Niger

In Niger, the deadly combination of malaria and malnutrition has created a vicious cycle that has a huge impact on some of the country's most vulnerable people.

Increasing numbers of children are being treated for malaria and malnutrition in southern Niger compared to one year ago.

In this article, originally published on the Huffington Post, MSF pediatrician Susan Shepherd discusses the reduction of childhood mortality in Niger and strategies to reduce it worldwide.

MSF is treating an influx of patients for malnutrition and malaria in Niger's Maradi region.

MSF nutrition experts Susan Shepherd and Stéphane Doyon discuss the need for long-term solutions to malnutrition in Africa's Sahel region. 

People displaced by conflict are fleeing Mali en masse—and settling in places already weakened by food insecurity.

Refugees from the West African country of Mali face insufficient levels of assistance in camps rife with disease and malnutrition where the looming rainy season will further complicate the deployment of aid. 

This update details MSF's recent activities in Africa's Sahel region, where widespread malnutrition and water shortages are exacerbating the outbreaks of diseases like meningitis.

Close to 10,000 Malians have found refuge in the Tillabéry region in Niger after being displaced from their homes by violence.

In Niger, the stretch from June to October is known as the “lean season,” a time during which the country faces recurrent and often severe food and nutritional crises.

In an MSF study, mortality rates were observed to be 50 percent lower among young children in Niger who received highly nutritious supplemental food.

Despite an aggressive response to the nutritional crisis in Niger by MSF and other organizations, tens of thousands of children suffered from malnutrition in 2010.

In December, Doctors Without Borders/Médecins Sans Frontières (MSF) will support the national Ministries of Health of Niger and Mali to carry out meningitis vaccination campaigns using a new, low-cost, longer-lasting vaccine. This vaccine, which was recently endorsed by the World Health Organization (WHO), is a major improvement over older meningitis vaccines and has the potential to save thousands of lives each year.

This month, in Mali and Niger, MSF will support the provision of a promising new vaccine that could prevent future outbreaks of the deadliest form of meningitis.

The Meningitis Vaccine Project was launched in 2001 with the main goal of creating an affordable vaccine that would respond to a specific meningitis strain that plagues Africa each year.

"With the extended protection offered by this vaccine, we can hopefully prevent the epidemics from taking place at all."

Malaria is particularly dangerous for malnourished children, and the cases of malaria are flaring right now during Niger's rainy season; MSF has treated nearly 130,000 children already.

MSF has set up treatment centers in response to cholera outbreaks in Cameroon, Chad, Niger, and Nigeria.

In Niger more than two million children are entering the peak of what authorities say is a particularly devastating hunger season causing a severe risk of malnutrition-related fatalities.
 

MSF and its local partners have treated 77,000 severely malnourished children in Niger this year and are distributing food supplements to 143,000 young children. To address a recurrent nutritional crisis, prevention is crucial.

"Unfortunately, we are witnessing recurrent crises that vary only by intensity from year to year."

With Niger once again in the grips of a nutritional crisis, MSF is hurrying to care for the most vulnerable members of the population.

In Niger, MSF is working with communities to identify and treat childhood malnutrition earlier.

Nearly 400,000 children and young adults were vaccinated against meningococcal meningitis in the areas of Zinder, Maradi, and Madaoua when MSF supported the ministry of health during a vaccination campaign that ran from April 13 to 25.

About 10 inches of rain, roughly a quarter of the average annual rainfall, fell on Ouagadougou, Burkina Faso's capital, over 12 hours on September 1. The downpour created floods that destroyed more than 24,000 homes and displaced about 150,000 people—one in 10 of the country’s inhabitants.

Following four days of heavy rains in Niger’s northern Air Mountains, severe floods wreaked havoc on the city of Agadez on September 1. Doctors Without Borders/Médecins Sans Frontières (MSF) teams present in the city provided emergency assistance in order to meet the urgent needs of the affected population.

During the last four months, MSF teams in cooperation with the national health officials have been moving quickly, following the epidemic trend, to help treat tens of thousands of patients and to proceed swiftly on a massive vaccination campaign for 7.5 million people.

