Welcome to the Spring 2010 edition of Concern Worldwide’s CTC newsletter Malnutrition remains a major challenge throughout the developing world. Concern Worldwide has sought to combat this by implementing a nutrition programme known as Community-based Therapeutic Care (CTC). CTC seeks to tackle acute malnutrition by addressing the problem at community level rather
than via more traditional, centralised, therapeutic feeding centres. Concern has also introduced a ready to use therapeutic food (RUTF) which is palatable and nutritious for children. Community-based Therapeutic Care is funded by the Scottish Government, and recently entered its final year in Lilongwe and Nsanje districts of Malawi. In 2009 alone, over 8,600 children have been treated - 80% of those were treated entirely as outpatients, with treatment given at home. One of the major aims of Concern
Worldwide’s project is to assist the local health authorities in Malawi – the District Health Office (DHO), – to incorporate CTC into their routine health services. This means that once Scottish Government funding ends, the Malawi government will be fully able to continue treating malnourished children using their own funds and staff. Concern and the Scottish Government aim to raise awareness of CTC by demonstrating the impact it has on the lives of malnourished children. We hope this information will be of interest to you.
Recovery revives hope for young Davison Seven months ago, three-years old Davison Samusoni was a healthy, bubbly child with a loving family. But Davison’s mother, Maria, passed away just after his second birthday and his father was unable to care for him.
to be suffering from malnutrition and mild malaria. He was referred to the Outpatient Therapeutic Programme (OTP) for treatment. “I was given tablets to give Davidson to treat the malaria and eight pots of chiponde (local name for RUTF) to take home,” said Zeliya. Besides the chiponde, Concern field staff also advised Zeliya on the importance of good feeding habits and using locally available nutritious foods.
“When my late daughter was alive my grandchildren were growing up well. Davison will continue to Soon after Maria’s death, they had no receive chiponde until he one to look after them,” said Zeliya finally regains his health. Kuthengo (50), Davison’s grandmother, who lives in Chisuzila village in Traditional Authority Njewa, Lilongwe. After staying for three months with his grandmother, Davison’s health deteriorated which forced Zeliya to seek David Gillanders medical help. Davison was diagnosed
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Case Study 1
Update on CTC activities in Nsanje and Lilongwe districts, Malawi The two districts of Lilongwe and Nsanje are quite different. Lilongwe, the district surrounding Malawi’s capital, has a large urban population. Nsanje, on the other hand, is at the extreme south of Malawi, with a low elevation and the Shire River keeping the district perpetually hot and muggy. Nonetheless, both districts have huge problems when it comes to children’s health. Nsanje has the highest child mortality rate in the country, with 17.1% of children dying before their fifth birthday. Lilongwe has an under-five mortality rate of 16.6%.
Roughly half of all children in these two districts are chronically underweight, many are severely malnourished and in need of medical treatment. Since 2005, Concern Worldwide has been assisting Malawi’s Ministry of Health to provide treatment and management for malnourished children through the Community-based Therapeutic Care (CTC) program. Over the last year, Concern and the District Health Office (DHO) have established a plan for handing over all CTC services, with the government gradually taking on responsibility for training, planning, funding, and monitoring.
The DHOs in both districts have made terrific progress. In Nsanje, the DHO manages all the stocks and medicines for the program through its pharmacy system, and has established a transport plan so that ready-to-use therapeutic food (RUTF) is transported to health centers on time each month. In Lilongwe, the district takes responsibility for training all the health staff in CTC – both districts have government staff who act as trainers for the program. Concern Worldwide has also been working to build the skills of health staff in collecting and analysing data and then using it to make program decisions, skills that are useful for all health programs being carried out in the districts. Over the coming year, Concern will continue to train health staff in CTC, conduct a workshop on how to carry out effective supervision, and will organise learning visits for district health staff to see and learn from CTC projects in other districts. Concern Worldwide will then officially hand over to the district in December.
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Happiness as Christina finally recovers “I remember crying with joy when the assistant at Mankhanga Health Centre told me that my child was fully recovered,” said Rose Mailosi, mother to three year old Christina.
“I was told that Christina was suffering from severe acute malnutrition and also had malaria,” recalls Rose. Health staff referred Christina to the out patient therapeutic programme after being given routine medications for her other ailments. “I know that chiponde (RUTF) played a big role in my child’s recovery. She likes it more than any other food,” said Rose. Christina weighed just 6.3 kg on admission and now weighs a healthy 7.8 kg. With advice from Concern staff, Rose has also been able to supplement the chiponde with other foods from her garden, thus securing Christina’s long term health.
