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Niger: missing the second birthday

© UNICEF Niger/2010/Ally
A baby being weighed to ascertain malnutrition level

Madarounfa, Niger, 25 June 2010 -  Mariam Awal is a very pretty 25 year old mother of two.

She’s a very pleasant personality and chats openly as she cradles 10-month old Ibrahim in her arms. At 5.35kgs, he’s a bit small and light for his age.

His skeletal frame is evident. It is clearly that he is severely malnourished.

"He’s been in and out of hospital and has been sick a lot. My husband and I spent all our money on doctors, we have no more. "We are farmers and our crops have failed. There is little to eat and Ibrahim is sick again. My neighbour’s child was also sick and he got better after come to this hospital, so I decided to bring him here too," she explained.

This CRENI (a hospital that treats children who are severely malnourished and who also have medical complications) is the largest in Niger, a stone’s throw away from the Nigerian border.

It is run by MSF and supported by UNICEF.

Saving children from severe malnutrition
It had a reputation for treating difficult cases and children are referred here from 19 CRENAS in the area. A CRENAS is a medical outpost that treats severe malnutrition. There is one within easy reach of every villager in the Maradi region in which Madarounfa is located.

There are 82,949 children in this area. "When we saw that the harvests last year were poor, we knew that trouble was on the horizon," Dr Moussa Laouali, Deputy Chief of the CRENI explained.

"We took measures to enhance our capacity in anticipation of an increase in cases." UNICEF has provided additional beds and two large tents to this CRENI. In addition, the CRENI has trained 38 additional people to detect and treat severe malnutrition in the CRENAS.

Dr Laouali says that there’s been a 70% increase in admissions for the first quarter of this year while the death rate has increased by 41%. "Children come here with complications," Dr Ousmane Hamissou explained, "these tend to be malaria, diarrhoea or respiratory infection. Unfortunately, Ibrahim may become one of those statistics.

“Look here,” Dr Laouali said picking up Ibrahim and showing us his right side of the head. “He has fluid on his brain and we have installed a tube to drain it to his abdomen where it is discharged.”

Surgery and medication can fix the problem but this CRENI is not designed for this type of operation. He can refer the child to other hospitals but the surgery is not free.

"We have no more money," says Mariam, a shade downcast but still trying to remain pleasant and polite. Ibrahim will be the second child she will loose.

For other children there, such as 23-month-old Inoussa Aboubacar, recovery is more likely. Inoussa has come with a chest infection and the doctors are investigating it to rule out TB.

Both these children are among an estimated 400,000 expected to become severely malnourished in Niger because of crop failures. Eight out of ten people in Niger work in agriculture – either growing crops or raising animals.

Some crops such as millet and sorghum are grown for their families to eat and should last then a whole year. Other crops are grown to sell, so they can earn money to buy clothes and other necessities.

But the harvest was very bad last year and by March this year, food had gone. Grazing grounds have dried up and animals are dying in the thousands.

Herders are making a mere 17% sending dying animals to the slaughter houses. One herder said he sold all his dying animals for CFA 70,000 (£97) which is not enough to feed his family.

His children are badly malnourished and have been in and out of hospital. Ordinarily, these animals would have fetched CFA 400,000 (£554).

More therapeutic food and medicines needed
As part of its emergency response, UNICEF is supporting CRENIs and CRENAS all over Niger.

They are provided with Plumpy’Nut to treat severe malnutrition along with other supplies such as Vitamin A and other minerals and vitamins.

UNICEF has also provided extra beds and tents in some CRENIs and also training nurses. "With the increase in cases of severe malnutrition we needed more therapeutic foods and medicines and UNICEF has provided us with an adequate supply," said Dr Laouali. “The problem in the CRENAS is that we do not have sufficient staff.

Nine nurses are now in training being provided by UNICEF. However, seven CRENAS which are operated by (another international NGO) are to be closed due to a lack of funding. UNICEF has offered to pay the staff to keep them open and I hope this can happen.

We cannot afford to lose these CRENAS,” he added. In addition to the 400,000 expected cases of severe malnutrition this year, there are another 1.2 million children who are moderately malnourished.

These are normally handled by the World Food Programme (WFP) but Dr Laouali says that since January promised supplies of CSB (a corn soya blend) have not materialised. Blanket feeding now taking in almost 1 million children (900,000) in four regions extending to December (previously to August).

UNICEF coverage for malnourished children increase from 400,000 to 1.6 million. Flash appeal being revised from US$22 million for nutrition to US$146,947,018.

By Terry Ally



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