Doctors Without Borders/Médecins Sans Frontières (MSF) presents further evidence that adequate food supplements are needed as early intervention to avert widespread malnutrition in young children.

More than 1,900 people affected by meningitis have died since the beginning of this year in an area of sub-Saharan Africa known as the meningitis belt. In Nigeria, Niger and Chad alone, MSF medical teams have treated more than 56,000 sick patients. The organization is currently vaccinating a total population of more than seven million in the three countries, the biggest vaccination campaign MSF has ever carried out.

Interview with Dr. Helmy Mekaoui, Emergency Coordinator, for Niger

Several countries in West Africa are facing a major meningitis epidemic. In Nigeria, this is the worst meningitis epidemic the country has experienced since 1996.

“It’s true that vaccinations stop the epidemic from spreading, but without emergency medical treatment for patients with meningitis, the number of lives lost would be catastrophic," says MSF doctor Nico Heijenberg.

Meningitis, a disease responsible for thousands of deaths in Africa, is currently spreading in several West African countries. While ensuring quick access to treatment for those already infected, MSF is also starting mass vaccination campaigns in Nigeria and Niger and is closely following the situation in other countries in the region. MSF is planning to vaccinate between 4 million and 5 million people against meningitis.

On January 21, 2009, the Journal of the American Medical Association (JAMA) published the results of a study on the preventive distribution of ready-to-use (RUF) therapeutic food products. This 2006 study, which was conducted in Niger, showed that the number of children who progress to severe malnutrition can be cut in half. These effective preventive strategies must be developed in areas where severe malnutrition strikes tens of thousands of children and is a major cause of death, explains Dr. Isabelle Defourny, MSF’s program manager for Niger.

New York, NY, January 21, 2009 — According to a study published today in the Journal of the American Medical Association (JAMA), children in rural Niger who received ready-to-use food in addition to their normal diet were nearly 60 percent less likely to progress to the most life-threatening form of malnutrition than children whose diets were not supplemented.

Some of the world’s leading photojournalists worked alongside our medical teams throughout 2008, documenting our work and following the lives of our patients and their communities. At the same time, some of our own staff captured unforgettable moments that we are pleased to include in this Year in Pictures issue of Alert, which brings together some of the most moving and telling photographs of the crises to which we responded in 2008.

Paris/Niamey, Niger October 30, 2008 – On July 18, 2008, the Niger government, suddenly and without explanation, terminated the medical and nutritional activities of the French section of the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) in the Maradi region of Niger. This decision has had grave consequences on mortality among young children.

Paris/Niamey, October 21, 2008 — Three months after Nigerien authorities suspended the activities of the French section of Doctors Without Borders/Médecins Sans Frontières (MSF), the international medical humanitarian organization is calling for an immediate resumption of its nutritional operations in the Maradi region.

Press Teleconference: Nicolas de Torrenté, executive director of MSF-USA and Marie Pierre Allié, president of the French section of MSF, discussed the organization’s suspension from treating malnutrition in the Maradi region of Niger.

Between 2001 and 2005, the Médecins Sans Frontières (MSF) therapeutic feeding programme in Maradi, Niger
offered treatment for severe acute malnutrition centred on the use of Ready to Use Therapeutic Food (RUTF) and the outpatient management of all uncomplicated cases.

Niamey, Niger, October 1, 2008 — Ten weeks after Doctors Without Borders/Médecins Sans Frontières' (MSF) authorization to treat malnutrition in the Maradi region was suspended, the French section of MSF is no longer providing any medical-nutritional treatment on site there. A new memorandum of understanding was drafted between the Ministry of Public Health and MSF, but the authorities of Niger have yet to sign it.

Paris, July 26, 2008 -On July 22, 2008, the French section of the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) was informed of a decree issued by the Minister of Interior of Niger, Albade Abouba, suspending MSF's authorizations to work in Niger. "MSF wishes to continue to work in agreement with the authorities of Niger in order to continue its medical activities there," said Dr. Marie-Pierre Allie, president of the French section of MSF. "We are seeking a meeting with the presidency of Niger as well as with ministries to try to rectify this situation," she added.

At the beginning of May, at the request of the health ministry of Niger, MSF provided backup assistance for a meningitis epidemic in the Dosso region. Here, Issiaka Abdou, MSF emergency co-ordinator, talks about the operation.

