MALNUTRITION: India: District hospitals to get 30 nutrition centres

Jun 09, 2011
HYDERABAD: In an attempt to reduce the mortality rate among children suffering from malnutrition and provide them better healthcare, the state government will soon establish 30 Nutrition Rehabilitation Centres (NRCs) in teaching and district hospitals in the state. The government on Wednesday accorded permission for setting up these NRCs in a phased manner by September 30 this year at a cost of Rs 489 crore including Rs 200 crore towards operational costs.
Malnutrition levels among children continues to be a major public health concern. According to National Family Health Survey III, about 34 percent of children under three years of age in Andhra Pradesh are stunted, 13 percent are wasted, and 37 percent are underweight. It is estimated that 3.22 lakh children in the state are suffering from severe acute malnutrition (SAM), a condition associated with high mortality and morbidity that requires specialised treatment and sustained follow-up.
It was also observed that majority of children with SAM suffer silently without access to appropriate treatment.
Hence, the government has decided to establish the NRCs to ensure that every child is born healthy and grows and thrives to realise his/her full potential. The objective is to ensure that children with SAM have access to inpatient treatment.
One NRC with 20 beds each will be established in the paediatrics department of the teaching hospitals at Srikakulam (RIMS), Visakhapatnam, Kakinada, Vijayawada, Guntur, Ongole (RIMS), Tirupati, Anantapur, Kadapa (RIMS), Kurnool, Warangal, Adilabad (RIMS) and� Gandhi Hospital (Hyderabad).
A 20-bedded NRC will be established in� district hospitals at Vizianagaram, Eluru, Nellore, Mahabubnagar, Nalgonda, Sangareddy (Medak district), Tandur (Ranga Reddy district), Karimnagar, Nizamabad and Khammam as integral part of the existing paediatrics dcepartment of these hospitals.
In addition, a 10-bedded NRC will be set up in the area hospitals in the ITDA areas at Paderu (Visakhapatnam), Rampachodavaram (East Godavari), Bhadrachalam (Khammam), Utnoor (Adilabad), Srisailam (Kurnool), Parvathipuram (Vizianagaram) and Seethampet (Srikakulam).
Funds will be provided from the allocations made under National Rural Health Mission (NRHM).
http://ibnlive.in.com/news/district-hospitals-to-get-30-nutrition-centres/157879-60-121.html

MALNUTRITION: NIGER: New approaches needed in tackling malnutrition

NIAMEY, 1 April 2011 (IRIN) -

 Photo: Claire Barrault/ECHO
Traditions around food often mean people do not eat the variety they need (file photo)

 Having experienced a series of droughts and food security crises over the past 40 years, Niger is now looking to move beyond simply countering emergencies, investing instead in development and recovery strategies - and changing gear in its efforts to feed a rapidly expanding, highly vulnerable population.
The need for new approaches in tackling malnutrition and chronic food insecurity has been one of the main themes of the Conférence Internationale sur la Sécurité Alimentaire et Nutritionnelle au Niger (CISAN), a two-day scientific and technical gathering in Niamey.
But is Niger ready to make the necessary changes? The country was at the epicentre of the Sahelian food crisis in 2010. Among those worst affected by the food shortages were children, with NGOs recording dramatic rates of severe acute malnutrition (SAM).
The government recognizes that tackling child malnutrition problems is crucial, and has been running an annual feeding scheme in partnership with the UN Children’s Fund (UNICEF) and the World Food Programme (WFP), targeting children aged 6-23 months. The programme reaches 200,000-300,000 children in a normal year, but the number shot past 600,000 in 2010 as the food crisis took hold.
“The timing is right,” said Guido Cornale, the UNICEF representative in Niger. He stressed that donors would be willing to invest more in nutrition interventions if they realized the country was serious about tackling malnutrition.
Development experts have warned that Niger requires long-term sustainable intervention if it is to avoid facing the same scenarios year in year out. Conference contributors emphasized the need to increase the quantity and quality of food and to secure better access to it, while also raising awareness about hygiene, the importance of a balanced diet and the nutritional value of different kinds of food.

Appeal for more resources
Dr Guero Maimouna from Niger’s Public Health Ministry (MSP) said the country had come through two crises in the past six years and had gained the necessary experience to take on bigger and longer-term interventions.
“But to do that we require resources. We are using our existing resources and money to handle the huge problem that we have at hand… We have a large population of malnourished children every year.”
Everyone is hoping the money that long-term interventions can attract will enable Niger to find sustainable solutions.
“You cannot rely on short-term emergency interventions - which are brought in at great cost - forever,” said Charlotte Dufour of the Food and Agriculture Organization (FAO). She stressed the importance of teaching people to do the best with what they had.

Traditional beliefs hamper progress
Recurring drought and the subsequent decline in agricultural production left Niger without food, but the main causes of malnutrition were traditional beliefs about food that prevented people from eating balanced meals, said Mele Djalo, head of health and social action in the prime minister’s office.
“For example, the Fula people, who live in the Maradi Region, do not eat fish; then we have ethnic groupings which consider chicken dirty; some don’t eat eggs, and so on. Creating awareness across these communities is a very difficult job and it requires resources,” she said.
The MSP’s Maimouna acknowledged that in some parts of Niger rations of fortified corn-soya blend, cooking oil and sugar were an attractive package for a family with no food or income: “They keep bringing their child back sick, as the mothers sell the rations given for the child.”
UNICEF’s Cornale said at the height of the 2010 food crisis they discovered that the monthly ration meant for a child lasted only a week. “We found that the families did not have any food and were consuming the rations.”
If you go to areas where there are no NGOs, there are no efforts under way to treat malnutrition
UNICEF then started a large cash transfer programme in the southwestern Maradi and Tahoua regions, targeting 35,000 households with about $126 each over three months to protect the children’s rations. An independent evaluation found the measure had been effective. “Families used 80 percent of the money to buy food,” Cornale said.
There are no national safety net programmes, but food was subsidized in times of crisis, and some emergency distributions were made.

Blanket feeding?
Conference participants debated whether communities should be trained to treat moderate malnutrition, which has a high incidence and affects almost half the children in some areas. An aid worker pointed out that communities were often unable to handle cases of malaria or even severe diarrhoea.
Stéphane Doyon, head of the Médecins Sans Frontières (MSF) nutrition campaign, said their research had shown it was more effective to provide blanket feeding for all children aged 6-24 months in vulnerable areas as a response to moderate chronic malnutrition, and rather use the limited resources, including personnel, to just treat children with SAM.
The mortality rate in children with moderate chronic malnutrition was 25 percent, while among those with SAM it was 75 percent.
Malam Kanta Issa of Forum Santé Niger (FORSANI), a local NGO comprising medical professionals, said there was a lack of budgetary support for improving health services. “If you go to areas where there are no NGOs, there are no efforts under way to treat malnutrition.” Aid workers pointed out that they had lobbied to get nutrition on the conference agenda.
Nevertheless, infant mortality has been a declining trend, and the UN Millennium Goal to reduce child mortality by two-thirds by 2015 might be the only one Niger is on track to achieve.
“There are 2,100 health posts in this country, which manage malnutrition in the rural areas,” UNICEF’s Cornale noted. “They seem to be doing their work.”


