Barely open, already full: feeding centres in Niger

© Anne Yzebe/MSF Click for large view Dozens of mothers have been waiting patiently for hours. Some have found shelter against a wall while others brave the sun.

Tuesday, July 12. A long line of mothers and children stretches out in front of the admissions tent at the Aguié TFC. It is noon and the temperature is close to 34 degrees celcius. Dozens of mothers have been waiting patiently for hours. Some have found shelter against a wall while others brave the sun. In a corner, a mother is feeding her baby a green paste made by boiling anza leaves. They will soothe the hunger temporarily, but will provide no nourishment.

Identifying malnourished children

Two teams are working to identify malnourished children in the MSF feeding centre admissions tent. Ernesto Paredes, the centre's supervising nurse, is training two new nutritional assistants, showing them how to assess a child's nutritional status using the MUAC (middle upper arm circumference), a plastic armband that is put on the upper arm and pulled snug. At its smallest measure, it is in the red zone and it indicates sever malnutrition.

Next, he teaches them how to calculate the height-weight ratio, which provides a more precise assessment of the degree of malnutrition. Today, al all MUAC tests fall into the red zone - severe malnutrition. The children's height-weight ratio is below 70% of normal. A confirmation of the condition of these children.

These children are admitted into MSF's feeding program. Those in the worst state, those who are ill as well as severely malnourished, must be hospitalized. Those who are not sick and have an appetite may return home with therapeutic foods their mothers will feed them. They will return every week to be monitored and see if they have gained weight, make sure they are still healthy and also receive their weekly food ration, along with a ration for their family.

© Anne Yzebe/MSF Click for large view Two teams are working to identify malnourished children in the MSF feeding centre admissions tent.

Moderate malnutrition: Aid still incomplete

Until recently, children suffering only moderate malnutrition - itself a serious condition with a height-weight ratio below 80% of normal - did not receive any food aid. Their mothers would watch as others left with food. Some would try to get food.

For MSF, it is unacceptable to be required to refuse food aid to children who are not "ill enough" as their condition could well worsen. As a result, MSF decided to set up food distributions for 50,000 moderately malnourished children. But this large-scale operation required meticulous preparation and only began in late July (see the article on moderately-malnourished children).

Until then, MSF's aid to the moderately malnourished involved providing access to care to those who were ill. The district hospital's facilities, a few feet from MSF's feeding centre, had been virtually deserted. The operating room, the laboratory and the blood bank were closed. There were no patients in the maternity ward or the health centre.

In Niger, people must pay for medical visits and medicine so many ill people cannot seek treatment. But today, a Nigerien public health doctor stands behind a table overflowing with medicines. MSF brought in the supplies. Those children whose illness was detected when they visited the feeding centre will be treated for free.

Increasing response to the emergency

By the end of the day, it is time to tally up. A total of 150 children were admitted to the severe malnutrition program in Aguié. That night, the team made the decision: they had to double the number of beds. The orders went out on an emergency basis between 8:00 pm and midnight.

It is now more critical than ever to launch the planned pediatric unit for sick children who are not suffering from severe malnutrition. It will be set up in the district hospital and MSF will manage it.