Key medical figures:
• 916,000 outpatient consultations
• 425,100 patients treated for malaria
Seasonal Malaria Chemoprevention (SMC) was used for the first time in Niger in 2013. Combined with malnutrition screening and treatment, this strategy aims to reduce suffering and child mortality.
During the months between harvests, there is a period known as the ‘hunger gap’, during which there is a steep rise in the number of children suffering from acute malnutrition. Children under five are particularly affected, as their young bodies have specific nutritional needs for proper growth and development and few reserves. The rainy season, which causes a proliferation of malaria-transmitting mosquitoes, also occurs during the hunger gap. This represents a dual threat to young children: malnutrition weakens their immune system, which makes it more difficult for them to cope with the malaria that causes anaemia, diarrhoea and vomiting, and that then leads to, or complicates, malnutrition. The combination of malaria and malnutrition is often fatal.
Aiming to shift from malaria treatment to prevention as much as possible, teams from Médecins Sans Frontières (MSF) widened the scope of prevention activities in 2013. SMC, a new strategy which has proven effective in Chad and Mali, was used in Niger for the first time. For four months during the rainy season, children received a course of antimalarial medicine in the districts of Guidan Roumdji and Madarounfa (Maradi region), Bouza and Madaoua (Tahoua region) and Magaria (Zinder region). On average, around 225,000 children received treatment at each of the four rounds and dependant on location coverage has been estimated at between 94 and 99 percent.
While the usual methods of mosquito bite prevention, including the use of nets and sprays remain the basis of the programmes, SMC is proving useful to protect the health of children at risk from severe malaria where there is limited access to care. Teams involved in the SMC campaign undertook it alongside activities for children with malnutrition. MSF has ongoing nutrition programmes providing mobile screening and treatment, as well as hospitalisation for severely malnourished children, in all these regions. Delivering essential healthcare closer to home is the goal of all MSF’s malaria and nutrition programmes, a strategy known as PE CADOM (Prise en Charge à Domicile). In Bouza and Madaoua districts, Tahoua region, MSF provided home-based malaria
diagnosis and treatment for pregnant women and children through community health workers based at 111 health posts. These staff are trained by doctors to detect and diagnose malaria, treat simple cases and refer complicated ones. They also examine children’s nutritional and vaccination status. Following a measles outbreak in March in Madaoua and Sabon Guida, MSF launched a vaccination campaign in May which reached 84,460 children under the age of 14. A new approach is also being adopted to help prevent severe acute malnutrition in some villages in Tahoua region. The mamans
lumières receive training from MSF teams on how to prepare food for maximal nutrition. The mothers, in turn, share what they learn with peers in their villages.
In Madarounfa district, Maradi region, where MSF provides paediatric care in conjunction with the Nigerien organisation FORSANI (Forum Santé Niger), a team also ran a malaria prevention programme for children under two years old in three of the five health areas. Nutritional supplements were provided, mosquito nets were distributed, and children received routine immunisations. Following heavy rains that destroyed homes and crops in Madarounfa in July, MSF distributed kits with mosquito nets, water cans, soap and blankets to 6,630 people. In Magaria, Zinder region, MSF continued to focus on decentralising points of care, thus making treatment for malnourished children more accessible. Consultations were held at ‘health huts’ and in people’s homes, eliminating their need to travel to larger facilities and allowing some of the most vulnerable people to obtain care in their own communities. The development of intermediate treatment and observation at health centres in Magaria, Dungass and Bangaza enabled staff to improve triage and reduced the number of referrals to hospital. MSF has also supported an inpatient feeding centre at Zinder hospital for many years, and this was handed over to the Ministry of Health at the end of 2013. Teams remain ready to open an additional 450-bed treatment centre during peak periods of malnutrition.
Caring for Malian refugees
Armed conflict in Mali since 2012 has led to massive population displacement as people cross national borders in search of safety. MSF teams provided basic and specialist care, maternal healthcare and immunisations to Malian refugees and the host community in Tillabéri region. A total of 57,500 consultations were carried out. The team responded to a cholera outbreak in May, treating 1,500 patients. Refugee healthcare was handed over to the Qatar Red Cross/UNHCR in September. MSF also worked in the Abala camp, about 250 kilometres north of Niamey, Niger’s capital. Basic and specialist care was provided to 14,000 Malian refugees in the camp and some 33,000 local residents. Obstetric and surgical emergencies were referred to the district hospital.
26 years old, Tounfafi village, Madaoua MSF community workers told us to come here for the malaria prevention medicine. We have now realised how important this treatment is and this is why so many people come here to take it. My children usually have malaria. Then their bodies burn with fever, causing seizures, vomiting and diarrhoea. This year … there are fewer malaria cases.