Kanem province has one of the highest malnutrition rates in Chad. Insecurity, climate change, but also cultural practices are the main causes put forward by the authorities who are trying to eradicate it with the support of their partners.
Yellowish hair, emaciated bodies, aged faces, swollen feet, arms and faces… These signs, Fatime Younous Abdraman, 37, has been trained to detect them. ” Whenever I spot a child in my entourage who develops them, I explain to the family that he is suffering from malnutrition and that it is urgent to take him to the Therapeutic Nutritional Unit (UNT) of Mondo “, she explains. Malnourished children from 0 to 5 years old are welcomed there, with their relatives, in order to be properly fed and cared for. But in these months of March-April, like other nutritional centers in Chad, the UNT welcomes an abnormally high number of beneficiaries. ” One hundred and eleven children were admitted in March, 78 in April. And we recorded 9 deaths in March and 5 in April. We really peaked says Dr. Djibert Ahmat Haliki, health delegate for Kanem province, whose malnutrition rate is one of the highest (39.1%) in Chad.
food emergency
For its part, the Chadian government is declaring a state of food emergency, while the United Nations estimates the number of people in a situation of food insecurity at 4.1 million (read here). “ I’ve never seen that, remembers Ali Younouss Ali, president of the association for the development of Mondo and director of Bissam radio. The little ones were with their mother, under sheet metal sheds. But at this time, the temperature can rise up to 47° C. Without electricity, can you imagine? »
Especially since in this month of March, the UNT of Mondo has to face another problem. The NGO Action Against Hunger (ACF), its partner for ten years, no longer covers the salaries of additional staff. This decision, announced for a long time (read below), leaves the nursing staff in disarray.
Low rainfall and poor harvests
How did we come to such a situation? ” Kanem is an arid zoneexplains Issa Belingar, zone manager of the Mondo health district. And this year has been particularly difficult. Due to poor distribution of the rains, the harvests have not been good. However, children need to consume energy, protective, builder foods, such as fruits and vegetables, which will allow them to develop their own immune defenses as well as clean water. But, they no longer eat their fill, or they consume meat foods, which are not at all suited to their needs. »
“harmful” cultural practices
Other reasons are also given. “ Populations have cultural practices that can also be harmful to the health of children, observes Issa Belingar. When children have, for example, an inflammation of the uvula, families make an ablation. This causes bleeding, even anemia, whereas a simple antibiotic treatment would be enough to treat it. Scarification and tooth extraction are also cultural practices that can lead to complications and health problems. »
But it is above all the duration of breastfeeding that concerns the health authorities. ” Exclusive breastfeeding rate among women is only 16%continues Dr. Djibert Ahmat Haliki. They are recommended to nurse the children for twenty-four months. How can mothers produce enough milk to feed their children when they themselves don’t have enough to eat either? Faced with these findings, the authorities are mobilizing to deal with the emergency, but also to find long-term solutions, in particular by trying to change mentalities (see below).
Report produced with the collaboration of Bissam radio, Mondo, Chad.
STRUCTURES THAT CARE FOR MALNUTRITION IN KANEM
In the province of Kanem, various structures take care of children suffering from malnutrition, depending on the level of severity. One hundred and ten Supplementary Nutritional Units (UNS) accommodate children and pregnant and breastfeeding women suffering from moderate acute malnutrition. Ninety-six Outpatient Nutritional Units receive populations affected by severe acute malnutrition, but without medical complications. And finally, the two Therapeutic Nutritional Units (UNT) in Mao and Mondo support children and their relatives suffering from acute malnutrition combined with illnesses (respiratory infections, diarrhoea, etc.). All these units are integrated into health centers or hospitals, allowing medical staff to monitor patients. ” However, Chad faces many difficulties, recalls Dr. Djibert Ahmat Haliki, health delegate for Kanem province. So our partners are very important. Unicef thus provides support for the feeding of children and certain treatments, the World Food Program (WFP) supports the UNS; and Action against Hunger (ACF) supports the UNTs, including that of Mondo, in particular in covering the salaries of additional staff.
