MALNUTRITION: Somalia: Community-based approach addresses acute malnutrition

“So much of this was new to me,” says Khadra Ibrahim. Her tidy home is fashioned from corrugated metal, tins hammered flat and sturdy tree limbs. Her daughters Happy, 2, and Nimo, 4, play outside while she feeds baby Ubah. “I didn’t know how important it was to breastfeed or how just washing my child’s hands with soap can stop illnesses that cause them to become malnourished.”

By Mike Pflanz

BURAO, Somalia, 12 February 2013 – The first year of Ubah Ismail’s life was difficult. At 5 months, she had pneumonia, followed by a severe intestinal upset that left her with diarrhoea for much of her sixth month.

UNICEF reports on an innovative, community-based approach to tackling malnutrition in Burao, Somalia. Watch in RealPlayer

Like hundreds of thousands of other Somali children affected by illness, Ubah lacked adequate complementary food and access to clean water. By the age of 7 months, she required treatment for severe malnutrition.

Addressing malnutrition – permanently

Ubah, who is now a year old, and her mother, Khadra Ibrahim, benefited from an innovative community-based approach to addressing acute malnutrition in Somalia permanently – an approach that goes beyond providing food and medicine to children like Ubah.

The package of treatment and care includes ensuring that more and more families are visited by health volunteers so that children suffering from malnutrition are identified early.

It includes home-based special feeding regimes, as well as enhanced access to oral rehydration salts and zinc, for those children suffering from diarrhoea.

And it includes encouraging mothers to take measures that will drastically reduce the chances that their children will suffer malnutrition again. They are taught the importance of exclusive breastfeeding, appropriate complementary feeding practices and good hygiene. They learn how poor nutrition is often caused by inadequate dietary intake and illnesses that leave the children unable to absorb food.

© UNICEF Somalia/2012/Pflanz

As part of the integrated approach to malnutrition in Burao, central Somaliland, health workers carry out routine checks to monitor children's nutrition status.

The integrated approach was launched because the nutritional status of Somalia’s children deteriorated, following drought in 2010–2011. It was implemented by UNICEF in partnership with Medair and PSI, supported by the Government of Japan, AusAID and the Saudi National Campaign for the Relief of the Somali People.

Health promoters

Aisha Mohamed and her team of 15 volunteers are a major part of the reason that mothers in Burao now know how to prevent malnutrition. Each member of the team is responsible for 15 households, which they visit regularly to keep an eye on younger children and on mothers, especially if they are pregnant.

These ‘health promoters’ hold discussions with mothers individually in their homes and in groups at health centres that focus on infant and young-child feeding and maternal nutrition issues.

One by one, Aisha lists the ways in which women can help themselves. 

“Good antenatal care, including making sure you yourself have good nutrition when you are pregnant,” she starts. “Have your baby in a proper health facility. Breastfeed exclusively for the first six months. Immunize your children. Keep your house clean and wash hands with soap before cooking and eating and after going to the toilet. Keep utensils clean. Purify your drinking water.” 

All of these are simple activities that cost even the poorest families next to nothing, says Zeinab Adan, a midwife who helps manage a major mother and child health centre in Burao town. 

“Breastfeeding is the best example,” she says. She has just held a discussion with 30 new and expecting mothers.  “It is free. It is healthy. Almost any mother can do it, if they learn how from us. It has no disadvantages at all.”

© UNICEF Somalia/2012/Pflanz

Khadra Ibrahim sits with her daughter Ubah in their home. When Ubah was treated for malnutrition, Ms. Ibrahim was taught about such preventive measures as breastfeeding and hand-washing.

Integrating prevention, even during emergencies

In 2010–2011, in response to the drought, Medair, a UNICEF partner in Somaliland, sent teams of health workers far into the countryside each week to seek out children suffering from acute malnutrition. Severely malnourished children were referred to outpatient therapeutic programmes, where mothers brought their children for weekly checks on weight, upper-arm circumference and signs of fever and were given supplies of peanut paste-based therapeutic food.

“This was a normal response to the crisis,” says nutrition manager for Medair in Burao Abdullahi Abdi. “What was different this time was that, even during the emergency phase, we were integrating lessons about preventing malnutrition into our response.”

Those messages reached many women, but there is a great need for them to reach more, Mr. Abdi says.

The integrated approach has been successful, but malnutrition is still a risk in Burao, and still needs monitoring.

At a health centre across town, Fauzia Hashi is among the women and children queuing so the children can be treated for severe acute malnutrition.

Asked if she knows about exclusive breastfeeding, good hygiene at home and immunizing her children against measles, she frowns.

“It’s only when I came here for the first time three weeks ago that I learned about this,” she says. “We need to know more about it – it can save our children from falling sick again.”