A breeder with cattle in the village of Danganari, 40km from Zinder in Southern Niger


http://www.irinnews.org/report.aspx?reportID=92344

POVERTY: PAKISTAN: Floods uncover evidence of feudalism’s impact on poor

 Photo: OXFAM
Land reform hampered by the fact that many politicians are also landowners

KARACHI, 17 February 2011 (IRIN) - The floods that swept across vast tracts of land from July to September 2010 covered many fields, houses and roads in a sea of swirling water - but they also played a part in exposing the depth of existing poverty and deprivation in Pakistan.
“The malnutrition we are seeing is not new. It has nothing to do with the floods; it is just that we are seeing it now as people come into contact with medical teams,” Shershah Syed, a gynaecologist who has devoted himself to caring for impoverished women requiring care during pregnancy and birth, told IRIN.
Some of the ways in which powerful feudal families - in many cases linked to the political and bureaucratic elite - acted to protect their own interests at the cost of ordinary villagers have been well documented. Feudal overlords have been accused, both in the southern Punjab and in Sindh Province of influencing decisions regarding the diversion of floodwater or the breach of over-flowing dams to protect their own land.
A judicial investigation continues into allegations that in other places protective dykes were breached by wealthy landowners to save their farms, while flooding those of impoverished - and powerless - villagers.
The more subtle ways in which Pakistan’s feudal system works against people, even in times when there is no natural disaster, are beginning to surface only now - in some cases as a result of surveys conducted to assess the plight of flood-affected people.
Vast estates belonging to feudal families stretch out across the country, sometimes covering hundreds of acres. According to the World Bank, about 2 percent of households control more than 45 percent of the total land area. Large farmers have also monopolized subsidies in water and agriculture - with the system in place contributing heavily to rural poverty, the Bank says.

Call for land reform
Throughout Pakistan, millions of peasants are working on land they do not own, giving between half and two-thirds of their crops to landlords. The poor peasants and landless agricultural workers are exploited in many ways
“In a country where about half the workforce is engaged in agriculture, the key to improving lives is an end of feudalism by implementing effective land reforms. No one should own more than 12 acres [4.86 hectares] of agriculture land,” Farooq Tariq, spokesman for the Labour Party of Pakistan, told IRIN.
“Throughout Pakistan, millions of peasants are working on land they do not own, giving between half and two-thirds of their crops to landlords. The poor peasants and landless agricultural workers are exploited in many ways. Workers often end up tied to the land, after taking a loan from a landowner and offering to pay it back by working. Sometimes whole families end up in this type of debt bondage, working to pay off a loan on which the interest keeps accumulating. This system is one of the many ways that ties the peasants to absolute poverty,” he said.
Historically speaking, land reform has been held back by the fact that many parliamentarians are themselves big landowners, and as such are unwilling to initiate a re-division of land.

Nutritional crisis
The impact of feudalism, and the poverty it gives rise to, is poorly documented, but six months after the most devastating floods in the country’s history, with Sindh Province worst hit, a provincial government report based on a survey conducted with UN Children’s Fund (UNICEF) support, has revealed a grave nutritional crisis. The survey has found a global acute malnutrition (GAM) rate of 23.1 percent in children aged 6-59 months in flood-affected areas of northern Sindh and 21.2 percent in southern Sindh - rates above the World Health Organization’s 15 percent emergency threshold level.
A severe acute malnutrition (SAM) rate of 6.1 has also been uncovered in northern Sindh, with the Sindh government estimating about 90,000 under-five children are malnourished.
According to UNICEF, SAM is an advanced state of acute malnutrition. Children with SAM need immediate treatment and are 10 times more likely than healthy children to die before they reach their fifth birthday. The survey also found high levels of malnutrition among women.
Experts working in the field, however, believe this situation is a product of entrenched deprivation, rather than floods.
"The malnutrition [revealed by the survey] was not caused by floods but by poverty; the majority of IDPs [internally displaced persons] in camps are from the lowest quintile of poverty", Andro Shilakadze, a senior UNICEF field officer in Sindh, told IRIN.
“The women of Sindh have suffered like this for thousands of years due to the feudal system in the province, and of course the mother’s health affects the child,” said gynaecologist Syed, who has performed life-saving operations in the most primitive conditions across flood-hit parts of Sindh and also runs a flood-relief camp.
“It is simple actually. Women work hard in the fields and in their homes. They receive only what is left of the food after the rest of the family has eaten. Men are served first, then the children and then the women last of all,” he added.
“It has always been like this. We women eat last, because we are least important,” Sumundri Bibi, an emaciated mother of six, told IRIN at a flood-relief camp in the southern Sindh town of Thatta.
“This is a patriarchal culture. Women suffer due to it,” Syed said.
James King’ori, nutrition cluster coordinator for UNICEF, told IRIN from Islamabad: “Women, particularly of child-bearing age (15-49), have an increased nutritional requirement to not only maintain their body growth, enable daily chore undertaking but also to support pregnancy and breastfeeding of infants. Addressing poverty in a strategic manner to benefit women is key,” he said.
But this seems unlikely to happen until there is a break from the system of uneven land ownership, and the exploitation that comes with it. “Ownership of land can quickly break the poverty cycle. We have seen examples of this in places where tenant farmers have taken control of land,” Tariq said.
“I know nothing about land ownership - just that we struggle to feed our children, and eat less ourselves so they have more on their plates,” Sumundri said.
Http://www.irinnews.org/report.aspx?ReportID=91952

MALNUTRITION: Niger: UNICEF-supported health centres

 04 Jan 2011 :  Joëlle Onimus-Pfortner
Seeking shade from the scorching midday heat, a small crowd of mothers who have brought their children in for malnutrition screening gather at the public health centre in Niger's south-central Maradi Region.
"I heard the health centre here treated children for malnutrition, so I brought my grandson Adamou. His mother died eight months ago and I take care of him now," says Hadiza, one of the many women gathered at the centre.
Hadiza has travelled 20 km to get treatment for two-year-old Adamou. Weighing less than six kilograms, he has already lost three brothers. One in four children dies before his or her fifth birthday in Niger, and malnutrition is often an underlying cause.

Sharing information
The centre at Takieta is one of 822 therapeutic feeding centres located throughout Niger. In 2010, more than 318,000 children under the age of five were admitted to these centres with severe acute malnutrition.
Despite an above-average harvest in 2010, admission rates to Niger's therapeutic feeding centres remain very high, at around 5,000 per week. This figure highlights the importance of the treatment approach at centres like the one at Takieta, where families learn how to treat and prevent malnutrition – and how to seek timely health care for their children when they see warning signs such as fever, weight loss or respiratory infections.
This year, a malaria epidemic sent a large number of children to the nutrition centres. The three huts in the courtyard of the Takieta facility represent its three-step process for malnutrition treatment. At each step, sharing information with mothers and other caregivers is key.

