Is the struggle against acute malnutrition in Niger gaining ground?

Encouraging results for MSF projects in 2006

In 2006, MSF treated 73,000 children suffering from acute malnutrition in two districts in Niger's Maradi region. For the first time, cases of severe and moderate malnutrition were treated in the same way, using a ready-to-use therapeutic food, without hospitalisation except where there were medical complications. This new strategy worked well: preliminary results show a recovery rate of over 91% and the number of cases of severe acute malnutrition was well below that of previous years.

In addition, in some villages in the Madarounfa region we conducted a pilot project involving the distribution of Plumpy'nut to all children under the age of three during the "hunger gap."

There again, the preliminary results are conclusive, since the proportion of children in this age bracket having experienced acute malnutrition (9.9%) decreased by almost half in these villages, compared with comparable villages where this systematic distribution was not available (in those cases the incidence of acute malnutrition for children under three reached 18.7%).

In 2006, MSF obtained good results from using Plumpy'nut to treat all children suffering from acute malnutrition, whether severe or moderate. However, while mobilisation against malnutrition has made progress in Niger, the response remains unsatisfactory. In 2007, we will be testing a new strategy involving the distribution, during the "hunger gap," of a nutritional product adapted to the needs of all children under three years of age. Isabelle Defourny, Deputy Program Manager, explains.

How is the food situation in Niger evolving?

In 2006, according to UNICEF figures, over 400,000 children suffering from acute malnutrition were admitted to the various feeding centres in Niger. In the two districts where we are working, we estimate that 50% of children under the age of three suffered from acute malnutrition at one time or another during the year.

So, contrary to what may be suggested by the preliminary results of a national survey carried out by the Niger Government, UNICEF and the World Food Program (WFP), I do not think that one can speak in terms of a "clear improvement".

On the other hand, it is true that the various parties involved have become increasingly mobilised over the malnutrition issue. For the first time in many years, children suffering from acute malnutrition have been able to access treatment centres. However, we still have serious doubts about the impact of these interventions at the national level.

Is the treatment of children suffering from acute malnutrition satisfactory?

Today, children who have severe acute malnutrition are treated with ready-to-use therapeutic food (RUTF) such as Plumpy'nut. However, except in the MSF program, those suffering from moderate acute malnutrition are treated with enriched flour, which is significantly less effective. Yet it is precisely within this group that the largest number of deaths occurs.

In 2006, MSF treated cases of moderate and severe acute malnutrition in the same way, using RUTF. Children who presented no medical complications were treated in our outpatient program, with a weekly monitoring visit. Only the more serious cases were hospitalised in our feeding centres.

This experience shows that utilising ready-to-use therapeutic products enables moderate acute malnutrition to be treated effectively and the number of severe cases to be reduced. For the first time in six years, in the district where we work, we did not see a peak in severe malnutrition during the "hunger gap." On the contrary, severe malnutrition decreased throughout the year. Up to now, no other aid participant has been able to show similar results.

What is MSF's 2007 operational strategy in Niger?

Our aim remains that of improving our response to global acute malnutrition, but we are changing methods in an attempt to heighten the impact of our intervention. In the district of Guidam Roumdji, most children lose weight during the "hunger gap," with a high proportion reaching the stage of moderate malnutrition. Therefore, once a month during this period we will be distributing portions of Plumpy'doz (a vitamin- and mineral-enriched paste of milk and peanuts) to all children under three years of age - that is, to about 50,000 children. This product is very similar to Plumpy'nut, but the vitamin and micronutrient composition has been modified.

Using these means, we enable mothers to provide their children with proper food, adapted to their specific nutritional requirements. We have already seen, in 2005 and 2006, that giving mothers the responsibility for treating uncomplicated acute malnutrition produces good results. It is only when a child is ill or severely malnourished that treatment takes place in medical facilities.

In tandem with this distribution, and in cooperation with the Ministry of Health, we carry out consultations for all sick children in five district health centres, and have an outpatient program for the treatment of severe malnutrition. These consultations will enable us to monitor the evolution of the food situation and to identify children who need to be hospitalised, either in government hospitals or - for malnourished children presenting severe medical complications - in MSF's own facilities.

What is the outlook for this type of program?

We hope that in 2007 we will achieve results that are comparable to those in 2006 (when there were few cases of severe malnutrition), while at the same time developing a program that is easier to manage. That is quite a gamble! Organising food distribution for 50,000 children is not that easy! We are hoping that the product's effectiveness will mean we will need to distribute less of it. Moreover, we will be counting a lot on the Niger authorities' expertise in organising distribution.

In a second phase, we hope that WFP and the government will take over the distribution. In that respect, two problems remain. Firstly, these actors involved in treating malnutrition must demonstrate their political will. Secondly, the cost of the ready-to-use food product is still too high, between two and three euros per kilo. We are exploring a number of avenues for reducing the cost of Plumpy'doz, particularly having it produced locally...