Women with their children in Kanem, western Chad, one area where conditions contribute to high child malnutrition

DAKAR, 1 October 2009 (IRIN) - Aid workers are looking at how to boost children’s nutrition and overall health in eastern Chad’s main city, Abéché, after a survey revealed that 20.6 percent of children under five suffer acute malnutrition.

The survey by Action contre la Faim (ACF) in the city of Abéché showed that of these, 3.2 percent suffer severe acute malnutrition – a very low weight for height, visible severe wasting or the presence of nutritional oedema.

The results paint a “worrying” picture of Abéché’s nutritional situation, ACF says in a preliminary report.

Acute malnutrition is the cause of 50 percent of deaths of under-five children in Chad, according to the UN Children’s Fund (UNICEF), which is assisting the government in tackling malnutrition in hard-hit regions.

ACF and UNICEF’s Chad representative Marzio Babille said the country’s health and nutrition problems have several profound causes.

“Chad bears the impact of multiple factors namely climate change, food price rises and post-conflict [conditions]. Increasing child malnutrition is observed in both rural and urban communities. The recent data of increased GAM [Global Acute Malnutrition] in Abéché points to this worsening trend.”

In Abéché the 20.6 percent GAM rate surpasses the UN World Health Organization’s “critical” threshold of 15 percent. WHO classifies GAM between 10 percent and 14.9 percent as “serious”, warranting supplementary feeding; 15 percent and above constitutes an emergency.

The ACF study in Abéché was carried out from 22 June to 1 July – during the lean season, “when a peak of malnutrition is generally observed”, the report said. The sample was 854 children.

More children at nutritional centres

But ACF and UNICEF in Chad say the number of children admitted to nutritional centres in Abéché has increased over the past few months, beginning long before the lean season.

Abéché is one of three areas of Chad hard hit by high food prices in the last year, according to UNICEF’s Jean Luboya, inter-agency nutrition coordinator in Abéché. The others are Kanem and Bahr el Gazel in the west.

Aid officials in Abéché say tackling malnutrition requires not only boosting measures to prevent and treat malnutrition but improvements in general health and hygiene.

ACF head of mission in Chad, Manuela Moy, told IRIN the focus in must be on malnutrition treatment and prevention as well as educating families on proper nutrition and hygiene. "It is an effort all actors – NGOs, authorities and communities – must invest in, to prevent a deterioration of an already worrying situation."

In the preliminary report ACF says 19.8 percent of under-five children had diarrhoea in the two weeks prior to the survey, and 13.3 percent acute respiratory infection. These levels are due in part to often poor hygiene in households and improper nutrition for infants, ACF said.

Difficult to detect

UNICEF’s Luboya said access to basic services like safe water and basic health care is lacking in Abéché and this must be addressed as part of an integrated approach, which will be an extension of an ongoing community-based programme.

In Abéché ACF and UNICEF run a US$1-million programme with outpatient treatment centres and supplementary feeding, according to UNICEF. They also survey communities to detect malnutrition cases.

But detection has been difficult, Luboya said. “Home visiting is still erratic with the community outreach volunteers. The increased incidence of acute malnutrition remains difficult to detect because of insufficient human resources and a lack of [nutritional knowledge and practices] at the household level.”

In eastern Chad aid agencies are assisting some 258,000 Sudanese men, women and children in refugee camps and 170,000 displaced Chadians, according to the UN Office for the Coordination of Humanitarian Affairs.

A nutritional survey conducted in the refugee camps in 2008 showed a GAM rate of 12.3 percent and severe acute malnutrition of 0.8 percent, according to UNICEF’s Luboya.

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