes so severe that other deadly illnesses – tuberculosis, diarrhoea and pneumonia chief among them – can take hold.

The weight and height of the children are measured, as is the circumference of their upper arms, to create a weekly snapshot of each child’s nutrition status, which is then checked against records from previous visits.

Plumpy’nut© – a pre-packaged high-nutritional quality peanut paste specially formulated to treat severe acute malnutrition – are handed out, as are Vitamin A supplements and zinc tablets to treat diarrhoea, where appropriate. Children with underlying complaints – like Salman – may be started on a course of antibiotics.

Appointments are made for the child to return for further check-ups in the coming weeks, and health workers living nearby are tasked with regular monitoring to make sure there is no sudden deterioration.

For Ms. Mohamed, Salman’s mother, and the dozens of other mothers dressed in bright shawls who gathered one recent Saturday morning to have their children examined, there are few other options if their children fall sick.

“Before, I had to find money to go to the private hospital or the pharmacy, and even then the medicines they gave helped only temporarily,” said Ms. Mohamed, 23.

“If I had no money, there was nothing I could do. Here, I am getting advice, I feel that they are following-up and checking how the children are progressing, whether the special food is working, what more can be done to help.”

UNICEF’s Outpatient Therapeutic Programme operates in 33 fixed sites across Somaliland, and a dozen mobile teams roam to 123 locations in remote areas to intersect with nomadic people herding their livestock.

In the first 10 months of 2010, 90 per cent of the more than 6,000 children treated in Somaliland for severe acute malnutrition recovered.

But UNICEF estimates that it reaches only half of those in need in Somaliland, the semi-autonomous region on the Gulf of Aden in Somalia’s far north, bordering Ethiopia and Djibouti.

UNICEF Somalia/ Pflanz
© UNICEF Somalia/ 2010/ Pflanz
Asha Mohamed, 30, smiles as she holds her nine-month-old daughter Ayan Yasin, who is recovering in a special ward for critically malnourished children in Hargeisa.

Asha Mohamed’s nine-month-old daughter, Ayan, was one of those still beyond the reach of the programme, in their remote village a 24-hour journey to the south of Hargeisa.

“She was sick for a month, and getting worse and worse. I spoke with my relatives and they sent us to a herbalist, which did not work, then to a pharmacy, but that did not work either,” Ms. Mohamed said.

“Finally, I made the decision on my own to get a truck to come to Hargeisa. It was a day and a night on the road, and Ayan was so sick and exhausted. Finally, we were told to come here, and now she is recovering so fast.”

“Here” is Hargeisa Group Hospital, where UNICEF supports a special ward giving round-the-clock treatment to children whose severe malnutrition is compounded with other medical complications.

It is one of Somaliland’s three ‘stabilisation centres’ for inpatient treatment, the step above the outpatient programme for the most serious cases.

Infants are slowly brought back to strength with measured interventions first to stabilise their condition, then to boost their appetite, and then to regain weight.

“It can kill a malnourished child to rush in to treat the malnutrition, first we need to treat the complications,” said Hawale Abdullahi, the stabilisation centre’s supervisor.

An average of 40 cases are admitted to the centre each month – but Mr. Abdullahi has hope that those numbers will drop if the outpatient programme can be expanded.

Zivai Mururi, UNICEF’s Nutrition Specialist based in Hargeisa, agrees.

“Children can deteriorate so quickly to the point where their severe malnutrition is difficult to manage,” he said.

“That’s why the stabilisation centres are there, but it’s also why we are trying to widen the reach of the outpatient programme, to catch children before complications set in.

“Then it’s so much easier to manage, it’s much less expensive than inpatient care, and in a short period, all of them are going to get better.”



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