Thursday, May 12, 2016

Nutrition services: A safety net for vulnerable children in urban poor communities

By Eun-Young Jeong and Darathtey Din

View from Phum 5 village, an urban poor area located near Beong Tra Baek river
which carry all the waste and dirty water from the city
© UNICEF Cambodia/2016/Antione Raab

It’s not even 9:00 a.m., and the alleyway in front of six-year-old Bunley’s house is buzzing. On any other day, it would have been just his grandfather, occupying a corner of the wooden bench across the house smoking cigarettes, while his younger siblings toddled nearby. Instead, there are about 20 children, from as young as 6 months old to around 6 years old, lined up for nutrition screening—UNICEF lingo for measuring children’s height and weight to identify those with severe acute malnutrition (SAM).

At the front end of the screening site, a health centre staff recorded the details of each child before the child stepped onto a weighing scale and then a wooden height measuring scale. Once the screening was complete, each child received a packet of high nutrient biscuits. As some children returned home with their biscuits, many more came to join the line.

Children waiting for been height and weight
© UNICEF Cambodia/2016/Antoine Raab

Bunley lives in Phum 5 village, an urban poor community, located at the southern end of Phnom Penh. People in this area live in small houses made out of wood and metal sheets. Most houses are supported by wooden legs that elevate the houses above a canal filled with floating garbage.

Bunley (front left) and his family
© UNICEF Cambodia/2016/Antoine Raab

Bunley’s family has been living in Phum 5 village since 2002. His father is a garbage collector and his mother was a street vendor selling fruits. She stopped working a few months ago when she had her sixth child.

Children in urban poor communities face high risks of malnutrition, which can undermine their physical, mental and intellectual growth. It is estimated that over 35 per cent of children under age 5 living in urban poor areas are underweight-more than one in every three children. This prevalence is higher than the national average, which stands at 24 per cent or about one in every four children. Malnutrition causes approximately 4,500 child deaths every year in Cambodia.

“This is the third screening that I’m doing here,” said Long Sophat, a staff from the nearby Phsar Deum Tkov community health centre. The centre is supported by the Ministry of Health, in partnership with UNICEF. Nutrition screenings by the community health centre for urban poor children began in 2014.

“We’re seeing improvements in the children, but there are still several challenges,” said Long. She said that parents’ lack of knowledge of proper feeding practices and their absence from home was a problem she observed during her visits. “Parents here are not at home most of the time because they have to work constantly and the children are left on their own. As a result, the children play in unhygienic areas and eat unsafe food, which affects their health.”

Long was concerned with the low number of parents she saw that day. She said more parents had attended the screening in her previous visits where she was even able to talk to some about how to properly feed children and prepare nutritious porridge.

Long Sophat (in light blue top) facilitates the screening
© UNICEF Cambodia/2016/Antoine Raab

Less than three footsteps away from the screening site, Bunley watched the action from his house. A few minutes later, he stepped up to be screened. Weighing 12.5 kilograms, with a height of 105 centimetres, he was identified to fall within the normal height and weight range for his age.

Bunley’s mother said the screenings are useful because her children can obtain food supplements like the biscuit packs they received today. She said the biscuits helped her children to gain weight since the last screening. Another mother, one of the few adults that we could find that day, said that the screenings helped to identify children who are in bad health. She added, “I see it as an act of caring. I feel like people like us, living in this area, haven’t been forgotten.”

Despite the high prevalence of malnourished children in Cambodia, malnutrition is not regarded as a disease and it is not common practice to monitor children’s growth at health centres. Nutrition screenings provide a safety net for children by identifying those affected by malnutrition, providing them with supplement nutrient food and referring children with severe cases to nearby health centres for additional treatment.

“But this is only a temporary solution,” says Arnaud Laillou, Nutrition Specialist at UNICEF. “We need a more systematic and long-term approach to tackle child malnutrition.” Dr. Laillou adds that such a sustainable approach with reverberating results would not look at nutrition alone, but be integrated with other areas that are critical to children’s proper growth and development, making sure that factors that cause child malnutrition in the first place are tackled.

“Children need good nutritious food to be well nourished. But they also need safe drinking water, clean toilets, good health care and better care from their parents. Just addressing one area will not solve malnutrition.” Explains Dr. Laillou.

UNICEF’s Integrated Early Childhood Development (IECD) Programme is designed based on this belief and brings together water, sanitation and hygiene (WASH), nutrition, health, child protection, early childhood education, and community development components to ensure that the most vulnerable children are supported to grow and develop properly. 

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