MSF experience of malnutrition treatment in Maradi, Niger
Scaling up treatment of severe acute malnutrition (2005)
In 2005, a year of exceptional food insecurity in Niger, MSF treated over 60,000 severely malnourished children using therapeutic ready-to-use food. 38,000 severely malnourished children were treated in Maradi alone, with a cure rate above 90%. They were cared for at four hospitals and 17 emergency outpatient feeding centres.
Expanding outpatient care to moderately malnourished children (2006)
Given the excellent results on a large scale for severe cases, MSF extended the use of therapeutic RUF through the outpatient strategy to moderately malnourished children. This was done in 11 outpatient centres and two hospitals in two different districts of Maradi region.
Nearly 65,000 children were treated, 92.5% of whom suffered from moderate malnutrition and 7.5% from severe malnutrition. Recovery rates reached 95.5% amongst the moderately malnourished and 81.3% amongst the severely malnourished. The seasonal peak of admissions of severe cases observed every year since 2001 when the programme opened in Maradi, did not occur. This experience suggests that treatment with therapeutic RUF can prevent the development of severe malnutrition in a large cohort of moderately malnourished children.
The results also confirm the efficacy of using therapeutic RUF to treat moderate acute malnutrition. Recorded weight gain (5.28 g/kg/day amongst the moderately malnourished) is markedly higher than that generally obtained in "classic" food supplementation programmes using blended flour (generally below 3 g/kg/day). Similarly, defaulter rates were very low compared to classic programmes, with a 3.4% defaulter rate among the moderately malnourished and 10.3% amongst the severely malnourished.
"We saw, in 2005 and 2006, that giving mothers the responsibility for treating uncomplicated acute malnutrition produces good results. It is only when a child is ill or severely malnourished that treatment takes place in medical facilities."
Isabelle Defourny, Deputy Manager of the nutritional programme in Maradi, Niger
Reaching more children with a two tiered approach (2007)
At the end of 2006, MSF data showed that more than half of the population of children under three years old developed an episode of acute malnutrition in MSF's two catchment districts in southern Maradi. MSF implemented a new two-tiered approach: earlier access to treatment for severe cases and earlier access to supplemental RUF for all children at risk in the area.
MSF began using the World Health Organization's new growth standards to define admission criteria, which are more "inclusive" (some children formerly considered moderately malnourished based on the former reference are now classified as severe) and therefore include more children at high risk of death. Based on these new standards, children suffering from severe acute malnutrition are treated with therapeutic RUF in outpatient feeding centres. In the case of serious associated illness, they are hospitalised.
The second component of MSF's new approach involves distribution of supplemental RUF, which does not replace regular meals but compensates for major deficiencies in their regular diet by meeting a child's daily nutrient needs. In 2007, MSF is distributing supplemental RUF to all 62,000 children from six months to three years of age in one district in Maradi on a monthly basis during the seasonal hunger gap.