Paediatric specialist Marco Olla worked in Médecins Sans Frontières malnutrition projects in Maiduguri, the capital of Borno State in northeastern Nigeria. He describes the scope of the crisis in the city, the medical impact of malnutrition on children and the treatment provided by our teams.
“In malnutrition crises, we typically treat children between six months and five years old. They are most vulnerable at this age, and depend directly on their mothers and fathers to survive. But if you see many malnourished children over five years old, then you know the situation is really bad and a severe nutritional crisis is unfolding. A mother recently came to one of our health centres with her seven-year-old daughter who was severely malnourished and had diarrhoea. We immediately hospitalised her in our inpatient feeding centre. When you looked at her, she didn’t laugh, she didn’t smile. They fled from a village east of Maiduguri settling in Muna Garage, a makeshift camp on the outskirts of the city. They stayed there for more than a month, but the millet and rice rations they received were much too little, and they didn’t have money for the state health facilities.
"If you see many malnourished children over five years old, then you know the situation is really bad and a severe nutritional crisis is unfolding"
In Médecins Sans Frontières health centres in Bolori and Maimusari in Maiduguri, we are screening for malnutrition all children up to 15 years coming for a medical consultation. If we see they are affected by acute malnutrition, whether it is a moderate or severe form, we treat them in our feeding centres. For feeding, we use therapeutic milk to stabilise their metabolism, however some of them are so weak that they refuse to eat. In this case, we feed them via a nasogastric (nose to stomach) tube. After this stabilisation phase, we give them ready-to-use therapeutic food, a peanut-based paste. Severely acute malnourished children without complications and children with a moderate form of malnutrition are treated at home and followed up in our ambulatory facilities. We also take care of pregnant women who often get not enough food. We distribute food to pregnant women during prenatal consultations and when women come to the postnatal consultations, and we screen their babies for malnutrition.
There are two main manifestations of malnutrition in children: marasmus and kwashiorkor. A child with marasmus is emaciated, looking like skin and bones whereas Kwashiokor is characterized by swelling. Both forms are related to deficiency of essential nutrients like proteins, vitamins and minerals. The immune system is particularly affected. This is the reason why they are susceptible to develop infections. When malnourished children die, most of the time they die of an infection. A malnourished child is prone to fall sick, and the disease aggravates the malnutrition. The deadly medical complications range from pneumonia, meningitis and malaria to diarrhoea and sepsis.
What is really tough here is the stories of the patients. I remember a mother who came with a two-year-old boy to our feeding centre. The family had fled the conflict, their house was destroyed, and the father had died. The woman then lost one of her four children in riots during the conflict, two others died of measles, and now she was here with her last son, who was suffering from severe malnutrition. When she finished her story, she started to cry. Many people really went through hard things; they are traumatised. Fortunately, this boy didn’t die. At the same time, it’s good to see the change in the behaviour of the children while they recover. They suddenly start to interact with you, they start to laugh. Like the seven-year-old girl. We treated her infection, gave her antibiotics and she started to eat again. I always try to approach the children to see how they react; I try to shake their hands. When they are weak, they often refuse and are irritated, but yesterday, the girl gave me her hand for the first time.”