A challenge to provide urgent care for endemic malnutrition

Since Médecins Sans Frontières launched a malnutrition programme in Burkina Faso in September 2007, more than 23,440 children have been treated, and 88% out of all admitted patients were cured. About 80% of patients were treated exclusively at home by using ready-to-use therapeutic food (RUTF), which can be easily fed by their own families.

“When I visited our programme, our Burkinabe doctors told me that they were not aware of so many malnourished children in their country before they started to work with Médecins Sans Frontières”, explains Jean-Luc Anglade, Médecins Sans Frontières programme manager for Burkina Faso.

In the rural areas around Titao and Yako, where Médecins Sans Frontières initiated a nutritional project in September 2007, malnutrition is a predictable endemic crisis. Each year, children under five years old lack variety of basic nutrients to achieve critical stage of their growth during hunger gap period, when food reserves from the last harvest become depleted while waiting for next harvest. Numbers of children suffer from acute malnutrition all around the year, with a peak period in early September. Médecins Sans Frontières responds to provide urgent care for endemic malnutrition since the problem tends to remain largely invisible.
“Awareness is a very important and necessary step towards making changes to cope with this kind of situation. Now, there is a growing consciousness in magnitude of the malnutrition crisis in the country”, Jean-Luc says.

An 88% cure rate

Early 2007, the Burkinabe Ministry of Health took a step forward and adopted WHO recommended new protocol to treat acute malnutrition by using RUTF, mostly through ambulatory care (see box1). Médecins Sans Frontières then proposed a partnership to implement new protocol in a region hard-hit by malnutrition. Since September 2007, more than 23,440 children have been treated in Médecins Sans Frontières project, with an 88% cure rate.

“Thanks to the outpatient treatment with RUF, the vast majority of malnourished children are now easily treated at home”, Jean-Luc emphasizes. During the peak emergency period in early September, Médecins Sans Frontières conducted an average of 600 admissions of malnourished children per week in the two districts.

Improved outreach

In Burkina Faso, Médecins Sans Frontières uses MUAC measure (Mid-Upper Arm Circumference) to optimize admission effectiveness. Easy to use, scientifically proven to indicate actual risk of death, the MUAC measuring bracelet enables to screen a large number of children within short time, and without demanding costly equipments or specially trained staffs. The simplicity allows Médecins Sans Frontières to train local community workers, who then can screen children at community level.

Moreover, the innovative approach of enlarging the admission criteria by using a MUAC measurement of 120 millimeters (instead of the usual 110 mm threshold) enables us to treat not only severely malnourished children, but also some suffering from moderate malnutrition.

Looking ahead

“We are focusing on children under-five, as they are the most vulnerable to malnutrition, in our program. Childhood malnutrition is an underlying cause of death for too many children, yet far from public attention. Young children need right amount of both macro and micro nutrients in their diet. Children without sufficient nutrients are at high risk for repetitive infections, and it can be fatal”, Jean-Luc comments.

In contexts similar to Burkina Faso, preventive distributions of nutritive supplements throughout the lean period have given very interesting results. A recent study on a preventive distribution of the therapeutic RUF carried out in Niger in 2006 showed this could reduce by as much as 58% the number of severely malnourished children. And in 2007, in the same region of Niger, a strategy with a specifically designed ready-to-use nutritive supplement suppressed the peak of malnutrition in the targeted district.

“Malnutrition is a serious medical emergency, and we already know that a high number of cases will reoccur around the same time next year. So instead of waiting, why not try to prevent it?", says Jean-Luc Anglade, "Early treatment strategies are a development of our project we would like to look into in 2009.”