May 25, 2005
Severely malnourished children from the southern areas of Niger are entering Doctors Without Borders/Médecins Sans Frontières' (MSF) therapeutic feeding centers at an alarming rate. From January through the beginning of May, the number of severely malnourished children admitted to MSF feeding centers has exceeded 5,000. MSF expects to treat approximately 20,000 children with severe malnutrition during 2005, double the number of last year.
In the past six weeks, 30 MSF aid workers have been dispatched to help bolster the team in Niger. MSF is operating three therapeutic feeding centers (TFC) for severely malnourished children as well as 21 outpatient sites in Maradi and Tahoua regions. So far MSF has airlifted nearly 120 tons of enriched flour into the capital Niamey, and 150 tons of millet, 75 tons of beans (niebe) and 10 tons of oil were purchased locally while waiting for an additional 800 tons of flour, sorghum, beans and oil to arrive by boat.
A nutritional survey conducted by MSF in April in the districts of Maradi and Tahoua has found high levels of malnutrition and premature death among children under five years of age as well as low levels of measles immunization coverage. Meanwhile, more than half of the families in these areas have no food stocks.
According to the survey, the severe malnutrition level for children under the age of five is 2.4 percent in Maradi district and 2.9 percent in Tahoua district. Global malnutrition level reached 19.2 percent in Maradi and 19.4 percent in Tahoua. MSF considers both levels very troubling.
Since January, children under the age of five have died at a rate of 2.2 deaths per 10,000 children per day in Maradi, and 2.4 deaths per 10,000 children per day in Tahoua. Retrospective mortality rates in both districts exceed the emergency level (two deaths per 10,000 children per day) for children. Measles immunization coverage among children under age of five was below 90 percent coverage for effective protection against an outbreak. Measles exacerbates malnutrition in children because of the fevers and other symptoms.
Equally troubling is that Niger is still a few months away from what is called the "hunger gap" period, when people must sustain themselves with remaining food supplies before the next harvest. The MSF survey also found that 51 percent of the families in Maradi have no food reserves left, and the proportion jumped to 61 percent in Tahoua.
MSF only hospitalizes the children who are unable to eat on their own or have serious medical complications like malaria or anemia. This screenings process prevents the TFCs from being overwhelmed by patients and allows more children to receive treatment.
The children that are malnourished, but still have an appetite and no serious medical conditions stay with their families. Each week MSF returns to these locations and supplies the child's family with plumpy'nut (a food made of peanuts and sugar, enriched with vitamins and minerals) for the child and a portion of a monthly food ration (256 kilos of flour, 15 liters of oil, 50 kilos of grain and 50 kilos of beans).
The following is an account of MSF's emergency response to the nutritional crisis in southern Niger.
APRIL 18 - View from the Air
We are flying over Niger on board an Ilyushin 76 cargo plane carrying 40 tons of enriched flour. It is the first cargo for MSF of this emergency operation. The ochre land is dry. Only an oasis dotted with irrigation wells provides a touch of green. When we arrive in Niamey, the capital, the temperature is 113Âº Fahrenheit. It takes four hours to transfer 1,600 sacks of flour from the plane to a truck. This load will leave for Maradi, a six-hour trip from the capital. And it's just the beginning. The MSF logistics center in Bordeaux, France, has already planned the staggered departure of other planes bearing similar loads and is organizing the departure of foodstuffs by boat.
In addition to food aid, MSF is also sending therapeutic milk, supplemental nutrition, vaccines, and medicines (antibiotics and anti-malarials) for children suffering from severe malnutrition. Tents have been sent for the opening of a third therapeutic feeding center in Tahoua district. The Maradi center is close to maximum capacity, with more than 200 hospitalized children, and the Dakoro center, which opened in mid-April, has begun taking admissions.
APRIL 19 - Coordinating Operations on the Ground
An emergency administrator, a doctor and four logisticians have arrived as first-line reinforcements. Some 30 MSF aid workers will be sent to Maradi and Tahoua districts. Medical staff, nutritional assistants, and daily workers must also be hired to unload, transport and set up the equipment and supplies. Job announcements were drafted to recruit Nigerien doctors and nurses. They will take a test in a few days so that they can be sent out as quickly as possible.
Seated around a table, maps spread out before them, a team prepares a nutritional survey that will help them precisely evaluate the situation in different areas of the country. A questionnaire is drafted, a route mapped out and the method carefully defined. Based on the survey results, in two or three weeks we will open new outpatient therapeutic feeding centers (TFC). Those children who are healthy enough will remain in their homes and come to the nearest outpatient TFC weekly to be weighed, treated and provided with supplemental nutrition. The treatment lasts around one month. This outpatient system makes it possible to limit the number and length of hospital stays and, thus, to treat greater numbers of children.
APRIL 21 - Distributing Food and Medicine
The 40 tons of enriched flour, medicines and logistical supplies are unloaded in an 8,600 square foot warehouse that has just been rented in Maradi. The medicines are stored separately in a pharmacy. Some of the supplies were quickly sent off to Dakoro and Tahoua. The next step is to organize the distribution of family rations.
MSF will distribute food products made of enriched flour, millet, beans and oil to the families of children admitted into the program for children with severe malnutrition. These ingredients have been calculated to provide supplemental food for the child's family, using a family of eight as the norm.
APRIL 22 - Treating Severely Malnourished Children
Since early April, between 200 and 300 children per week have been hospitalized in the Maradi therapeutic feeding center. The most severe cases are monitored around-the-clock in the intensive care unit. Those patients suffer from severe malnutrition with related illnesses and from gastroenteritis, malaria and respiratory infections. To avoid the risk of contagion, children with measles are housed in a separate tent. The diet (number and kind of daily meals) varies according to the child's state of health. Hospitalization lasts for an average of one week. The children may then return home and continue treatment on an outpatient basis. Children who do not suffer from illness receive simplified treatment. Admitted directly into the outpatient program, they receive a week-long treatment and their mothers may return home with the child and with food rations to supplement the family ration.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)