Dr. Susan Shepherd
By Dr. Susan Shepherd, MSF Medical Advisor, just returned from Niger
In Niger, MSF Works Out Agreement to Add Nutrient-Rich Supplement to Food Aid for Malnourished Children
In terms of nutrition emergencies, 2009 was a relatively calm year for MSF—but still we treated about 250,000 children for acute malnutrition—100,000 children in Niger alone. 2010 is another story entirely. There are reports of increasing numbers of malnourished children from the eastern regions of Southern Sudan to Chad, and across the Sahel to Mali. Once again, the children of Niger appear to be facing a particularly difficult year. The UN agencies operating there estimate that as many as 340,000 children will develop severe malnutrition, and they are anticipating an unimaginable 1.2 million children will suffer from moderate malnutrition.
Treating even 80% of 340,000 severely malnourished children seems out-of-reach. Last year the health system with support from NGOs treated about 125,000 severely malnourished children. But UNICEF assures that it has the necessary medications and therapeutic foods lined up to meet this overwhelming need. As of mid June, the health system has already treated 114,000. Experience tells us that the health system will have to treat more than double this number before the end of October; it will also have thousands of patients – many young children – with malaria in the months of August to November. Faced with numbers like this, what to do? Nurses, doctors and health workers in Niger already have more than enough to do. Reaching out to young children at risk of severe malnutrition and preventing them from losing weight is essential not only to protecting their health, but also to protecting the integrity of the health system.
The World Food Program (WFP) has launched large scale food distributions that provide grains and pulses (beans) for families, but these foods are lacking in the quality proteins, vitamins and minerals that young, rapidly growing children need. The WFP had planned to distribute a cereal porridge that contains some milk powder, but the supplies were not sufficient. So the back up plan is distribution of 8.3 kg per month of corn-soy blend [CSB] to 500,000 children under two years old for May through July, and an astounding 925,000 under 2’s for August and September. Already there have been distribution delays because CSB must be mixed with oil and sugar; the oil stocks were blocked in transport which meant that the June distribution took place two weeks late. Much of this food comes from far away. About half of the tonnage of CSB will come from the USA.
A young Nigerien eats ready to use therapeutic food at the Intensive Nutritional Rehabilitation Centre (CRENI) supported by MSF in Guidan Roumdi. ©Alessandra Vilas Boas/MSF
CSB is not the right food for young children. The protein quality is poor compared to milk or eggs, the porridge often is diluted in order to make it stretch further (many families report that the ration that was meant to last 1 month is gone in 1 week), and the balance of vitamins and minerals is not tailored to children’s needs. MSF has worked out an agreement with the Government of Niger and WFP to add on a ready-to-use food supplement to the CSB distribution for about 120,000 children in the areas where we have nutrition programs. The WFP is planning to provide ready-to-use food supplements to all 925,000 children, at least for the month of September. One month is better than none, but we need to do better.
Of the organizations distributing food, many are local groups. MSF is partnering with Nigerien organizations for distribution of special foods for children under 2s and for treatment of malnourished children. A small daily amount of about 45 grams of the ready-to-use supplement, or three tablespoons, should substantially improve diet quality for these young children. It provides milk powder, mixed into peanut butter with added vitamins and minerals tailored to the needs of young, rapidly growing children. The idea is that they will be better protected against weight loss and illness.
Although it is pretty widely accepted that young children need special foods, “baby food,” to meet their nutritional requirements, until very recently this concept has not been integrated into international food assistance. A one year old child is given the same food rations, in quantity and quality, as a 50 year old: generally cereals, pulses and some oil. Fortunately, this is starting to change. To help accelerate and expand this change, it is important to carefully document the impact of these improved food distributions on the health and growth of young children. Epicentre, the epidemiologic research center founded by MSF, is working closely with the Ministry of Health to monitor and evaluate how children do and what families think of this new “baby food.”
The children in Niger, and millions of others in similar situations, are at the heart of the Starved for Attention campaign. Let’s work towards convincing others that quality diets for young children make a big difference.
Dr. Susan Shepherd is a pediatrician who has worked full-time for Doctors without Borders/Médecins sans Frontières for the past 4 years. She currently coordinates MSF’s work in nutrition. Dr Shepherd’s interest in childhood malnutrition has grown out of her time in the field; she began volunteering with MSF in 2003 in a pediatric ward in Uganda, then in 2005 worked in a nutrition program in Chad during a measles epidemic. In the aftermath of the 2005 nutritional crisis, she worked in Niger for almost 2 years as a field doctor and then as medical coordinator. She appeared on CBS’ 60 Minutes in October 2007 while in Niger, advocating for MSF’s new approach to treat and prevent malnutrition. In addition to working for MSF, Dr Shepherd has spent time at the Children’s Hospital in Accra, Ghana as a Yale/Johnson & Johnson Physician Scholar in International Health. Dr. Shepherd received her BA in biology from Lawrence University in Wisconsin, and her MD from Université Libre de Bruxelles in Belgium. She completed her residency in pediatrics at the University of Chicago. Prior to joining MSF full-time she worked as a general pediatrician in Butte, Montana.