In Niger, a meningitis mass-vaccination campaign launched by MSF, in cooperation with the local Ministry of Health (MoH), has ended. The aim was to prevent a large-scale epidemic after a number of cases had been reported in late March. More than 300,000 people were vaccinated in 20 days with positive results—the spread of the epidemic was stemmed.

Since January, thousands of children have developed measles in Niger. MSF has sent medical teams to Maradi and Zinder, the regions with the highest numbers of measles cases, to prevent the spread of this highly contagious disease.

Paris/Niamey, October 24, 2007 — On Monday, October 22, five men, one of whom was armed, attacked a team of Doctors Without Borders/ Médecins Sans Frontières (MSF) workers travelling in two vehicles by road from Agadez to Dabaga, in central Niger, where MSF has been providing medical care at the local health post since the start of October. The assailants seized the vehicles and their contents. The team of six—one doctor, one nurse, one logistics specialist, one pharmacist and two drivers—made their way to the nearest village on foot and were able to return to Agadez.

New York, October 10, 2007 – The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today called for increased and expanded use of nutrient dense ready-to-use food (RUF) to reduce the five million annual deaths worldwide related to malnutrition in children under five years of age. Current food aid, which focuses on fighting hunger—not on treating malnutrition—is not doing enough to address the needs of young children most at risk, MSF warned.

Dr. Shepherd, a pediatrician, explains MSF's strategy to combat outbreaks of acute malnutrition in the country. Each year, tens of thousands of children, aged six months to three years, become acutely malnourished between June and October, the time period that corresponds to depletion of food stocks before the next harvest.

Every day, Doctors Without Borders/Médecins Sans Frontières (MSF) mobile teams criss-cross Niger's rural areas in search ofacutely malnourished children. The number of children treated in MSF's therapeutic feeding programs is growing steadily—more than 50,000 so far this year. The following account describes a typical workday for one of MSF's nutritional programs, based near Zinder, Niger's second-largest city.

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. Dr. Isabelle Defourny, who has just returned from Niger, offers an assessment of the nutritional situation in the country.

In the first quarter of 2006, 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.

In the Maradi region of Niger, MSF feeding centers have admitted approximately 1,000 children since mid-March. This is a very high number considering it is two months before the usual peak of acute malnutrition. Emmanuel Drouhin, head of MSF’s programs in Maradi describes the current situation.

On February 27, Doctors Without Borders/Médecins Sans Frontières (MSF) launched a massive meningitis vaccination campaign in the Maradi region of Niger. Five hundred thousand people are expected to be vaccinated initially. MSF teams are also treating people who have already contracted this highly-contagious infectious disease.

In 2005, MSF teams admitted more than 63,000 children under five suffering from severe acute malnutrition to their therapeutic feeding programs in five regions of Niger. This is a chronic emergency situation for which there is a simple, effective answer that targets acute malnutrition.

By Milton Tectonidis, M.D.

Between January and November 2005, MSF admitted nearly 60,000 severely malnourished children to its therapeutic feeding centers in Niger. While the severe malnutrition epidemic is slowly decreasing, the current situation and the outlook for 2006 remain troubling. Johanne Sekkenes, MSF Head of Mission in Niger, provides an update on the situation.

Despite increasing media coverage over the past months and the announced mobilization of international aid, the crisis is far from over in Niger. In the Zinder region, the number of children suffering from severe acute malnutrition admitted in MSF therapeutic feeding centers is not decreasing and free food distributions are far from addressing the needs of the most destitute families.

In Niger, the number of children suffering from severe malnutrition in Doctors Without Borders/Médecins Sans Frontières (MSF) therapeutic feeding centers remains at its highest level. Thierry Allafort-Duverger, head of MSF's emergency desk, reflects on a nutritional crisis, which is far from over.

Zinder, Niger, September 13, 2005 – Tens of thousands of children in Niger still require immediate nutritional assistance, according to the international medical aid agency Doctors Without Borders/Médecins Sans Frontières (MSF). A nutritional and retrospective mortality survey conducted by the group and its research affiliate, Epicentre, in the Zinder region this past August found one in five children suffering from malnutrition. The study revealed an even more critical situation for children less than 30 months old, with nearly one in three malnourished and 5.6% severely malnourished. Just last week, MSF medical teams admitted nearly 1,000 severely malnourished children for treatment in Zinder alone.

