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Niger: tackling severe malnutrition

© UNICEF/WCARO/2008/Pirozzi

SAHEL - Number of child deaths attributable to malnutrition every year: 300,000

The ward is a modest-looking affair with walls made of straw mats.

It houses around 15 beds where mothers sleep next to children who gaze out emptily. Despite their morose appearance, these youngsters are miraculous recoveries. Indeed, these children, the most severely affected by acute malnutrition in Niger, are survivors. Their mothers realize this. At first their eyes express shyness and shame, but soon a timid smile appears. They know that their children have escaped the worst.

When Hanatou Hassan, a 19-year-old mother, arrived at this intensive feeding centre in Tillabery, in western Niger, her son Boubakar was so thin and weak that he could not lift his head. Fearing she would lose her only child at the age of 19 months, she travelled from Soudani, a village located on an island in the Niger River, to Tillabery. She does not know how far it is but says it took her almost an entire day to complete the journey to the feeding centre known under its French acronym, CRENI. Upon arrival, little Boubakar, like most of the small children who are treated here, was suffering from marasmus, a state of extreme thinness caused by a diet that fails – in terms of both quantity and quality – to meet the child’s nutrition needs.

He was first admitted to a “stabilization” room, where newly arrived children are kept for several days and treated for medical complications (such as diarrhea, malaria, infections and anorexia) arising from the malnourished body’s weakened state. In Boubakar’s case, it was a lung infection. But acute malnutrition cannot be cured with medication, contrary to what many mothers think when they bring their children here. They expect them to be given injections, put on a drip or even given syrup – but they don’t expect them to simply be fed.

As soon as he arrived, Boubakar was given therapeutic food: two types of milk formula that are mixed with water (F75 and F100) and later a peanut paste-based ready-to-use therapeutic food which children simply adore, Plumpy’nut. He was also given vitamin A and iron, a much-needed boost for his greatly weakened immune system. And to make sure his digestive system was not being undermined from within by worms, he was dewormed. Soon, Boubakar recovered some of his strength and was able to go back to breastfeeding while he continued to be fed therapeutic foods. Little by little, he regained 85% of his “target weight” (the weight he should normally be). It all happened so quickly that when his father came to see him after two weeks, he didn't recognize him. “He did not believe it was his son!” Hanatou Hassan says in Zarma, one of Niger’s languages. “He was very happy. He thanked all the staff and he thanked God.

In Niger, intensive nutrition feeding programmes are helping children severely affected by malnutrition to pull through.
Such “miracles” often occur in Niger’s CRENI and CRENA (the ambulatory feeding programme for children with severe malnutrition without medical complications), where every year more than 50,000 children are saved. Last year, the CRENI in Tilabery treated around 400 children. Some mothers travel up to 100 kilometres to have their children treated here. Care is completely free, and transport costs are covered. This is an important detail. “It reassures them because their primary concern is money,” says nurse Abdulaye Saley. “People think the CRENI will cost them a lot of money and they don’t want to take the risk of having their children treated. They don’t even know anyone rich enough to help them.”

Unfortunately, some mothers do not stay until the end of the treatment, which can take up to two weeks. Bibata Hamidou Souley, a nurse, says one mother withdrew her child under pressure from her husband, who had threatened to divorce her. “The mother was in tears,” she recalls. “But she left in the end.”

Later on, the nurse heard that the young child did not survive. When Hanatou Hassan returns to Soudani, she intends to share with the village women what she learned at the Tilabery CRENI, starting with the importance of exclusively breastfeeding children up to the age of six months; to varying their diet by giving them complementary foods and giving them preventive vitamin A supplementation and deworming.

She will go back with her son strapped to her back and, in her bundle, she will carry two gifts: an insecticide-treated mosquito net, which will protect her son against malaria, and something she will not have to beg him to eat: Plumpy’nut.

by Michel Arseneault





Malnutrition in the Sahel


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