Dr Jean-Clément Cabrol:“Treating malnutrition in isolation is an outdated approach”
August 8, 2012
“Treating malnutrition in isolation is an outdated approach”
A food crisis is brewing in the countries of the Sahel in sub-Saharan Africa. Dr Jean-Clément Cabrol, MSF director of operations, has just returned from southern Niger. He describes what he found, and why a new approach is needed to treat the children bearing the brunt of the region’s chronic food insecurity.
Is there a food crisis in Niger?
If you’re asking if the situation is exceptional, then the answer is no. In Niger, problems accessing food, and triggering widespread malnutrition, are unfortunately recurrent. In 2011, which was not even considered a crisis year, more than 300,000 severely malnourished children were treated throughout Niger, and not only by MSF. This year, that figure could reach 390,000.
In 2012, the chronic food insecurity has been exacerbated by additional factors: rising prices of commodities; the return of large numbers of workers who had previously sent money home from Libya; the early arrival of the rains which increased malaria cases; and the influx of refugees from Mali, which has put pressure on an already-suffering population.
What should the response be?
Thanks to new, ready-to-use therapeutic food products developed in the early 2000s, malnourished children without complications no longer need to be admitted to hospital. They can be treated at home by their mothers. This has enabled a significant increase in the numbers of children treated – it would be impossible for the health system in Niger to admit 390,000 children to hospital.
MSF has called unceasingly on major UN agencies like UNICEF and the World Food Programme (WFP) to use foods such as peanut paste fortified with milk protein, vitamins and minerals, which are formulated specially for children and contain all the nutrients necessary for their growth.
More recently, we have started doing ‘preventive’ food distributions for children under the age of five, with the aim of providing them with an additional source of food to protect them against malnutrition.
We have also decentralised our approach to a community level. In the villages, agents trained by MSF can now monitor malnourished children and, where necessary, provide them with ready-to-use therapeutic food. This means that treating patients costs less, and it takes the pressure off overcrowded hospitals and clinics. If the condition of a child being treated in the community worsens, or they have medical complications, then they are referred to the closest intensive treatment centre for medical care.
How do you see malnutrition being managed in the future?
I believe we should go beyond a purely nutritional approach, except in emergency situations. This means taking action against all the main causes of infant mortality – malaria, diarrhoea and respiratory infections, as well as malnutrition – because children who are sick are at far greater risk of becoming malnourished. So community agents will not focus solely on malnutrition but will also test for and treat cases of uncomplicated malaria.
The health of mothers and children as a whole needs to be more integrated into our medical and preventive strategies. For example, when a mother comes for a prenatal appointment, we should systematically take the opportunity to vaccinate her children and test them for malnutrition. Today, we at MSF believe that treating malnutrition and other conditions in isolation is an outdated approach.
Médecins Sans Frontières/Doctors Without Borders (MSF) and its partners – the Nigerien medical NGOs Forum Santé Niger (FORSANI) and Bien-Être de la Femme et de l’Enfant au Niger (BEFEN) and the international NGO ALIMA – work together closely with the Federal Ministry of Health in the areas of infant malnutrition, paediatric care and maternal heath in many health centres and hospitals throughout Niger. MSF also provides healthcare to the Malian refugee populations. Since the start of 2012, MSF has treated more than 38,000 malnourished children in Niger.