Timely intervention for severe acute malnutrition saves children’s lives

Timely intervention for severe acute malnutrition saves children’s lives. Early identification and effective treatment has been made possible through the concentrated efforts of JAM and its partners and donors to scale up nutrition services in South Sudan

Nagaidok had no idea that her only child was suffering from severe acute malnutrition when, on an afternoon in late June, five volunteers from Joint Aid Management (JAM) arrived in her village, on the outskirts of Pibor town, South Sudan.

“They put the tape, and it was on red,” she recalls, referring to the colour-coded MUAC (mid-upper arm circumference) measuring tape used by JAM’s nutrition volunteers during the community screening initiative.

Nagaidok, 22, adds: “Before the volunteers came, I thought everything was okay. While my child did seem a little quieter than usual, I did not know he was at risk of dying.”

Nagaidok is among thousands of mothers enrolled at one of JAM’s 42 outpatient therapeutic programme (OTP) clinics across Pibor county that treat children with severe acute malnutrition.

Early identification, enrolment and timely treatment of her child has been made possible through the concentrated efforts of humanitarian partners and donors — including JAM, UNICEF, and the South Sudan Humanitarian Fund — to scale up nutrition services.

With early assessments showing an average of global acute malnutrition rates at 24% in late 2020, with some payams [administrative districts] in Pibor as high as 32% – well above the World Health Organisation’s 15% emergency-level thresholds – the scale-up not only sought to identify and treat cases of acute malnutrition, but also to invest in long-term prevention.

The scale-up has also been in response to the critical “famine-like” humanitarian situation projected for 2021.

According to Simon Mawa, JAM’s Nutrition Officer, who was intimately involved in the scaling up of nutrition services in western Pibor, there are multiple factors that led to the emergency situation including floods and conflict. He says: “During the big floods, which followed a major conflict that occurred just before, people lost all their cows. We were doing assessments and finding extremely high rates of malnutrition within communities. It’s because all of a sudden, they had nothing: no assets, and, as a result, no source of income or food.”

Having been a victim of conflict himself and forced to live as a refugee in Uganda in the past, he intimately understands the life-threatening impact that losing assets can have on individuals and the type of support that is needed to recover from it.

A decentralised and integrated approach has been utilised to address root causes of acute malnutrition and manage wasting through increased emphasis on child health, clean water, hygiene, sanitation, maternal nutrition, dietary behaviour and nutrition-sensitive agriculture at household and community levels.

Fix up to scale up

For JAM, the scale-up initiative included rehabilitation of nine previously defunct nutrition sites and the construction of 11 new facilities in the hard-to-reach areas of Pibor. This was in accordance with the decentralisation strategy agreed upon by humanitarian partners – to bring services out of the town centre of Pibor and into the remote areas.

The results of this decision are visible today with mothers and children receiving services within the facilities near to their homes.

Three weeks into the treatment of her child, Nagaidok says she is hopeful her child will make a full recovery. The early signs are encouraging too. With a smile on her face, she states: “I can see that the baby is gaining weight. He is more active; and that makes me feel really good.”

During her weekly visits to the OTP, Nagaidok has also had the chance to engage with the other mothers facing similar challenges. She is now feeling inspired to establish a kitchen garden at home by learning vegetable gardening skills alongside her peers at the demo plot next to the clinic.

Nagaidok says: “I learned many things: the way to sow onion, Sukuma and okra. I learned that these vegetables are very healthy for the child.”

She adds: “Even other Murle people in my village are beginning to be aware of what malnutrition is: how to prevent it; how to identify it; and where to go for treatment when it happens.”


Work still to be done

Although encouraging, the work is not yet complete for JAM and other humanitarian partners operating in Pibor. Service disruptions are frequent because of the flooding and violence, which imperils steady and meaningful progress.

Nevertheless, as demonstrated by Nagaidok and stories similar to hers, progress is evident in Pibor. In previous years, her child’s sickness might not have been identified in time to allow for the necessary treatment because of a lack of facilities and initiatives.

Considering that, according to research, a child with severe acute malnutrition is 12 times more likely to die when compared to a well-nourished child, timely identification can mean the difference between life and death for many children.

When asked to give a brief assessment on where things stand with regards to acute malnutrition in Pibor, Simon states: “We have stopped the spike. This is a tremendous achievement. To bring the rate down to acceptable levels, however, it’s going to require a more sustained and multi-year effort. We need to keep up our efforts to properly address the root causes. Otherwise, we can easily go back to where we came from.”

For the humanitarian partners providing services in Pibor, that is not a direction they want to contemplate.

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