Malnutrition in Niger | Doctors Without Borders

November 1, 2011
Malnutrition in Niger
A New Treatment Model Shows Great Promise

Niger 2010 © Yann Libessart/MSF

A child is measured for malnutrition.

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 2010, the crisis was particularly intense. By April, roughly half the country’s population was in a moderate or severe food security situation. Two months later, Nigerien officials estimated that one of every six children was, or would soon be, suffering from acute malnutrition. Among children between the ages of six months and two years, the ratio was one out of four. In MSF’s feeding programs in the country, up to 85 percent of children admitted for severe acute malnutrition were under two years of age.

Niger 2010 © Yann Libessart/MSF

A mother receives supplemental food for her children

A Historic Response

In response, Nigerien officials, the United Nations, and local and international NGOs implemented a historic crisis response plan. More than 300,000 children suffering from severe acute malnutrition were enrolled in therapeutic feeding programs. Food distributions intended to prevent malnutrition were given to another 675,000 young children—almost one-third Niger’s infant population.

MSF, along with Nigerien partners Forum Sante Niger (FORSANI) and ALIMA/ BEFEN (Bien-être de la Femme et de l’Enfant au Niger), treated 150,000 of the 300,000 children enrolled in therapeutic feeding programs with ready-to-use therapeutic foods (RUTF), a peanut-based paste that provides 100 percent of the energy and nutrients a severely malnourished child needs to recover. In addition, MSF and partners provided another 150,000 at-risk children with ready-to-use supplementary food (RUSF).

RUSF is also peanut-based and contains the milk and micronutrients necessary for the development of a growing child. Unlike RUTF, however, RUSF is designed to be supplemental, to complement breast milk and family foods a child is already getting. Its precise formulation, therefore, is adjusted depending on the age, diet, and location of those receiving it. The RUSF used by MSF in Niger was developed according to the typical needs of a young child growing up in the Sahel.

Fighting Malnutrition Effectively

Malnutrition results from inadequate quantities of food and from unbalanced diets lacking in essential nutrients. It can stunt growth and weaken immune systems to the point that diseases such as diarrhea or malaria can be fatal. According to UNICEF, 195 million children suffer from malnutrition globally. Worldwide, it factors into more than 30 percent of the eight million annual deaths of children under five years of age—one third of which occur in west and central Africa.

And yet the most-widely used forms of food aid—a porridge made of fortified blended flours—are considered by most experts to be unsuitable for young children or children with moderate malnutrition. They do not deliver enough essential micronutrients and do not have the animal or milk protein essential for their growth.

Ready-to-use products have several advantages when it comes to treating malnutrition on a large-scale in a resource-poor environment. They are simple to use, require no preparation, and can be distributed in a way that allows mothers to take several weeks worth of supplies with them, rather than having to return frequently to a fixed-point clinic. They are also easy to store, and they can be produced in the countries and regions where they are used.

Niger 2010 © Yann Libessart/ MSF

A child with ready-to-eat therapeutic food.

Studying the Results

During the 2010 nutrition crisis in Niger, Epicentre, MSF’s epidemiology unit, conducted monthly surveys among a cohort of several thousand young children in zones in which MSF and its partners were distributing RUTF and RUSF. Preliminary findings showed that mortality rates were 50 percent lower among those who received supplemental food and who received basic health care.

This confirmed for MSF the importance of nutritional supplementation in programs aimed at reducing infant mortality in the Sahel and in countries where malnutrition is endemic. Interventions designed to combat and prevent malnutrition have to address immune-weakening nutrient deficiencies and protect children from the diseases that can kill them.

“Providing young children with high quality nutritious foods has long been one of the foundational principles of successful malnutrition and child mortality reduction programs,” said Dr. Susan Shepherd, MSF child nutrition advisor. “We can save children’s lives today if the appropriate resources are put behind similar interventions to those we deployed last year in Niger.”

End the “Double-Standard”

Over the past several years, a scientific consensus has emerged on the importance of providing suitable food for growing children in countries where malnutrition’s toll is highest. A new generation of nutritional foods tailored to the needs of the most vulnerable children makes possible the establishment of a new standard.

In 2010, the World Health Organization began establishing guidelines for supplementary food formulations. Aid agencies such as UNICEF and the World Food Program have begun similar initiatives and are including quality, age-appropriate food supplements in their programs for young children. Some main donors, USAID and ECHO in particular, have recently provided financial support.

Despite the encouraging advances, however, international food aid continues to be largely comprised of enriched flours that contain no milk and are thus ill-suited to the needs of young children. This has to change, because, as MSF’s experience in Niger last year shows, a concentrated effort to provide suitable, effective food aid can quite literally be the difference between life and death.

To learn more, and to see documentaries on the topic of malnutrition by some of the world’s top photojournalists, go to starvedforattention.org