Nutrition crisis among children in Chad: Bringing medical care closer to people through community-based care

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An emergency malnutrition response launched by MSF in September 2021 has since evolved into a long-term project to address the recurrent nutritional crises in Hadjer Lamis region. MSF teams support the inpatient therapeutic feeding centre (ITFC) in Massakory provincial hospital and manage ambulatory therapeutic feeding centres (ATFC) in support of 12 health centers in the district. In a region where several other preventable childhood diseases, such as measles and malaria, aggravate malnutrition and contribute to morbidity and mortality, hundreds of mothers are forced to travel many kilometers each week to give their babies a chance of survival. Since May 2023, MSF has brought medical care closer to populations through the integrated community health care + (ICCM+) approach managed by community members with MSF supervision and treating the most common illnesses as well as malnutrition.

ATFCs seek to prevent malnutrition amongst children and mothers and stop cases from becoming severe

Every week, MSF teams arrive at N’doukouri health center to manage the MSF ATFC in collaboration with the Ministry of Public Health and Prevention to treat cases of malnutrition in children under 5 years old. Once there, the teams set up for the day under a shaded area where they screen for and treat malnutrition, malaria and other common illnesses. The teams refer complicated cases of malnutrition to the provincial hospital in Massakory, where MSF runs an inpatient therapeutic feeding centre (ITFC) with a capacity of up to 60 beds during the lean season. MSF teams also distribute soap for body hygiene and mosquito nets to prevent malaria for children admitted into the programme.

Early in the morning, around two hundred women gather on mats spread out on the ground in the courtyard of the N’doukouri health center, waiting with their children for the arrival of MSF teams. Many are already in the nutrition programme, while others are coming to have their children screened for malnutrition for the first time or after discharge. “This is the second time he has fallen ill with malnutrition,” Mariam Abdoulkarim shyly explains, who gently holds her baby in her arms. The child had already been diagnosed with malnutrition and taken care of by MSF teams a few months ago. But in recent days, he has started having diarrhoea again and is struggling to breathe properly. It is the second time he is diagnosed with malnutrition. Asked why he is suffering from malnutrition again, Zara explains: “It’s hunger and the climate – the harvests aren’t good, because of that there’s nothing to eat here and the water one drinks is not good”. Some children are readmitted into the programme within six weeks of being discharged. This is because the conditions at home that led to malnutrition in the first place are unlikely to have changed.

In 2022, MSF received 17,620 admissions of acute malnutrition across our ATFCs in Massakory health district, and 2,062 cases in the ITFC. By the end of July of this year, we have already treated around 10,200 children with malnutrition in our ATFC, and 647 children in our ITFC. “Poverty, the effects of climate change, difficulties in accessing healthcare, recurrent measles outbreaks, childhood diseases (malaria, diarrhoea and pneumonia) and the lack of access to good quality drinking water are all reasons that explain the persistence of acute malnutrition in the health district of Massakory. To this day, the food security and nutrition responses remain insufficient throughout the region of Hadjer Lamis.” Explains Dr Christian Mwemezi, Medical Team Leader for MSF in Massakory.

Care by and for the community to facilitate access to medical care for people in hard-to-reach areas

To answer the problem of hard-to reach areas, MSF has decided to launch ICCM+ activities, which bring health care closer to communities, treating the most common childhood illnesses such as malaria, respiratory infections, and acute watery diarrhoea. What is unique about the approach in Massakory is that ICCMs will also treat malnutrition. Community health workers, with technical and material support from MSF, manage the ICCMs. Patients in a critical condition are referred to the nearest health center, or to the hospital if necessary. Within the first two months of opening, 516 children have been treated across the four ICCM+ sites in Massakory.

In the village of Karkoure, located 20 kilometers from Massakory town, community health workers – chosen by the community itself and supported by MSF – ensure people’s access to vital health care. “To get to the nearest health centre, and wait my turn for my baby to be seen and then walk back home, I have to sacrifice a whole day. If I do that, I don’t know how my other children will do without me,” says Zara Oumar, who came looking for medical care for her baby. For this mother, it is a great relief to have medical services available in her own village.

Béchir Abdouraman is a community health worker. A community hut serves as a treatment room where he receives and examines the ill; he provides them with first aid using the medicines offered by MSF. Twice a week, an MSF team travels to Karkoure and sets up consultation tables in front of this hut, which has become the fixed site for the ICCM activities. They provide care to the children who come from the surrounding villages. For Younous Hissen Ahmat, Chief of the village of Karkoure, this activity is a godsend for his constituents. “We have a lot of problems with child malnutrition, malaria and diarrhoea in the community. It is the role of the Chief to take care of his people, so if MSF comes to help us in this task, we can only be very grateful”, he rejoices.

“There is a clear need for nutrition services in Massakory, but looking forward we plan to strengthen our ICCM activities, which we hope will address some of the challenges in accessing health care,” says Susanna Domeij, outgoing MSF project coordinator in Massakory. “But people need a lot more help than we are currently able to provide to respond to hunger and malnutrition among children in Massakory. Other actors are urgently needed to support WASH services to reduce diarrhoea, respiratory infections and other preventable illnesses, as well as agricultural and income generating activities to prevent malnutrition in the first place.”

Distributed by APO Group on behalf of Médecins sans frontières (MSF).


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