An MSF staff member measures a child's mid-upper arm circumference at a nutrition program in the Guéra region. © Boris Revollo / MSF
MSF is conducting emergency nutrition interventions in Chad, in the Sahel region, where approximately 10 million people are expected to suffer from food insecurity. Hear more from the latest MSF Frontline Reports Podcast.
Recent flooding in Niger has drastically affected food supply, increasing the country’s already-high rate of childhood malnutrition.
MSF’s nutritional centers expect to treat close to 150,000 Nigerien children this year. Listen to MSF’s Dr. Susan Shepherd discuss malnutrition in Niger on BBC’s World Service radio program, “World Today”.
Despite the current spike in malnutrition, Dr. Shepherd says, “We know that every year is a bad year for the young children in Niger when it comes to malnutrition;” what is needed are “ways to avoid having to develop last-minute, chaotic, huge, and very expensive emergency programming.”
New research points to successful prevention of malnutrition in Niger.
By Dr. Susan Shepherd, Nutrition Coordinator, Médecins Sans Frontières (MSF), New York, USA
A recent study in the journal Pediatrics shows how the timing of a nutrition intervention in Niger during the first years of a child’s life, as well as the extended duration of food supplementation with high-quality, balanced food supplements – in amounts as small as 250 kcal/day – can have positive effects on the growth of young children and protect them from episodes of weight loss during the critical hunger gap (most food-insecure months of the year).
The study, Reducing wasting in young children with preventive supplementation: a cohort study in Niger, compared the effects of ready-to-use supplementary food (RUSF) and ready-to-use therapeutic food (RUTF). It was conducted by Epicentre, the research affiliate of Doctors Without Borders/Médecins Sans Frontières (MSF), in Maradi, Niger – a region where food security is a chronic concern.
The 1,645 children who received nutritional supplementation were 6 months to 3 years of age, which is widely regarded as the critical window of opportunity when the quality of a child’s diet has a profound, sustained impact on his or her health and physical and mental development. One group received 250 kcal/day of RUSF for 6 months, and the other received 500 kcal/day of RUTF for 4 months.
Just under half of the children participating in this study had received a short-term (3-month) distribution of RUTF (500 kcal/day) the previous year, 2006 (Isanaka et al, JAMA 2009). At the beginning of the second distribution round in 2007 (6 months after the end of the previous one), these children had less wasting and stunting compared to those who received no supplementation. This finding suggests that lasting benefits on children’s growth can result from even short-term distributions of high-quality, calorie- and micronutrient-rich foods like RUTF.
For the 2007 distribution, the duration of supplementation appeared to be more important than the amount of calories provided by the food. Among the children who received both the 2006 and 2007 distributions, those who were supplemented with RUSF fared better and had 50 percent less wasting compared to those who received RUTF.
These two studies by Isanaka et al complement work done in Malawi, where Phuka et al (Archives of Pediatrics and Adolescent Medicine 2008) showed that daily supplementation with 250 kcal/day of RUSF in children 6-18 months of age improved growth in stunted children significantly better than a fortified corn-soya blend.
Taken as a group, these studies lend credence to the use of balanced, complete food supplements tailored to the nutritional requirements of young children as an effective way to promote healthier growth in the 6-35 month age group and protect these young children from weight loss during the hunger gap.
Although this is a particularly difficult year in Niger and elsewhere in the Sahel requiring expensive, rapid-response programming, every year MSF and others treat hundreds of thousands of malnourished children in this region. These emergencies come as no surprise. The growing evidence of benefit to children who receive high-quality food supplements should compel aid organizations and international donors to make wiser use of resources and develop strategies and interventions that aim to reduce the burden of childhood malnutrition.
“Reducing wasting in young children with preventive supplementation: a cohort study in Niger” by Sheila Isanaka et al. Pediatrics 2010;126(2):e442-e450
Host a Starved for Attention screening event in your community. The Action Kit includes a DVD of the documentaries, fact sheets on malnutrition, a copy of the petition, and outreach materials to spread the word about your event. Organize your community to help rewrite the story for the 195 million children around the world who suffer annually from malnutrition.
Order your free Action Kit here:
http://www.starvedforattention.org/actionkit
Get your community involved in the Starved for Attention campaign.
Action kits include a DVD of the documentaries and a Take Action CD full of useful outreach materials.
