In Madagascar, reducing malnutrition among children under five

Four-year-old Nomy arrived at the hospital in Amboasary with a diagnosis of severe acute malnutrition – a potentially deadly condition – with medical complications. By 11 a.m., he had been admitted for emergency treatment. AMBOASARY, Madagascar.

VIDEO: UNICEF reports on the treatment of severe acute malnutrition among children under age 5 in Madagascar.

But Nomy was lucky. His condition was identified by a community agent in his home town who noticed Nomy’s face and feet were swollen, signs of severe malnutrition requiring immediate specialist treatment. Célestine, Nomy’s mother, was advised to take him to the nearest health centre, where medical staff referred him to the hospital.

Outpatient treatment

At the hospital, Nomy’s condition will be monitored closely. When his weight has reached an acceptable level, he will be discharged to continue treatment at home with ready-to-use therapeutic food (RUTF) supplements and regular visits to the local health centre.

For 16-month-old Andry, these visits are already familiar.

Women and children wait at Ankilikira Health Center, in Madagascar.
Women and children wait for consultation with a health worker at Ankilikira Health Center, in Madagascar. Health workers and community agents are being trained to diagnose malnutrition. UNICEF Image © UNICEF Madagascar /2011/Raharijaona

In the village of Ankilikira, 50 km from Amboasary, Andry is making his fifth trip to the basic health centre, part of his outpatient treatment for malnutrition.

Andry’s health had deteriorated after a series of bouts of diarrhoea. Health centre staff diagnosed him severe acute malnutrition – without medical complications, which meant he could be treated at home with RUTF.

And to prevent future malnutrition, outpatient treatment programmes also give mothers advice on how to ensure their children receive the best nutrition possible.

But for many parents, especially those in drought-prone southern Madagascar, this is a challenge.

“The main reason for severe acute malnutrition among children under 5 in this region is poverty,” said Masy Juliette, a community agent in Ankilikira. “In addition, every season our crops harsh weather conditions, unreliable rain and even drought. This often means that people cannot produce enough food for their families.”

Reducing child malnutrition

Malnutrition among children under 5 years old remains a constant challenge for the country. Madagascar ranks sixth among countries with the worst stunting rates.

Boy with severe acute malnutrition. Amboasary, Madagascar
Nomy, 4, sits with his mother, Célestine, at a hospital in Amboasary, Madagascar. He has been admitted for treatment for severe acute malnutrition. UNICEF Image © UNICEF Madagascar /2011/Raharijaona

“In Madagascar, more than 38,000 children die every year before their fifth birthday because of diseases that can be prevented such as diarrhoea, acute respiratory infections, and malaria. This number is equivalent to 104 children dying every day,” said Bruno Maes, UNICEF Representative in Madagascar. “

Today, UNICEF’s work in southern Madagascar is a major part of the national nutrition programme, significantly contributing to reducing mortality and morbidity among children under five. In 2010, more than 7,000 children with severe acute malnutrition received UNICEF-supported treatment.

UNICEF is also helping to train community agents to screen children for malnutrition and to refer children in need of treatment to health centres and hospitals. UNICEF also supports biannual Mother and Child Health Weeks, during which micronutrient supplements are distributed to children under 5 and among pregnant and breastfeeding women.

UNICEF will soon begin supporting the Infant and Young Child Nutrition Programme, which aims to prevent malnutrition among the most vulnerable children by equipping parents with the knowledge and skills to improve the health and nutrition of their families. Trained agents will be supplied with ‘counselling cards’, which will help them share key messages on health and nutrition for children and women. These efforts will be reinforced by programmes broadcast on local and national radio stations.

And special attention will be paid to the most vulnerable children.

“We must reinforce our work in southern Madagascar, where access to education, to water, and to healthcare services remains among the weakest in the country,” said Mr. Maes.

UNICEF Representative in Madagascar Bruno Maes
UNICEF Representative in Madagascar Bruno Maes visits a hospital in Amboasary, Madagascar. UNICEF Image © UNICEF Madagascar /2011/Raharijaona