Childhood malnutrition is one of the greatest challenges faced by humanitarian organisations that seek to eradicate extreme poverty.
Malnutrition during the first 1,000 days of a child’s life can have a damaging and long-lasting impact. The World Health Organisation (WHO) estimates that approximately 45 million children aged under five are wasted, meaning that they are an abnormally low weight for their height. In addition, 149 million children are stunted (a low height for their age) as a result of malnutrition.
Wasting usually occurs because a child has not had enough food, or has been sick for a prolonged period of time, or both. Severely wasted children are at least nine times more likely to die than those of a healthy weight. Undernourished children catch infections more easily and experience a more difficult recovery, because their immune systems are impaired.
Both wasting and stunting occur because a child has not had enough food of sufficient quality, or has been sick for a prolonged period of time, or often both. Wasting bears a very immediate risk of mortality if not treated. Stunting cannot be treated and is very difficult to reverse after a child reaches the age of two, after which that child will bear an increased risk of death and/or cognitive and physical disability throughout their lives.
A young Ethiopian child named Salma was one of the many children across Sub-Sharan Africa who almost suffered this fate, before her family received the help they needed.
Currently aged two, Salma was just one year old when her mother Halima brought her to a local health centre, as she noticed that her daughter was displaying symptoms of severe malnutrition – which can be fatal if left untreated.
Halima, Salma, and her four-year-old brother Anas live in Legahida, a remote woreda (district) in Ethiopia’s Somali region. The population in Legahida is pastoralist and frequently moving to find pasture and water for their livestock. The foods most readily available to Halima are rice, pasta and vegetables.
Days begin early for the family, with a dawn call to prayer broadcast across the settlement on a tannoy system. In the mornings, Halima and her children eat a breakfast of Somali flat bread. As her soldier husband is frequently stationed in another town for extended periods of time, Halima prepares her children’s meals, ensures they are bathed, and cleans the house and compound. For lunch and dinner, they eat either rice or pasta with vegetables.
The Horn of Africa is currently experiencing its worst drought since 1981. The effects of this prolonged drought are being felt across Somali region: the Ter Shet river which, when full, can separate one side of the settlement from the other, has run completely dry. Legahida is also a very isolated area, prone to food crises.
Earlier this year, Halima noticed that Salma had begun to display worrying symptoms:
“She had diarrhoea, vomiting and a fever. She had these symptoms consistently for two weeks and her weight decreased dramatically.” She had never previously witnessed symptoms like this in her daughter, so she decided to take Salma to the local health centre.
One group that is actively responding to the malnutrition crisis facing Salma and thousands of other children across Sub-Saharan Africa is Concern Worldwide, an international humanitarian aid organisation headquartered in Dublin.
Concern has embarked on an ambitious three-year programme called Enhanced Responses to Nutrition Emergencies (ERNE), which aims to reduce levels of malnutrition, sickness and death among children aged under five. By combining lifesaving emergency nutrition treatment with long-term preparedness and prevention activities, Concern seeks to directly reach 700,000 vulnerable people, whilst building community resilience in the face of malnutrition.
The programme is funded by the EU’s humanitarian department ECHO, and is being implemented in five countries in Sub-Saharan Africa: The Democratic Republic of Congo, Ethiopia, Niger, Republic of Sudan and South Sudan.
Since ERNE began, Concern has worked with local services and health centres to support almost 82,000 people with lifesaving cash, food, or voucher transfers. 41,041 children have now been successfully treated for malnutrition through the programme, including Salma.
After a week of treatment at the health centre, Salma’s condition improved. She began to regain weight, became more responsive, and experienced an easing of her previous symptoms. Following a course of antibiotics and regular portions of plumpy’nut (a protein-rich paste designed to quickly treat severe malnutrition), she made a full recovery.
“I was very happy to see my child healthy again,” Halima shared. “Had she not received this treatment, her condition would have become much worse. We were told that if a child gets ill and becomes wasted, or if there is a loss of appetite, we should bring them to the health centre.”
At the core of ERNE is Concern’s community-based approach, which provides families with the support and education they need to care for malnourished children at home.
Halima is a member of a mothers’ support group which meets four times a month. During these meetings, women are able to share and learn key healthcare information, and in turn, can then pass this on to other mothers. Fathers also have the opportunity to attend workshops, where they gain vital insights into childcare and family health issues.
In addition to providing parents with a greater awareness of the primary healthcare services available in the area, Halima’s support group sessions cover breastfeeding, nutrition, and personal hygiene. “I have brought all of these things into my home and it has been beneficial,” Halima said. “This education has changed my life.”
ERNE is also changing the lives of parents like Amal Abdulahi in Salahad, located in the Somali region of central Ethiopia. Three of Amal’s six children, Nimo, Jnale and Nahwo (aged five, four and three, respectively) received life-saving treatment for severe acute malnutrition under the programme.
Salahad is a very dry and hot area of the Somali region, where temperatures reach the mid-30 degrees Celsius on most days. The ongoing drought in the region has dried up crops and water sources, forcing many families to find new places to live across East Africa.
According to Amal, she and her husband lost all their livestock and could not find work with local pastoralists, which led to them having very little food. This had a detrimental and almost fatal impact on their children: “They became weak. We had (only) dried food, which was not nutritious.”
When Concern became aware of Amal’s family situation, they added her to the list of over 10,000 households in Salahad who received three monthly cash payments of 1,200 Birr (€22), which enabled them to buy food and other essential items locally.
This type of aid response is designed to help vulnerable people at the outset of a crisis: emergency cash transfers prevent families from selling off any of their remaining assets to meet basic food needs.
The rapid speed of Concern's support greatly relieved Amal and her family. After several weeks of receiving nutritional pastes and vitamin supplements, her children’s health markedly improved, as did their mood: “You can see it in their faces, they are brighter,’ Amal said with a smile. “They are more mischievous now, and they play more.”
Concern is now working to increase the resilience and capacity of local government and health bodies by developing systems to observe seasonal patterns. This enables communities to anticipate when surges in demand for malnutrition treatment are likely to occur.
Concern provides additional staff, nutritious rations and vital medicine to help ill and wasted children. The organisation also offers clean water and latrines at clinics, as well as emergency cash payments such as the ones received by Amal, helping families to weather crises like floods and droughts.
During the first 19 months of the ERNE programme, Concern achieved the following goals:
*Community-Based Management of Acute Malnutrition method, which is used to identify and begin treatment for children with acute malnutrition before they become seriously ill).
For more information about Concern’s EU funded work to tackle malnutrition with the ERNE programme, please CLICK HERE