Two months ago Doctors Without Borders/Médecins Sans Frontières (MSF) launched our “Starved for Attention” campaign on childhood malnutrition. We released seven short films that document how malnutrition is affecting the lives of and futures of 195 million children around the world. Alongside the films, we launched a petition drive aimed at rewriting food aid policy.
We’ve heard your feedback on Facebook, Twitter, and on this blog, and we want to answer your questions and thank you for your support.
Join Dr. Susan Shepherd, MSF medical adviser, and Jason Cone, MSF-USA Communications Director, for a live video chat about why the campaign was launched and the latest developments in the field.
Please ask your questions in the comments box below or on Twitter using the hash tag #STRVD.
You can watch the live chat here or on the Ustream website, where you can join the conversation with others watching.
Dr. Susan Shepherd
We got some great feedback on this recent blog post about treating malnutrition in Niger. Here, Dr. Shepherd responds.
Darrel H. (on Facebook): FYI…As you share Plumpy nut, make sure it is only given to children 6 months to 2 years. It has to high of a content of fat for older children. Just learned this at the International Food Aid and Development Conference in Kansas City.
Dr. Susan Shepherd: PlumpyNut is given to severely malnourished children at any age for a limited period of time (6-8 weeks) to support lean tissue weight gain after a period of weight loss. The issue is not fat content for a specific age group, but for a specific metabolic state. A high fat diet is appropriate for people who have abnormal weight loss (catabolic state); it is not appropriate for healthy children who are growing at a normal rate (anabolic state).
Chika O. (on Facebook): What is the government of Niger doing to solve this problem? Why are they abdicating that responsibility to MSF? That is the real question.
Dr. Susan Shepherd: The government of Niger has supported the development and revision of a national protocol for the treatment of malnutrition. It has included severe and moderate malnutrition in its health statistics, monitored weekly, similar to other diseases that require rapid response (meningitis, cholera, measles). Childhood malnutrition is now being taught to medical students at the University in Niamey. In 2010, the Ministry of Health is participating in the oversight of innovative programs to reduce the incidence of severe malnutrition in the under 2 year age group. Niger is one of the regions of the world most affected by childhood malnutrition, it is a huge public health concern. The real challenge is to devise strategies to address the problem that don’t break a weak, developing health system.
Caro O. (on Facebook): God bless, its breast feeding week from 16th to 20th in Kenya, wish you would attend. Breast feeding is suppose to stop malnutrition to the still breast feeding kids, i agree with you Darrel H, plumpy nuts does miracle, have seen its amazing positive effect,they are great!
Dr. Susan Shepherd: Breast milk is all a child needs for the first 6 months, but at that point, all infants need quality complementary foods that provide quality protein, fats and vitamins/minerals: particularly calcium, zinc and iron [breast milk cannot meet babies' requirements for these]. So breastfeeding is essential, but it is not sufficient on its own to assure proper nutrition from 6 months – 2 years, the transition period when children shift from breast milk alone to family food. This is why children need baby foods that are calibrated to their particular nutritional needs. Foods similar to PlumpyNut can provide the proper nutritional balance in an infant’s diet, in addition to breast milk, of course.
We welcome more feedback or questions. You can leave them in the comments here, post them on our Facebook page, or tweet them to us at @MSF_USA.
Interview with MSF President, Dr. Marie-Pierre Allié
Dr. Marie-Pierre Allié, president of Doctors Without Borders/Médecins Sans Frontières (MSF), returned recently from a trip to Niger. With another nutritional emergency underway, new preventive approaches are emerging in the struggle against malnutrition.
Mothers wait to receive ready-to-use therapeutic food at a nutrition program in the district of Guidan Roumdji. © Alessandra Vilas Boas/MSF
What is your analysis of the situation?
Clearly, Niger is experiencing a serious food and nutritional crisis. Last year’s poor rainfall produced inadequate harvests in a food security context already weakened by a gradual increase in food prices over recent years.
The most recent data on the country’s nutritional situation showed that rates of childhood malnutrition are above the emergency threshold of 15 percent in many regions of the southern part. In certain areas, such as Maradi, where we work, one child out of five is suffering from acute malnutrition. And four percent of children under 5 [years of age] suffer from the most severe form of malnutrition.
