One of the sustainable development goals adopted by the UN in September 2015 was to eliminate hunger by 2030. But eliminating hunger does not « just » mean ensuring that everyone has enough to eat. It also means combating malnutrition: a scourge that kills over 3 million children under 5 out the 6.3 million who die each year all over the world, as we learn from the UN’s World Food Program. Malnutrition, as defined by the World Health Organization, covers two extremes: over-nutrition, linked with non-communicable diseases such as diabetes and obesity, which is more widespread in developed countries, and undernutrition, which causes deficiencies that affect children’s physical and cognitive development, and is more prevalent in developing countries. This is the type tackled by the NGO Alliance for Medical Action (Alima), which has had the bright idea of teaching mothers in the Niger to detect undernutrition in their own children.
Training mothers to make up for the lack of health community officers
To fight malnutrition effectively, it needs to be detected. Screening methods include measuring the arm circumference between the elbow and shoulder, known as the MUAC (mid-upper arm circumference). This is the most efficient indicator for pinpointing a severe mortality risk in children aged 6 to 59 months. Using graduated tapes, health staff can rapidly spot children suffering from acute malnutrition. Unfortunately, because there are not enough staff, especially in rural zones, the test is not given to all the children who might need it, resulting in an under-diagnosis of infantile malnutrition.
And this is where Alima’s idea comes in. The NGO, which provides medical care to vulnerable populations in Africa, and is developing a considerable R&D activity in humanitarian medicine, is offering to teach mothers to do these tests on their own children and thus pinpoint the first signs of undernutrition early on.
Between May 2013 and April 2014, the NGO carried out a comparative study in two rural regions of the Niger. In one, health community officers carried out a standard MUAC screening operation, with an average of one officer for every 50 households. In the other, 13,000 mothers were trained to use the MUAC tape. The results were telling: in the « mothers » region, where there were not enough health professionals, the mass training of women made the malnutrition screening process just as effective, wrote the NGO in the results of its study, published in early September 2016 in Journal Archives of Public Health. As well as the positive impact on children’s health, Alima emphasizes that this method makes health systems more efficient: while the initial investment in training for the mothers was bigger, the overall cost of treating children was lower in the « mothers’ region » because of early detection: $8,600 dollars (€7,690 euros) compared with $21,980 dollars (€19,660). For the NGO, there is absolutely no doubt that « making mothers a central element in screening strategies should be included in programs for combating malnutrition. »
This promising approach now needs the funding to roll into action effectively. As Viviane Van Steirteghem, the Niger UNICEF representative, said in Le Monde, « This needs organization within civil society. It should certainly be encouraged and tried out wherever NGO partners are present. But in zones with less coverage, governments are already finding it hard to supervise community health centers. » Nonetheless, the approach helps families to become central players in the public health care and prevention programs designed for them, giving them more control over their own health.
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