Acute malnutrition a "social problem"

In the Liberian capital Monrovia acute malnutrition is due not only to poverty and inadequate health and sanitation services but also to factors such as high teenage pregnancy and the war’s damage to the social fabric, say nutritionists, who call the condition “a social problem”.

“The high levels of acutely malnourished [children] are partly a hangover from the war,” said James Fireman, manager of the Action contre la faim (ACF)-supported outpatient feeding centre for children in Pipeline, a northern Monrovia suburb. Liberian NGO ANDP runs the centre.

“There was a breakdown in families, girls were being raped and their parents killed,” he said. “If you don’t have a family to teach you caring practices, how will you learn how to raise a child?”

Fireman said communities are no longer well-defined. “People lost everything and after the war became more individualistic. Liberia is now a country of displaced people and refugees.”

Too young

Liberia has one of West Africa’s highest teenage pregnancy rates: one in three girls aged 15-19 has had a child while almost one in seven children born to mothers in this age group will die within the first year, according to Liberia’s latest (2007) Demographic Heath Survey.

“Teenage pregnancy is a silent crisis here in Liberia,” USAID spokesperson Nena Terrell told IRIN. “People are not worried enough about it.”

Photo: Anna Jefferys/IRIN 
An assistant with ACF helps prepare F-100 infant formula for severely acutely malnourished children at the VOA centre

In Liberia older women traditionally pass on childrearing practices to younger generations, but many families were separated by the war, interrupting this knowledge transfer, said ACF care practices manager Audrey Gibeaux.

“Teenager mothers are not ready, willing or able to look after their babies,” nutrition assistant and nurse at ACF Pipeline centre Roselyn Toe told IRIN. Many teenage mothers drop out of school to give birth but want to return to their studies as soon as they can, she said, which means they cannot provide exclusive breastfeeding.

Many teen mothers IRIN spoke to said they fed their babies water in the early months, a potentially deadly practice in a country where just one in three people can access safe drinking water.

Diarrhoea is the second biggest child killer in Liberia after malaria according to the UN.

Veenah Sefa, 22, has brought her sister’s 17-month-old to Pipeline. The baby was sick and losing weight.

The baby’s mother “is just a young girl” and has returned to school, Sefa said. She said the baby has been drinking water since she was a few months old. The infant appeared to suffer severe acute malnutrition and was likely to be referred to an in-patient feeding centre for children needing critical care, ACF’s Fireman explained.

Acute malnutrition causes 20 percent of infant deaths in Liberia, according to UN Children’s Fund (UNICEF). In Monrovia acute malnutrition is 6.2 percent, according to the DHS; while below the 10 percent intervention threshold that guides many donors, this equals 5,000 severely acute and 20,000 moderately acute malnourished children.

The European Commission humanitarian aid department (ECHO) and private firm Carluccio's are supporting the ACF programme.

The Pipeline centre is one of five ACF acute malnutrition centres across the country, currently treating 1,311 children. ACF teams go to communities to evaluate children and place the acutely malnourished into a programme in which they receive fortified food, oil and sugar.

Photo: Anna Jefferys/IRIN 
The ACF-run therapeutic feeding centre

Those who are severely acutely malnourished are sent to an in-patient therapeutic feeding centre in the VOA neighbourhood of western Monrovia.

Mamie Masako, 19, has brought her 16-month-old malnourished baby to the VOA centre. As she fed the infant specially-designed formula supplied by UNICEF, she told IRIN she still attends school while her mother looks after the baby.

Before young mothers leave the centre, they are taught how to prepare special weaning food made up of plantains, sesame seeds, palm oil and rice powder.

At the VOA feeding centre on a neighbouring cot, Keema Sama, 16, is feeding four-month-old Elijah. Sama left school in the 7th grade to have her baby. “I want to go back to school but I don’t know who can take care of my baby – as soon as he is walking I will go back.”

But by that point, nurse Toe said, Sama might be pregnant again.