Screened for malnutrition
To begin with, mothers are advised of simple hygiene and nutrition practices that can significantly reduce malnutrition at home, such as washing hands with soap and practicing exclusive breastfeeding during the first six months of an infant's life.
Next, children are measured for height and weight, or for upper arm circumference, to screen for malnutrition. During the medical examination, the child receives routine medication such as vitamin A and folic acid supplementation, as well as deworming treatment.
Finally, in the third hut, food is distributed. It is here, that Zeinabou Moussa, a dedicated health and social worker, gives mothers a weekly ration of either Plumpy'nut, a high-energy peanut paste for children suffering from severe acute malnutrition, or a corn-soya blend that is used to treat moderate acute malnutrition.
A crucial role
"This food is for this child only," Ms. Moussa explains to one of the mothers. "If you share it among other members of the family, he will not get well."
A mother of six named Zouhera has come to the centre with her daughter Aichatou to receive treatment for the fourth week running. She nods attentively as she listens to the instructions. "Everyone understands that Aichatou is sick and needs more attention," she says.
UNICEF plays a crucial role in the fight against severe acute malnutrition in Niger. With the support of its donors and partners, including the European Union, UNICEF provides the government and non-governmental organizations with therapeutic foods, essential drugs, equipment and capacity-building assistance. Needs have increased with the nutrition crisis here, and providing supplies on time is critically important.
http://wwww.reliefweb.int/rw/rwb.nsf/db900sid/KKAA-8CT55U?OpenDocument

MALNUTRITION: The government of Niger and its partners determined to continue their efforts against child malnutrition in Niger

Angeline Fox: 4 January 2011
NIAMEY, NIGER,- Despite a good harvest and pastoral season in late 2010, the nutritional situation of children remains alarming in Niger where more than 15 children in 100 suffer from acute malnutrition, according to the results of the National Nutrition Survey made public on 16 December. The Niger government, UNICEF and the World Food Programme (WFP) called on the international community to intensify its efforts and mobilize all means necessary to fight against child malnutrition and its structural causes to sustainably meet the needs of the most vulnerable children.
The prevalence of global acute malnutrition (GAM) among children under five years of age in Niger decreased from 16.7 per cent to 15.5 per cent between June and November 2010, but it remains above the emergency threshold of 15 per cent – and this for five of the country’s eight regions.
The situation remains worrisome for children aged six to 23 months. More than a quarter of them are affected by this form of malnutrition.
And severe acute malnutrition (SAM), which dramatically increases the risk of death for the under-five age group, has impacted 7 per cent of children in the under-two year age category, and is present in 3.2 per cent among the under-five group, according to the findings of this new survey.
These figures reveal not only the severity of the food and nutrition crisis experienced by Niger in 2010, but also the speed and quality of the response implemented by the government and its partners. Between 1 January and 5 December 2010, 313,000 children under five suffering from SAM received care though public health facilities supported by UNICEF and nongovernmental organizations (NGOs). Some 38,000 children were hospitalized and 275,000 received outpatient treatment. These numbers represent one-fifth of all children treated for SAM worldwide.
In addition, the government, WFP, UNICEF and NGOs helped 686,000 children under two to receive adapted food rations between July and December 2010 as part of Blanket Feeding operations to prevent malnutrition among children living in 38 food-insecure districts -Niger is made up of 42 districts.
“The magnitude of resources used and efforts made by all humanitarian actors and donors have saved the lives of tens of thousands of children,” said Guido Cornale, UNICEF Representative in Niger. “This mobilization has stabilized the nutritional status of children, but this is far from enough.”
“Each week, thousands of sick children continue coming to health centres, demonstrating once again that we must resolutely confront the underlying causes of malnutrition in Niger.”
According to the government of Niger and its UN and NGOs partners, a consolidation of resources and measures for preventing and treating child malnutrition is crucial at this point. Structural policies in the areas of health, education, social welfare, agriculture, and food security must be applied quickly to avoid the disastrous consequences of climatic shocks on people in the Sahel, who are highly vulnerable to crises and epidemics.
According to Richard Verbeeck, WFP Representative in Niger, the results of this survey show that the response has been appropriate. “Without the concerted actions of the humanitarian community and the government of Niger, malnutrition rates would have been disastrous,” he said. “The battle against malnutrition is far from over and we must continue our efforts for a permanent and lasting solution to this problem,” Mr. Verbeeck concluded.
http://www.iewy.com/13116-the-government-of-niger-and-its-partners-determined-to-continue-their-efforts-against-child-malnutrition-in-niger-2.html

MALNUTRITION: UNICEF-supported health centres combat malnutrition in Niger

By Joëlle Onimus-Pfortner



  © UNICEF Niger/2010/Pirozzi : An upper arm measuring tape is used to assess malnutrition levels at the Intensive Nutritional Rehabilitation Centre located 50 km from Maradi, Niger.

TAKIETA, Niger, 4 January 2011 – Seeking shade from the scorching midday heat, a small crowd of mothers who have brought their children in for malnutrition screening gather at the public health centre in Niger’s south-central Maradi Region.
“I heard the health centre here treated children for malnutrition, so I brought my grandson Adamou. His mother died eight months ago and I take care of him now,” says Hadiza, one of the many women gathered at the centre.
Hadiza has travelled 20 km to get treatment for two-year-old Adamou. Weighing less than six kilograms, he has already lost three brothers. One in four children dies before his or her fifth birthday in Niger, and malnutrition is often an underlying cause.
Sharing information
The centre at Takieta is one of 822 therapeutic feeding centres located throughout Niger. In 2010, more than 318,000 children under the age of five were admitted to these centres with severe acute malnutrition.

   UNICEF Niger/2010/Pirozzi : In Niger, a mother feeds her severely malnourished child Plumpy'nut, a therapeutic food paste, at the Intensive Nutritional Rehabilitation Centre supported by UNICEF and managed by MSF Belgium.
Despite an above-average harvest in 2010, admission rates to Niger’s therapeutic feeding centres remain very high, at around 5,000 per week. This figure highlights the importance of the treatment approach at centres like the one at Takieta, where families learn how to treat and prevent malnutrition – and how to seek timely health care for their children when they see warning signs such as fever, weight loss or respiratory infections.
This year, a malaria epidemic sent a large number of children to the nutrition centres. The three huts in the courtyard of the Takieta facility represent its three-step process for malnutrition treatment. At each step, sharing information with mothers and other caregivers is key.

Screened for malnutrition
To begin with, mothers are advised of simple hygiene and nutrition practices that can significantly reduce malnutrition at home, such as washing hands with soap and practicing exclusive breastfeeding during the first six months of an infant’s life.
  © UNICEF Niger/2010/Pirozzi :  A mother holds her child at the Intensive Nutritional Rehabilitation Centre, which treats undernourished children in Niger.

Next, children are measured for height and weight, or for upper arm circumference, to screen for malnutrition. During the medical examination, the child receives routine medication such as vitamin A and folic acid supplementation, as well as deworming treatment.
Finally, in the third hut, food is distributed. It is here, that Zeinabou Moussa, a dedicated health and social worker, gives mothers a weekly ration of either Plumpy’nut, a high-energy peanut paste for children suffering from severe acute malnutrition, or a corn-soya blend that is used to treat moderate acute malnutrition.

A crucial role
“This food is for this child only,” Ms. Moussa explains to one of the mothers. “If you share it among other members of the family, he will not get well.”
A mother of six named Zouhera has come to the centre with her daughter Aichatou to receive treatment for the fourth week running. She nods attentively as she listens to the instructions. “Everyone understands that Aichatou is sick and needs more attention,” she says.
UNICEF plays a crucial role in the fight against severe acute malnutrition in Niger. With the support of its donors and partners, including the European Union, UNICEF provides the government and non-governmental organizations with therapeutic foods, essential drugs, equipment and capacity-building assistance. Needs have increased with the nutrition crisis here, and providing supplies on time is critically important.
http://www.unicef.org/infobycountry/niger_57340.html

