Environmental degradation, limited health facilities and lack of public awareness all contribute to pushing malnutrition in eastern Chad over the emergency threshold.
By Alex Duval Smith
Reducing childhood malnutrition in eastern Chad requires improved health facilities and greater public awareness – both of which are challenges in an environment marked by poverty, distance and environmental degradation.
ABECHE, Chad, 12 December 2013 – Mariam and Abdallah are both toddlers from similarly poor families living in eastern Chad, one of the harshest environments in the world. And both had the spark taken out of their eyes by malnutrition. Yet there is a world of difference between their survival chances.
Under the biggest tree in the village of Kelingan, 14-month-old Mariam rests, weak but calm, on her mother’s lap. Hawai Mahamat has joined a group of two dozen mothers attending an outreach clinic. Vaccination, malaria prevention and nutrition tips are offered by a team of health workers from the nearest town, Abeche.
“She seems to be the weak one in the family,” says Mahamat, who at 21 is the mother of four children, and six months pregnant. The visiting nurse, Ache-Moussa Abderamane, says Mariam’s is a classic case of moderate malnutrition. “You stopped breastfeeding her,” the nurse tells Mahamat. “If you had continued, your child would not be in this state, with fever and diarrhoea.”
Mahamat explains that soon after Mariam was born, she introduced broth and water into her diet. As soon as she knew she was pregnant again, she stopped breastfeeding Mariam altogether. She claims: “You cannot breastfeed one child when you are pregnant with another. The milk of a pregnant woman is rotten,” she says to nods of approval from her friends. Nurse Abderamane, 38, reaches for a spiral-bound flip chart. She launches into a quiz focused on vital nutrients and the virtues of exclusive breastfeeding for the first six months.
Fighting for life
Two hours’ donkey ride away, on a rusty bed in the spartan paediatric ward of Abeche Regional Hospital, 20-month-old Abdallah rests on the lap of his mother, Hawa Ahmat, 25. He has a tube taped to his face. His head is slumped back over her forearm. He is fighting for his life, and his feverish body rejects food. Nurses have bandaged his hands to stop him ripping off the feeding tube.
In a 2013 study, severe acute malnutrition among under-5s in the Ouaddai region, where Abeche and Kelingan are situated, stood at 2.6 per cent. The World Health Organization classifies a severe acute malnutrition rate of 2 per cent or higher as a nutritional emergency.
In the scorched landscape of eastern Chad, many factors contribute to this desperate situation. Health infrastructure is minimal. Distances are great. And climate change is turning the landscape to dust.
Khadidja Chaib Mahamat, a nurse at Abeche Regional Hospital, tries to understand why Abdallah has reached such a weak state. His mother says she is no longer breastfeeding the boy because she is five months pregnant. She is expecting her eighth child.
“I stopped three months ago to avoid damaging the baby. I gave him meat broth,” she says.
Ahmat brought Abdallah to the hospital two weeks ago after he lost his appetite. He weighed 6.6 kg (14.5 lbs) at a height of 72 cm (2 ft 4 in). He had blisters on his feet and white discharge – thrush – coming from his mouth. Staff immediately identified severe acute malnutrition.
Since admission, the boy’s weight has fallen to 5.3 kg (11.6 lbs). “It has declined because we have treated the blisters, and the water in those was adding weight,” says Ms. Mahamat. “Now we hope he will turn the corner but he will not be discharged until he reaches a target weight of 7.9 kilos.”
Education is key
Nurse Mahamat says there are 15 children in Abeche’s paediatric ward with severe acute malnutrition. She has spent 10 years at the ward without seeing any improvement in mothers’ knowledge of nutrition. “We are better able to cope these days, as UNICEF funds 21 staff, supporting the nine of us who are paid by the government.”
The Government of Chad, supported by UNICEF, has undertaken to do more to improve the chances of Chad’s babies. A national nutrition policy has just been introduced.
“But none of these children would be here if the mothers were better informed,” she says. “We speak to them about breastfeeding, nutrition and contraception, but by the time they get here, all they are thinking about is the survival of the child. Then they go off, fall pregnant again and make the same mistakes.”
UNICEF, with the support of the European Commission Humanitarian Aid and Civil Protection Office (ECHO), is helping provide a safety net to produce good results. Community health workers have been trained, and the number of monthly outreach clinics – such as the one held by nurse Abderamane at Kelingan, where Mariam’s case of moderate malnutrition was spotted – is growing. Local radio stations and town criers with megaphones spread nutrition messages.
Baby Mariam is an example of a malnutrition case that was caught early. She should be able to recover full health without being admitted to hospital.
When she is not at Kelingan or one of the other three villages she visits once a month on her motorbike, nurse Abderamane can be found running a clinic in Abeche.
“The key is education, and we need to do a lot more of it,” she says.