Moving to home-based care in Niger
Previously all severely malnourished children were hospitalized for periods of up to one month so that they could receive medical care and gradually increasing quantities of therapeutic milk. With the 2001 introduction of new products which are essentially the solid equivalent of therapeutic milk, MSF has largely switched to the ambulatory management of all children not requiring intensive medical care.
This new solid food is a ready-to-use, fortified peanut butter paste that requires no preparation, water or cooking. Because it comes in individual packets that are resistant to microbacterial contamination, it can be stored for months. Unlike therapeutic milk powders, these qualities make the product ideal for treating a severely malnourished child at home, thus sparing the mother the need to leave the rest of her family for an extended period.
Instead, the mother brings the sick child once a week to one of MSF's ambulatory centers where the child is examined and given medical treatment, if necessary, along with a week's supply of the solid therapeutic food. Only those who develop complications or severe illnesses are referred to one of MSF's inpatient units.
The introduction of outpatient care has had a huge impact on treatment during the crisis in Niger. Without it, says Dr. Milton Tectonidis, a nutritional specialist for MSF who has worked in Maradi, Tahoua and Aguie, Niger, "we wouldn't have been able to treat nearly as many children.
"Before, we probably would have limited ourselves to Maradi, with maybe three or four fixed therapeutic feeding centers. Caala, Angola, in 2002, was MSF's last big nutritional response that did not include outpatient care.
Through three nutritional centers, we treated 8,600 children, whereas we are heading towards 30,000 in Maradi and the neighboring areas. So it's a huge difference. The experience in Niger may make the combination of outpatient and inpatient care the definitive strategy for MSF. I don't think we can go back again."