This update details MSF's recent activities in Africa's Sahel region, where widespread malnutrition and water shortages are exacerbating the outbreaks of diseases like meningitis.
Burkina Faso: Treating Malnutrition and Caring for Malian Refugees
In the wake of violent clashes between Mali's army, Tuareg rebels, and other groups active in northern Mali, nearly 46,000 Malians have fled their country and taken refuge in northern Burkina Faso since mid-January. Most of the refugees are gathered in Oudalan, Seno, and Soum Provinces, though the largest number, 35,000, are in Oudalan, a desert region in the northern part of the country.
After making food and water distributions in Mentao, in Soum Province, the first camp to be formalized in early February, Doctors Without Borders/Médecins Sans Frontières (MSF) started working in Oudalan Province in early March. The MSF teams are providing support to the Gandafaou health post and running mobile clinics to the Ferrerio camp as well. The staff has held more than 1,600 medical visits in four weeks, treating respiratory infections, skin infections, and gastric illnesses, all of which are symptomatic of a lack of access to water, sanitation, and shelter. MSF provides free care to the refugees and to the local populations in these areas
Unrelated to the Malian refugee situation, MSF has worked for several years in Titao, and, in January 2012, expanded its work in the area from treatment of malnutrition to the broader provision of pediatric care services. The MSF teams are now working in 11 health areas (in health centers and community-level clinics) to screen and treat children for malnutrition, and in pediatric and therapeutic feeding wards of Titao’s hospital. The program had admitted 633 malnourished children and treated another 222 in the pediatric ward of the hospital by the end of March.
Chad: Combining Emergency Response with New Strategies to Prevent Malnutrition
MSF teams have been conducting nutritional surveys and needs assessments in several regions in Chad that have been projected to be the most severely affected by poor harvests, spikes in food prices, and trade disruptions resulting from the instability in neighboring Libya. With little access to health care and a very limited local capacity for emergency response, the Chadian population is extremely vulnerable to malnutrition and epidemics.
By the end of March, MSF had opened new emergency malnutrition treatment programs in Biltine and Yao, where rates of acute malnutrition of as high as 24 percent and 20 percent, respectively, have been reported.
The Biltine program will include an intensive therapeutic feeding center and treatment for critically ill non-malnutrition patients. Outpatient therapeutic feeding centers in the outlying areas are also planned.
In Yao, in Batha region, MSF is providing inpatient and outpatient care, as well as primary health care and vaccination services. Health assessments are taking place in the regions of Hadjer Lamis, Abéché, and Ouaddai.
MSF continues to run a 170-bed pediatric hospital in the town of Massakory in western Chad's Hadjer Lamis region. The peak of malnutrition this year is expected in July, though 2,100 children were already admitted from January through the end of March, the majority of them for reasons related to malnutrition.
MSF is also conducting operational research aimed at developing strategies to lessen the impact of the seasonal peaks in malnutrition cases in Chad. In order to reduce the need for inpatient malnutrition care, MSF has started distributing ready-to-use supplementary food, an enriched peanut paste, with the intention of reaching thousands of children aged between six months and two years over the coming months. A study is being carried out to evaluate the most efficient means of distributing these highly effective nutritional products in the effort to counter or even pre-empt malnutrition (which also involves simplifying protocols and decentralizing management of acute malnutrition). Additionally, several immunization campaigns have been planned in an attempt to break the vicious cycle of disease and malnutrition.
Ultimately, the aim of this study is to define the best way of organizing the distribution of nutritional supplements to reduce the number of new cases of severe acute malnutrition, decrease the need for establishment of costly inpatient nutrition centers, and ease the treatment of malnutrition with outpatient structures. Mothers can provide the supplements themselves to their children. The results of the study, which are expected in 2014, will be shared and discussed with the Chadian Ministry of Health.
Besides opening malnutrition treatment programs, MSF teams are responding to a meningococcal meningitis outbreak in Chad. By the end of March, eight districts had surpassed the epidemic threshold for the disease and four other districts were placed on alert.
In the eastern Oum Hadjer region, the epidemic threshold was passed during the week of February 12, and by the end of March, a total of 252 meningitis cases and 10 deaths had been reported. In the southeastern Am Timan district, epidemic levels were reached during the week of March 18, and 147 cases and 8 deaths have been recorded. Meningitis has also reached epidemic levels, as measured by caseload, in the districts of Am Dam, Abou Deia, Lere, Dono Manga, Massakory, and Bedjondo.
In response, in collaboration with the Ministry of Health, MSF launched mass meningitis vaccination campaigns targeting persons aged 1 to 29 years of age in Oum Hadjer and Lere. These campaigns are using the new MenAfriVac vaccine, which carries significant benefits when compared to vaccines used in the past. MenAfriVac lasts 10 or more years and is four times as efficient as earlier vaccines, thus conferring longer immunity to individuals and, as a result, protection to a wider section of a given population.