Paris/Niamey, August 22, 2005 - Doctors Without Borders/Médecins Sans Frontières (MSF) warned today that recently begun food distributions in Niger are not reaching those with the greatest needs, especially children under five years of age in the worst-affected areas. MSF calls on United Nations' Secretary General Kofi Annan to take measures to ensure that UN agencies like the World Food Program (WFP) and UNICEF distribute aid according to the real needs of people.

Habiba Souleymane (her name has been changed to protect her confidentiality) has just received a food ration at the Doctors Without Borders/Médecins Sans Frontières (MSF) ambulatory feeding center in Chare Zamna, which is located west of Zinder, Niger.

Between January 1 and the beginning of August 2005, MSF admitted 16,000 severely malnourished children to the feeding centers. The rhythm of admissions has accelerated, with an average of 1,000 children entering the feeding centers per week since the month of June, increasing to 1,600 per week at the end of July.

Dr. Milton Tectonidis, nutritional specialist for MSF, just returned from one month in Maradi, Tahoua, Aguie, and explains how home-based, outpatient care has allowed MSF to treat many more children.

Dr. Sylvaine Blanty, a general practitioner, has been working at the MSF therapeutic feeding center for severely malnourished children in Aguié, Niger, for a month. Before coming to Niger, she had already worked with MSF in the Democratic Republic of Congo (DRC). She writes about her experience over the last month.

On June 27, Doctors Without Borders/Médecins Sans Frontières (MSF) opened its fifth therapeutic feeding center in Niger. This one has 150 hospital beds but two weeks later, it was already full. To respond to the influx of children suffering from severe malnutrition, the number of beds had to be doubled.

In Niger, Doctors Without Borders/Médecins Sans Frontières (MSF) is operating in the regions of Maradi and Tahoua where MSF has treated over 12,000 children suffering from severe malnutrition and is bringing food to children suffering from moderate malnutrition. To successfully carry out its projects, MSF has mobilized 50 international aid workers and 450 locally hired staff.

In addition to treatment programs for children suffering from severe malnutrition in Maradi, Niger, MSF made the decision to provide food aid to 25,000 children in the Maradi region suffering from moderate malnutrition in order to protect them from slipping into a severe state of malnutrition.

June 28, 2005, Niamey/New York – Tens of thousands of children are suffering from severe malnutrition in Niger today, many in grave condition and in danger of dying unless they receive urgent medical care, according to Doctors Without Borders/Médecins Sans Frontières (MSF). A recent nutritional survey by MSF and its research affiliate, Epicentre, in the villages to the north of Maradi and Tahoua, found mortality rates for children under five years of age above the emergency threshold of 2 deaths/10,000 people/day for the past two months.

The first warning about Niger's nutritional situation was sounded in October 2004. However, by late June, the international aid system was still unable to deliver appropriate assistance to those at greatest risk. In simple terms, this means a death sentence for the children of Niger's poorest families.

New York/Paris, June 9, 2005 - In response to the nutritional crisis in Niger, Doctors Without Borders/Médecins Sans Frontières (MSF) has more than tripled its capacity to treat severely malnourished children. Immediate provision of food aid is the only way to avoid a life threatening situation for thousands of already malnourished children.

Severely malnourished children from the southern areas of Niger are entering MSF's therapeutic feeding centers at an alarming rate.

New York/Niamey, April 26, 2005 - In the face of increasing severe malnutrition in Niger, the international medical aid organization Doctors Without Borders/Médecins Sans Frontières (MSF) is significantly increasing its ability to provide assistance to people in the most affected regions. The number of malnourished children treated by MSF teams has reached unusually high levels for this period of the year, and an already alarming situation is rapidly worsening. MSF calls upon other agencies to mobilize.

In Doctors Without Borders/Médecins Sans Frontières (MSF) program in Maradi in southern Niger, the number of children arriving with severe malnutrition continues to climb.