MALNUTRITION: Mumbai slum children facing acute malnutrition

File photo: Paul Noronha

Malnutrition, illness and abject poverty have taken a severe toll on children in Mumbai's Rafiq Nagar slum. Situated in a vast dumping ground, swarming with flies, and packed with garbage heaps at every step, the destitute colony has seen a series of child deaths since April this year, even as authorities scramble to ascertain their causes.
The infant, Asif Sheikh, from Rafiq Nagar slum died on Tuesday. His death comes less than a week after one-and-a-half-year-old Sahil Sheikh lost his life in the same slum. Sahil was not able to digest his food properly, officials of the Integrated Child Development Services (ICDS) told The Hindu.
The ICDS ward office has asked for data from the organisation Apna Le, which has been keeping a record of child deaths and malnutrition in 650 houses in the area for the past five years.
The Apna Le volunteers have recorded 18 deaths since April of which 10 have been due to malnutrition, said Pushpa Adhikari. There are 429 children in the age group of zero to 5. Of those who have been weighed so far, 25 were found to be in the acute stage, 80 fell in the moderately underweight stage and 143 were normal.
Najmunisa's four children are in varying stages of malnutrition. Her two-year-old son Mohammad Ahmed falls in the acute stage, weighing only 6 kg instead of the required 8 kg. Her six-day-old daughter weighs 2.5 kg, about 1/2 kg less than the average weight.
The pale Najmunisa is herself has a low blood count of 9.5, due to which she cannot undergo family planning operation.
It's the same story in Asma Sheik's house and practically every other house in Rafiq Nagar. Many of the residents here are migrants, eking out a living as garbage-pickers for which they erratically earn around Rs.3,000 a month.
“During the monsoon there is no work, so we have to take loans to survive,” said Najmunisa. Of the meagre earnings, a large amount is spent on water, which costs about Rs.40 a drum. Large families subsist on one drum for two days. Asma's house of five children, for instance, uses the same water for drinking and cooking.
“There are times when for eight days there is no water tanker. So there is no water to cook food,” said an ICDS staff. The extreme squalor gives rise to a host of diseases against which the children of Rafiq Nagar completely lack immunity.
Mothers reported that municipal schools refused to admit their wards either without birth certificates or summarily. Due to this, many cannot avail of the mid-day meals they are entitled to.
The Apna Le, which provides food for 250 children daily, hit out at the lackadaisical approach of government agencies. “We cannot blame the anganwadi teachers; they simply don't have the tools – the weighing scales, the cards to track malnutrition. Workers don't come to weigh the children every month. Two years ago, in reply to an RTI application, the ICDS said, there was not a single malnourished child in this area. In anganwadis, no record of beneficiaries is kept. The ICDS is a good scheme, but its implementation is poor,” said Ms. Adhikari.
According to the ICDS data, in Shivajinagar area, in which Rafiq Nagar falls, 915 children between zero to five years had severe underweight problem in the month of October this year. A climb down from 1,113 children in the same category in September.
The number of children who are moderately underweight rose from 1,982 in September to 2,122 in October. The ICDS has recorded 12 deaths in Shivajinagar, of which two were due to malnutrition, six still births and the rest were due to illness, ICDS staff said.
“Migration and demolitions [severely affect the growth of the children]. Their immunity is very low. There is no gap between the children. Anganwadi gives only one meal, but that is not enough,” the ICDS workers said.
Rafiq Nagar is part of a 900-acre dumping ground, which stretches over many other slum colonies. “It's an encroached property. How can the civic body provide any services? Do they pay taxes? They come here because in Mumbai they can at least get two square meals,” said a civic official.
http://www.thehindu.com/news/article954719.ece

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."

MALNUTRITION: Niger: Red Cross volunteers make vital contribution in the fight against malnutrition

6 August 2010
Moussa Maliki is 42, but looks younger than his age. Despite his casual appearance, his eyes are alive, full of energy. A volunteer with the Red Cross Society of Niger since 1986, a few days ago he started working at the health centre in Goudel in the suburbs of Niger’s capital, Niamey. The centre is supported by the French Red Cross and the International Federation of Red Cross and Red Crescent Societies (IFRC).Every morning, he travels the ten or so kilometres to get to his new place of work. From morning to evening, Moussa only enjoys a brief respite. He oversees a team of volunteers who work tirelessly to save hundreds of malnourished children who come each day with their mothers for a consultation at the health centre.Sometimes, he fills in a referral form and sometimes he screens the children by measuring their nutritional status through a tape that goes around their left forearm. The bracelet is divided into three parts to indicate the severity of malnutrition. The red zone indicates severe malnutrition, the yellow zone shows moderate malnutrition and the green indicates that the child is well fed.Increased malnutritionMoussa Maliki is one of 400 volunteers the Nigerien Red Cross has trained, with the support of the IFRC, to combat malnutrition in the outskirts of Niamey and in the Dosso region. These areas have little food due to poor harvests last year. The result is that malnutrition among children is increasing. The situation is also exacerbated by the fact that many farming families have fled the harsh life and risk of starvation in rural villages and have come to settle in the outskirts of the capital.“66 per cent of the children we see each day are malnourished,” says Nana Barira Moustapha, welfare officer at the health centre in Goudel. According to a national survey published by the Nigerien government, nearly 17 per cent of children under five in Niger are suffering from acute malnutrition, an increase of 42 per cent over the same period last year.“Most families here do not have resources to meet minimum daily food requirements and it is children who suffer first,” says Moussa Maliki.Screening and managementMalnutrition is so widespread that some families do not immediately notice their child’s weight loss. Hundreds of volunteers from the Niger Red Cross criss-cross neighbourhoods looking for signs of malnutrition among children and asking them to return to the health centre. They also educate families about the best feeding practices for children through nutrition education.“Children with severe malnutrition are referred to health centres where they receive adequate care and food rations,” says Moussa.In July, when the temperature exceeds 40 degrees, Moussa continues to move back and forth between the unit and the courtyard of the nutritional health centre where women patiently wait their turn.He takes Mohammed Nazir, a 15-month-old boy, to be weighed. The results aren’t positive. Mohammed is in the red zone. His severe malnutrition is confirmed when the needle on the scales stops at 6 kg – extremely low for his height of 77 cm.“This is the latest in a long line of serious cases of malnutrition this morning,” says Moussa.Mohammed’s mother tests her son’s appetite by trying to get him to swallow a sachet of food therapy. After first rejecting it, Mohammed eventually swallows it, bringing a smile not only to his mother’s face, but also to Moussa’s.
http://www.blogger.com/post-create.g?blogID=3604033512937490051

MALNUTRITION: video with commentary

Excellent video and discussion based on photo-jouranists' work across the world, with commentary by MSF experts.
http://www.pbs.org/wnet/need-to-know/video/malnutrition-the-silent-epidemic/2305/

