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Expansion of Nutrition Services Impacts Recovery of Malnourished Children in Niger

Mother with recuperating childThe Center for Human Services (CHS) is leveraging QAP's established countrywide Pediatric Hospital Improvement (PHI) Collaborative to rapidly expand nutritional recuperation services for acutely malnourished children in 15 district hospitals in Niger. Initiated in 2003, the PHI Collaborative works in 32 of Niger’s 43 government hospitals and has made nationally recognized gains in improving quality of first referral IMCI (Integrated Management of Childhood Illness) services.

The project is applying Quality Improvement (QI) methods to build capacity for improved recuperation of malnourished children within Niger’s national health system. At facilities participating in the Rapid Expansion of Nutritional Recuperation Services for Malnourished Children in Nigerien Facilities project, funded by USAID’s Office of U.S. Foreign Disaster Assistance (OFDA), the percentage of children screened for malnutrition has risen sharply, and case fatality rates have dramatically declined. 

Nurse counseling caretakers of malnourished children

Nurse counseling caretakers of malnourished children

Niger is a Sahelien country with a long history of repeated cycles of famine due to environmental vulnerability and extreme poverty. Persistently high acute and chronic malnutrition rates contribute to one of the highest childhood mortality burdens in the world (198/1000, EDSN Niger 2006). The 2005 food crisis in Niger severely strained a struggling national health system with limited capacity for integrated child nutrition services. Despite recurrent food crises, services for malnourished children in Niger have traditionally been provided by transient relief groups working outside the public health system.

In August 2005, the Nigerien Ministry of Health (MOH) and partners issued the first-ever national guidelines for prevention, screening, and recuperation of childhood malnutrition. 2006 witnessed an influx of relief-oriented nutrition programming. The national MOH and partners are now working hard to translate national guidelines into an integrated continuum of accessible preventive and recuperation nutrition and health services. The project is building local Ministry of Health facility capacity for effective nutritional counseling, screening, referral, and recuperation services.

Active Feeding: Counseling Poster to promote active feeding of malnourished or sick child

Active Feeding: Counseling Poster to promote active feeding of malnourished or sick child

The OFDA-funded program targets 15 of the 32 PHI facilities in 7 of Niger’s 8 administrative regions. Project objectives include strengthening referral/counter-referral mechanisms between primary health and district hospital facilities and implementing a behavior change communication strategy, using job aids developed by CHS, to integrate nutrition counseling into health service delivery. A primary goal of the OFDA-funded program is to systematically integrate nutritional recuperation services into national child health and nutrition programs. 

The project team is working in partnership with the Nigerien Ministry of Health, UNICEF, Helen Keller International (HKI), and Islamic Relief to expand nutritional recuperation services by improving the quality and efficiency of 6 existing centers (known in French as Centre de Recuperation Nutritionnelle Intensif or CRENI) and establishing 9 new CRENI’s in regional and district government hospitals.

Mothers prepare malnourished children to take recuperation porridge

Mothers prepare malnourished children to take recuperation porridge

As of March 2007, the nutrition recuperation program has admitted 1,936 severely malnourished children for recuperation into the 15 participating hospitals. These facilities have made significant progress in improving the quality and coordination of nutritional screening and recuperation services. As shown in the table below, the percentage of children systematically screened for malnutrition upon contact with the health service has increased, facilitated by use of a user-friendly screening tool called the MUAC (Middle Upper Arm Circumference), from 0% at baseline to 41%. Overall compliance with recuperation standards including screening, nutrition recuperation, medical management, and discharge/referral planning, has increased from < 10% at baseline to an average 88%. The average monthly malnutrition case-fatality rate has decreased from 29% in the first quarter to 13%. The proportion of children referred from primary care centers or the community has increased from 43% to 55% of admissions. Routine participatory nutrition counseling is now systematic in all recuperation centers.

For more information contact Dr. Kathleen Hill at khill@urc-chs.com.


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The Quality Assurance Project (QAP) is funded by the U.S. Agency for International Development
(USAID) under Contract Number GPH-C-00-02-00004-00.