Côte d'Ivoire: treating and preventing malnutrition

 

      When five-month-old Barakissa Ouattara arrived at the Red Cross nutritional centre in Korhogo, she weighed just one kilogram. “She was very weak and we thought she was going to die that same day,” said Salimata Coulibaly, the director of the centre. “One week later, it seemed that she had managed to pull through. To an inexperienced eye she still looked frighteningly thin, but she appeared to be nursing fairly energetically, her tiny emaciated hand resting on her mother’s breast.

Barakissa is the victim of poverty and a lack of awareness. " She was a normal weight when she was born, but she developed diarrhoea, " explained her mother Haminata softly. " I gave her some medicine, but it didn't work. " The director suspects that the problem was caused by the poor quality of her mother's milk. " In the beginning, Haminata herself was very thin. She has begun putting on weight since arriving here. "

Haminata told us about the millet, maize and peanut harvests which no longer produce any surplus that can be sold, her exhausting work in the fields, the death of her father-in-law who used to help the family financially, and the three other children she also has to feed.

 Caring for both mothers and children  

It’s Thursday, weigh-in day. Around 50 children were waiting their turn in the reception area of the centre, sitting on their mother’s lap, wrapped snugly in a sling, or playing on the floor if they had enough energy. There were at least 10 sets of twins. As Salimata Coulibaly observed, " If the mother isn’t getting enough to eat, she certainly doesn't produce enough milk to feed twins. "

One by one, the mothers entered the consulting room. If their child weighs less than 70 per cent of the normal range for its age, it qualifies for assistance.

Luckily for the children of this northern region of Côte d'Ivoire, affected by both the country's political crisis and by the bad harvests, Salimata is a stubborn lady. Shortly after the centre opened in 1999, she had to close it down due to lack of funding. " But I said to myself that if there were malnourished children before the crisis, there must surely be even more afterwards. "

One August day in 2004, someone brought her a child who had weighed 4.6 kilograms at birth, but now weighed just a third of that. It was like an electric shock. “I immediately re-opened the centre. I had no money, but I appealed to my former nutritionists to come and work as volunteers, which t hey did, " the director recalled.

" The child's mother had a problem with her nipples that meant she could not breastfeed, so she was giving her baby water to drink. This gave him diarrhoea.” It was a vicious circle, and one which would have swiftly resulted in the infant’s death.

Various foreign agencies working in the region agreed to make donations, meaning that the centre’s activities could start up once again. In 2006, the ICRC became the main partner of the centre, supplying therapeutic milk and drugs, training staff, and constructing latrines, a fence and the building that houses the mothers of the most seriously ill babies.

In 2007, 611 moderate cases of malnutrition were treated on an outpatient basis, and 181 seriously ill children in the 0-5 age bracket were treated as inpatients. Between harvests, the centre sometimes deals with over 40 serious cases a month.

 Sacrifice the harvest – or a child?  

 

       

Very often, these families eat just one meal a day, and with their mothers in the fields all day, “the smallest ones end up with whatever’s left after their older brothers and sisters have finished, " said the director. Mothers are so exhausted they stop breastfeeding too soon. And, if a baby falls ill, the mother is faced with a terrible choice: " carry on with the harvest and lose your child, or stay at home to look after your child and lose your crops. " Cultural factors are also at play: there are more malnourished girls than boys.

Although it may be difficult to change the region's economic situation, making mothers aware of simple health rules can change behaviour. Salimata teaches them to breastfeed for as long as possible, to be present when their youngest children are eating, to respect basic hygiene rules, and to spot the symptoms of malnutrition. There is a vegetable garden at the centre, which gives staff the opportunity to instil good dietary principles in the minds of the mothers staying on-site.

The ICRC would like this information to be provided in a more systematic way. “Our study showed that most beneficiaries came from specific districts of Korhogo and certain villages in the region, " said Oscar Avogadri, the organization's medical coordinator. The ICRC is therefore going to help train community health workers who will operate in these villages and will try to better organize efforts to raise awareness and identify cases of malnutrition more quickly.

Salimata proudly shows us her photo album. On the left are skeletal children, with gaunt features, their eyes swollen with oedema in some cases. On the right, we see chubby-cheeked little boys, and round-faced little girls wearing pink dresses and ribbons in their hair. The most spectacular and most meaningful kind of " before and after " pictures imaginable. If all goes well, the photo of Barakissa will be added to the others in two or three months’ time.