POVERTY: Malaysia's 'forgotten' tribes face poverty, hunger

Jul 17, 2010
KAMPUNG BERTANG LAMA, Malaysia — Just a few hours from the glittering Malaysian capital is a pitiful scene of hungry children and desperate parents, in an indigenous village home to the "forgotten Malaysians".
Naked youngsters with the tell-tale signs of malnourishment -- bulging stomachs and brown tinged hair -- sit listlessly in a hut, while others cling to their mothers as they suckle milk.
Welcome to Bertang Lama village, home of some of Malaysia's Semai people, an indigenous tribe mired in poverty and struggling to adapt as the multicultural nation races towards modernity.
The village, which houses about 300 people, is located close to Cheroh, a small town in central Pahang that sits along the Titiwangsa mountains which form the backbone of Peninsula Malaysia.
The Semai, once nomadic but now largely settled, are seeking recognition of their traditional land rights as well as basic needs -- piped water, electricity, medicine, education and tarred roads.
There is little food in the village where families live a subsistence life, hunting and gathering to trade in jungle products like rattan and agarwood.
Neither is there much money, as the forest they depend on is fast being depleted of its resources thanks to deforestation caused by logging, and the rapid expansion of rubber and palm oil plantations.
There are an estimated 45,000 Semai in Peninsula Malaysia, among some 150,000 indigenous people divided among 19 linguistic groups who live on the country's mainland.
Colin Nicholas, coordinator of the Centre for Orang Asli Concerns, said the people of Bertang Lama and others like them have become "the forgotten and invisible Malaysians".
Nicholas said the Semai played a valuable role in the British offensive against communist insurgents in the 1950s due to their stealth and tracking skills, but are now seen as irrelevant.
"Come elections, ruling party politicians make promises in exchange for votes but after that they renege on their words. Because of their small population, they are easily ignored by the government," he told AFP.
"The indigenous people have been pushed to the brink. Their situation will only get worse. After nearly 53 years of independence, the government is in a state of denial."
Not all Semai or Orang Asli people are impoverished, and some communities, particularly those located closer to urban infrastructure, have done much better in terms of education, employment and health.
But the plight of Bertang Lama village was highlighted when Lim Ka Ea, an executive officer with the Malaysian Bar Council visited recently and recounted her shock at the scene there in a newspaper article.
"The Orang Asli have been regarded as invisible by many people," she told AFP.
"What we do see in them is their 'primitive' form of lifestyle and the entrenched stereotype that they serve no purpose to the advancement of our nation except to make our tourism advertisements look exotic and attractive."
In the village, 11-year-old Jolisa returns home from the forest, armed with a machete and a bamboo basket on her back as she skips along with three other barefoot friends.
"We went looking for wild vegetables," she says.
"Yes I would like to go to school if there was one in our village," she replies with a smile to a visitor's question.
Nearby, inside a dilapidated hut, a naked two-year-old child with mucus dripping from his nose and an expressionless face holds a bowl containing only mashed tapioca, a flavorless starch, for his breakfast.
The chidren are mostly illiterate, and mostly hungry as their families can only provide them with vegetables and tapioca sourced from the jungle.
The village is located just 11 kilometers (seven miles) from a main road but it is a tedious drive along an unsealed logging track.
"We sell rattan, bamboo and agarwood sourced from the forest. But it is hard to find them now," says Yoke Ham, a 47-year-old father of 12 children who says his ancestors settled here hundreds of years ago.
"The average income per month is less than 300 ringgit (94 dollars)," he adds, as cryng babies drown out the chirp of insects.
Prime Minister Najib Razak, who is striving for Malaysia to achieve developed-nation status by 2020, earlier this month assured all Malaysians that no one will be left behind.
"I promise you, as prime minister I will be fair to everybody. We will help all communities to move forward. We will make Malaysia a high-income country," he said.
But the lofty goals mean little to Robina, who looks in her thirties but does not know her age. She holds her sick three-year-old daughter, Sinar, on her lap and appeals for help as tears roll down her face.
"My child has a fever. I have no money to buy food and rice for her," she says. "We have not had our breakfast yet. Life is difficult."
http://www.google.com/hostednews/afp/article/ALeqM5iGsP44klvLRbmyq1E5fRxJ-LIr8Q

General: MSF video of activities July 2010

Haiti, sub-Sahara, Kyrgyzstan
http://www.msf.ca/news-media/video/

MALNUTRITION: People think malnutrition is normal

NIGER: A crisis, not (yet) a catastrophe MOGHEM, TAHOUA REGION,
13 August 2010 (IRIN) - Although Niger is facing a severe food crisis, early large-scale responses have so far helped prevent a rapid deterioration in the nutritional state of children. "We managed to avoid the worst until now," said the coordinator of Niger's early warning system, Harouna Hamani. "Even though the population is suffering and rates of malnutrition are very high, it could have been catastrophic without early interventions." Almost 17 percent of under-five children are malnourished [http://www.irinnews.org/Report.aspx?ReportId=89657] and nearly half of Niger's 15.2 million people are at risk of hunger after harvests failed in 2009, the government said. [http://www.irinnews.org/Report.aspx?ReportId=89598] Distributions of fortified flour, oil and sugar to children under two years old, backed by the UN and several NGOs, have been taking place since May in areas where rates of acute malnutrition are above the emergency threshold of 15 percent set by the World Health Organization (WHO). The supplementary rations are meant to prevent more children from becoming malnourished, said Rachid Boumnijel, Tahoua's food security manager for Irish NGO Concern in Tahoua region, central Niger.The NGO has also focused on strengthening the capacity of 10,000 families to cope with the crisis and feed their children by giving them cash and, in some cases, seeds, and on treating malnutrition. [http://www.irinnews.org/report.aspx?ReportId=89499] Since April, Concern's team of 330 volunteers has been dispatched to villages in Tahoua and Illela departments, in Tahoua region, to find children with signs of malnutrition and refer them to the nearest medical facility. "We started as soon as we saw that the situation was going to be difficult," said Boumnijel. "Our goal was to limit the number of cases of severely malnourished children, and we have been able to keep the situation under control." The organization has been supporting the treatment of acute malnutrition in several health centres, and a recent survey indicated that prevalence of this condition in the area Concern covers is now below WHO's emergency threshold. "The situation this year is much worse than in 2005, but the response is much better," said Eric-Alain Ategbo, nutrition manager at the UN Children's Fund (UNICEF). [http://www.irinnews.org/Report.aspx?ReportId=88958] "Since then, efforts have been made to increase the capacity of national structures. Now Niger is one of the countries on the continent with the highest number of facilities for the treatment of malnutrition." Clinics have treated nearly 150,000 severely malnourished children since the beginning of 2010, and 6,000 to 7,000 new cases are reported every week, according to the UN. Variable access and quality Yet this positive picture is not always consistent, nor is access to quality healthcare and assistance. Saratou Mahamadou had to walk for half a day with severely malnourished 16-month-old Rachida on her back to reach the health centre in Moghem village, in Tahoua region. "Only 44 percent of the population lives within a distance of 10 km or less from a health centre," said Adamou Oussemi, regional director of public health in Tahoua. [http://www.irinnews.org/Report.aspx?ReportId=89393] He noted that outreach efforts in districts not supported by an NGO were inadequate. "The number of cases increases when there is a partner [organization supporting the public structures], since an active identification [of malnourished children] takes place. Elsewhere, children may die at home - if they don't come to the hospital, we have no way of knowing." UNICEF's public health consultant in Tahoua, Pacifique Kitanina Fuoto, said more than a third of the region's health centres were not receiving such support and had limited capacity. [http://www.irinnews.org/report.aspx?ReportId=88541] Pockets of insecurity are also limiting the ability of NGOs to assess and respond to needs, said Modibo Traoré, head of the Office for the Coordination of Humanitarian Affairs in Niger. "Movements are limited in northern Tahoua, Tillaberi and Agadez regions. Areas may be left out, which has an impact on the quality of care offered." Underestimations by the government and the UN mean not all disadvantaged infants received supplementary rations, but the number of children has now been revised from half a million to more than 900,000, said UNICEF's Ategbo. In Bagga village, home to 5,000 people, only 100 of the many children in need of help received the ration. "In the end, we had to do a draw to select them," said its chief, Idrissa Dayabou. Difficult months ahead Tahoua Public Health director Oussemi warned that the situation could worsen, as malnutrition usually peaked in August and September, before the harvest. The start of the rainy season - when families begin planting - could lead to a deterioration of the nutritional state of children, because parents were likely to wait for longer before seeking medical care, said Manuel Lopez Iglesias, head of mission at Médecins Sans Frontières-Spain, which works in two departments in Tahoua. "People think malnutrition is normal and tend to wait until a child is really sick," he said. "We have to push people to go to health centres, especially when they are busy cultivating their fields."

