Treating severely malnourished children in N’Djamena, Chad

Upon arrival, children are seen by nutritionist assistants and then examined by doctor and nurses to assess the severity of their health status.
CHAD 2018 © Mohammad Ghannam/MSF
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Endemic across the region, acute malnutrition affects children under five in the rural provinces of the Sahel as well as in N’Djamena, the Chadian capital. But this season it has reached alarming proportions in this city of 1.5 million inhabitants.

“It has become critical this year, due to a worsening economic situation that followed the drop in oil prices,” explains Chibuzo Okonta, deputy program manager for emergencies for Doctors Without Borders/Médecins Sans Frontières (MSF).

MSF launched an emergency response on July 26 in partnership with the Ministry of Health, opening an inpatient therapeutic feeding center (ITFC) in the neighborhood of Ndjari. The ITFC has been set up to treat children aged six months to five years suffering from severe acute malnutrition and associated medical complications.

Emergency nutrition program in N’Djamena
Inside MSF's inpatient therapeutic feeding center in Ndjari.
CHAD 2018 © Mohammad Ghannam/MSF

Over 100 children admitted within two weeks

“We have opened this center because the few facilities already run by the Ministry of Health and its partners were working at full capacity and were overwhelmed by the large numbers of severely malnourished children they were receiving,” explains Patient Kighoma, manager of the new MSF inpatient therapeutic feeding center in N’Djamena. “The children arrive in a very critical state and at this age, when they are so fragile, the worst can happen very quickly.”

The ITFC is divided enabling children to be cared for according to their condition. It includes an intensive care unit, where MSF staff stabilize the most critical patients who require constant medical supervision. They are too weak to swallow and are fed by a feeding tube from nose to stomach. Some are given respiratory assistance and intravenous fluids.

“Once they have been stabilized and regained their appetite, we give them therapeutic food like milk formulas, prepared by nutritionist assistants, or peanut-based paste. We also continue to treat them for any other diseases or complications,” says Kighoma.

Over 100 children have been hospitalized by the MSF team in Ndjari since the ITFC opened two weeks ago. When their condition improves, and they are discharged, these children continue treatment with ready-to-use therapeutic foods at home and have weekly check-ups at a health center, as part of an outpatient program.

Vulnerable families struggling to support themselves

The high levels of acute malnutrition seen every year in Chad are the result of many factors. This year in N'Djamena, the phenomenon has been amplified by a crisis in purchasing power, particularly severe seasonal food insecurity, and a public service strike affecting the health sector.

Unemployed laborers, out-of-work street sellers and seasonal migrants, under-paid or unpaid civil servants and white-collar workers—many families in the capital are affected, and not all of them have the means to adapt.

“My husband lost his job. He had not been paid for seven months. At the end of each month, when he was supposed to be paid, he was told, ‘come back tomorrow,’” says Fatima, whose second child, Bathradine, is being cared for at MSF's inpatient therapeutic feeding center.

Fatima's family first sought new opportunities in the south of the country, but they returned to N'Djamena empty-handed. Then they sold their valuables, carpets, curtains, and mats, and still they were unable to pay the rent. The owner of their home seized what belongings they had left.

“When I find a little money, I buy and sell small goods at the market to feed my children. There is not much to eat at home right now: no rice, no flour, some potatoes. But I can’t buy more,” Fatima worries.

About 33 yards from the MSF inpatient therapeutic feeding center stand huts made of sheet metal, bits of old cars, and other recycled materials, on what is known as “reserve” land. That is, land seized by the authorities and frozen for future use, on which people whose property has been expropriated; people arriving from the countryside seeking odd jobs in the capital; and others who don’t have means to settle elsewhere build temporary settlements with what they can find.

Zenaba, a young woman in her 20s, has lived here for two years since leaving Mongo, a small city in the Guera region in central Chad.

Emergency nutrition program in N’Djamena
Zenaba with her two-month-old baby.
CHAD 2018 © Anaïs Deprade/MSF

“We are farmers,” she explains. “The rains were increasingly getting worse, and we had several bad harvests, so we came to N'Djamena to find work and feed our family. My husband worked in N'Djamena as a laborer on construction sites and markets, loading and unloading sacks of flour. However, he has not found anything lately. He has just left to look for work in Abeche (Chad’s fourth largest city, on the eastern side of the country).”

Inside her hut, Zenaba takes care of her two-month-old baby: “I gave birth to twins, but I only have one baby left. The other did not survive. I work in private homes: I clean, and I wash their clothes. This is how I try to feed my family, but during my pregnancy, it was very difficult.”

Limited access to nutritional and pediatric healthcare

Economic hardship is not the only reason for the alarming levels of malnutrition among children in N’Djamena.

Hajja, a mother whose 18-month-old son has been admitted to the MSF feeding center, is adamant: she has the means to feed her son; her biggest challenge was finding a health facility that could treat him when he fell sick. “Adoudou developed a fever, then diarrhea,” she explains. “I took him to hospital and paid for his treatment and medication. A few days after his release, he got very bad again. The clinic in our neighborhood is closed—the staff are on strike—so I went to another clinic and was told that he could be malnourished, but that it was ‘not the right day’. I was finally referred to the Ndjari health center, and now, after all this, I'm here at the MSF hospital,” she sighs.

Of the 60 or so health centers in N'Djamena, at least 25 have a therapeutic feeding unit for children suffering from acute malnutrition who have not yet developed complications that need hospitalization. Apart from the six units supported by Alima/Alerte Santé, which operate from Monday to Friday, most of the others, whose supply depends on UNICEF, only do follow-up consultations and distribute ready-to-use therapeutic food rations once a week. This makes getting rapid access to treatment for children at this critical age all the more complicated.

“We have to keep in mind that when severely malnourished, a child’s metabolic functions are impaired and the immune system is affected. That is why they are likely to quickly contract infections and complications that can be fatal,” says Okonta.

“We must increase the capacity for hospitalization, as we have done with the emergency opening of the Ndjari inpatient center, but it is crucial that we also do everything we can to ensure that severely malnourished children are cared for on time in health centers before they develop complications.”

To this end, in partnership with the Chadian Ministry of Health, MSF is launching nutritional activities in two health centers in N’Djamena and is preparing to further expand this type of activity around the city.