Integrating critical services to save lives of mothers and children across South Sudan

Kuom health center also treats children for infection and malnutrition

By Pavithra S Rangan
A mother holds her baby
UNICEF South Sudan/2018/Rangan
30 March 2018

AWEIL, South Sudan, 30 March 2018 – A young girl (not over 12 years) tries with all her might to hold her wailing 15-month-old brother, Achan Dut, in her arms. A nurse carefully goes through the infant’s outpatient card, and while listening to the symptoms of his illness, pulls out a small white dipstick. Placing in it on the table, he puts on his gloves and having successfully distracted Achan, deftly pricks his finger.

Immersing the drop of blood on the dipstick, in less than ten minutes he declares the result of the rapid diagnostic test for malaria as positive. “It’s simple malaria and I’m prescribing an anti-malarial drug (ACT 50 mg). Give it to him once a day for three days. If his condition does not improve, bring him back,” explains Nutrition nurse Daniel Deng Deng to the little girl in the local language.

“If malnourished children have severe illnesses or medical complications, we refer them to the stabilization center,” says Daniel. “When children are brought for treatment at an early stage, we administer antibiotics or other drugs that can treat them here, at the center.”

Besides catering to common, yet life-threatening, childhood illnesses among children under five (i.e. malaria, pneumonia and diarrhea), the Kuom health center also treats children with severe and moderate acute malnutrition. “Malnourished children are extremely prone to infections and communicable diseases, which further weakens them and perpetuates the fatal cycle of disease and malnutrition,” says Daniel Deng. “We, therefore, try to treat both the infection and malnutrition in besides providing health and hygiene education which is important for prevention and to avoid relapse.”

Rapid response testing in Aweil, NBeG
UNICEF South Sudan/2018/Rangan

Rapid response testing in Aweil, NBeG

It’s a cloudy Monday morning and the women are seated in neat rows, with children on their laps, in one corner of the crowded shelter. With rapt attention, they listen to the health worker who is displaying colorful images of women washing hands, children being breastfed and of other healthy practices. She is frequently interrupted with questions, which she answers at length.

In about an hour, the weekly lesson ends and the mothers proceed, in practiced order, for treatment of their children at the facility. In front of a small white board that reads ‘anthropometric area’, two nutrition assistants are recording the weight, height, mid-upper arm circumference and other signs of malnutrition.

With these measurements noted on their OTP cards, the children undergo an appetite test. Over two dozen infants, all under five years, are given a sachet of plumpy nut (a ready-to-use therapeutic food to treat malnutrition). To be treated as an outpatient a child should be able to consume a third of the sachet in around 30 minutes, says the nutrition assistant supervising the appetite test. Inability to do so is an indicator of a medical complication and the child will be referred to the stabilization centre. At the next table, two nutrition nurses are assessing and examining the children for signs of illness or medical complications.

In its fifth year, the ongoing crisis in South Sudan has led to extremely high rates of maternal mortality (789 deaths per 100,000 live births) and infant mortality (90 per 1000 live births). UNICEF and partners are trying to save the lives of thousands of mothers and children, through these unassuming health and nutrition clinics that provide access to several critical services. Health workers also go from door-to-door to conduct weekly screening of all women and children in the area for any complications, to ensure timely identification and treatment.

With no market linkages and little government investment, people across the country are faced with a serious dearth of livelihood opportunities, the consequences of which find reflection in the severe food insecurity, malnutrition, disease and lack of access to basic life-saving services, among others.

The UNICEF supported facility in Kuom is accessed by nearly 1600 households in Aweil, Central Northern Bahr E Ghazal. It is also frequented by those living in remote villages, who can walk several hours before arriving at the facility. While there are several new admissions at the center each day, children with severe acute malnutrition come to the center for follow up treatment on Monday and Tuesday, while those with moderate acute malnutrition visit on Wednesday and Thursday. Friday is reserved for pregnant and lactating women, whose care can go a long way in reducing both maternal and infant mortality.

All new mothers visiting the facility are also provided long-lasting insecticide-treated nets (ITNs) for the prevention of malaria, besides soap, buckets and collapsible jerry cans to inculcate hygienic practices that will combat illnesses such as diarrhea. In January and February 2018 alone, nearly 10,000 families in humanitarian situations have received two ITNs. Routine immunization services for children, and all women of child bearing age (15 to 45 years), are also provided at the facility. UNICEF and partners are providing similar integrated health, nutrition, water and sanitation facilities in over 100 such facilities across the Northern Bahr E Ghazal state.

At the facility, the two nurses are discussing one-year-old Lual Madouk’s case, even as the child is fast asleep on his mother’s lap. “When he first came here three weeks ago, he was severely malnourished, had edema and severe pneumonia. We were afraid he wouldn’t survive and instantly referred him to the stabilization clinic,” recalls a nutrition nurse Mark Machiek. “He was discharged 10 days ago after being cured of pneumonia, and has since been undergoing treatment for malnutrition here. We are very happy with his progress.”

Lual’s mother, Adut, smiles as she holds him close. “His stomach was bloated and he refused to feed. He had very high fever for days and would cough all the time,” she says. “Now he’s so much better. He doesn’t have fever, he’s feeding well and, see, even the rash on his leg is getting better,” she says pointing to a healing infection on Lual’s right leg.

(Grants for the delivering of health, nutrition, water and sanitation programmes are generously provided by the German Development Bank-KfW and the German Foreign Office.)

(Grants for the malaria response strategy are provided by the US Fund for UNICEF.)