Apada Camp, Aweil Center County, South Sudan - "Over 100 mothers are crowded under the tree in Apada camp, each with a baby in her arms and another two or three young children waiting in amongst their brightly coloured skirts. The mothers have gathered for a visit from Malaria Consortium’s community nutrition worker, Santino," Ruth A Allan, Country Director of Malaria Consortium South Sudan, explains. "Santino is one of the organisation’s trained volunteers supporting our outpatient therapeutic programme (OTP) for children with severe acute malnutrition."
Since South Sudan gained independence on 9 July 2011, the UN estimates that over 72,000 people have chosen, or have been forced, to migrate to the north westerly province of Northern Bar el Ghazel, bordering South Darfur.
"The influx of returnees has put additional stress on the already weak health system which has been struggling to cope to provide basic health care services to both host and returnee communities. Many returnees are still living in shelters at Apada, a temporary camp for returnees outside the state capital; Aweil Town. Flooding during this year’s extended rainy season has not only increased cases of malaria but caused many people to be displaced again."
Screening for severe acute malnutrition
Santino receives training and tools from Malaria Consortium’s nutrition team and 300 South Sudanese pounds (approximately $100) per month to carry out ‘screening’ of children for severe acute malnutrition (SAM) in his community. Severe acute malnutrition is a life threatening condition which requires urgent treatment. Community screening and therapeutic feeding programmes such as Malaria Consortium’s OTP in Apada camp help to identify children with uncomplicated SAM in the community and ensure that they receive the treatment they need.
‘Screening’ involves Santino measuring the circumference of each child's arm, using a mid-upper arm circumference (MUAC) tape. The tape is colour coded so that Santino can see clearly if the child is not malnourished (green), suffering from moderate malnourisment (yellow) or from severe acute malnutrition (red). The WHO defines severe acute malnutrition as a mid-upper arm circumference of less than 11.5 cm. Children identified as having severe acute malnutrition are monitored and receive food supplements – ready-to-use therapeutic food (RUTF) – through Malaria Consortium’s OTP.
“The mothers do not always understand the process, or the signs of severe acute malnutrition, so Malaria Consortium's Supervisor explains why Santino is measuring the babies arms and why the children who have very small arms, shown as red on the measuring tape – are given the ready-to-use therapeutic food supplements. Everyone seems satisfied with the explanation and those mothers with thin armed babies move forward to receive the food supplement.”
Health care and nutrition in a complex environment
In South Sudan, services provided by the Ministry of Health are still limited and non existent in some areas. There are not enough health facilities, trained health workers or drugs and it is estimated that fewer than 40 percent of the population have access to basic primary health care services.
The complex environment has had a significant impact on local health. “Northern Bar el Ghazel borders South Darfur and has the highest number of newly arrived returnees within the country,” explains Ruth. “Many have come from Khartoum and have been traveling for months, with inadequate food, safe drinking water and shelter, by the time they reach the camp. Their immune systems are weakened from the journey and often they have nowhere to live when they arrive. It creates a huge burden on host populations and adds pressure to already stretched resources.”
The Food and Agricultural Organisation reports that Northern Bar el Ghazel’s food security status remains at ‘crisis’ level. Following independence and the closure of the northern border, market supplies of essential commodities were severely disrupted to Northern Bar el Ghazel state and food prices escalated. Flooding from the heavy rains in early 2012 is also expected to lead to poor yields from the first harvest.
“A combination of these complex political, economic and environmental factors result in children, especially those under the age of five, being at risk of becoming malnourished.”
Malnutrition puts people at higher risk of contracting malaria, pneumonia and diarrhea – the biggest child killers – and so Malaria Consortium is running an innovative programme where treatment for malnutrition is provided alongside treatment for these three diseases.
“By addressing malnutrition as both a cause and effect of the three diseases, the programme aims to have a greater impact on childhood mortality and morbidity,” adds Ruth. “Because there are few option for accessing health care, Malaria Consortium is taking the innovative approach of working through community networks and training volunteers to get services out to people in remote and hard to reach areas. And it is working, on a small scale, but it is working."
In the last three months, 2,000 mothers received information on infant and young child feeding (IYCF) practices during celebrations for World Breastfeeding week; 1,500 children were vaccinated; and over 2,000 children were screened for malnutrition, given vitamin A supplements and de-wormed, by volunteers like Santino. The State Ministry of Health, local authorities and community leaders have been active partners in this work.
Malaria Consortium works to reduce the burden of malaria, neglected tropical diseases and childhood illnesses and to improve access to health care in nine countries in Africa and Southeast Asia. To find out more about our work visit our website at www.malariaconsortium.org or email us at [email protected].
Sources: UNOCHA; WHO; South Sudan Facility Mapping Survey (2009)