6 January 2016

Sierra Leone: Caring for Malnourished Children in Ebola-Affected Sierra Leone

Photo: PHOTOESSAY: West Africa and Ebola

As the Ebola outbreak raged, Ebola Deeply's team of contributors - reporters from Guinea, Liberia and Sierra Leone, as well as international journalists - shared images of daily life in the grip of the outbreak. 


"I had reached a point where I thought my child was going to die," says Francess, the mother of 1-year-old Naomi Sam. Francess thinks that she could have lost Naomi if a community health worker had not recognized the young child was suffering from malnutrition.

The Ebola outbreak that just ended in Sierra Leone infected at least 8,704 people and killed at least 3,589. What will take longer to measure and to understand, however, will be its wider impact on the nation's health.

Before Ebola, nutrition was already a challenge, with 12.9 per cent of under-5 children malnourished, according to the 2014 Sierra Leone National Nutrition Survey report. Quarantine and travel restrictions, infections, fear and an economic downturn are likely to have had a significant impact on nutrition.

In Kombayendeh village in Kono District, eastern Sierra Leone, most parents did not know the basics about malnutrition and its causes, and the sight of malnourished children in the community was a common occurrence.

Early this year, amid the ongoing Ebola outbreak, the NGO Sierra Leone Poverty Alleviation Agency (SILPA), with support from Irish Aid and the Japanese government, started community-based active case findings using self-screening tools, as part of UNICEF's Integrated Management of Acute Malnutrition programme. The effort aimed to reach malnourished children in every chiefdom of the district, despite the logistical challenges posed by poor road conditions.

Urgent attention

One-year-old Naomi is one of the children benefiting from community management of acute malnutrition in Kombayendeh village. When she was seen by SILPA's field-based monitor, Charles Bockarie, about 10 months ago, she was acutely malnourished and in a very sick state. She was immediately brought to the Koidu Government Hospital for treatment, along with her mother Francess.

"Naomi was visibly sick and needed urgent attention, so I brought her to the hospital the very day she was identified," says Mr. Bockarie.

At the hospital Naomi was found to have other health complications in need of close monitoring. She was admitted for two months, during which she was treated for malnutrition and the complications related to it.

"I am very grateful that Charles came here and saw her, and referred us for treatment," Francess says. "He helped save her life."

Naomi was treated with Plumpy'Nut, a peanut-based ready-to-use therapeutic food, and to the surprise of her mother and other family members, Naomi became healthy again.

"I used to wonder what magic was in the treatment that made her recover so soon," Francess says. "I was so surprised about the improvement in her look, just a few weeks after she started eating those packets."

Spreading the word

Francess has also been trained to use locally available food to feed her child and has become a 'nutrition ambassador', sensitizing other mothers to feed their children well, and also persuading those with malnourished children to go for treatment.

"I learned the importance of exclusively breastfeeding our babies until they are six months old and then giving complementary food with continued breast milk, so they can be healthy and not fall sick as Naomi," she says. "I am advising my friends in our village to do the same."

"I have a backyard garden where I grow fresh food items. I will continue feeding Naomi well to ensure she doesn't get sick again, but rather grows up healthy and strong and able to take care of me when I get old."

Though nutrition remains critical issue in Sierra Leone, major gains have been made in making people aware of malnutrition and the benefits of proper nutrition. The ready-to-use therapeutic food now known across Sierra Leone has helped save the lives of thousands of malnourished children - since the start of 2015, nearly 4,000 children across Kono District alone have received treatment for malnutrition and recovered.

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