How to start a child survival epidemic

By Susan Shepherd

Taking your infant to the paediatrician for a check-up and shots may seem like just another chore but, last week, Nigeriens mothers, nurses and doctors reminded me just how powerful and important these simple actions are.

I’m just back from southern Niger where Medecins Sans Frontieres (MSF) has worked for more than a decade. Yes, we still treat many children for malnutrition, malaria and other illnesses, but there’s something new going on.

Thousands of mothers and infants are coming to the health centre monthly for weight checks, immunisations and — once a baby reaches six months of age — to receive nutritious baby food to complement breastfeeding. As mosquito nets are distributed to new mothers, nurses and mums engage in lively exchanges about how to care for sick babies and prevent childhood malnutrition.

For most Nigeriens, daily life presents many challenges. In a country where the majority of its 16 million people work the land to make a living, Niger has been through three food emergencies in the past six years, beginning with a 2005 nutritional crisis that sparked, what was then, the largest ever response to severe acute malnutrition. Then, nearly 100 000 children were treated for malnutrition; 60 000 by MSF programmes alone.

In 2010, almost half the population received either short-term food aid or cash transfers. This year, the same is true of about one quarter of Nigeriens.

But amid this hardship, Nigerien politicians and health professionals are making remarkable progress in child survival. Child mortality rates have fallen by almost 50%, dropping twice as fast as those in its bigger, wealthier neighbour, Nigeria. This flies in the face of conventional wisdom suggesting improved health indicators only follow economic growth.

So what is happening in Niger? The country has scaled-up treatment for childhood malnutrition and the ministry of health now conducts annual childhood health and nutrition surveys, which are indispensable components of any health system. A June 2010 survey prompted major changes in nutritional programming — now, for the three years, many children under two years of age receive nutritional support with novel, enhanced nutritional foods before the harvest.

MSF studies have found that mortality rates were halved when children received quality food supplements tailored to their needs in a programme with high levels of adherence and acceptability.

Nutrition and health are inextricably linked: children are more prone to sickness and death if they are malnourished and vice versa. In Niger, where malaria is a major cause of illness and death, it’s unthinkable to treat children for malnutrition without malaria screening and insecticide-treated bed-net distribution. Since 2005, the number of children under five years treated for malaria has more than tripled and reached more than 1.5 million in 2009 alone.

This was possible because Nigerien politicians provided free healthcare for children under five, and the Global Fund to Fight Aids, TB and Malaria provided the drugs. The percentage of families who sleep under bed nets has increased by 75% since 2005.

Finally, since 2005 the percentage of two-year-olds who have been fully vaccinated has doubled. This is definitely progress although children in Niger don’t yet benefit from all childhood immunisations available in more developed nations.

Nigerien leaders set in motion much of this progress; humanitarian actors and Nigerien health professionals accelerated some of it. This conglomerate of governmental and emergency aid organisations has laid the groundwork for revitalising the most important activity: infant check-ups.

Breast-feeding, healthy diets, acute malnutrition treatment, vaccinations, malaria prevention and treatment, and good data collection are the backbone of this success. This isn’t rocket science, but the hard part will be to keep the system working because progress is fragile. While enabled by good policy, many health gains can be traced to investments by emergency aid organisations, whose funding is unstable.

The next, critical phase will be integrating the connection between nutrition and health into public health systems to reach children earlier. It should be about improving children’s health as much as an emergency response.

Here lies the challenge for the Scaling Up Nutrition (SUN), a UN initiative comprised of 30 countries that aims to curb under-nutrition worldwide. Nigerien mothers and health professionals have shown what is possible, now the SUN initiative will have to figure out how to consolidate and accelerate gains in contexts like Niger. It starts by recognising that providing nutritionally enhanced supplements to treat and prevent childhood malnutrition, and essential health services are among the most effective interventions. If Nigerien leaders, and international and national non-governmental actors are up to the task, who knows how fast this child survival epidemic can spread.

Dr Susan Shepherd is a paediatrician from Butte, Montana, in the US. She has worked for MSF for the last six years coordinating nutrition in countries such as Chad, Niger and South Sudan.