Marie-Pierre Allié: Follow the Niger and Mali Models to Tackle Malnutrition
[THE GUARDIAN] – Nutrition treatments have made huge developments in the past few years. The advent of highly nutritious ready-to-use therapeutic foods [RUTF] have made it possible to save millions of children from the severest forms of malnutrition.
Malnutrition can be triggered or worsened by illness; and illness can weaken immune system and easily kill a malnourished child. So to prevent malnutrition, it will take not only nutritious food, but also attention to a child’s general state of health. We’ve seen that preventative health programming – when made available in addition to nutritious food supplements and standard treatment for malnutrition – cuts mortality rates and reduces stunting.
Niger, a landlocked country subject to recurrent food crises, has shown the way. Here more than 1 million children have been treated for severe malnutrition over the past five years, according to research MSF undertook with Unicef, but health policy has taken treatment for severe malnutrition far beyond helping a child gain weight. In Niger, when a nurse treats a malnourished child, she also provides vaccinations and cares for other common illnesses. Not only are children being treated for severe malnutrition by the hundreds of thousands annually, but vaccination rates and the numbers of children treated for malaria are climbing. Niger stands as an example of how creating efficiencies, combining preventative and curative care at each clinic visit, can pay off: child mortality rates in Niger have dropped by 45% since 2006.
Similarly, in Mali, where one in three children are stunted and one in six do not make it to age five, the ministry of health and MSF offer a comprehensive package of services designed to prevent malnutrition from occurring. In villages in the rural south-east of Konseguela, children under two years old are vaccinated against childhood diseases, benefit from malaria prevention through bed net distribution, and receive highly nutritious dietary supplements once they are six months old. If they fall ill, medical care is available free. And adopting this strategy has made a massive difference in this part of Mali: people in the area report that child mortality rates have dropped, and MSF has seen the prevalence of severe malnutrition fall by more than half in children under two and stunting reduced by 34% at two years of age.
Such progress is possible for other countries hit hard by malnutrition. It requires looking at the specific causes of childhood illness and death in that region and working out the most effective preventive and curative strategies, including the provision of foods to meet young children’s nutritional requirements. In both Niger and Mali, as in other countries, improved nutrition and health programming have gone hand in hand.
Not only are combined health and nutrition programmes the smart and right thing to do, it is not as expensive as one might assume. MSF and Mali’s health ministry together spend about £65 per child per year to offer a comprehensive paediatric service in Konseguela. Approximately half of this cost goes for the highly nutritious food, which amounts to less than 70 pence per week; the other 45% is spent on salaries, medicines and vaccines.
By contrast, through the Healthy Start programme in the UK – a programme that similarly seeks to improve the nutritional adequacy of young childrens’ diets – families receive vouchers worth up to £6.20 per week per child to purchase milk, fruits and vegetables.
As discussions continue on how best to tackle childhood malnutrition, children’s health must stay at the centre of the debate. To use a term often used in these deliberations, “resilience”: a child will be resilient to “shocks” like disease or seasonal changes in his family’s diet only when he is healthy. Thus preventing malnutrition means providing vaccinations, breastfeeding support, and treatment for illness as well as highly nutritious foods. From the perspective of a young child, resilience in the face of poverty goes beyond family wealth; it is primarily an issue of health.
As has been shown in Niger and in Mali, health and nutrition programmes, even in the most difficult places, can save lives and help children grow. Money for agriculture or food alone cannot strike out malnutrition; but money spent wisely on health and nutritious food can buy a child’s well-being, for now and for the rest of her life.
Dr Marie-Pierre Allié is a medical doctor and the former president of MSF in France and member of the SUN Movement Lead Group