On April 1, MSF started a mass vaccination campaign in Oum Hadjer. After 15 days of vaccination activities, a total of 137,000 people had been vaccinated. MSF is also providing quality medical treatment to meningitis patients; on April 26, MSF started its campaign in Lere, in the southwest of the country, with the goal of reaching more than 200,000 people. Additionally, MSF is providing treatment for people suffering from meningitis in these areas, as well as in Pala district.
Mali: Treating Chronic Malnutrition and Responding to Conflict
Since 2009, MSF has been working in five health centers and the pediatric ward of the Koutiala district hospital, which has up to 350 beds for malnutrition and malaria during the peak season for both. The program had admitted more than 800 severely malnourished children by mid-March, which is consistent with admission rates from previous years. In Kidal and Timbuktu, MSF started providing outpatient care of malnutrition in mid-March.
MSF is also conducting assessments in Djenné, Tenenkou, and Macina, where the food security situation is reportedly very serious. Teams are heading to the region between Banamba and Nara and in the zones of Djenné, Tenenkou, and Macina located between Ségou, Gao, and Mopti.
Mauritania: Meeting the Needs of Malian Refugees and Preparing for Outbreaks of Malnutrition
MSF sent assessment teams to Mauritania’s Brakna region after a national nutritional survey launched in early 2012 showed a global acute malnutrition rate of 13 percent (just below the emergency threshold of 15 percent), with 2.7 percent severe acute malnutrition rate (just below the emergency threshold of 3 percent). The results of the assessment led MSF to decide to establish six outpatient nutrition centers and a small inpatient center in Brakna with the capacity to manage some 1,300 cases of severe acute malnutrition over the coming four months. Another exploratory mission is ongoing in the Assaba area as well.
Meanwhile, in the southeastern Hodh Ech Chargui Region, MSF is providing primary health care, maternal health, and nutritional care for malnourished children from local communities and to more than 57,000 Malian refugees who have been forced to seek refuge in Mauritania’s border region following the outbreak of fighting between the Malian army, the Tuareg movement, and other armed groups in northern Mali earlier this year. Ninety percent of the refugees living in Mbéra camp are Tuareg families coming from Timbuktu. Since April 5, the flow of refugees has jumped from 200 to 1,500 arrivals per day.
Though refugees continue to arrive, the distribution of food and water and the lack of sufficient hygiene services remain a great source of concern. Some 57,000 refugees are sharing 100 latrines, and they have each nine liters of water per day. These conditions fall well below accepted humanitarian standards, which require 20 liters of water per person per day and one latrine for every 20 people.
Food insecurity threatens both refugees and local people, and the arrival of refugees in distress creates even greater pressure on Mauritanian families already stretched to their limits by bad harvests.
There are currently around 264 children suffering from severe malnutrition in Mbéra camp. What’s more, nearly 24 percent of children may fall into malnutrition if they do not get protection rations.
In terms of access to health care, Mauritania has few qualified doctors and shortages of drugs supply suggest that it will be difficult to meet the enormous needs. In the Mbéra and Fassala camps, MSF has performed more than 8500 consultations since March.
Niger: Addressing Childhood Malnutrition as a Public Health Crisis
Since 2001, MSF has been treating malnutrition in Niger. These programs have expanded over the past decade as innovations in outpatient care have made it possible to reach more patients with both curative and preventative assistance. Since 2010, MSF has treated more than 100,000 malnourished children in Niger annually. More than 90 percent of children admitted to these programs recover.
MSF’s expansion of treatment and prevention programs has coincided with the Niger government’s implementation of progressive pediatric care policies that include the increased access to nutritionally appropriate foods, vaccinations, and health care for young children. Over the past few years, Niger has also worked with international partners to implement innovative strategies to prevent malnutrition peaks during the hunger gap.
Taken together, these policies, along with the presence of nongovernmental organizations, leave Niger much better prepared to deal with the seasonal peaks in malnutrition than many of its Sahelian neighbors. However, these advances remain contingent on continued investment of government and institutional donors and the NGOs supporting Niger’s fragile health system.
In 2011, the incidence of malnutrition among Nigerien children between 6 and 23 months of age was 30 percent, in the same range as previous years. This shows that childhood malnutrition cannot be considered an exceptional humanitarian emergency, but rather a persistent public health threat that cannot be addressed strictly through emergency programs.
By the end of March, MSF programs based in the Bouza, Dakoro, Guidan Roumdji, Madarounfa, Madaoua, Magaria, and Zinder regions had admitted 1,572 malnourished children to inpatient nutrition centers and another 14,482 to outpatient nutrition centers.
In Guidan Roumdji region, MSF supports five government health centers—in Tibiri, Sae Saboua, Souloulou, Guidan Sory, and in the town of Guidan Roumdji. These health centers also include outpatient nutrition centers where children are screened for malnutrition and other common childhood illnesses. Like all of MSF’s nutrition programs in Niger, malnourished children without significant medical complications are sent home and their caretakers are provided with a supply of nutrient-dense, ready-to-use therapeutic food (RUTF) to help the children recover.
