Last February a 4-months old orphan, Conceição, was admitted into the Community based Management programme of Acute Malnutrition (CMAM) in Caala (Huambo Province), which was affected by the 2012 drought. Conceição’s mother had died a few weeks after delivering and her father never took care of her, so until now Conceição has been raised by her aunt and other family members.
When the community health activist Maria first visited Conceição’s aunt’s house in February 2013, she had a mid-upper arm circumference of 9.5 cm, which means that she was affected by severe acute malnutrition. She was never breastfed and survived on “kisangua”, a local drink made out of fermented maize. Her story was included in a UNICEF video documentary filmed in March 2013.
After significant progress during the first weeks of community treatment, a few months ago Conceição got ill again. During one of her regular visits to Conceição’s family, Maria noticed symptoms such as diarrhea, severe cough and fever. Most of the times Conceição had no appetite, and it took her the whole day to finish the two packs of RUTF (Ready for Use Therapeutic Food), which is the recommended daily dose given by Maria before she developed these symptoms. Maria recommended taking the child to the nearest health post of Kalenga, where Conceição was examined and received medicines for her medical complications.
Community activists have been trained to refer children to local hospitals, when there are signs of severe acute malnutrition presenting medical complications, and in case there is no significant improvement in weight after the community treatment. But even if children are hospitalized the activists, who most of time belong to the community or neighborhood where they work as volunteers, never really stop being concerned about them. In a way, they think about the children as part of their own family.
“Activists usually visit an average of 50 children every week, and I can say that the battle against malnutrition is a tough one, – says Geraldo, Caala CMAM Municipal Supervisor – because even if we expect children to recover in eight to ten weeks of community treatment, some of them need more time, so we can’t let them go, we can’t leave them alone even when the treatment is “formally” completed. Their families know it, and they thank us all the time for what we do.”
According to a nurse of the Caala’s inpatient facility centre, where Conceição has been hospitalized over the past two weeks, she is now showing signs of slow improvement. But one more time her family will need to be closely guided within her community on how to apply effective nutrition practices, based on a combination of milk and affordable local products.
“It’s vital to keep monitoring the worst cases of acute malnutrition in the medium and long term in order to achieve tangible results, – says the UNICEF Representative in Angola, Francisco Songane – as it’s important to assist families and mothers who are have difficulties or who are not used to reach out hospitals and health posts. This is where CMAM, with the determination, experience and good will of 2 000 trained volunteers, has made a tremendous difference for the communities.”
Since January 2013 the European Commission – Humanitarian Aid & Civil Protection Department (ECHO) has been funding UNICEF and the NGOs World Vision, People In Need and Africare to implement the Government-led CMAM project in the four most vulnerable provinces hit by the 2012 drought (Huambo, Bie, Kwanza Sul and Zaire). Nearly 700 000 children were screened by trained community health activists, and out of them more than 80 000 children have been treated either for severe or moderate acute malnutrition.
“Acute malnutrition is one of the biggest factors in causing under-five mortality in the world, – declares the EU ambassador in Angola, Gordon Kricke – and countries with high rates of malnutrition can also have a disastrous long-term loss of human capital due to mental and physical stunting of its children. Such countries can experience a negative economic effect estimated to be up to as much as 8% of the country’s GDP. The European Union is significantly increasing its efforts to fight against world hunger, food insecurity and malnutrition and has taken firm public commitments to directly contribute to reducing by at least 7 million the number of stunted children worldwide by 2025.”
Acute malnutrition represents one of the most serious threats to people’s health and socio-economic advancement, and potentially one of the most important indicators of poverty reduction and sustainable development.
“From a healthcare perspective, our priority is to monitor the nutrition situation using professional assessments, to create nutrition recovery units, and to take this opportunity to train our staff on this specific demand. – highlights the Minister of Public Health, José Van-Dúnem – This is a huge effort which requires the mobilization of all staff and resources in order to produce the most efficient and effective response. For this reason the Government collaborated with UNICEF, WHO and with civil society organization that are partners of the Ministry of Health for interventions at the community level. It was a well-coordinated effort, which produced good results and is a replicable practice for the future.”
By Luca Solimeo
Emergency Communication Specialist / UNICEF