MALNUTRITION: CHAD: Malnutrition outstrips response

DAKAR, 24 August 2010 (IRIN) - In parts of Chad acute malnutrition levels far exceed the international emergency threshold, according to a new study - fallout, partly, from crop failure hitting already fragile communities where access to basic health services is low and aid agencies are scarce. The study, by Action contre la Faim (ACF) along with the government, donors and UN agencies, showed that in Nokou and Mao in the western Kanem region, acute malnutrition strikes 27.2 percent and 21 percent of under-five children, respectively. The figures for severe acute malnutrition - which commonly results in death if untreated - are 6.4 and 4.7 percent. The highest numbers are in the central-west Barh El Gazel region, where 28.1 percent of children are acutely malnourished - 10.4 percent severe. Even in a part of the world where periods of grave hunger are common, the recent survey numbers shock, Cyprien Fabre, head of the West Africa office of the European Commission's humanitarian aid department (ECHO), told IRIN. "In the Sahel [region of Africa] we always have high malnutrition rates during the lean season, above the World Health Organization emergency threshold of 15 percent," he told IRIN. "But when we see numbers like 27 and 28 percent, it's appalling." Of the roughly 102,000 children nationwide classified as having severe acute malnutrition, about half are in Chad's Sahel band - a semi-arid zone some 500km wide stretching from near the capital N'djamena to the border with Sudan, according to UN Children's Fund (UNICEF). Malnutrition rates are higher than in neighbouring Niger, another West African country where poor food and fodder production from 2009 has destabilized agro-pastoralist communities who already live on next to nothing during lean seasons. In Chad, UNICEF says, under-nutrition is also due to poor access to health services and safe drinking water, inappropriate infant feeding practices and a lack of trained staff in hard-hit areas. Malnutrition has been above the 15 percent threshold in Chad for a decade, according to UNICEF. Kalzeubé Payimi Deubet, governor of Barh El Gazel, lives about 100m from the main regional hospital. He says he sees malnourished children daily. "It is difficult just being in that atmosphere," he told IRIN. "You have little children, their skin just sagging over bones - nothing but skin and bones."Response, but not enough While aid groups have been operating for years in eastern Chad, where over 400,000 Darfur refugees and displaced Chadians live, humanitarian agencies are scarce in the rest of the country. UNICEF has long pointed to the lack of aid partners as a barrier to tackling acute malnutrition in Chad. From January to May 6,508 children were treated at UNICEF-supported therapeutic feeding centres in the Barh El Gazel and Kanem regions, according to UNICEF. The recovery rate at outpatient therapeutic feeding centres was 88 percent; in inpatient feeding centres the rate was lower and varied widely - from 16 percent to 75 percent. UNICEF says this is due in part to the lack of centres for severe cases (Barh El Gazel, population 260,865, has just one); in many cases children are simply arriving too late. Malnourished children with other health complications receive medical treatment in addition to therapeutic feeding. For severe acute malnutrition children receive foods like special fortified milk several times a day and are closely monitored by health staff. Some children can be treated at home with nutrient-dense, ready-to-eat Plumpy'nut, with regular checks. Barh El Gazel governor Kalzeubé told IRIN children in many of the region's villages are simply not being reached, even for detecting under-nutrition. "We do not have the means to diagnose and treat all children." ACF operates 33 nutritional centres in Kanem and Barh El Gazel - expected to reach 43 in the coming months, with one mobile clinic - according to ACF head in Chad Jean-François Carémel. Some areas with high malnutrition are supported by Médecins Sans Frontières and other NGOs, but "the system is not covering all the needs," Carémel told IRIN. He said government health structures are "weak" with a lack of skilled staff and quality care. Under a just-revised national protocol for treating malnutrition - to reflect changed World Health Organization standards - more children would be classified as needing treatment, which will only underscore the deficiencies of the health system, ACF says. Funding shortfall The UN Office for the Coordination of Humanitarian Affairs in Chad said the nutrition response needed more aid workers and more dollars. "We received US$3.8 million from the UN Central Emergency Response Fund (CERF) early in the year for this crisis but much remains to be done," said OCHA humanitarian affairs officer David Cibonga. "We need more aid groups to fill coverage gaps. At the same time we need more funds; the UN consolidated appeal for Chad is funded at only 50 percent." OCHA is seeking another $8 million from CERF. Parallels with Niger 2005 Patricia Hoorelbeke, ACF West Africa representative, said Chad's nutritional situation today is similar to Niger's in 2005, when few humanitarian agencies were in place when a hunger crisis hit. "There is a lack of implementing partners in Chad as was the case in Niger at that time; that's still a major problem." ECHO's Fabre said the comparison is apt. "There is not enough attention [by aid agencies and donors] to the nutritional situation in much of Chad. The problem is overshadowed by the refugee situation in eastern Chad and by Niger." For Nicolas Louis, ECHO's representative in Chad, the "weak humanitarian response" to date has dire consequences: "Quite high morbidity and mortality, as well as potential long-term effects on psychomotor development." He added: "Irregular migration [driven by the crisis] and household debt burden could block some families from restoring their lives and livelihoods, thereby making them more vulnerable to future shocks."