MSF-USA: NIGER — The Daily Struggle Against Malnutrition

October 2, 2006
NIGER — The Daily Struggle Against Malnutrition

Every day, Doctors Without Borders/Médecins Sans Frontières (MSF) mobile teams criss-cross Niger's rural areas in search of acutely 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.

It's 10 a.m. and the temperature is already nearly 104 degrees. Nonetheless, almost 200 mothers have gathered in front of MSF's outpatient feeding center in the town of Miriah. They have come because of their children, swathed in carrying cloths. MSF staff set up a rope waiting line to guide the mothers and their children. They will work their way through a health screening process that will save many of the children's lives.

MSF staff member measuring the upper-arm-index of a child— the first station in the health circuit at MSF's inpatient feeding center in Miriah. Photo © Raphael Weber/MSF

At the first station, the children have their middle-upper-arm circumference measured. This is a preliminary indicator of the degree of malnutrition. Next, their height and weight are taken. These figures establish the severity of malnutrition. Today, nearly every child between birth and six years old is diagnosed with acute malnutrition. Skin folds, edema, and discolored hair further confirm the diagnosis among many of them. Most of the children between one and three years old enter MSF's feeding program.

At the next station, medical examinations determine whether the children can be treated without hospitalization. In that case, they receive a ready-to-use therapeutic food (RUTF) called Plumpy Nut®, a peanut butter enriched with milk powder, oil, sugar, and other minerals and vitamins. This product has created a revolution in the fight against malnutrition. Previously, mothers had to prepare food products at home, often with mixed results. Once Plumpy'nut is removed from its packaging, it can be given directly to children. This kind of food also quickly strengthens the body and produces marked weight gain. Its ease of use has introduced a high-performing, uniform treatment that allows many more patients to be treated.

It also explains how, after 30 minutes, the first mothers and children are already leaving the Miriah outpatient feeding center. They take enough Plumpy'nut to last a week and their families are given Unimix (a corn-and-soy flour mix enriched with vitamins and lactose), a liter of oil, and a bar of soap home with them, which represents one week's ration. In the weeks ahead, they will return to the feeding center for follow-up visits and additional rations.

However, not all the children will be able to go home. The serious cases are referred immediately to the Zinder inpatient therapeutic feeding center for hospitalization.

Intensive care station in Zinder, Niger, MSF's intensive nutritional recovery center. An MSF doctor examines a two year old girl. Photo © Raphael Weber/MSF

In Zinder, at MSF's inpatient feeding center, all children are first admitted into the intensive care unit. Most will leave after a few days, already considerably better nourished than upon admission, and enter the outpatient program. Others will stay for weeks, or even months. For them, malnutrition is the result of a serious illness that must be treated first. MSF provides that treatment when the child cannot be transferred to the public hospital.

That is the case for little Fatima. The child, now two, spent more than two months at the inpatient center with her mother and older sister. She had fought for her life since the age of one month. She had tuberculosis and after recovering, quickly gained weight and was able to be transferred to "phase 2," where children in stable health continue to be fed. Today, Fatima smiles—happy and well-nourished—she is securely strapped to her mother's back. Tomorrow, she will be able to leave the inpatient feeding center and will only have to make regular visits to one of the 13 outpatient feeding centers for follow-up care.

Children are not the only ones in the feeding center. Mothers have been weakened, too. Many have problems nursing their children and thus also receive enriched food. Nigerien staff also provide them with information on topics like feeding and hygiene.

Unfortunately, some cases end sadly, like Mubarak's. This one-year-old infant was reduced to barely a skeleton. Since his hospitalization, he fought to survive. Mubarak was HIV-positive, but there was not enough time to begin antiretroviral treatment. The morning after his death, the team's mood was at a low. "Many mothers wait too long to bring their children here," a local doctor said, pensively.

However, recovery rates are encouraging: more than 90 percent of children with acute malnutrition treated by MSF in Niger are now in good health. The program in Zinder treats close to 1,500 children every month. The Zinder and Magaria feeding centers, as well as the neighboring outpatient centers, treat more than 50 new cases of children with acute malnutrition every day. That trend continues to increase.