“I HAVE SEEN so many children transformed from these skeletal, very unhappy, very uncomfortable beings to playful, happy kids in just five or six weeks. You see them running around and layers of stress lifting off their parents’ faces.”
As an aid worker with Concern, Kate Golden has spent years working with vulnerable and malnourished children around the world, and she knows the power of proper prevention and treatment.
Since last June she’s been working as a Senior Nutrition Advisor on one of the Concern’s most ambitious aid programmes yet: ERNE, or Enhanced Responses to Nutrition Emergencies.
ERNE is a three year EU-funded programme which aims to tackle malnutrition in children under the age of five in some of the world’s poorest countries.
Five countries
The pilot programme is currently running in five locations: Niger, the Democratic Republic of Congo, Ethiopia, South Sudan and Sudan, using Concern’s 50 years of experience in the area of nutrition to forge long-term change.
The WHO estimates that there are more than 150 million children under five experiencing severe effects of malnutrition right now. A lack of proper nutrition in those early years can have long-lasting effects that are sustained right into adulthood.
Stunting, when a child is abnormally short for their age, is one effect of malnutrition that is irreversible if treated too late, explains Golden:
If you don’t keep up a healthy growth trajectory during the first two years of your life in particular, you could wind up never getting it back. In general, younger children are more vulnerable because of the complex kind of growth and development that happens at that age.
Another major effect of malnutrition is wasting, when a child’s weight is too low for their height. This can be reversed, but the consequences can be dire if it is not treated in time. Severely wasted children are at least nine times more likely to die than those with a healthy weight – they catch infections easily, and if they are in a severe state when they arrive at the health centre, their recovery can take far longer.
Long term change
The ERNE programme aims to transform how the health systems in the world’s poorest countries approach malnutrition.
Twenty years ago, Concern pioneered the community-based management of acute malnutrition, making it possible for children to get treatment at local health centres, rather than forcing their parents to bring them to hospitals hours or even days away from home.
This approach became global best practice in 2007, and thanks to the ERNE project, community-based care can be offered to even more children in need.
At the same time, the programme is working to reduce the number of children who become malnourished in the first place, and to ensure any child who does present with symptoms can always receive proper treatment.
In the community, part of this work involves education of parents through regular support groups and campaigns. At a typical mother support group, community health workers might cover topics like proper handwashing and danger signs for illnesses, but the meetings are about more than just sharing information, says Golden:
“The group means mothers have a place to come where they can share their worries with other mothers, talk to a community health worker and not feel so alone.
“It’s a place where a mother can come and say something like, ‘I leave my two year old in the care of my nine year old when I go to work in the field each morning and I’m not sure the younger one eats all day, but I don’t have time to be there to make sure he does.’ She can share a problem like this and start a dialogue with a health worker to find a solution.”
Emergency aid
The ERNE programme also allows for small cash donations to families when a short term crisis like a drought or a bad harvest is on the approach:
It’s a small cash bundle, the equivalent of around €40 to €50, so that families aren’t forced to sell their livestock for a low price just to get money for food, or to sell on the last of their seeds that they could have planted.
As well as working with families, the ERNE funding allows Concern to do more direct work with health centres.
Workers are trained to plan ahead for predicted spikes in patient numbers – “in Niger, we typically see more queues in July, when the harvest isn’t in yet and malaria is also through the roof,” says Golden – to ensure their clinic has exactly what it needs, when it needs it.
Prevention is better than cure
On the whole, the ERNE ethos is that any child who needs help should receive it, but that the fewer children who need help, the better. And the work is far from done, says Golden:
“The five countries on the ERNE programme are some of the worst affected, but so many countries have a huge caseload of malnourished children.”
So what’s ahead for ERNE, now that it’s almost one year into its three-year pilot stage?
We’ve really bedded down in each country now and have treated so many children already. We’ve also done a really comprehensive assessment of the 200 health facilities we’re supporting across the five countries, to understand what’s working, what isn’t and what they need.
“Their needs can vary. They might need access to clean water, better training for staff, or they might just need something basic like a handwashing station made from a plastic drum.”
The scale of malnutrition in children today is “mind boggling”, says Golden.
“Our aim is to find the best ways to prevent it, and also find the best ways to treat it.”
Find out more about the ERNE programme here.
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