MALNUTRITION: Childhood Malnutrition & Elderly Brains

ANN ARBOR, MI (Michigan Radio) - A new Michigan State University study found diminished brain function later in life has its roots in childhood. Childhood malnutrition has long been linked to high mortality rates and life-long physical health problems. But little attention has been paid to long-term effects on brain development and function. Researchers studied more than 15 thousand elderly people in China. They found men who suffered from childhood hunger were 29% more likely to have cognitive impairment. Women were 35% more likely to have impaired brain function. MSU researchers say their findings could be very important to the developing world, where an estimated 178 million children under the age of 5 suffer from chronic malnutrition. The study appears in the journal Social Science & Medicine
http://www.publicbroadcasting.net/michigan/news.newsmain/article/7/0/1670644/Education/Childhood.Malnutrition..and..Elderly.Brains

POVERTY: India rethinks a food safety net

JHABUA, India - Inside the drab district hospital, where dogs patter down the corridors, sniffing for food, Ratan Bhuria's children are curled together in the malnutrition ward, hovering at the edge of starvation. His daughter, Nani, is 4 and weighs 20 pounds. His son, Jogdiya, is 2 and weighs only 8.
Landless and illiterate, drowned by debt, Bhuria and his ailing children have staggered into the hospital ward after falling through India's social safety net. They should receive subsidized government food and cooking fuel. They do not. The older children should be enrolled in school and receiving a free daily lunch. They are not. And they are hardly alone: India's eight poorest states have more people in poverty - an estimated 421 million - than Africa's 26 poorest nations, one study recently reported.
For the governing Indian National Congress Party, which has staked its political fortunes on appealing to the poor, this persistent inability to make government work for people like Bhuria has set off an ideological debate over a question that once would have been unthinkable in India: Should the country begin to unshackle the poor from the inefficient, decades-old government food distribution system and try something radical, like simply giving out food coupons, or cash?
The rethinking is being prodded by a potentially sweeping proposal that has divided the Congress Party. Its president, Sonia Gandhi, is pushing to create a constitutional right to food and expand the existing entitlement so that every Indian family would qualify for a monthly 77-pound bag of grain, sugar and kerosene. Such entitlements have helped the Congress Party win votes, especially in rural areas.
To Gandhi and many left-leaning social allies, making food a universal right would ensure that people like Bhuria are not deprived. But many economists and market advocates within the Congress Party believe the delivery system needs to be dismantled, not expanded; they argue that handing out vouchers would liberate the poor from an unwieldy government apparatus and let them buy what they please, where they please.
"The question is whether there is a role for the market in the delivery of social programs," said Bharat Ramaswami, a rural economist at the Indian Statistical Institute. "This is a big issue: Can you harness the market?"
India's ability, or inability, in coming decades to improve the lives of the poor will very likely determine if it becomes a global economic power, and a regional rival to China, or if it continues to be compared with Africa in poverty surveys.
India vanquished food shortages during the 1960s with the Green Revolution, which introduced high-yield grains and fertilizers and expanded irrigation, and the country has had one of the world's fastest-growing economies during the past decade. But its poverty and hunger indexes remain dismal, with roughly 42 percent of all Indian children younger than 5 being underweight.
The food system has existed for more than half a century and has become riddled with corruption and inefficiency. Studies show that 70 percent of a roughly $12 billion budget is wasted, stolen or absorbed by bureaucratic and transportation costs. Gandhi's proposal, still far from becoming law, has been scaled back, for now, so that universal eligibility would initially be introduced only in the country's 200 poorest districts, including here in Jhabua, at the western edge of the state of Madhya Pradesh.
With some of the highest levels of poverty and child malnutrition in the world, Madhya Pradesh underscores the need for change in the food system. Earlier this year, the official overseeing the state's child development programs was arrested on charges of stealing money. In Jhabua, local news media recently reported a spate of child deaths linked to malnutrition in several villages. Investigators later discovered 3,500 fake food ration booklets in the district, believed to have been issued by low-level officials for themselves and their friends.
Inside the district hospital, Bhuria said he had applied three times for a food ration card, but the clerk had failed to produce one.
"Every time he would say, 'We will do it, we will do it,"' Bhuria recalled. "But he never did."
A farmer, Bhuria fell into deep debt six years ago after he mortgaged his land for a loan of 150,000 rupees, or about $3,200. Like most people in the district, Bhuria is a Bhil, a member of a minority group whose customs call for the family of the groom to pay a "bride price" before a wedding. Bhuria spent most of his loan on his brother's wedding and was left landless, yet he and his wife kept having children. They now have six.
He and his wife migrated with their children to work as day laborers in the neighboring state of Gujarat. Working in Gujarat is common for farmers from Jhabua, but since none can use their ration booklets outside their home villages, they struggle to feed their families. When migrants returned to plant their fields in July, the malnutrition wards began to fill up at the district hospital.
"This is a cycle," said Dr. I.S. Chauhan, who oversees the wards. "The mother is also malnourished. And they are migrant workers. They work all day and can't care for their children."
Moneylenders are common across rural India, often providing loans at extortionate rates. Some farmers hand over food booklets as collateral. Sitting in a small shop, Salim Khan said people approach him for loans when a child is sick or if they need cash to travel for migrant work.
"Until they repay me," he said, "I keep their ration card."
He uses the cards to buy grain at government Fair Price Shops at the subsidized rate of about 2 rupees, or 4 cents, a kilogram. He resells it on the open market for six times as much. The margin represents interest on the loan. He has held the ration cards of some migrants for seven years. "Sometimes I'll have 50 cards," he said. "Sometimes I'll have 100 or 150. It's not just me. Other lenders do this, too."
He said he was willing to lend slightly more money to the most destitute because their yellow ration booklets made him eligible for the full 77 pounds of grain, the most available in a tiered rationing system. "The yellow ones are best for me," he said.
This is just one of the illegalities that permeate the system, according to people in Jhabua. Bribery is also common; government inspectors are known to extort monthly payments from the clerks who sell the subsidized grain. Some clerks pay small bribes to local officials to get their jobs or keep them. In turn, moneylenders slip money to clerks to let them use the ration cards to collect the subsidized grain, sugar and fuel.

In a cavernous government warehouse, bags of grain are stacked almost 15 feet high, awaiting trucks to carry loads to different Fair Price Shops. R.K. Pandey, the manager, blamed local men for the persistent malnutrition in the district, saying they often sell the subsidized wheat on the open market and buy alcohol. He also noted that the Bhil population favored corn, not wheat, so besides buying alcohol, they also sell the grain to buy corn.

Efforts are under way to reform the national system. Officials in the state of Chhattisgarh have curbed corruption by tracking grain shipments on computers, so that officials cannot steal and resell it.
Many social advocates, suspicious of market solutions, say that such reforms prove that the system can be improved. But pro-market advocates say that issuing either food coupons or direct payments would circumvent much of the corruption and allow recipients more mobility and freedom of choice. They point to the eventual creation of a new national identity system - in which every person will have a number - as a tool that can make such direct benefits possible.