By mid-March 2012, MSF had provided care to nearly 1,751 children in the five outpatient nutrition centers and provided almost 13,800 consultations for children under five. MSF also supports an inpatient nutrition center where 278 children were admitted and a 70-bed pediatric ward where 1,092 children were admitted through mid-March.
In the Tahoua region, MSF manages nutritional programs in Madaoua and Bouza districts. In Madaoua, MSF supports the district hospital, focusing its activities in the maternity and pediatric wards and the inpatient stabilization center where malnourished children with complications are treated. MSF also supports 11 health centers (in Madaoua, Bangui, Aoulloumatt, Sabon Guida, Ourno, Manzou, Takorka, Magaria, Arewa, Leyma, and Arzerori) where malnutrition is treated on an outpatient basis.
In Bouza, MSF supports the pediatric department and stabilization center for malnutrition in the district hospital and is working in five health centers (in the town of Bouza, as well as in Tama, Baban Katami, Karofane, and Tadoupta). MSF teams had admitted 276 children to inpatient nutrition centers and 831 to outpatient nutrition centers by the end of March.
Additionally, due to the influx of approximately 1,600 Malian refugees in Tillia in northern Tahoua, MSF is supporting the Ministry of Health with a vaccination campaign and will continue to assess the needs in the area.
MSF began its activities in Dakoro in 2005. In collaboration with the Ministry of Health, MSF supports the district hospital and eight health centers (in Adjie Koria, Alforma, Goula, Kornaka, Sabon Machi, Soly, Korahane, and the town of Dakoro). MSF also conducts nutritional activities and assists with an ambulance referral system for emergencies.
At Dakoro Hospital, MSF supports the maternity and pediatric departments, sterilization, the operating theater, water and sanitation activities, and waste management and laboratory services. By mid-March 2012 more than 9,460 antenatal consultations had been carried out, 534 children had been hospitalized, and more than 680 babies had been delivered, including 64 by Caesarian section.
In the eight health centers, MSF provides medical care to children under five, and in seven of those centers, MSF also runs activities to improve antenatal and postnatal care, family planning, and screening for syphilis. By mid-March 2012, MSF had carried out almost 20,000 consultations for children under five in the health center
MSF and FORSANI, a Nigerien medical nongovernmental organization, have run a joint program since 2009 in Madarounfa, in Maradi region. Treatment of malnutrition, malaria, and other pathologies is run in two inpatient structures, five outpatient structures, and 19 health posts that provide full health care services to children under two. This includes access to ready-to-use supplementary foods (RUSF), routine vaccination and follow-up consultations, early detection, and malaria treatment. By mid-March, 1,100 children had been treated for severe acute malnutrition in 2012.
Since 2005, MSF has been running a nutrition program in Magaria, in the Zinder region, with six outpatient nutrition centers and one inpatient center with the capacity to treat more than 18,500 severely malnourished children over the course of a year (70 percent of whom are treated during the hunger gap). The program also provides access to pediatric care. In addition, MSF supports 18 small health clinics that provide pediatric care. MSF treated about 13,000 cases of malaria, 9,000 cases of respiratory infections, and about 11,000 cases of diarrhea in 2011. By the end of March, 419 malnourished children had been admitted to inpatient nutrition centers and another 1,405 malnourished children to outpatient nutrition centers supported by MSF.
In the city of Zinder, MSF manages an inpatient nutrition center in the main hospital, in which teams have treated an average of 3,000 severely malnourished children annually.
Since 2009, MSF has been working with BEFEN, a national medical organization, in Zinder’s Mirriah district, and ALIMA, a French organization, to provide free quality care to around 15,000 children under five years of age annually (ALIMA supports BEFEN’s project management and fundraising efforts and works with BEFEN and MSF on malnutrition strategies in the area). By the end of March, 301 malnourished children had been admitted to inpatient nutrition centers and an additional 2,994 treated on an outpatient basis.
As a result of violence in Mali, nearly 26,000 Malians have sought refuge in Niger’s Ouallam Department. MSF responded by working with the Ministry of Health and opening emergency programs in the four locations in which refugees have been settling with their families (Abala, Chinagodar, Mangaizé, and Ayorou). MSF teams in the projects provide primary health care, referrals, screening and treatment for malnutrition, vaccinations for children, and health care for pregnant women to the refugees and to another 25,000 or so Nigeriens from the local area.
In Agadez, one of the primary migration routes in the region, MSF provides access to health care for migrant populations and local communities.
Senegal: Supporting Treatment of Severe Cases
Since Senegal’s Diourbel and Matam Regions have been deemed at-risk for outbreaks of childhood malnutrition, MSF teams are establishing a 15-bed inpatient nutrition center in the town of Diourbel and supporting an existing center in the Bambey district to treat severe cases. In the Matam Region, MSF teams will continue to monitor the situation for any increase in malnutrition.