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Bottom up - Top down: how undernutrition is combatted in Niger

© UNICEF/Niger/2009/Holtz
Seventeen months-old Roumanatou Sani is slowly recovering from an episode of acute malnutrition after a three-week stay at a therapeutic feeding centre in Zinder.

Zinder, Niger, 18 November 2009 - At a UNICEF and ECHO-supported therapeutic feeding centre in Zinder, in the South of Niger, seventeen months-old Roumanatou Sani is slowly recovering after her three-week stay at the intensive care unit. Her mother, Nana Hassane, acknowledges she should have gone earlier to seek help.

Roumanatou became malnourished from recurring bouts of diarrhea over several weeks. Food intake is only one cause of child malnutrition. Access to health care, to life-saving information, to clean water and hygiene also play a role.

In this arid country landlocked in the heart of the Sahel, insufficient food intake is but one cause of child malnutrition. Factors such as the availability of health care, access to life-saving information, clean water and hygiene also play a role. Up to 350,000 children suffer from malnutrition in normal years.
Soumana Noufou is a health worker at this centre, which is run by the Government, in collaboration with the NGO Médecins Sans Frontières (MSF) Switzerland. He has been working for many years in rural Niger. He knows that when the lean season starts – between June and September each year, the number of children suffering from severe malnutrition will dramatically increase in his ward. “Acknowledging that one’s child is malnourished is difficult. Parents try to keep it secret out of shame but this behaviour has dire effects on children’s health”, explains Soumana Noufou.

This is particularly true in Roumanatou’s family. In her neighborhood of Birni, in the city of Zinder she is considered a privileged child. Her father is a bus driver who is making a comfortable living, according to Nana Hassane. In addition to providing his family with regular rice and millet meals, her husband never thinks twice when it comes to purchase additional food. Even after sharing with neighbors, they still have enough to eat. Yet her child became malnourished.

“Our child had been losing weight for some time. She lost her appetite and had several episodes of diarrhea. My husband never accepted the idea that she was malnourished, having in mind how hard he worked to provide well for us. When we finally decided to take her to the health center, I could feel it was too late. My family was shocked when I told them that she was suffering from malnutrition.”

Getting the right mix of nutrients
Nana Hassane says health workers at the centre have advised her how to cook nutritious meals with available local foods. They also highlighted the importance of clean water and sanitation to prevent diarrhoea. Even her husband’s views on malnutrition have changed. “Now I realise that I had no idea of the good combination of foods that would provide her with the daily required amount of calories necessary for her health”, Nana admits. 

“Malnutrition cases referred to therapeutic feeding centres are almost always coupled with other diseases, among which diarrhea and acute respiratory infections, such as pneumonia”, says Elizabeth Zanou, a UNICEF Niger nutritionist. “A skinny body with edema and a complete loss of appetite, causing children’s belly to shrink, are the visible signs of the kind of malnutrition Roumanatou has been affected with. The first few days at the intensive care unit can however make the difference”.

The Government of Niger and UNICEF, with funding from ECHO, have developed a road map for the integration of the management of malnutrition within the national health care system so that every malnourished child can be treated in the vicinity of his/her home. In the Maradi region, West of Zinder, each health district is now equipped with at least one inpatient facility for the treatment of severe malnutrition, and every health centre has the supplies necessary for the outpatient treatment of severe malnutrition.

Preventing children to be malnourished in the first place is the real challenge that specialists face, in a country where the rates of global acute malnutrition seldom fall below 10%.

ECHO is supporting UNICEF to provide for these foods, such as Plumpy’ Nut, that help undernourished children to recover within two to three weeks. In 2009, ECHO provided UNICEF with funding worth $800,000. These funds have also enabled UNICEF to organise activities such as capacity building for health worker at therapeutic feeding centres, awareness raising sessions by heath volunteers at the community level, as well as conduct a nutrition survey nationally every year.

A recent national nutrition and child survival survey, partly supported by UNICEF, and using ECHO funding, indicates that global acute malnutrition has decreased in the past four years from 15 per cent to 12 per cent. However, despite progress, acute malnutrition remains a public health issue in Niger.

By Seydou Amadou Oumarou






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