The Outpatient Nutrition Unit that kicks out children malnutrition in Dosseye refugee camp.

An ordinary Tuesday at the Outpatient Nutrition Unit in Dosseye refugee camp, Chad.

Francine Tchouta
Mothers holding babies with plumpy nut
UNICEF Chad/2021/Frank Dejongh
05 May 2021

Since I have been coming here with my son Abdoul and following the treatment he was given, he is much better. Today, I came for the follow-up. I hope he will be declared cured like his brother and sister who suffered from malnutrition and were treated here.

Mairo Bouba, 36, is a regular client of the outpatient nutrition unit (UNA) of the health centre located in the Dosseye refugee camp. In the past, this Central African refugee mother of seven children had two of her children treated in this outpatient nutritional unit. A few weeks ago, she was back again with Abdoul, her youngest child. Abdoul, barely 12 months old, was suffering from malnutrition.

"When we arrived, I was afraid because Abdoul was very sick. He was overheating and had diarrhoea. On top of that, he was crying all the time and was not eating at all. " Mairo recalls with a hint of sadness in her eyes.

The Dosseye refugee camp is located in southern Chad, near to the Central African Republic border. To reach it, you need to drive for almost two hours from Moundou, the capital of the Logone Oriental Province. Its access is closely linked to the ups and downs of the weather and the seasons, so that it sometimes takes more than two hours to reach it.

Within it, there is an outpatient nutrition unit supported by UNICEF with financial support from ECHO and USAID/Food for Peace. This nutrition unit welcomes both Central African refugee children and those from surrounding villages. Here, every Tuesday, the teams in charge of nutrition take care of nearly a hundred malnourished children aged 6 to 59 months.

therapeutic foods
UNICEF Chad/2021/Frank Dejongh
As the mothers’ sensitization takes place, the therapeutic foods commonly known as plumpy nuts are made available. They will be distributed to the mothers of patients.

While children suffering from severe malnutrition with medical complications are sent to the therapeutic Nutrition Unit of the Goré District Hospital, those suffering from severe acute malnutrition without medical complications like Abdoul are treated at the community level.

At the beginning, the mothers were not understanding the importance of nutrition. As we raise awareness at the community level and in the outpatient nutrition unit, they understand more and more what to do to prevent their children from suffering from malnutrition. " Symphonien, a male nurse on duty at the Dosseye UNA, explains.

With his son declared cured a few weeks later, Mairo can now smile. Like the other malnourished children, Abdoul was treated by the Dosseye outpatient nutrition unit, following a protocol that allowed him to recover his health.

How do malnourished children like little Abdoul manage to regain their health after their stay at the Dosseye ANU? The answer to this question can be found every Tuesday at the Health center.

First of all, Mairo and the other mothers are educated on malnutrition, but also on good nutrition practices for newborns and young children. To enable them to better understand, the awareness raising activity made in local languages (Fulfulde, Sango and Kaba) by community relays is reinforced by picture boxes meant for a better illustration of the explanations.

Sensitization session
UNICEF Chad/2021/Frank Dejongh
In his mother's arms, little Abdoul takes a nap. Meanwhile, his mother listens with interest to the nutrition advice given during the sensitization session.

After ensuring that everyone has understood the explanations, the nurses and community relays continue the process. The growth indicators of each of the children  are taken and then filled in on individual cards, along with their names, ages, and parents' addresses. During this stage, nothing is left out. Arm circumference measurements, nutritional oedema research for each patient, everything is recorded! Usually, the weight and height of the children are also taken. However, given the covid-19 and the necessity to reduce interactions, this protocol was slightly modified.

Following this, the kid’s appetites are tested using therapeutic foods commonly known as "plumpy nuts". The appetite test consists of giving each child a sachet of plumpy nut and seeing how much they will eat. The less a child eats, the more cause for concern. Recovering children like little Abdoul have no difficulty in finishing the whole sachet. In order to continue the treatment at home, plumpy nuts are also given to the mothers to enable them follow-up the nutritional monitoring at home.

Mothers holding babies with plumpy nut
UNICEF Chad/2021/Frank Dejongh
Once malnourished, 12-month-old baby Abdoul recovered his health after a few weeks of treatment. The proof: he swallows his bag of plumpy nut with great appetite

Thanks to UNICEF, with funding from ECHO and USAID/Food for Peace, the UNA in Dosseye is supplied with therapeutic food, medicines, equipment for detecting cases of malnutrition, data collection tools, and materials for raising awareness among mothers.  In addition, technical support is provided through the training of nurses and community relays who provide care and raise awareness about the the Integrated Management of Acute Malnutrition Protocol (IMAM), infant and young child feeding counselling and Essential Nutrition Actions. Between January and May 2021, 4,246 children were thus supported and treated in the UNAs of the Logone Oriental Province, with 3,053 of them being cured.

While the care of malnourished children takes place every Tuesday, children are also received on the other days of the week. Thanks to a mechanism set up within the programme, community relays, who are also refugees, are trained to raise awareness among mothers of children, but also to detect cases of malnutrition. These cases are referred to the UNA which takes care of them, to the delight of the mothers who are happy to see their children regain their colour, their smiles and their appetite.