Outpatient services save the lives of severely malnourished children in Nigeria
By Karen Allen
KATSINA, Nigeria, 20 July 2012 – The first rains have arrived in northern Nigeria. Tufts of guinea corn are peeking out from the soil.
Farmers are optimistic that this year’s growing season will yield good results – yet hundreds of children are packed into a community clinic near Katsina, seeking treatment for severe acute malnutrition.
“It’s not that they’re hungry,” said Rabia Mohammed, chief government nutritionist for Katsina State. “It’s just that they’re eating the wrong kind of food.”
Treating malnutrition in the community
It’s estimated that just under a quarter of a million children in Nigeria are suffering from severe acute malnutrition, a deadly condition.
The staple diet here is guinea corn, maize meal and rice. All are rich in carbohydrates, but, on their own, they are not sufficient to ensure that children get the range of nutrients they need.
As a result, thousands of children are now attending outpatient therapeutic centres for treatment. These centres are part of an integrated health strategy that UNICEF is supporting called Community Management of Acute Malnutrition (CMAM).
The children wait under a tree, the clinic’s waiting area. All exhibit the classic symptoms of acute malnutrition: Some have swollen limbs, a tell-tale sign of protein deficiency; others have chronic diarrhoea and vomiting. But their rehabilitation is taking place in the community, rather than in hospital.
Here, the children are regularly weighed, offered medications and fed supplementary foods. Their mothers are taught about nutrition and hygiene. Any childhood immunizations they may have missed are also administered on the same site.
So far, the programme has treated 16,000 children under age 5, out of a target of 31,000 in Katsina State. It is seen as a model for the region.
“With 20 per cent of the population under the age of 5, these kinds of integrated strategies are critical,” said Ibrahim Lawal Dankaba, the local government representative whose teams are working in collaboration with UNICEF.
Promoting exclusive breastfeeding
The families of the children clustered outside the clinic are all engaged in farming.
Like thousands of others, Lawal Ramatu sells half of what she grows and tries to survive on what remains. But it is not enough – nor is it the appropriate food for her 10-month-old son Saidu, who has just been diagnosed with severe acute malnutrition.
Mothers of infants are being encouraged to exclusively breastfeed their children to keep disease at bay. But local traditions encourage women to feed their children water as well, even though access to clean water is limited.
“The lack of exclusive breastfeeding is a big problem,” said Ms. Mohammed. “Poverty is also making things worse. So, too, is ignorance and disease.”
One in seven children won’t survive to see their fifth birthday in Nigeria, and malnutrition is a huge factor.
Saidu will spend the next eight weeks in the CMAM programme, with local community health workers ensuring that his mother brings him to the outpatient therapeutic centre for regular check-ups.
UNICEF is working to scale-up such projects across the north, but a funding gap is limiting these efforts. So, too, are logistical challenges.
A warehouse not far from the therapeutic centre is stuffed with boxes of recently received therapeutic feeding materials – but delays at the port hundreds of miles south, in Lagos, mean life-saving foods often do not get through.
Nigeria is Africa’s most populous nation. Its nutrition crisis may have failed to capture the headlines, but without intervention, its toll could be staggering.