Case Study 2
Reasons for poor nutrition in Nsanje District, Malawi
CTC: the pride of a volunteer
Malnutrition has been a problem for many decades in Malawi, with little improvement despite rapid economic growth and bumper harvests over the last few years. In Nsanje district, malnutrition rates are high with one in six children dying before their fifth birthday.
Cecilia Chikati, 56, is from Zuwaki Village in Nsanje. She lives with her two grandchildren whose mother died from an AIDS related illness four years ago.
In December 2009, Concern Worldwide conducted a survey in Nsanje district, with the support of the District Health Office (DHO), to investigate practices around child health and nutrition. The aim was to help understand the reasons for poor health and to guide Concern Worldwide in developing a new program to target and prevent malnutrition and illness in young children. This will continue to support the district after the CTC program is handed over to the DHO in December 2010. The survey found that many health and nutrition practices have improved in the last few years. The use of bed nets to prevent malaria has increased, and more and more women are choosing to give birth in government health facilities. The percentage of children who receive treatment when they are ill with malaria, diarrhea, and pneumonia has also improved, although many children still do not receive the care they need. Overall, the survey indicated that there is a great need for interventions designed to educate and assist mothers on how to best feed their young children, in order to improve household practices and reduce malnutrition and child mortality in Nsanje district.
Cecilia was trained as a CTC volunteer in 2007 by Concern Worldwide. Her motivation stems from personal experience - the CTC program saved her grandson Briton Wadi when he was 4. Celia said, ”There was nobody to take care of the children since their father had disappeared from the village. So I took the responsibility of caring for the two orphans, Briton and his brother, Jemu”. When Briton was about two years old, he was regularly being sick and his legs began to swell. “I became
worried when Briton started losing weight. When I pressed his feet, as I was taught by our facilitator, to test for oedema, I realised that he had a problem. That is why I quickly took him to the Health Centre.” Health staff at Sankhulani confirmed her grandchild was severely malnourished. Briton was put on chiponde treatment. “After three weeks I started seeing a big improvement in his health. Now he is a healthy and happy child, and very soon he will start primary school,” said Cecilia. Brighton’s illness did not deter Cecilia’s work as a volunteer, she said: “I know I have to help mothers in my situation to get their children to the OTP. Sometimes they don’t know how important it is to their children’s wellbeing, so I have to remind them.”
Case Study 3
Soferele pulls through A few months ago, Harold lost his wife, Tereza, when their twin girls, Soferele and Safina, were only nine months old. He relocated to a new village after his wife’s death to start a new life. However, separating from his children proved difficult, “The children were so young and I thought it wise to leave them in the care of their grandparents. However, the last time I visited them I was deeply worried about Soferele’s health. She was having continuous diarrhea and her legs were swollen,” said Harold. Harold learnt that her in-laws believed that Soferele’s illness was a passing phase in the growing up process. “They told me that every child must open bowels and swell
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as a result. In their local customs, they say the child will be ‘trying to adjust and find her normal body hence the swelling and diarrhea’. However, Harold sensed danger and took Soferele to Nsalu Health Centre where she was diagnosised to be suffering from malnutrition. The young girl was admitted in the out patient therapeutic programme (OTP) and has made some marked improvements. Harold said:” The chiponde worked wonders, all the swelling is gone”
Perseverance and hope saves David’s life
Case Study 4
“I was confused and tired from hopping from one hospital to another,” said 35 years Old Elestina Joseph, “none of the medical staff I met could tell me what was wrong with my son.” Elestina’s son David was vomiting every time he had a meal. David was only given medication to stop the vomiting but this did not solve the problem. “I had completely lost trust in these health centres, but I still had hope that my son could be cured.” After some medical assessments, David was referred to Baylor Children Centre of Excellence. Further test were conducted and David was diagnosed to be HIV positive. David was admitted to the nutrition rehabilitation unit (NRU). While there, he was put on a strict diet of chiponde, which the clinic gets courtesy of Concern Worldwide. He also started receiving ARTs.
Elestina said: “Now that David is improving, I plan to start a small business so that I can buy other foods to supplement the chiponde he is taking.”
Concern wins innovation award
Concern Worldwide, Valid Nutrition and Irish Aid were named winners of the “Organisational Systems and Processes” category at the Irish Times All Island Innovation Awards.
The award recognised the extraordinary success of Community Therapeutic Care (CTC).
The awards were designed to recognise the best innovations in businesses. Over 120 companies entered the competition.
Concern Worldwide - Committed to a world without poverty 40 Saint Enoch Square Glasgow G1 4DH Tel: 0141 2213610 www.concern.net Fax: 0141 2213708
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By empowering communities to understand and address malnutrition, CTC has supported an eightfold increase in the number of people accessing treatment, and has significantly reduced mortality rates in children under five.