THE IMPORTANCE OF PARTNERS: THE CASE OF UNT DE MONDO
During March, when Action against Hunger (ACF) stopped supporting the health delegation in the management of additional staff, while the number of beneficiaries was pouring in, the situation was tense. ” It was young people from Mondo who informed me that the UNT was struggling to work and that it was left to its sad fate, explains General Ousmane Brahim Djouma, Governor of Kanem. So, I decided to go and see on the spot and I noticed that, since the departure of ACF, the children always had a little food, but the accompanying persons were no longer taken care of and the nurses worked without salary. Normally, the departure of ACF should have been accompanied by the services of the State and other NGOs to avoid any rupture. But, there was a miscommunication that led to this situation. The governor urgently released one million CFA francs allowing support for accompanying persons for a month. ” Unicef agreed to support five agents and the Ministry of Public Health three agents, including a doctor “, specifies Dr. Djibert Ahmat Haliki, the health delegate of the province of Kanem.
Henri-Noël Tatangang, the Chad director of ACF, explains, for his part, the reasons for the withdrawal of the NGO from the UNT of Mondo: ACF has been financing, for ten years, the salaries of the additional staff of the UNTs of Mao and Mondo with the support of the donor, ECHO, the Emergency Unit of the European Union. Our donor felt that after ten years, we needed to finance more structuring projects. We announced the end of staff support over a year ago. In addition, we have just obtained funding from the French Development Agency (AFD) which will benefit the UNT of Mondo in terms of equipment and training. Finally, ACF was able to obtain support from Sweden to finance the salaries of the UNT in Mondo. ” But, as another solution has been found in the meantime, this fund will be allocated to other structures said Mr. Tatangang.
PREVENTIVE ACTIONS TO ERADICATE MALNUTRITION IN THE LONG TERM
How to face, in the long term, the consequences of climate change and try to eradicate the food crisis which affects, among others, the province of Kanem? What actions can be implemented?
Develop agriculture in all seasons
For health authorities, solutions can be provided at different levels. ” In the long term, it is necessary to produce food, such as fruits and vegetables, and to promote small livestock “, recommends Issa Bélingar, zone manager of the Mondo health district. How to cultivate them in an arid region where the climatic conditions deteriorate from year to year? ” The province has plenty of arable landsays General Ousmane Brahim Djouma, Governor of Kanem. It is necessary to be able to carry out agriculture in all seasons, by exploiting wadis with the help of solar boreholes and by providing fences to protect the seeds of livestock. How to make a field to produce sufficient food? How to give work to young people? This is what we must succeed in doing. But this requires support, particularly from agricultural centres. And that will take time to implement. »
Insecurity and investment
Henri-Noël Tatangang, director of ACF in Chad, says the NGO is already supporting communities by developing wadis, using a solar-powered irrigation system. ACF would not be the only one to finance this type of project. “ But this is not enough to cover the food needs of the population of Kanem, regrets Koumaye Vaïtchedé Vanjoua, in charge of agricultural technical supervision in the sector of Mao, capital of the province. To develop more wadis, we would need more technical means, but also human resources in order to train more farmers. » « For this, funding is needed, continues Mr. Tatangang. But the government has security and budgetary constraints that prevent it from making these investments. With the authorities, we are studying the possibility of developing larger plots. »
Short term prevention
In the meantime, actions with short-term effects are being considered. “ It is important to quickly detect the signs of malnutrition and diseases (infections, diarrhoea) thanks to a network of community relays, says Dr. Djibert Ahmat Haliki, the province’s health delegate. And then, nutrients can be provided in the form of powders to be added to flours to make enriched porridges for children. This is a strategy that we are experimenting with in the district of Mao with the support of Unicef and which could be extended. »
“ There are other factors, more specific to the province, on which we can also act, says the governor. It is important to educate mothers so that they do not wait until their children are in critical condition to take them for treatment. Young people can certainly do this awareness work with mothers. »
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