MSF-USA: Barely Open, Already Full: Feeding Centers in Niger

July 27, 2005
Barely Open, Already Full: Feeding Centers in Niger

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.

Tuesday, July 12. A long line of mothers and children stretches out in front of the admissions tent at the Aguié therapeutic feeding center. It's noon and the temperature is close to 95 degrees Fahrenheit. Dozens of mothers have been waiting patiently for hours. Some have found shelter against a wall while others have braved the sun. In a corner, a mother is feeding her baby a green paste. He's eating boiled anza leaves. They will soothe his hunger temporarily, but provide no nourishment.

Identifying Malnourished Children

Ernesto Paredes, nurse and supervisor of the Aguié CRENI training nutritional assistants. Photo © MSF

Two teams are working to spot malnourished children in the MSF feeding center admissions tent. Ernesto Paredes, the center's supervising nurse, is training two new nutritional assistants. He is showing them how to evaluate a child's nutritional status using the MUAC, a plastic bracelet that measures the circumference of a child's mid upper-arm. Next, he teaches them to calculate the height-weight ratio, which provides a more precise assessment determination of the degree of malnutrition. Today, most MUAC bracelets fall in the red zone, a sign of severe malnutrition. The children's height-weight ratio is below 70 percent of normal.

These children are admitted into MSF's feeding program. Those in the worst condition, who are ill as well as severely malnourished, must be hospitalized. The ones who are not sick and have an appetite may return home with therapeutic foods that their mothers will be responsible for feeding them. They will return weekly to determine if they have gained weight, make sure they are still healthy and receive their weekly food ration, as well as a ration for their family.

Moderate Malnutrition: Aid Is Still Incomplete

For now, children suffering from "only" moderate malnutrition – itself a serious condition with a height-weight ratio below 80 percent of normal – do not receive any food aid. Their mothers watch with envy as others leave with food and some will try to get food nonetheless. It is unacceptable to be forced to refuse food aid to children who are not "ill enough" as their condition could well worsen. As a result, MSF decided to set up food distributions for 50,000 moderately malnourished children. But this large-scale operation required meticulous preparation and began only in late July.

Until then, MSF's aid involved providing access to care to children who were ill but not suffering from severe malnutrition. The district hospital's facilities, a few feet from MSF's feeding center, have been virtually deserted. The operating room, the laboratory and the blood bank were closed. There were no patients in the maternity ward or the health center. In Niger, people must pay for medical visits and medicine so many ill people cannot seek treatment. But today, a Nigerien public health doctor stands behind a table overflowing with medicines. MSF brought in the supplies. Those children whose illness was detected when they visited the feeding center will be treated for free.

Increasing the Ability to Respond to the Emergency

At the end of the day, it's time to tally up. One hundred and fifty children were admitted to the severe malnutrition program in Aguié. That night, the team made the decision: they had to double the number of beds. The orders went out on an emergency basis later that night. It's now more critical than ever to launch the planned pediatric unit for sick children who are not suffering from severe malnutrition. It will be set up in the district hospital and MSF will manage it.