Download a PDF of this issue - Field Exchange - Emergency ...
Download a PDF of this issue - Field Exchange - Emergency ...
Download a PDF of this issue - Field Exchange - Emergency ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
<strong>Field</strong> Article<br />
Figure 1: Model <strong>of</strong> intervention for the management <strong>of</strong> acute malnutrition in Guinea<br />
Figure 2: Map <strong>of</strong> Guinea focused on Conakry communes<br />
Community<br />
screening<br />
Referal<br />
g CS<br />
Screening<br />
in CS<br />
Transfer<br />
g CNT<br />
cSAM CM<br />
in CNT<br />
SAM<br />
cSAM<br />
cSAM<br />
Treated<br />
cSAM<br />
Stabilised<br />
Transfer g CNA<br />
< 5years AM<br />
Suspected<br />
AM<br />
Referred<br />
sSAM<br />
sSAM<br />
Treated<br />
sSAM<br />
Recovery<br />
MAM<br />
Recovery<br />
MAM<br />
Treated<br />
MAM<br />
Referral<br />
g CNS<br />
Transfer<br />
g CNA<br />
sSAM CM<br />
in CNA<br />
MAM CM<br />
Activity<br />
Child<br />
RATOMA<br />
MATOTO<br />
Key to figure: AM: acute malnutrition; SAM: Severe acute malnutrition; MAM: moderate acute malnutrition;<br />
CS: health centre; cSAM: complicated SAM; sSAM: Uncomplicated SAM; CNA: ambulatory nutrition centres;<br />
CNS: supplementary nutrition centres; CM: case management<br />
KALOUM<br />
DIXIN<br />
MATAM<br />
cal, material and equipment support to the nutrition<br />
units <strong>of</strong> the health facilities.<br />
The staff <strong>of</strong> Fondation Tdh comprises two<br />
medical doctors and a nutritionist. Technical<br />
support includes training and on the job supervision.<br />
Fondation Tdh also invests in quarterly<br />
nutrition programme supervision <strong>of</strong> all the<br />
health facilities by the higher authorities <strong>of</strong> the<br />
Conakry City Health Directorate. Fondation<br />
Tdh staff also assist the health facilities in<br />
collating and analysing data generated from<br />
their nutrition activities. Through these analyses,<br />
weaknesses are jointly identified and<br />
decisions are reached on corrections. Further,<br />
on the request <strong>of</strong> the health authorities,<br />
Fondation Tdh acts as an active interface<br />
between the health authorities and agencies<br />
like UNICEF and World Food Programme<br />
(WFP) for supplies to the health facilities. This<br />
is a temporary arrangement pending the time<br />
the authorities study the reporting mechanisms<br />
<strong>of</strong> these agencies and identify a liaison person<br />
for <strong>this</strong> activity.<br />
In addition to the technical support,<br />
Fondation Tdh also provides material support<br />
to the nutrition units, such as stationery, IEC<br />
(information, education, communication)<br />
materials, cooking materials, MUAC tapes and<br />
weighing scales.<br />
Urban Community Health Workers in<br />
Ratoma commune<br />
In six <strong>of</strong> the 20 quarters <strong>of</strong> Ratoma, Fondation<br />
Tdh in collaboration with the communal health<br />
authorities, recruited and trained 32 urban<br />
community health workers (UCHW). The<br />
UCHWs participate in the community screening<br />
<strong>of</strong> children for acute malnutrition in their<br />
neighbourhoods, follow up on defaulting cases<br />
and engage in the promotion <strong>of</strong> healthy nutrition<br />
practices through cooking demonstrations,<br />
counselling on breastfeeding and hygiene (See<br />
Figure 3).<br />
Screening <strong>of</strong> children for acute<br />
malnutrition<br />
Screening <strong>of</strong> children for acute malnutrition<br />
takes place at two levels – in the neighbourhoods<br />
(active screening) and at the health<br />
facility level (passive screening). See Figure 3.<br />
Active screening<br />
Each <strong>of</strong> the UCHWs is assigned an area within<br />
their neighbourhoods. The UCHWs compile a<br />
list <strong>of</strong> all the children within their area and visit<br />
their homes on a monthly basis. In the course <strong>of</strong><br />
the visits, MUAC <strong>of</strong> children 6-59 months is<br />
measured and recorded. Children with MUAC<br />
<strong>of</strong> 65 cm), MUAC is also measured.<br />
Children between 6-59 months presenting<br />
with acute malnutrition are assigned to the<br />
appropriate treatment as directed by the<br />
National Guidelines.<br />
The total case load <strong>of</strong> malnutrition for Ratoma<br />
Comune and St Gabriel is shown in Table 2.<br />
Management <strong>of</strong> SAM<br />
The child with sSAM is prescribed Ready to use<br />
therapeutic foods (RUTF) 1 and routine drugs<br />
like Vitamin A, antibiotics and anti-helminthics.<br />
RUTF is given on a weekly basis to the children<br />
and at the end <strong>of</strong> each week, the child presents<br />
at the health facility for a check-up until the<br />
child attains and maintains the target weight<br />
(85% <strong>of</strong> the median % weight-for-height) at two<br />
consecutive weekly checkups (option 1) or<br />
option 2 (discharge on reaching 85%) without<br />
two consecutive check-ups.<br />
Monitoring reports indicate that St Gabriel<br />
Dispensary has had major problems with<br />
defaulting in the treatment <strong>of</strong> sSAM. In 2010, <strong>of</strong><br />
a total number <strong>of</strong> 1,133 recorded exits, 35.6%<br />
were cases <strong>of</strong> defaulting. The reason for <strong>this</strong> is<br />
that, unlike the four other CNAs supported by<br />
Fondation Tdh, St. Gabriel Dispensary has a<br />
reputation for inexpensive and quality medical<br />
treatment which extends far beyond Ratoma<br />
commune. The dispensary charges a flat rate<br />
which includes costs for consultation, laboratory<br />
tests and medicines. Many people travel<br />
great distances, sometimes up to 200 km, to<br />
seek treatment is <strong>this</strong> dispensary. Normally,<br />
parents do not recognise signs <strong>of</strong> acute malnutrition<br />
in their children and come to the<br />
healthcare centre expecting treatment for<br />
illnesses rather than for malnutrition. The<br />
healthcare centre staff identify malnourished<br />
cases through routine measurement <strong>of</strong> the children.<br />
When a child is diagnosed as suffering<br />
from acute malnutrition and the parents are<br />
told that treatment is necessary and that <strong>this</strong><br />
will involve several weekly check ups (a total <strong>of</strong><br />
5 to 10 visits), many <strong>of</strong> them fail to return to the<br />
centre after one or two follow-up visits. This is<br />
due to the distance they have to travel each<br />
time. These cases present a problem for the<br />
Dispensary, because there are no CNAs or CNS<br />
in the villages <strong>of</strong> origin <strong>of</strong> these children to<br />
which they can be referred.<br />
All identified cases <strong>of</strong> cSAM are referred to<br />
INSE. Fondation Tdh supports the patients<br />
through the payment <strong>of</strong> transport costs from<br />
the referring health facility to INSE. Further,<br />
Fondation Tdh pays the treatment costs <strong>of</strong><br />
cSAM cases referred from any <strong>of</strong> its intervention<br />
centres. cSAM cases are managed with F75<br />
formula until stabilisation and then referred<br />
back to referring centre for Phase 2 management<br />
as prescribed by the National Guidelines.<br />
Management <strong>of</strong> MAM<br />
Breastfed children