These sorts of debates seem like abstractions in much of Jhabua, where poverty and hunger are twinned. At the malnutrition ward, Chauhan said that Jogdiya, the tiny 2-year-old, had pneumonia, diarrhea and possibly tuberculosis. His health had been steadily deteriorating in recent weeks, but his father, Bhuria, had no money for either food or medicine. He had gone to Gujarat in mid-July in search of migrant work but then quickly returned after Jogdiya and Nani became sicker. A relative had warned him not to go, saying his children were too sick.
But he had felt he had no choice. "We didn't have anything to eat," he had said.
http://www.printthis.clickability.com/pt/cpt?action=cpt&title=With+many+starving%2C+India+rethinks+a+food+safety+net+-+Hawaii+News+-+Staradvertiser.com&expire=&urlID=433213687&fb=Y&url=http%3A%2F%2Fwww.staradvertiser.com%2Fnews%2Fnyt%2F20100810_With_many_starving_India_rethinks_a_food_safety_net.html&partnerID=651569&cid=100249119

MALNUTRITION: Afghanistan, Merlin

Merlin has launched a nutrition programme in Afghanistan to help tackle the shockingly high rates of mother and child deaths in the country.
This month, we are delivering 100 metric tonnes of nutrient-rich food to malnourished women and children, and a further 15 tonnes of therapeutic food and equipment to treat severe acute malnutrition in the north-east of the country.
Dr U Aye Maung, Merlin's Country Health Director in Afghanistan, says:
"A third of children under five in the country are underweight, and more than half of all children are suffering from chronic malnutrition. Caused by a combination of poverty and past droughts, it is a serious health problem here with our teams seeing an increasing number of malnourished children."
As a major factor of mother and child deaths, we are targeting under-served populations including children under five, women, and pregnant and lactating mothers.
The programme, operating in Kunduz and Badakhshan provinces, is taking a holistic approach to the problem, using both static and mobile clinics, as well as working to include nutrition as a core component of health services in Afghanistan.
Ben Mascall, Afghanistan Country Director, says:
"Based on our experience of tackling malnutrition in other Asian countries, Merlin health staff are working hard to ensure the same success is repeated here and we can save the lives of as many children and mothers as possible."
In Kunduz province, we are screening and treating malnutrition in over 40 health facilities, as well as establishing 12 supplementary feeding centres and training female community health workers to address issues such as breastfeeding.
In Badakhshan province, we have included nutrition as part of the outreach services in our mobile clinics, serving communities in the remotest parts of the province with no access to health care, while also carrying out referrals for more serious cases. This is achieved through a team of dedicated Merlin health workers who travel on foot to reach communities, while transporting food and medicine by donkey to areas beyond the reach of cars.
These community outreach services also focus on educating community members on the causes and treatment of malnutrition to help prevent its occurrence.
This is the first time any organisation has attempted to address malnutrition through mobile clinics in Afghanistan, and we hope it can serve as a model to be adopted nationally.
It is complex work, when considering the mountainous terrain, natural disasters and snowfall that can cut off villages for six months of the year, but we are confident that we will make a difference.
http://alertnet.org/thenews/fromthefield/218926/24bcbb26c508a820abb9f1f757333545.htm

MALNUTRITION: Chad

As the Hadjer Lamis region of western Chad is facing a nutritional crisis, Doctors Without Borders/Médecins Sans Frontières (MSF) has set up a number of emergency therapeutic feeding interventions. One of these is in Massakoury, one of the country’s main towns more than two hours drive from the capital, N’Djamena, where MSF is also running a therapeutic feeding center. Dr. Benoit Kayembe, the medical coordinator for this project, gives the details.
The food situation is serious throughout the Chadian Sahel strip that extends from the Hadjer Lamis and Kanem regions through Batha and Guéra. This is the result of two successive years of drought, swarms of locusts, a lack of drinking water and no access to care. The health care system in this region is shaky, even non-existent in some areas.
Could you describe the medical situation?
The best way to describe the magnitude of the food situation is to tell the story of Rabia, a mother age 20 or so. She brought us her one-year old son, who was immediately admitted in our program, suffering from severe acute malnutrition. Rabia had already lost three children from this illness that can, however, be easily treated. Here we see dozens of mothers who lose their children to acute malnutrition every year.
Since we started our action here, more than three weeks ago, we have admitted more than 1,000 malnourished children into our program. Around 100 of them had to be hospitalized.
Could you describe the program?
Currently, in Massakoury, we have one ITFC, inpatient therapeutic feeding center, where malnourished children who have serious additional medical complications, such as respiratory infections, are hospitalized, and 15 ATFCs ambulatory therapeutic feeding centers, where children are treated, but as outpatients in the various zones around Massakoury. Most of our patients live in places that are about a five-hour drive from N’Djamena. It is thus essential to set up mobile units to give patients easier access. Children suffering from severe acute malnutrition with medical complications are then referred to the Massakoury ITFC by MSF teams.
How are these children being treated?
Children treated in the outpatient programs are each given a systematic medical treatment and a week’s supply of a ready-to-use therapeutic food (RUTF) product made of peanuts and milk. It is rich in the micronutrients and vitamins that are needed by these children.
The children hospitalized in Massakoury are very weak, unable to drink or swallow, and even unconscious. In this case, beside medical care, they are given therapeutic milk initially, and RUTF later, once they start recovering. As soon as their condition allows it, they are followed as outpatients by the ATFC.
MSF is calling for more organizations to intervene in the region.
Some actors are already active in certain regions of Chad, but this is not the case in all the regions affected. It is necessary to have more actors involved to meet the needs of nearly two million people who are thought to require food aid in Chadin the coming months.
If the international community does not intervene rapidly, this country is on the brink of a catastrophic food crisis.
MSF is currently active in the Batha, Guera, Hadjer Lamis, Salamat and Quaddai regions as well as in the capital N’Djamena. It is also planning to carry out an assessment around Massaguet where the situation seems to be as serious as in Massakoury
How are the local authorities reacting to the situation?
The local, regional, and national authorities are aware that the food situation is very serious, owing to poor crops resulting from the drought and swarms of locusts in the last two years. The fields didn’t produce much and the crops are of very poor quality. Food prices are up and cattle breeders are selling their cattle to get money to buy food for their family.
http://www.doctorswithoutborders.org/news/article.cfm?id=4511&cat=field-news&ref=home-center-relatedlink

MALNUTRITION MALI: More aid needed for the north

DAKAR, 14 July 2010 (IRIN) - Aid agencies are struggling to meet the food and water needs of people and their livestock in drought-hit Mali, with potentially "catastrophic gaps" in the humanitarian response, according to Oxfam's country head, Gilles Marion. Some 258,000 people are in need of urgent assistance in Mali, according to the government-led early warning mechanism (SAP), with a further 371,000 at risk, following poor rains across the Sahel region. There are severe acute malnutrition rates of 19 percent in some pockets of the northeast, according to Oxfam. Meanwhile, 40 percent of cattle in the north are sick or dead and a further 30 percent at risk of disease or death, according to food security analysts FEWSNET. [http://www.fews.net/docs/Publications/Mali_fsu_2010_06_fr.pdf] Eight out of 10 people in northern Mali raise and breed cattle to survive. "There will be a catastrophe if more people do not respond," Marion told reporters at a press conference in the Senegalese capital, Dakar. The World Food Programme, Food and Agriculture Organization, the UN Children's Fund (UNICEF), the International Committee of the Red Cross (ICRC) and Oxfam, are some of the main actors responding to the crisis in Gao and Kidal. Oxfam has US$6 million - from the UK government, British public, the European Union humanitarian aid office (ECHO) and the US Agency for International Development - to help pastoralists in the north feed their animals, or to use as vouchers to spend on household priorities, whether food, water, animal fodder or medical care. ICRC has distributed food and seeds to 97,000 people in the north, is buying up thousands of cattle at pre-crisis prices, and is putting cash injections into the economy to try to stabilize prices. The government has subsidized cereals and animal fodder since April, and distributed 7,000 tons of food to 23 communes; a further 2,600 tons of grain are on their way. It is also sending 1,100 tons of animal feed to Gao, Kidal and Timbuktu, but "this is not nearly enough to meet all the livestock needs, and some at-risk communes will not receive grain," Madeleine Diallo Ba at the Agriculture Ministry in the capital, Bamako, told IRIN. She is in urgent talks with the World Food Programme (WFP), the European Union and Japan to see if they can release rapid funding to enable the government to procure more. WFP head Alice-Martin Dahirou told IRIN there are enough actors in place but not enough money. "The region is well-served by several NGOs and local associations who could do the job if resources were put at their disposal to support the government services." She added: "It is difficult to determine at this time the additional number of people who need support, in the absence of a comprehensive analysis of the situation." Fragmented responseThe quality of the aid response in the north is being compromised because it is not well-coordinated, said Marion, who called on the Office for the Coordination of Humanitarian Affairs (OCHA) to fulfil this function. Food Commissioner Lansry Nana Yaya Haidara agreed: "Agencies are intervening, but in a fragmented way. We want all partners to start working together towards common goals - that is the only that way we can get tangible results on the ground," he told IRIN. Noel Tsekouras, deputy head of OCHA in West and Central Africa, told IRIN: "OCHA had a presence in Mali from 2005 but was forced to discontinue in 2008 due to financial constraints. As mentioned by Oxfam, there may be a need for the UN to reinforce the cooperation among the key [response] stakeholders." On the financial front, some "encouraging" headway has been made, he said, with emergency activities under way and US$1.5 million provided by the UN Central Emergency Response Fund (CERF). However, only 23 percent of the $8.8 million requested by Mali under the West Africa appeal has been funded. "Without more resources, it will be difficult to tackle the acute vulnerabilities being reported," he told IRIN. "The priority at this point is to. assist the government in coordination, and to scale up the response. However, it remains the responsibility of the government to facilitate the short-term response and tackle the longer-term structural causes," said OCHA's Tsekouras.

