MALNUTRITION: DJIBOUTI: Challenges remain, despite nutrition gains

 Photo: IRIN
The government of Djibouti is working with partners, such as UNICEF, to eradicate malnutrition by 2015, according to Mohamed Aden Ahmed, the medical doctor in charge of nutrition in the Ministry of Health

DJIBOUTI, 15 February 2011 (IRIN) - In a region with some of the world's worst indicators for malnutrition, Djibouti is making gains and ensuring mothers and their children have access to life-saving interventions, say officials.
"We are making progress in the fight against malnutrition but much remains to be done; I applaud the government of Djibouti for its efforts to ensure that children have access to the help they need," Josefa Marrato, the representative of the UN Children's Fund (UNICEF) in Djibouti, told IRIN.
The rate of global acute malnutrition in Djibouti has dropped from 17 percent three years ago to 10 percent today, according to UNICEF.
Marrato said serious challenges, such as funding, remain, with almost 70 percent coming from emergency monies.
"The problem with emergency funding is that you cannot plan for, say, next year," Marrato said. "You cannot plan for non-life-saving interventions which are critical to the fight against malnutrition.” Emergency funding is "to respond to a crisis, it is not for prevention and we need that here".
Lack of statistical data to facilitate proper planning and adequately trained staff were the other challenges, Marrato said.
"In all of Djibouti, we have one pediatrician," she said.
Djibouti’s neighbours in the Horn of Africa have large populations and experience frequent conflict; its tiny area and population mean it is often overlooked by donors.
"People look at the Horn and see a small country, in peace and [with] a growing economy, and say Djibouti has no problems," Marrato said.

Possible progress
However, Marrato said she was confident that further progress against malnutrition is possible. "If we continue the way we are today, malnutrition will be under control in 2015 in Djibouti."
A sentiment echoed by Mohamed Aden Ahmed, the medical doctor in charge of nutrition in the Ministry of Health, who said the government was working with partners such as UNICEF to eradicate malnutrition by 2015.
"It is extremely important for the government and the ministry to not only reduce, but eradicate, malnutrition," said Ahmed.
At present, only 70 percent of malnourished children are reached, Ahmed said. "Our aim is to reach 100 percent by 2015."
In 2010, he said, with the help of UNICEF, a community-based surveillance system was established throughout the country. "What this does is alert us to problem areas and enable us to know what the situation of malnutrition is in any given area."
The system involves local communities participating in the fight against malnutrition. "We train them to identify malnourished children and provide them with the medicine and the food they need."
Ahmed said the government had deployed nutrition specialists to all six regions of the country to treat the most vulnerable.
He said the national nutrition surveillance system aims to collect data continuously, to follow up on interventions and to identify problem areas and give early warnings; "basically, it allows us to be proactive instead of reactive".
Through such strong community-based health networks, mass media education and support from partners, "we will achieve our goal of total eradication of malnutrition", said Ahmed.

Reaching more children
According to Aristide Sagbohan, a nutrition specialist for UNICEF, since the introduction of these systems, coverage of malnourished children had improved dramatically.
"Two years ago, we were covering 40 percent of the children in need, now our coverage is over 70 percent," Sagbohan said. "This, in large measure, is due to improvements in the management of therapeutic supplies, such as milk and Plumpy’nut [a high-energy peanut paste]. We have decentralized the storage of supplies where now you have stocks in different regions for easy delivery to where they are needed, instead of coming to Djibouti city."
Another component in the fight against malnutrition is the promotion of infant and young child (younger than five) feeding, which involves educating mothers on better family nutrition.
"At this level, we promote exclusive breastfeeding for the first six months and adequate complementary feeding," said Sagbohan.
Mohamadou Bachir Mbodj, head of UNICEF's child survival and development programme section, said Djibouti had also recorded some success in its maternal and child health programmes.
He said immunization coverage was up to 89 percent via the expanded programme on immunization (EPI), the introduction of new vaccines and campaigns, as well as improving the cold-chain by replacing and maintaining refrigerators to ensure vaccine storage at correct temperatures. Djibouti is also introducing the pneumococcal and pentavalent vaccines.
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