Journal: Malnutrition in Somalia

Here I am measuring a Somali child for oedema, excess fluid in the body that can occur in the lower limbs, feet, face and hands, by pressing my thumb down on the child's foot to see if the imprint holds for a few seconds. It's one of the screening processes to assess for malnutrition, the end result of a nutritional deficiency (lack of protein and energy and not enough vitamins and minerals) and disease. This child has nutritional oedema because the imprint holds on both feet and in his case, it is a sign of kwashiorkor, which also means a deficiency in micronutrients (Vitamin A and iron) and a listless manner.

Mulki, a measurer, is weighing a child with kwashiorkor. We measure the child's height on admission to assess the severity of the malnutrition. There's a special chart that everyone uses to figure out whether the child has mild, moderate or severe malnutrition. During the child's stay, we continue to weigh and measure height and oedema.

Mothers, supported by MSF national staff, spoon-feed malnourished children F75, a high-energy milk especially for phase one, a period during which children must receive intense treatment and monitoring. At the start of the treatment, children are weak and don't like the milk, since they are used to eating boiled mangoes and drinking river water. Staff must sometimes resort to forcing it down. If that doesn't work, the child must receive milk via a naso-gastric tube.

This child is suffering from marasmus, severe wasting from malnutrition leading to loss of muscle, combined with the onset of other diseases such as diarrhoea, respiratory infections and measles. The child is too weak to drink the milk. Here the nursing assistant is taking the child's temperature, assessing for dehydration and looking for signs of any new diseases. The mother plays an important role in the child's recovery because she monitors whether the child is improving.

MSF nurse Nicole Riordan from London applies zinc cream to soften the swollen skin of this child who is being held by his grandmother. Swollen skin is one of the main symptoms of kwashiorkor.

This child with kwashiorkor is being given antibiotics in the form of crushed tablets, which keep better than syrup in hot weather. In phase one, the children all get antibiotics to deal with any underlying diseases. We encourage mothers to be involved in the treatment and recovery of their children.

When the malnourished child has gained his appetite and his oedema has been reduced (this can take 2-3 weeks), we transfer him into phase two, because then the children are actually drinking the high-energy milk themselves or with the help of their mothers. Play therapy is an important part of the child's recovery, hence the bubble blowing to stimulate the children.

Feeding assistants are giving a high calorie peanut paste called plumpy maltid to children who have made it to phase two. The paste is very rich and sticky and kids love it. By this stage children have a good appetite and want to eat rice and maize again so we try to include a local meal.

This is the new, permanent therapeutic feeding centre we built after a year of working in temporary structures. When we arrive, we start off basic because it's quick and easy to put a tent up. We then move to plastic sheeting and finally a permanent building if we think the situation will continue. We know there is malnutrition every year in Somalia because of lack of rain and poor crops.

The child who was being treated with zinc cream earlier is about to go home with his grandmother because he does not have oedema any more. Our goal is for all the children we treat to be able to go home and live a normal life again.