Thursday, June 26, 2014

Cambodia fights to eliminate childhood malnutrition - From the eyes of a UNICEF nutritionist

By Miriam Iuell Dahl

PURSAT, Cambodia, June 2014 – With over 40% of Cambodia’s children under the age of 5 chronically malnourished, 11% suffering from acute malnutrition, and 28% underweight*, it is needless to say that something needs to be done. One of my tasks, working at the Maternal, Newborn and Child Health and Nutrition section at UNICEF, is to evaluate the management and treatment of malnutrition in the country.

Interviewing a mother and her 11 month old daughter at a hospital in Kampong Cham
© UNICEF Cambodia/2014/Miriam Iuell Dahl


One of the challenges we’re facing is that there is little evidence of how many children are actually cured of malnutrition. So my job is to collect data on the proportion of children that are treated for malnutrition in hospitals and health centres in the country, for then to establish how many have been cured versus the proportion of children being discharged too early or dropping out of treatment. In addition to burying myself in hospital records and battling to understand doctors’ handwriting in Khmer, I also get the chance to speak to the mothers or caretakers of the children receiving treatment. This helps shed some light on why these children ended up being hospitalised in the first place, and helps identify types of interventions needed for prevention of malnutrition in the future.

Cambodia has seen great improvements in infant and young child feeding over the last decade. Thanks to promotion of breastfeeding, exclusive breastfeeding rates increased from 11% in 2000 to 74% in 20101. Breastfeeding is the best source of nutrition for children in the early stages of life, it’s safe to use and readily available – It’s the best thing for your baby. However, the lack of knowledge regarding appropriate feeding, and the increased use of unsafe breast-milk substitutes are still endangering the lives of Cambodian children.

BP-100 is one example of a Ready-to-Use Therapeutic Food. This is a nutrient-fortified wheat-and-oat bar that can either be consumed as it is, or as porridge by adding boiled water.
© UNICEF Cambodia/2014/Miriam Iuell Dahl

When children are treated for severe acute malnutrition they are provided with Ready-to-Use Therapeutic Foods (RUTF). This is a food that is specifically designed to provide children with the right amount of energy and nutrients for appropriate weight gain and development.

A concerned mother and her child at Pursat Provincial Hospital
© UNICEF Cambodia/2014/Miriam Iuell Dahl

A couple of weeks ago when I visited Pursat province (almost 190km north-west of the Cambodian capital, Phnom Penh), I met this 10 month old little girl and her mother at the Provincial Hospital.
This hospital is sponsored by UNICEF and is a Baby Friendly hospital, which means that they promote and support breastfeeding.

The mother told me that her daughter weighed 3.5 kg when she arrived at the hospital a week ago. She had been screened for malnutrition at their local health centre, and referred to the hospital for treatment. With her slightly red hair, baggy skin and big eyes, I could see straight away that the child was malnourished.

This statue of a breastfeeding mother is the first thing you see when entering the Pursat Provincial Hospital
© UNICEF Cambodia/2014/Miriam Iuell Dahl

When I asked about her birth weight, the mother replied that she weighed 1600g when she was born, and continued to say that she thought that was an average size for a newborn baby. An average birthweight is around 3500g, and 1600g is worryingly small for a newborn. Newborns in Cambodia do tend to be smaller compared to other countries, mainly due to the fact that many mothers are malnourished, and therefore not able to gain enough weight throughout the pregnancy. However, if a child weighs less than 2500 grams it’s defined as low birth weight, which can lead to severe health outcomes for the child by inhibiting growth and cognitive development, and increases the risk of chronic diseases later in life.

After speaking to the mother it became clear that she had never breastfed her child, and when I asked her why, she said that her mother and husband made the decisions regarding feeding practice, and she believed that breast-milk substitutes were the best options for her child.


At 10 months of age this little girl weighs the same as an average newborn baby
© UNICEF Cambodia/2014/Miriam Iuell Dahl

She also explained that she couldn’t afford the food she thought she needed for her daughter. This underlines the importance of information and education on appropriate feeding practices, where there is a need to focus not only on the mother, but also on the influential people in her life. The message must get through that there is no need to buy expensive breast-milk substitutes, when the best thing for your child is breast-milk. Breast-milk is tailored to suit the nutritional needs of your growing child, it’s uncontaminated and safe, contains antibodies that protects the child from infections, and best of all it’s free!

After responding well to the treatment, she is now on her way to recovery and a healthy future
© UNICEF Cambodia/2014/Miriam Iuell Dahl

At least there is a happy ending to this particular story. By being admitted to a Baby Friendly hospital supported by UNICEF, her mother received counselling on appropriate infant and young child feeding, and is now aware of the benefits of breastfeeding and knows what is best for her child’s health. Her daughter responded well to the treatment, and gained 500g in the first week alone. Now with a big smile on her face, and a firm grip around my finger, she is finally on track to a healthy future.

*National Institute of Statistics (2011). Cambodia Demographic and Health Survey 2010. Phnom Penh.

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