Nutrition experts in Guinea are studying options for treating moderately malnourished children, as funding shortages disrupt normal programmes using fortified flour.
In recent months local health centres ran out of supplies and had to refer families to remote facilities for corn-soya blend (CSB), used for the treatment of moderate acute malnutrition and provided by donors through the UN World Food Programme (WFP).
WFP is seeking funds to maintain CSB stocks in Guinea. “We recently received some CSB but needs still outweigh supply,” WFP-Guinea head of programme Foday Turay told IRIN. While recent unrest in the country led some donors to pull back, a lack of funding for WFP nutritional programmes pre-dates the latest instability.
Humanitarian workers told IRIN the current situation reflects the overall difficulty of attracting aid funding for Guinea and underlines the need to find alternative and long-term solutions.
“The break in WFP’s pipeline is representative of the problem everyone has finding [aid] funding for Guinea,” Reza Kasraï, head of Action contre la Faim (ACF) in Guinea, told IRIN.
“We’re in a no-man’s land between a politically stable country where donors would like to give development funds and a full-on emergency where humanitarian donors contribute regardless of the political situation.”
The funding and supply breaks are forcing aid agencies and the Health Ministry to turn to temporary solutions – like using therapeutic foods designed for severe acute malnutrition – but a more sustainable strategy is needed, nutrition experts say.
Wasting is the main characteristic of acute malnutrition. It occurs as a result of recent rapid weight loss, malnutrition or a failure to gain weight within a relatively short period of time. Wasting occurs more commonly in infants and younger children. Recovery from wasting is relatively quick once optimal feeding, health and care are restored. Wasting occurs as a result of deficiencies in both macronutrients (fat, carbohydrate and protein) and some micronutrients (vitamins and minerals).
Chronic malnutrition, on the other hand, is commonly referred to as “stunting”, i.e. a failure to grow in stature, which occurs as a result of inadequate nutrition over a longer time period. It is a slow, cumulative process, the effects of which are not usually apparent until the age of two years. Severe acute malnutrition (SAM) is the most dangerous form of malnutrition. If left untreated, SAM can result in death.
When CSB stocks ran out, ACF used Plumpy’nut for some moderate malnutrition cases, Kasraï said.
“These are stop-gap measures… Using Plumpy’nut for moderate acute malnutrition is not in the national [malnutrition treatment] protocol, and just because the product is on hand does not mean it’s a long-term solution.” The product is more expensive than foods used to treat moderate acute malnutrition (MAM), he said.
Nutrition workers in Guinea are debating the viability of using Plumpy'nut for moderate cases if the need arises; another option being discussed is using local foods, prepared specially for children’s nutritional needs.
“Stop-gap measures may be better than nothing but a plan is needed to assure adequate funding for the CSB supply and access to contingency funds to mitigate the impact of CSB shortages,” Sheryl Martin of Helen Keller International in Guinea told IRIN.
“We are all frustrated by the lack of funding and are doing the best we can in the short term.”
ACF’s Kasraï said it is important to use an integrated approach – not only therapeutic feeding but also programmes to address the principal causes of undernutrition in Guinea, by boosting people’s livelihoods, ensuring proper breastfeeding and weaning practices and improving home hygiene and access to health services, sanitation and safe water.
He said there is a growing movement towards community- and even household-based management of MAM, which would also reduce the strain on health centres. "The challenge is in finding a reliable way of ensuring that moderately malnourished children receive fortified [with vitamins and other micronutrients] and high-caloric diets in the home."
A January 2010 ACF nutritional survey in Conakry’s Matoto commune shows a global acute malnutrition rate of 7.3 percent, with 1.6 percent severe acute malnutrition, he said.
“While these percentages are not alarming, if you look at absolute numbers you’re talking about some 10,000 children suffering acute malnutrition – and that is in just one of five Conakry communes.”
Mamady Daffé, Health Ministry head of nutrition, said the combination of poverty and a lack of knowledge of children’s nutritional needs contributes to child malnutrition. He said even if families understand children’s nutritional needs, many do not have the means to meet them.
“People’s living conditions must improve. Without this we will not be able to tackle malnutrition," he told IRIN. "The cost of living is up; people cannot buy what they need to eat properly.”
In the Dixinn commune of Conakry, health workers conducting a nutritional survey in January saw a malnourished four-year-old girl. Her father is unemployed and her mother barely makes ends meet doing petty commerce.
“Sometimes I go for days without preparing a proper meal,” the mother, Fatoumata Keita, told IRIN. She said she often gives her daughter quinine to ease stomach pain.
The latest monthly nutritional survey in Conakry – carried out by HKI and the Health Ministry – showed a rise in moderate acute malnutrition among under-five children from 3.8 percent in January to 5.5 percent in February.