CHAD: Acute malnutrition reaches alarming levels in N’Djamena

MSF opens emergency nutrition programme to respond to critical situation faced by children in Chadian capital N’Djamena

Monday, July 30, 2018 — Doctors Without Borders (MSF), has opened in partnership with the Ministry of health a therapeutic feeding centre to respond to the plight of thousands of under five-year-olds in N’Djamena as the few facilities which provide treatment to children with acute malnutrition are completely overwhelmed by their numbers.

Endemic both in Chad and N’djamena all year round, acute malnutrition has now reached alarming proportions in N’Djamena. This is due to the cumulative effect of the decline in people’s purchasing power, particularly severe seasonal food insecurity and a public workers’ strike that is impacting the health sector.

The latest survey coordinated by Chad’s Ministry of Health in July 2017 already showed malnutrition rates among children in Ndjamena to be above emergency thresholds. But since January this year, the number of severely malnourished children hospitalised in Chad-China Friendship Hospital has risen 45% compared to the same period in 2017. The hospital, which NG0 Alima supports, has admitted up to 170 sick and severely malnourished children, many more than the number of patients its 80 beds are able to cope with.

Given the critical situation, it is urgent to increase inpatient capacity to treat severely malnourished children and to provide early treatment in outpatient facilities. Outpatient nutrition centres have a crucial role in facilitating home treatment to prevent children’s health from deteriorating and, as a result, the need to hospitalise them. But most centres in N'Djamena are open just one day a week and experience frequent shortages of ready-to-use therapeutic foods, which are vital to severely malnourished children and provided by UNICEF. “Access to emergency paediatric care services is an uphill battle In N’Djamena, so everything must be done to stop kids becoming so sick they have to be taken into hospital. Action is required urgently to increase the number and the reach of outpatient nutrition centres and make sure they have the means and support to provide effective assistance,” says Natalie Roberts, MSF’s head of emergency programmes.

In partnership with Chadian health authorities, MSF has opened an inpatient therapeutic feeding centre that is starting off with 50 beds with capacity.  The plan is also to open several ambulatory nutrition centres across N’djamena to enable children to receive treatment and appropriate follow-up at home.   

The nutritional status of children with moderate malnutrition also needs to be improved, but they receive no form of treatment. “Until now in N’Djamena, children who are screened and found to have moderate malnutrition were sent home with nothing. But we know that, once they’re back in their homes, moderate malnutrition rapidly descends into acute malnutrition because their mothers aren’t able to give them enough food. We shouldn’t have to wait for these kids to be at death’s door to respond to their basic needs!” says Natalie Roberts.

In coming weeks, MSF will include the distribution of supplementary food provided by the World Food Programme in its outpatient activities to treat children suffering from moderate malnutrition.

Providing assistance in Chad for the past 37 years, MSF works in the regions of Salamat, Mandoul and Logone Orientale delivering medical care to the local, displaced and refugee population. Every year the organisation boosts its capacity to screen and treat child malnutrition during the lean period that falls at the same time as the increase in seasonal malaria, which usually get under way in May and ends in September. With the situation especially critical in N'Djamena this year, MSF has launched an emergency nutrition programme to extend the provision of treatment of acute malnutrition. 

