MSF's response to the Niger food crisis: One of the largest feeding programs

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Five intensive therapeutic feeding centers

MSF's intensive nutritional rehabilitation centers (CRENI) in Niger provide nutritional and medical treatment for children between the ages of six months and five years suffering from severe malnutrition.

The availability of doctors in each therapeutic feeding center results in a relatively low mortality rate - 6% for all children released from the program in 2004. There are four doctors in each feeding center for hospitalizations, plus a few doctors for several ambulatory centers. The most severe cases are closely monitored in the intensive care units.

During the first phase of treatment, children are given therapeutic milk eight times a day. In phase two, the number of calories is increased and spread out over six meals; the children drink therapeutic milk at three meals and eat a peanut-based therapeutic food called Plumpy Nut TM during the other three. In phase two the children no longer require close medical surveillance and having regained their appetite can go onto the ambulatory care stage.

The four feeding centers are in Maradi, Dakoro, Keita and Tahoua: a fifth center is opening in Aguié.

Twenty-seven ambulatory centers treating severe malnutrition

A new way of treating severe malnutrition was set up in Niger in 2003. Before, patients were hospitalized with their mothers for the entire duration of their treatment. One month away from home is a lot both for the child and for the mother, as well as for the other children left at home. However there was no other solution as therapeutic milks are highly perishable and can therefore only we consumed in a medical facility.

Finally, five years ago, solid therapeutic foods became available that can be stored for several months. They do not require any preparation, not even drinking water or a receptacle is necessary, and can therefore be consumed at home. When a child's health does not require close medical surveillance, the child no longer has to be hospitalized.

Children are hospitalized on average for one week in the therapeutic feeding centers. Some do not even have to be hospitalized at all. As soon as their health permits, they can go home and once a week a medical team checks their weight and health status and gives them enough therapeutic food for one week (two packets of Plumpy Nut TM per day).

In order to prevent children from abandoning their treatment, the therapeutic feeding center must be near their home. In Maradi, for example, 11 ambulatory centers have been set up in 11 villages. Every week a medical team goes to each center. They screen new cases, ensure the follow-up of children already enrolled in the program and refer children that require intensive care to the CRENI.

The number and location of these ambulatory centers is adapted according to the needs. We have opened 27 CRENA (centers de nutrition thérapeutique amabulatoire - ambulatory therapeutic feeding centers) in Maradi and Tahoua provinces.

MSF is currently treating more than 3,500 severely malnourished children: 600 in the internal phase and 3,000 in the external phase. The average length of hospitalization is five days, while total treatment duration is one month.

Distribution of food and access to healthcare

Since the beginning of May 2005, MSF has been distributing food rations to children in our programs. During treatment, the child is given a weekly family protection ration of 25 kilograms of enriched flour and five liters of vegetable oil. When the child is cured and leaves the program, the child and his family are given 50kg of millet, 25kg of niebe (beans) and 10 liters of oil.

This involves enormous logistics, including two warehouses with a capacity of 500-1,000 tons in Maradi and Tahoua. Two other warehouses in Keita and Dakoro each have a capacity of 100 tons and there are daily deliveries to the ambulatory centers.

MSF is reinforcing its food distributions. South of Maradi, moderately malnourished children who come to our ambulatory centers will be given food rations.

Concerning access to healthcare, the ambulatory centers carry out consultations and give medications to moderately malnourished children or children who are ill. This activity is going to be reinforced so that the children can have access to healthcare every day of the week and not just on the day the MSF ambulatory center is present. We also want to improve the referral of patients to hospitals or our feeding centers.

Footnotes:

1 There are different types of malnutrition: - Chronic malnutrition, manifested by stunted growth. - Acute malnutrition, characterized by a weight/height ratio between 70% and 80% of the median Each of these two forms (chronic and acute) can be further characterized as severe or moderate based on the degree of severity.

The most lethal form is severe acute malnutrition, with a weight/height ratio below 70% of the median. Severe acute malnutrition leads to immunosuppression in children, which leaves them very susceptible to infection. Without intensive care, this vicious circle leads irreparably to death.