Wednesday, September 16, 2015

Severe acute malnutrition in Cambodia: Victories, challenges and a fresh approach

By Arnaud Laillou, Megan Gayford and Samoeurn Un

Eighteen-month-old Pheap Maneuy with her mother at their home in Kon Ka Ek Village, Battambang Province
©UNICEF Cambodia/2015/Arnaud Laillou

Eighteen-month-old Pheap Maneuy had a good start in life. She was exclusively breastfed for six months, in line with UNICEF and World Health Organization guidelines. But things started to change once her mother introduced solid foods. “She didn’t eat much of the porridge that we prepared, but we thought it was enough,” says her mother, Mean Sokmom, who is 27.  

In early 2015, Pheap was identified as severely malnourished during a routine screening at the community health centre. As she had no medical complications, Pheap received her treatment – several nutrient-dense, vitamin-rich bars known as BP-100 – and went home. 

“At the beginning, my daughter ate the bar and had a better appetite and better growth,” her mother says. Pheap gained 400 grams the first week. But after several days, she started to refuse the BP-100. “I tried to mix it with boiled water, but she just she didn’t like it.” Eventually, Sokmom stopped giving her the supplement, despite the health centre’s recommendation to continue for at least two months.

Pheap’s situation is unfortunately all too common in Cambodia: not only are many children severely malnourished, but even when effective treatments are provided, they may not be properly administered at home.

The 2014 Cambodia Demographic Health Survey showed limited improvement of children’s nutritional status over the last five years. One in 10 children under five years old is acutely malnourished, putting this group at higher risk of poor health and premature death. UNICEF Cambodia estimates that each year, almost 90,000 children become severely malnourished. While severe acute malnutrition carries the greatest risk, any form of malnutrition can impair a child’s physiological and cognitive development and have a life-long impact on their potential and on the communities in which they live.

UNICEF has a long-standing commitment to tackling child malnutrition in Cambodia, which begins with appropriately identifying and treating cases of malnutrition. Children with severe acute malnutrition who are otherwise fairly well are treated by health centre staff as outpatients, receive a treatment plan for BP-100, and go home. Those in more serious states of health are hospitalized. With support from the Australian, Hong Kong, Korean, and Czech Committees for UNICEF, almost 8,000 severely malnourished children across the country have been treated since 2011, including 1,300 children in 2013 to 2014 as outpatients. 

But as Pheap’s case shows, simply providing ready-to-use therapeutic food like the BP-100 is not enough. In response, UNICEF and the Cambodian Ministry of Health are cooperating to better address severe acute malnutrition by increasing knowledge of healthy complementary foods while also devising ready-to-use therapeutic foods that children want to eat.

Like many elderly Cambodians, Chhay Chamroeun cares for her grandson, Boris Ratanak, while his parents are at work. In this way, grandparents can be powerful influencers in decisions concerning breastfeeding and young child nutrition.

Chhay Chamroeun and her 19-month-old grandson Boris Ratanak in Kon Ka Ek village, Battambang Province
©UNICEF Cambodia/2015/Arnaud Laillou
“My grandson was diagnosed with severe acute malnutrition when he was 19 months old,” she explains. “When he received the BP-100, he seemed to like it. But after three weeks, he started to eat it less. We didn’t complete the treatment, but he seemed better and gained weight.” 

Though Chhay did not follow the health centre’s instructions, she was fortunate to have heard Ministry of Health-UNICEF radio spots on the importance of porridge and animal-based foods. “Now, I prepare the enriched porridge two or three times a week,” she says.

Thanks to good national-level cooperation, UNICEF and the Ministry of Health have identified this issue – a local distaste for the BP-100, coupled with caregivers’ decision not to complete the entire treatment – as an obstacle to improving young Cambodians’ nutritional status.

UNICEF is not giving up the fight. Though the treatment programme for severely malnourished children has expanded to 108 health centres across the country, this falls far short of the 20,000 target by 2020 set by the Ministry of Health. 

UNICEF Cambodia and the Ministry plan to increase mass screening so that communities and health centres can further identify cases of severe acute malnutrition and provide appropriate treatment. To make the ready-to-use therapeutic food more appealing, a locally made option suited to the Cambodian palate is being tested. And to promote beneficial complementary foods, the radio campaign will continue and be updated in the future to stay apace with communities’ needs. 

Baby Pheap and Boris’s experience also demonstrate that national guidelines on severe acute malnutrition must not only be clearly defined, but also effectively enforced. 

These initiatives, coupled with UNICEF’s determination to make severe acute malnutrition a problem of the past, are paving the way for Cambodian children to eat their way toward healthier, longer lives.

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