Helping malnourished children

People who saw Marie were worried. 

The one and a half year old girl was too thin. She had a cough, and there was something wrong with her throat. 

A community health worker decided to take action. She encouraged Marie’s parents to take their baby girl to the health centre to get checked out.

“I am afraid of the future, I am concerned about what to do in the future and concerned about the future of Marie. I think about Marie’s food and her health,” Marie’s mother Hawa says. 

At the clinic, the circumference of Marie’s arm was measured – a way to identify malnutrition. She scored a minus four on the table diagram, the worst form of malnutrition. She was immediately placed in a World Vision funded Outpatient Therapy Programme (OTP), given medication and a highly nutritious supplement called Plumpy’nut to nurse her back to health. 

Marie’s mother Hawa explains this year’s drought that is sweeping across parts of West Africa led to her daughters’ condition. 

“When we have a good harvest we eat three times a day. Before last year’s harvest we had more than 20 goats but now only five goats are left,” Hawa says. 

In other years, Marie’s family gets a harvest that fills up 60 to 80 donkey carts. They grow maize, sorghum and peanuts, and the harvest is enough to feed the family and their animals. 

But last year was different. The severe drought left the family with only one donkey cart full of millet and about half a donkey cart of sorghum. The peanut and rice crops was a total failure. They reaped nothing from it. 

In order forMarie and her family to survive, her parents had to sell their animals and buy food. The adults are eating only once a day now, and the children eat twice a day. In order for the food to stretch and last as long as possible, her family eats smaller portions. 

To make matters worse the price of maize is very expensive now and the quality is poor. 

“The maize we buy in the market is not very nutritious because we get hungry very quickly, but we have no choice and the price is very expensive now,” Hawa says. “The last good harvest we did not buy maize. Last year a 100 kg bag of millet cost 10 000 cfa [about 20 US dollars] now that same bag of millet costs 25 000cfa [about 50 US dollars].”

Doctor Kene Mark Guindo is the World Visionnutrition project manager. He has been a general practitioner (GP) since 2006, but specialized in midwifery. Doctor Kene Mark recalls a time when there was severe malnutrition in the Sikasso Region of Mali during 2002. There is a big difference between the malnutrition in 2002 and in 2012, he says. 

In 2002, the screening of children was poor, he reports. Now the health centres are better organised, he says. In 2002, mothers used to wait until the child was extremely malnourished with complications and then take the child to the health centre. Such cases would have to be referred to the district health centre. 

Now, Kene Mark says,World Vision has trained health volunteers in villages to do malnutrition screening once a month now. Screening involves measuring the bicep to determine the health status of the child according to a table diagram which has colours red, yellow, green and oedema (severe malnutrition with complications). The community health volunteer takes the results of the table diagram to the doctor or nurse at the community health centre for the Outpatient Therapy Programme. A health volunteer covers about 35 to 50 households in a village. This approach was started in 2012. The health worker also has a little mobile pharmacy to treat common sicknesses like malaria, diarrhoea and fever. 

A health volunteer saved Marie, by referring her to health services. Since the child started the Outpatient Therapy Programme, she has grown. She ate Plumpy’nut every day for a week and is now 65 cms tall and has a bicep diameter of 105 mm. 

Her mother is also planning to take Marie to have her cough and throat infection looked at. 

“I am glad Marie can come to the Outpatient Therapy Programme, because Marie is sick,” Hawa says. 

The lack of rain has resulted in a severe drought resulting in food shortages for over 3.5 million people in Mali. If children under two years of age lack vital nutrition, it can result in physical and mental stunting which will affect them for the rest of their life. 

The malnutrition rate in Mali is alarming. It is over the critical global acute malnutrition rate. Based on the acute malnutrition rates from the latest nutrition survey conducted by World Vision Mali in December 2011, the country has a global acute malnutrition rate of 12.2 per cent with a severe acute malnutrition rateof 2.7 per cent. World Vision Mali is planning to serve 10,364 acutely malnourished children ages six to 59 months from whom 2,294 are expected to be severely malnourished within the Tominian health district.

For this reason, World Vision Mali is working with the Ministry of Health to train community health volunteers to identify malnourished children and to refer them to the community health centre to be enrolled into the Community Management for Acute Malnutrition(CMAM) activities. In addition, about 99 people were trained on the community management for acute malnutrition, which included 11 World Vision Mali staff, 10 Ministry of Health agents, one non-government organisation(NGO) representative, 23 Community Health Workers and 54 Community Health Volunteers. 

The community was mobilised by the community health worker who informed community leaders on the importance of outpatient therapy programme (OTP). Community leaders ensured that all children under the age of two brought to be screened by the health volunteer in each village. The health volunteer measures the child’s bicep to determine if he or she is malnourished or not according to the colour code. Green indicates healthy, yellow indicates moderate malnutrition while red indicates severe malnutrition. The following day the children who were in the red are sent to the community health centre where the Outpatient Therapeutic Programme runs. The OTP is already achieving incredible results in a short space of time. Take NenimaThera, for example.Two weeks ago he was 7.4 kgs, now he is 9.5 kgs. He moved from red to green in just two weeks. NenimaThera no longer needs to come to the OTP sessions. 

The OTP happens once a week on market day when people from a number of villages come to do their weekly shopping. 

“I believe that during this difficult time that our country is passing through, this programme will certainly save children lives,” says San-San Dimache, World Vision nutrition advisor for West Africa. 

World Vision runs OTP in eight community health centres.