Training on Malnutrition Screenings

For three days in September, I participated in a "formation" facilitated by the ICP in Karang and a USAID agent.

The target audience of malnutrition screenings, broadly speaking, is children under the age of 5; they are most likely to die of malnutrition-related complications, and to suffer from developmental delays later on in their lives.

The Senegalese government promotes two kinds of activities designed to identify signs of malnutrition in the field.

Causerie on malnutrition

The first, "peusées", targets children between 0 and 23 months. Health relays use a Salter scale to weigh babies once a month to make sure that they are gaining enough weight as they grow older. In the field, health relays have a table showing age correlated to healthy target weights, so that they can see if a child is within a healthy range.

Practice run in nearby Same 

The second kind of activity is called "dépistage", and should take place once every 3 months.  It targets children between 6 and 59 months. Health relays use a "centrisouple" to measure a child's left MUAC (Mid-Upper Arm Circumference). The resulting number, in centimeters, corresponds to a color on the band: green indicates a normal circumference, yellow suggests moderate malnutrition, and red severe malnutrition.

No problems here!

You probably realize that neither of these methods are particularly precise. The point is to monitor children over time, identify problems, offer dietary advice, and refer the most severe cases to the health post.

Most kids in Same were healthy, but one little girl named Awa turned out to be severely malnourished. Especially when compared to her twin, a perfectly normal chubby 2 year old. Awa looked like an emaciated 6 month old, not yet walking and refusing her mother's breast. This little girl was promptly referred to the health post in Karang.

At the health post, children with moderate and severe malnutrition are given calorie-rich nutritional supplements, PlumpySup and PlumpyNut, respectively. Each child gets a certain quantity of packets depending on the amount of weight they have to gain, over a number of weeks. They are asked to return periodically to the health post so that the ICP can monitor weight gain. These methods don't always work out so well, by the way.  I often so my 7 year old sister sucking on a PlumpySup not her own, because kids share the packets between themselves. And most patients don't return to the health post after their initial visit, so we end up loosing track of them.

Back in the field: dépistage and/or pesées. If a child doesn't seem to gaining enough weight, the health relays make enquiries about his or her diet, and make suggestions on how to improve it.

In Senegal, we run against some cultural obstacles to proper child nutrition. First, people eat family-style around a large metal bowl; the most nutrient-dense food items are placed in the center of the bowl. It is generally considered rude for children to reach for these foods themselves. Instead, a well-behaved child should wait for his or her mother to parcel out these items to him. Second, nutrient-dense foods--like meat--are usually only affordable in small quantities, so there's not much to go around. Finally, adults alway eat the best foods first.

(Short anecdote: soon after I arrived in village, I was gifted with a live chicken. It was so fat that everyone in my family ate his fill, "even the children" said my mother. Unfortunately, it is a rare thing for a child to fill up on chicken. Instead, they tend to eat very carb heavy meals, largely lacking in any kind of nutrient.)

So for example, a health relay might encourage a mother to feed her child more protein and fat rich meals. Some locally available foods include eggs, cow peas, moringa leaf, palm oil (usually enriched in Vitamin A). They might also suggest women let children select their own foods from the bowl.

More on this later.

Hard at work