Burkina Faso: MSF Treats Widespread Malnutrition

Valérie Batselaere/MSF
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More than 23,440 children have been treated, and 88 percent cured since Doctors Without Borders/Médecins Sans Frontières (MSF) launched a nutrition program in Burkina Faso in September 2007. The majority of patients were treated with nutrient-rich, therapeutic ready-to-use food (RUF).

In the rural areas around Titao and Yako, north of the capital Ougadougou, malnutrition is a predictable, recurring crisis. During the hunger-gap periods, when food stocks and money are running low before the next harvest, children under five years old lack the basic nutrients needed to reach a critical stage of their growth. A number of children suffer from acute malnutrition throughout the year with a peak period in early September.

“When I visited our program, our Burkinabe doctors told me that they were not aware of so many malnourished children in their country before they started to work with MSF,” said Jean-Luc Anglade, MSF program manager for Burkina Faso. “Awareness is a very important and necessary step towards making changes to cope with this kind of situation. Now, there is a growing consciousness in magnitude of the malnutrition crisis in the country.”

A Step Forward

Early in 2007, the Burkinabe Ministry of Health took a step forward and adopted the World Health Organization’s recommended new protocol to treat children for acute severe malnutrition using therapeutic RUFs, which contain micronutrients and vitamins that children need. MSF then proposed a partnership to implement the new protocol in a region hard-hit by malnutrition. About 80 percent of patients were treated exclusively at home with RUF, which caregivers can easily administer to children.

Each week, for a minimum of four weeks, or until they recover, the children come back to one of MSF’s 17 ambulatory centers in Loroum and Passoré districts in central Burkina Faso. Their health condition and weight gain are monitored and they receive another supply of RUF.

“Thanks to the outpatient treatment with RUF, the vast majority of malnourished children are now easily treated at home,” Anglade said. With this system, only the more complicated cases need to be hospitalized; children who have lost all appetite or who have developed associated diseases that gravely endanger them, such as malaria. MSF has two hospitalization structures to refer those children to–one in Titao, which has an 80-bed capacity, and one in Yako with a 60-bed capacity. During the peak emergency period in early September, MSF conducted an average of 600 admissions of malnourished children per week in the two districts.

In Burkina Faso, a high prevalence of malaria is found among the general population, and as much as 65 to 70 percent of the children admitted to the MSF nutrition program are infected during the malaria peak. In 2008, for the duration of the annual malaria peak during the last months of the year, MSF addressed this issue by providing malaria treatment (Artemesinin Combination Treatment) to children, whether they were malnourished or not, as well as to adults. In 10 weeks, a total of 10,794 children were treated.

Improving Effectiveness

In Burkina Faso, MSF uses a bracelet that measures a child’s middle-upper arm circumference (called a MUAC) to identify potentially malnourished children. The tool allows health workers to screen a large number of children in a short period of time. Its simplicity allows MSF to train local community workers to screen children at the community level.

“We are focusing on children under five, as they are the most vulnerable to malnutrition, in our program,” said Anglade. “Childhood malnutrition is an underlying cause of death for too many children, yet far from public attention. Young children need the right amount of both macro- and micronutrients in their diet. Children without sufficient nutrients are at high risk for repetitive infections, and it can be fatal.”

In contexts similar to Burkina Faso, preventive distributions of nutritional supplements throughout the lean period have given very interesting results. A recent study on a preventive distribution of the RUF carried out in Niger in 2006 showed it could reduce the number of severely malnourished children by as much as 58 percent. And in 2007, in the same region of Niger, MSF conducted a nutrition intervention using RUF as prevention, which successfully suppressed the peak of malnutrition in the targeted district.

“Malnutrition is a serious medical emergency, and we already know that a high number of cases will reoccur around the same time next year,” said Anglade. “So instead of waiting, why not try to prevent it? ’Early treatment’, or prevention strategies are a development of our project we would like to look into in 2009.”