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24 Sep 13 09 Oct 13

Ethiopia: Isolated and malnourished - MSF treats malnutrition in rural Afar

When Zahari Nur’s grandmother brought her to the outpatient post where MSF teams were conducting their outreach activities in Digdiga, one of the 12 kebeles (division – provincial administrative unit) that Médecins Sans Frontières/Doctors Without Borders (MSF) is covering in their nutritional intervention in Afar, everybody thought it was just a matter of days before she went way of all flesh.

“I had given up hope on my grandchild. I thought she was going to die like the three others before her,” says Eisa Wasaitu, Zahari’s grandmother.

The one year old was suffering from severe acute malnutrition and marasmus (malnutrition characterised by energy deficiency) when she was first brought to the MSF outreach post.

Her mother is also ailing and suffers from psychosis. She is in no condition to take care of Zahari and her older brother leaving the grandmother as their sole guardian.

Treating malnutrition

After two months in the MSF programme and admission into the stabilisation centre where, apart from being treated for malnutrition, she was given specialised treatment for pneumonia, Zahari slowly blossomed back to life.

When we saw her a few weeks ago, her weight had increased from 3.2kg to 4.9 kg.

“When I see this child I feel very happy because the grandmother and the rest of the community thought she was going to die, but we saved her life and she is still alive,” says Nabiyu Ayalew, MSF’s outreach nurse.

Nutritional emergency

MSF traversed the inimitable lands of Afar in April to respond to a nutritional emergency. The Afar state is vast and the area that MSF covers is one of the remotest and most neglected.

If we divide the state into four zones; four being the remotest, four is where the MSF base in Teru is located.

Teru is subject to huge aggressive sand storms in the dry season with extreme temperature and violent rainstorms that flood seasonal rivers and make non-existent and partly dirt roads impassable in the rainy season.

MSF’s intervention, that recently closed, covered 12 kebeles (neighbourhoods), all of which were very far from each other and whose inhabitants are completely cut off from healthcare.

Complications

The decision to intervene was reached after an assessment found an alarming severe acute malnutrition rate in the region to be 26.6 percent in an estimated catchment population of 87,374 people.

“Most of the cases that we admit in the stabilisation centre are severe acute malnutrition with complications - most of these are combined with either pneumonia or tuberculosis,” says Frank Katambula, MSF’s Medical Team Leader in Afar.

MSF has been providing therapeutic feeding alongside treatment for various diseases like pneumonia and tuberculosis.

Some cases, like that of Salama Hassan, whose nine-month-old baby has been admitted thrice in the MSF stabilisation centre, have been particularly problematic.

Salama does not believe that her child suffers from malnutrition but that a bad wind must have blown when they were released from the stabilisation centre and this wind made her child sick.

Therapeutic feeding

Nevertheless, most cases have now stabilised and children under the age of five continue to receive therapeutic food.

Overall, a total of 726 malnourished children were admitted in the therapeutic feeding programme (including 134 children in the stabilisation centre) and 1,154 moderately acute malnourished patients (including 416 pregnant and lactating women) benefitted from programme.

 “In total we have 78.2 percent cured cases and a defaulter rate of 4.5 percent, which to me is quiet ‘good’ considering that access (in terms of accessing patients and patients accessing healthcare or MSF facilities) in this area is not at all easy,” adds, Jean François Saint-Sauveur, MSF’s Medical Coordinator in Ethiopia.

The Afari are a pastoral nomadic people that move from place to place in search of water and pasture for their animals.

This aspect of their life largely contributes to the defaulting of their treatment. This, combined with geographical access difficulties, complicates MSF’s capacity to follow up on defaulters.

The presence of MSF in the area is significant, not only in providing healthcare but also in highlighting the healthcare problems of the rural Afari population and advocating for the provision of basic healthcare to this population, a principle clearly stated in the MSF charter.

Find out more about MSF’s work in Ethiopia