In the first quarter of 2006, Doctors Without Borders/Médecins Sans Frontières (MSF) treated more than 26,000 children suffering from acute malnutrition in the Maradi region of Niger. As of late June, the beginning of the most critical period, more than 2,000 children are being admitted every week. Last year, the seriousness of the situation forced MSF to launch an emergency program to strengthen the malnutrition treatment program underway since 2001. Emmanuel Drouhin, MSF program manager in Niger, provides an update on the situation after visiting the field.

What struck you in particular during the visit?

Thanks to MSF's eleven outpatient feeding centers in the Maradi region, most acute malnutrition cases can be treated. Only children with additional medical complications require hospitalization. Photo © Anne Yzebe

I was particularly struck by the fact that we are now talking about tens of thousands of children who have received treatment. Since January, 26,000 children have been treated in our programs in the Maradi region. All the nongovernmental organizations working throughout Niger have treated 140,000. We have exceeded all previous treatment figures. Two years ago, we were treating only 10,000 children in a year—20,000 at a maximum—and only the most serious cases.

Is access to food still a problem in the Maradi region?

The situation remains critical. Many families are living on credit and lack food. They pay the previous year's debts in-kind, and because interest rates are prohibitively high, the reserves they store after October's harvest run out by March or April and they have to reduce their food consumption. When they have no reserves to offer as repayment, they must sell their land and there are growing numbers of landless peasants in the region. And although there is a strong tradition of mutual aid in the villages, it is difficult for people to support one another when the shortages are too severe.

As the dry season begins, are admissions into our centers already increasing?

The trend line is rising, with more than 1,500 admissions per week since mid-May and more than 2,000 as of late June. Last year, 60 percent of the children were treated between mid-July and mid-October. At that time of year, lack of food—in terms of both quantity and quality—is particularly significant. It is also the season for malaria, diarrhea, and respiratory infections.

This year, we are admitting all children with severe and moderate acute malnutrition. (MSF is using a malnutrition treatment strategy in which the majority of the children are cared for on an outpatient basis with ready-to-use therapeutic foods that can be taken at home. Only children who are suffering both from acute malnutrition—whether severe or moderate —and a complicating illness are admitted to an inpatient feeding center). Nine out of 10 children receive the nutritional treatment before becoming severely malnourished. Because of this new treatment strategy, we cannot make comparisons with preceding years, but we hope that it will help reduce the mortality rate throughout the year and, in particular, during the dry season.

Are the strategies implemented to address the nutritional situation in Niger adequate?

Most of our 11 outpatient nutritional centers in the southern Maradi region are now open all week and we will open additional facilities as needed. MSF is also opening a nutritional program in Aguié and the western area of the Maradi region, and continuing our activities in the Zinder region. Children in all MSF centers suffering from severe or moderate acute malnutrition are now treated with a ready-to-use therapeutic food that has been proven effective.

Beyond MSF's programs, a significant response is underway. Niger's health ministry, United Nations agencies, and various nongovernmental organizations are prepared to treat 500,000 children in 2006. From July to September, the World Food Program will distribute 26 pounds (12 kilos) of cereal every month to every child under 5 years of age in the Maradi, Zinder, and Tahoua regions, where acute malnutrition is prevalent. The Niger government has also adopted a new treatment protocol for severe acute malnutrition and has also made treatment free for children under five. Of course, the impact of these political decisions is not always visible in the field. That takes time and, in particular, major resources. However, these developments speak to a strong desire to take action on this public health issue.

Despite this response, we are still critical of the fact that the more effective treatment is basically limited to children suffering from severe malnutrition. Those in the "moderate" phase of malnutrition also need this therapeutic treatment, which involves ready-to-use therapeutic foods and the outpatient strategy. In the majority of cases, the mothers become the caregivers and the results of our programs in Niger prove that they are effective, with recovery rates above 94 percent.

Still, we often hear that mothers don't take good care of their children?

In Niger, malnutrition is often attributed to mothers' ignorance, lack of hygiene, or observance of food taboos. However, mothers were the first to understand that malnutrition is not necessarily fatal and that with an appropriate treatment, their children can be saved. Cost is the main obstacle for having access to treatment. Photo © Anne Yzebe

No one trusts them. In Niger, malnutrition is often attributed to mothers' ignorance, lack of hygiene, and observance of food taboos. However, they were the first to understand that malnutrition is not necessarily fatal and that with an appropriate product, their children can be saved. I met a woman who had walked 150 miles (250 kilometers) to bring her child to the nutrition center. Because she thought there was really a way to save the child, she overcame all obstacles—including her husband's opposition—to get there. Everyone knows about the nutrition centers. Everyone has seen a neighbor's or relative's child gain weight back and do well. For me, that's the most important—and the most encouraging—change.

In a majority of cases, giving children a therapeutic food is enough for them to gain weight back and recover their strength. The problem now is that families don't have the money to buy this product. The price of one treatment (two sachets of the ready-to-use therapeutic food Plumpy'nut per day for one month) is approximately $19 (15 euros). Today, the issue is to reduce the cost so that it is affordable in a country where family purchasing power is extremely low.