A malnutrition examination at an MSF clinic, Niger. Photo © Anne Yzebe / MSF

On September 1, 2006, Doctors Without Borders/Médecins Sans Frontières (MSF) had more than 10,000 acutely malnourished children currently on treatment in its nutritional program in the Maradi region. In January 2006, MSF modified its operational strategy in an effort to limit the number of deaths and prevent children from becoming severely malnourished. Dr. Isabelle Defourny, who has just returned from Niger, offers an initial assessment.

Three months after the start of the dry season, what is the nutritional situation in Niger?

While last year's acute crisis may have passed, all indicators suggest that the situation is still quite serious. Between January and late August 2006, nongovernmental organizations working across the country treated a total of 250,000 acutely malnourished children⁽¹⁾. Since the beginning of 2006, our program in the Maradi region has admitted more than 45,000 children in just two departments (provinces). This is a very high number and is particularly shocking given that the situation has improved compared to 2005. The last harvests were good and while market prices are still high, they remain stable.

Furthermore, these figures reflect only the number of children treated—that is, those who were screened and met the nutritional treatment criteria. This does not mean that the others enjoyed good nutritional status. In Niger, the vast majority of children under five do not have access to foods that meet their nutritional needs. Indeed, Niger experiences an annual demographic catastrophe among infants and children, with one child out of every five dying before the age of five. Malnutrition is a key factor in this high mortality level, which is one of the highest in the world

In 2006, MSF decided to modify its strategy for treating acute malnutrition. What is that strategy?

"In Niger, the vast majority of children under five do not have access to foods that meet their nutritional needs. Indeed, Niger experiences an annual demographic catastrophe among infants and children, with one child out of every five dying before the age of five." – Dr. Isabelle Defourny, assistant program manager for MSF's projects in Niger.

Over the last several years, we have used a therapeutic product that became available at the end of the 1990s. It is a peanut-milk blend enriched with micronutrients and is ready-to-eat, which means that it does not require water or utensils. The child may consume it at home, with reduced medical oversight. It allows children with acute malnutrition to gain weight quickly and effectively and also provides an adequate balance of essential nutrients. We first used it on a large scale last year with children who had reached a severe stage of malnutrition. The recovery rate among the 60,000 children treated was above 90 percent. The results were thus very positive, leading us to ask whether we should use this effective product sooner, without waiting for a child to slip into a state of severe acute malnutrition, thereby limiting the risk of death. We began doing so in early 2006, giving this therapeutic product to children as soon as they became acutely malnourished (before becoming severely malnourished). This is a new practice because the food that most aid groups give those children is an enriched flour that requires water for preparation, does not contain milk, and is less appropriate for meeting the nutritional needs of young children.

Eight months later, what are the results?

This product is more effective than enriched flour. Children gain weight more quickly and the treatment lasts for three to four weeks, rather than two months. The recovery rate is above 95 percent, the death rate throughout the program is below 1 percent and there are fewer children in serious condition than in the past. We think that this strategy has allowed us to prevent moderate acute malnutrition from becoming severe and thus limit mortality.

However, while it has been effective, the strategy also has its limitations. Additional work is required if we are to implement it on a national scale in a country like Niger and have impact on child mortality.

What does this additional work involve?

We have been following the same approach for several years, asking how we can limit the number of malnutrition-related deaths in an epidemic outbreak area. We first pursued a strategy for the most serious cases and the Nigerien authorities adopted this protocol throughout the country. This year, we are expanding our response to all malnutrition cases, but that is too ambitious for the health system of a country where hundreds of thousands of children suffer malnutrition every year to implement.

Neither Niger, considered the poorest country in the world, nor any other actor can take on such a program on a multi-year basis. In addition, there are all those children who may not be severely malnourished but whose nutritional status is inadequate to fight off infections, which sometimes prove fatal.

We can further simplify and improve the medical-nutritional response in our programs, but it must also include a strategy for preventing acute malnutrition. This is relevant at the individual level—the child receives what he or she needs to reduce the risk of illness—and is also critical to reducing the number of children who need medical care and treating them.

This is a very ambitious project. To follow through, we must be able to obtain the product we use—Plumpy'Nut—at a much lower price and find an effective product, equivalent to enriched milk, for children under five to prevent malnutrition.

Read more about acute malnutrition

⁽¹⁾Source: Unicef