Some people describe this as a “famine,” saying that this is a “crisis of previously unheard-of proportions.” Is that true?
It would be counter-productive to exaggerate. We should be careful about our choice of language. We don’t have to go to extremes to dramatize the situation in order to emphasize that this is a serious situation, nutritional indicators are alarming, and an appropriate response must be organized. Furthermore, we should also put the current situation in perspective with respect to recent years. Although the crisis of 2010 is certainly more serious, it is not radically different than those the country has experienced in the last few years. Unfortunately, we are witnessing recurrent crises that vary only by intensity from year to year.
Therefore, the key is not to rank them by severity—which would also be extremely complex—but, rather, to emphasize their periodic occurrence.
Is there a difference between the crises of 2010 and 2005?
Yes, in terms of the breadth and quality of the response. Both have changed dramatically since 2005. At that time, response was slow, both because the regime in power was unwilling to acknowledge the problem and because of the lack of effective warning and response mechanisms. MSF sounded the alarm, calling for deployment of international aid and the adoption of new treatment protocols.
At that time, we heard a lot of talk about “ready-to-use therapeutic foods.”
That was the first time these new products had been used on a large scale, allowing us to treat cases of severe malnutrition on an outpatient basis. Thanks to this strategy, MSF’s sections managed to treat 63,000 malnourished children. It had previously been impossible to treat such a large number of children because of the burden (volume and cost) their hospitalization would have represented. Since that time, Nigerien health authorities have adopted these new strategies for treating severe malnutrition, thus increasing the number of children who can be treated.
However, Nigerien authorities seem to have been less open concerning nutritional issues after 2005.
Yes, there’s a certain paradox. President Tandja chose to deny the seriousness of the situation and the significance of the stakes involved in responding appropriately. In 2008, the French section of MSF was forced to leave the country.
However, some important changes did occur, including new protocols for treating malnutrition, free medical care for children under five, the adoption of new standards for defining severe malnutrition (recommended by the World Health Organization) and, last, local production of ready-to-use therapeutic foods.
What measures have been adopted to address the crisis of 2010?
The new Nigerien authorities began alerting the international community to the seriousness of the situation in March. They organized sales of cereal at low prices and free food distributions. The response plan should also make it possible to treat more than 300,000 severely malnourished children in the country, which is four times more than in 2005.
In addition, we should emphasize that widespread preventive measures are also part of this approach, including the distribution of complementary foods intended for infants, who constitute the most vulnerable populations.
Is the response meeting the needs?
What we can say for sure is that the response is ambitious and will certainly make it possible to save many children. The response plan has evolved as the situation has changed. Unfortunately, it did not target immediately the areas most affected by childhood malnutrition but instead, gave priority to areas experiencing agricultural production deficits. Here again, the issue is emergency response, which requires considerable resources to treat children who are already severely malnourished. The malnutrition prevention measures that have been implemented are a good way to begin moving beyond this approach and to respond sooner.
It will be particularly important to make sure that these measures are maintained after the most difficult period winds up and that they are implemented systematically to prevent the recurrent peaks in severe malnutrition that we see every year, from June to October.
What role is MSF playing in this context?
MSF teams are working in the regions that have been the most seriously affected by the crisis: Tahoua, Maradi, Zinder and Agadez. We have strengthened our treatment programs to face the crisis and are now managing 8 nutritional hospitalization centers and approximately 60 outpatient centers, working in conjunction with the Nigerien Ministry of Health. Since January, we have treated approximately 65,000 children and expect to treat a total of 150,000 this year.
We are also organizing supplemental food distributions for children from six months up to two years, in the areas where we are working. This should allow us to reduce significantly the number of malnourished children during the second part of the season. We also hope to continue these distributions beyond the crisis period, to get ahead of the “hunger gap” of 2011.
MSF’s French section has returned to Niger. What does that mean?
It signals the common willingness for both Nigerien authorities and MSF to resume our joint efforts to address the pediatric and nutritional problems in that country. To do that, we are working with a Nigerien medical NGO, Forsani. We had decided to support the organization after we left in late 2008. In 2009, more than 12,600 severely malnourished children were treated under the joint program in Madarounfa.
We hope to develop sustainable treatment and preventive programs by working with these young Nigerien doctors, health authorities and other aid actors.