Amaboua Abde is 22 years old and comes from a small village near Gambir in Bokoro, Chad. <br/>Her youngest child, Ziham, is six and a half months old and has been coming to the MSF clinic for two weeks. Ziham has a fever night time as well as a cough. Amaboua says he’s been like this since he was born. <br/>After their weekly check-up and receiving supplies of plumpy nut MSF, Amaboua leaves the clinic with her children. As Zahim is still malnourished she will return next week. She lives a short walk away. Photographer: Charlotte Morris
Amaboua Abde is 22 years old and comes from a small village near Gambir in Bokoro, Chad. <br/>Her youngest child, Ziham, is six and a half months old and has been coming to the MSF clinic for two weeks. Ziham has a fever night time as well as a cough. Amaboua says he’s been like this since he was born. <br/>After their weekly check-up and receiving supplies of plumpy nut MSF, Amaboua leaves the clinic with her children. As Zahim is still malnourished she will return next week. She lives a short walk away. Photographer: Charlotte Morris
Amaboua Abde, 22, from a small village near Gambir watches as her baby is weighed. Photographer: Charlotte Morris
MSF teams unpack boxes of plumpynut and set up the mobile clinic for the day at the mobile malnutrition clinic in the village of Gambir.<br/>MSF teams weigh babies and children, measure their upper arm circumference, check they have an appetite and also give a measles vaccination or medication for malaria if necessary. Mums receive plumpynut, soap and a mosquito net for their child and are asked to return the following week, until their children are no longer malnourished. Photographer: Charlotte Morris
The village of Gambir, where MSF runs a mobile malnutrition clinic. Here MSF teams weigh babies and children, measure their upper arm circumference, check they have an appetite and also give a measles vaccination or medication for malaria if necessary. Mums receive plumpynut, soap and a mosquito net for their child and are asked to return the following week, until their children are no longer malnourished. <br/>On this day around 50 women arrive with their babies or children. <br/>MSF mobile malnutrition clinics are run from 15 different villages around the region of Bokoro, Chad one day per week. The clinic in Gambir is open every Tuesday. The villages can be difficult to reach due to track roads which can flood during the rainy season. Photographer: Charlotte Morris
Zara Abba, 32, from the capital of Chad, N’djamena, has been in the MSF intensive care unit in Bokoro town for four days. She is there with her granddaughter, Katalma Moussa who is two years old. <br/>Zara Abba was visiting Bokoro to pay her respects to a family member who'd died when her granddaughter fell ill. “She hadn’t put much weight on for a while and then she started to get diarrhoea and her health got even worse. She hasn’t had any energy to be able to play with other children.”<br/>“This is my daughter’s first child. She’s still in N’djamena but I’ve been speaking to her every day. She calls to ask about the health of her daughter. I say her daughter is getting better. MSF have gone above and beyond to help your daughter. They’ve worked really hard.”<br/>Zara Abba also has a two year old daughter of her own. “I would travel all the way to France for my children’s health.” She says. “I have given birth to 15 children. Seven of them have died and eight are still living. Two of them were twins and they died on the same day they were born. The others, I don’t know why, it was God’s choice.” Photographer: Charlotte Morris
Suzanne Moja, 36, from Madrid, Spain is an epidemiologist. She measures the middle upper arm circumference (MUAC) of a child as part of a survey to determine the impact of MSF's work to tackle malnutrition in the area.<br/>Around three times a year the team of epidemiologists and researchers travel to villages across Bokoro to survey 800 families and their children to understand the impact MSF’s work is having. <br/>After finding a family who need to be surveyed, Suzanne and the team get to work. “We informed the family of what we’re doing and always ask their consent. Then we ask them some questions such as have they been to an MSF project, did they receive soap, plumpy’doz, mosquito nets and try to understand what they do with them.” This family had tried to visit a nearby MSF clinic, but their children were over five years and so too old to be eligible for the malnutrition programme. Photographer: Charlotte Morris
MSF teams weigh babies and children, measure their upper arm circumference, check they have an appetite and also give a measles vaccination or medication for malaria at the MSF mobile malnutrition clinic in the centre of Gama. Mums receive plumpynut, soap and a mosquito net for their children and are asked to return the following week, until their children are no longer malnourished. <br/><br/>MSF teams often see hundreds of women at this clinic each day. On this day around 4-500 women arrive with their babies or children. <br/><br/>Mums that have visited the clinic before head straight to the temporary building constructed by MSF, whilst new mums and babies are treated in the shade of the tree. A cooler respite from the heat and noise of the clinic. Photographer: Charlotte Morris