In the village of Doney, Madaoua, in southern Niger, several mothers meet under the shelter of two large trees to attend a cooking demonstration. Today they will learn how to cook enriched kouli-kouli (peanut butter) soup. The session is being run by two Mamans Lumière (mothers of light); Ai Gaiya is one of them. “We teach the mothers how to make soups and vegetable purées that are rich in vitamins. We run two sessions a week and the rest of the time the participants practise at home. The mothers themselves provide the ingredients: millet, sorghum, cabbage… The advantage is that they are local products and easy to get,” she explains.
Preventing acute malnutrition
Women like Ai Gaiya are at the centre of a strategy to prevent acute malnutrition in the community itself. It's known as Homes of Nutritional Learning, Rehabilitation and Prevention (FARPN, in its French initials). In the programme, families take responsibility for improving the nutritional condition of children who are at risk of suffering acute malnutrition. To achieve this objective, positive changes in the community's behaviour are encouraged with regard to nutrition, hygiene and health practices.
“The programme is based on encouraging a 'positive role model' in order to avoid inappropriate mother-child care at home. This way, we can be sure that practices that lead to illness or a poor diet – two direct causes of malnutrition– are not promoted within the family itself,” explains Núria Salse, nutrition advisor for Médecins Sans Frontières (MSF). “It is one more tool in the fight against child malnutrition, one that that complements the treatment programmes and gives families an active role in their children's development, using the resources they already have.”
Encouraging other mothers
Implementing this initiative is relatively simple. First, it requires finding a woman from the community whose children are healthy and who looks after their health correctly; one who completes their vaccination schedule, goes to the health centre when necessary, and follows good hygiene and dietary practices. This woman has to encourage the other mothers to follow these practices and explain the advantages to them. So, she is the “positive role model”, the mother who provides the others with light; the “village mother of light”.
Then, mothers are chosen whose children are between 6 and 23 months old and at risk of suffering acute malnutrition, and a support group is set up that will take care of approximately 15 children. After receiving training from the MSF teams on the best practices for preventing malnutrition, the “mother of light” takes on the running of the group. She explains which foodstuffs from the region are most nutritious, and how they should be cooked in order to preserve the largest number of vitamins and nutrients. In addition to the cooking sessions, key messages about health and hygiene are also passed on.
Identify warning signs quickly
In order to monitor the children's nutrition properly, the “mothers of light” use the MUAC; an armband that measures the brachial perimeter of the smallest children and determines whether they are suffering from malnutrition or are at risk of doing so. All of the mothers in the programme know how to use the MUAC and continue to assess their children at home. This allows them to identify warning signs quickly and go to the treatment centre in the event of any deterioration. Early detection of malnutrition is key to reducing mortality.
‘This strategy is easy because it adapts to our reality’
Souweba Mamane, 31 years old, takes part in the Mamans Lumière sessions in Doney. “My husband is in Nigeria and I look after the children. Three of them have suffered malnutrition and one died,” she explains. Her children were receiving treatment for malnutrition as outpatients, and Souweba had to walk 21 kilometres every week to attend the monitoring consultation and collect the therapeutic food preparations. “I often had to spend the night somewhere en route. I was frequently forced by fatigue and hunger to beg for money to pay for transport. Many women in this village were in the same situation as me.”
In 2013, MSF put the FARPN strategy into operation in the districts of Madaoua and Bouza and the community immediately saw the advantages offered by the initiative. “There are fewer and fewer children suffering serious malnutrition. Before, our women travelled many kilometres to take their sick children to Madaoua, and they would even have to sell their seed reserves to cover their transport costs. Things have changed now thanks to this programme. This strategy has allowed our women to come together to control their own fate and that of our children. The strategy is easy in practice, because it adapts to our reality,” explains Issa Kadri, Doney's village chief.
Every year in Niger the population has to face some critical months, between July and October, when their food reserves run out and the following harvest cannot yet be gathered. This period coincides with the time of year with the greatest incidence of malaria and it is critical for the smallest children. In the last few years, child mortality reduction programmes increasingly include more prevention components and work that takes place within the community.
While she feeds her baby, Souweba explains the benefits of the strategy: “We have learned that with the little means we have, we can take responsibility for our children's future with regard to their nutrition. At the cooking demonstration session, I learned how to make enriched soup, bean purée and other recipes. This programme is very beneficial for both us and our children. I no longer need to travel long distances to take my son to the nutrition programme. I use that time and my energy to investigate solutions to other needs that benefit my family.”
'Empowering mothers is to believe in them'
"It's one solution, but not the only one. The prevention of acute malnutrition should be integrated into the new preventive and decentralised health strategies, close to the community and well accepted by the population. Thanks to this and to the rapid detection of the first signs of malnutrition, this struggle will pay off. Empowering mothers is to believe in them, providing the means to fight against a plague which, unfortunately, kills every year," said Luis Encinas, head of MSF projects in West Africa.
MSF has been working in Niger since 1985. The main objective of its activities is to improve access to healthcare for pregnant women and children under five through preventive action and early treatment that focus mainly on fighting malnutrition and malaria. The MSF teams are currently working in the Zinder, Maradi and Tahoua regions