MALNUTRITION: LiveAid, 25 years later

OUP: You were one of the first journalists to report on the Ethiopian famine in the 1980s. Could you tell us a bit about how you came to do that?
PETER GILL: It was one of those experiences which live with you for a career and a lifetime. I’d been trying to get an ITV documentary crew into northern Ethiopia for months, but the military regime kept blocking us. When they finally relented, they allowed us in before the news people. So we were the first team to reach the epicentre of the famine at a place called Korem. I’ll always remember meeting the official in charge of the relief camp as soon as we got there. He had a little black notebook which recorded that deaths from starvation in the previous 24 hours had topped 100 for the first time.
OUP: What is the situation in Ethiopia now?
PG: In lots of ways, it’s very much better. Up in those former famine lands, there’s been peace for almost 20 years, and there’s been a real drive for development. Even in the harshest conditions and despite the impact of climate change, there are real grounds for optimism. The problem remains that so many Ethiopians – more than three in four of them depend on the land – live on a real knife edge. The population, for instance, has doubled since the big famine. That sort of increase is unsustainable in the long run. And some parts of the country like the South and the Somali Region are subject to terrible food shortages.
OUP: Do you think that other parts of Africa can learn anything from Ethiopia’s experiences?
PG: Despite the challenges that Ethiopia faces, maybe even because of them, I think there are very important lessons for the rest of Africa – and for the rich donors as well. Ethiopia has insisted on charting its own development course over the past 20 years. The country was never colonised and it is not going to accept the dictates of outsiders now. On the face of it, everyone agrees that Africa will only really move when it fully takes charge of its own destiny. On policy matters, Ethiopia keeps showing the way. That’s sometimes uncomfortable for the aid-givers, but they’ve been proved right already in some of the directions they took.
OUP: Is China’s role in Africa broadly negative or positive?
PG: When I started researching this book, I knew only what I’d read about the Chinese in Africa – their rapacious interest in the continent’s natural resources and their relations with some pretty unpleasant regimes. I didn’t frankly think I’d learn much more. What I found was that the Chinese were both helpful and courteous – far more open than I’d expected and far more so than they ever used to be. China has a large and ambitious programme in Ethiopia – infrastructure, telecommunications, trade, aid, there are even teams of Chinese volunteers – and Ethiopia certainly doesn’t fit the pattern of the easily exploited or exploitable. We seem already to acknowledge China’s growing influence around the world. What I’m interested in watching is how China’s approach to raising people out of poverty works in Africa.
OUP: Do you think that 2005’s Live 8 worked in the same way that Live Aid did? And as an extension of that, are there things that Live 8 did differently as a result of the Live Aid experience?
PG: Live Aid in 1985 was a money-raising exercise, and a very successful one at that. We have all seen the pictures and some of us remember the vehemence with which Geldof demanded our cash. Twenty years on Live 8 was much more political. It was twinned with the ‘Make Poverty History’ campaign and played into Tony Blair’s G8 summit at Gleneagles. Geldof himself says it all comes down to politics, and his critics say that Live 8 was not political enough. We certainly haven’t got the politics of world poverty anywhere near right so far – getting a fair deal for the poor world in trade, for instance, is far more important than aid.
OUP: Do you believe that current aid levels will be sustained in light of the financial crisis?
PG: They may well be in Britain for the next few years. The Conservatives and the Liberal Democrats are certainly holding the line so far. Many other countries are not doing so well in keeping their past promises. In the longer run, I think our economic woes will prevent us having the decisive influence over eliminating world poverty that we should have exercised over the last decade or two of the boom.
http://blog.oup.com/2010/07/live-aid2/

MALNUTRITION: NIGER: Acute child malnutrition increases by 42%

DAKAR, 28 June 2010 (IRIN) - Nearly 17 percent of Niger's children younger than five suffer acute malnutrition, a 42 percent increase over the same period last year, according to a national survey released by the government. More than 15 percent acute malnutrition is classified as a critical emergency by the UN World Health Organization (WHO). The report links this increase to the poor 2008-2009 harvests. [http://www.irinnews.org/Report.aspx?ReportId=86689]. The government, with UN agency and NGO support, surveyed 8,000 under-fives nationwide from late-May to mid-June. In Agadez region, only urban centres were surveyed due to insecurity. Without immediate intervention, the situation is likely to further deteriorate before the September harvests, according to the government. Below are some of the report's most important findings: . Nationwide acute malnutrition: Nearly half a million children are acutely malnourished, including some 87,000 severely malnourished. The most affected regions are Diffa [http://www.irinnews.org/Report.aspx?ReportId=88425], Maradi [http://www.irinnews.org/Report.aspx?ReportId=89393], Zinder [http://www.irinnews.org/Report.aspx?ReportId=88541] and Tahoua [http://www.irinnews.org/report.aspx?ReportId=89499], where acute malnutrition falls into WHO's critical threshold. Acute severe malnutrition has increased to 3.2 percent from 2.1 percent a year ago. According to WHO, the median fatality rate for severe acute malnutrition ranges from 30 to 50 percent, but can be reduced substantially when properly treated. . Age and gender: Throughout the country, with the exception of Diffa region, children younger than three are twice as affected by acute malnutrition than older children (21.7 percent compared with 9.5 percent). More boys than girls are malnourished. . Mortality: The rate is higher than one death per 10,000 children a day but remains below the humanitarian community's emergency threshold of two deaths per 10,000 children a day, except in Zinder region. The relatively low death rate may not reflect the gravity of the nutritional crisis due to the ongoing depletion of food stocks. . Chronic under-nutrition: Similar to 2009, nearly half of Niger's children are chronically undernourished and lacking life-sustaining nutrients. In Zinder region, six children in 10 do not eat enough on a daily basis to maintain natural physical activity. In Niamey, 17 percent of children suffer from under-nutrition. A fifth of the surveyed children nationwide are severely chronically undernourished.