Guest blog by Susan Shepherd, MD, Nutrition Coordinator, Médecins Sans Frontières/Doctors Without Borders (MSF), New York, NY, USA
To work for Médecins Sans Frontières (MSF) in Niger is to run from epidemic to epidemic: meningitis from January to May; acute malnutrition from May through October; malaria takes off about 6 weeks after the rains start and lasts through January. There’s usually cholera somewhere by the end of August. In this respect, 2010 is, unfortunately a typical year.
But in one important way, Niger 2010 is unusual. The 2009 harvest failed to meet expectations, and food prices continued trending upward in the months immediately following. Niger may be remote and land-locked, but it is far from isolated from the speculation and price pressures that have characterized the food markets these past years.
Plans were already under way to provide supplemental feeding to 500,000 children under 2, but when a nutritional survey showed a worsening situation, the World Food Program (WFP) revised its strategy and budget. The result is that 674,000 children under 2 are receiving foods to supplement their diet for 8 months in 2010. And it’s not just the usual rations of corn-soy fortified flour. By September the WFP through its local partners were reaching more than 250,000 children with high-quality foods that provide vitamins, minerals, proteins, and energy in the balance that infants require. Combined with the 150,000 under 3s in MSF distribution programs, more than 60% of the young Nigerien children in the supplemental distribution are finally receiving the food they need.
MSF, in collaboration with two Nigerien non-governmental organizations (NGOs), planned to manage about 150,000 severely malnourished children (twice the number of children treated within its programs last year), and in parallel try to decrease the numbers of children deteriorating to the point of severe acute malnutrition, through distributions of high-quality food supplements designed with babies in mind. As of October 1, about 100,000 severely malnourished children have been admitted to therapeutic feeding programs where they receive RUTF.
Doctors understand that a growing child is a healthy child. Well, in Niger half of young children are not growing, and as a consequence, malaria, respiratory infections, and diarrhea exact a particularly deadly toll. In neighboring Ghana, where malaria accounts for a third of all childhood deaths under age 5, a 2009 study2 showed that children who are underweight are twice as likely to die from common childhood illnesses.
Malaria is a particularly deadly infection for all children – well nourished or not. Although MSF programs in Niger are primarily organized around detecting and treating children with acute wasting, every year within these programs we treat tens of thousands of children for malaria with artemisinin-based combination therapies (ACTs).
Antimalarials or antibiotics are more likely to have maximum impact in nutritionally advantaged children. The same Ghana study found that malaria chemoprophylaxis was less effective in malnourished children. An evaluation of health programming designed to accelerate gains in child mortality through appropriate care for common illness (malaria, pneumonia, and diarrhea) and a set of preventative actions concluded, among other things, that the nutrition component of child health programming needs strengthening.
Small wonder that I, as a pediatrician and aid worker, am coming to see weaning foods as the equivalent of an essential medicine in this region. Asking me to choose between treatment for common illnesses and quality diets for young children is like asking which of my hands is more useful.
So it is encouraging that the WFP has taken up the call to provide young children with foods that meet their needs. Babies need food tailored to their specific needs, and this year in Niger the WFP has finally started to give it to them. I hope that Niger in 2010 sets the precedent for quality food in food aid, much the way Niger in 2005 helped establish the treatment of ready-to-use therapeutic foods as the standard of care for acute malnutrition. World Food Day is an appropriate moment to make the commitment to ensure that babies receive food for babies.
UNICEF. UNICEF and WFP appeal for urgent mobilization of the international community to fight child malnutrition in Niger. 24 June 2010. http://www.unicef.org/media/media_54059.html
Danquah I et al. Reduced efficacy of intermittent preventive treatment of malaria in malnourished children. Antimicrob Agents Chemother 2009;53:1753-1759.
Bryce J et al. The Accelerated Child Survival and Development programme in west Africa: a retrospective evaluation. Lancet 2010;375:572-582