Friday, January 23, 2015

Screening to treat child malnutrition in Cambodia’s urban poor communities

By Samoeurn Un and Arnaud Laillou

PHNOM PENH, Cambodia, 23 January 2015 - Phalla Sophy, aged 10 months, is one of five brothers who lives in his grandmother’s make-shift house in Sangkat Deum Tkov: one of 120 urban settlements in Cambodia’s capital, Phnom Penh. During a recent UNICEF-supported nutrition screening of over 4,000 children under 5 years old in the settlements, Sophy was found to be malnourished. His cousin Lon Samthida, a 7 month old girl, who lives in the same house, was identified as severely malnourished.

Phalla Sophy, 10 months of age, being screened for malnutrition in Sangkat Deum Tkov, one of 120 urban settlements in Cambodia’s capital, Phnom Penh.
© UNICEF Cambodia/2014/Arnaud Laillou

Their mothers work informally in Phnom Penh city, collecting trash for recycling and earning between 10,000 and 20,000 Riels per day (US$2.50 and US$5.00). Samthida’s mother, Sok Srey Mao (20) says, “Those earnings are not enough to cover our daily expenses for foods and any other costs.”

Rapid growth of urban poor communities

Over the past two decades Phnom Penh has experienced rapid growth, doubling its population mostly due to the migration of rural Cambodians seeking employment in the booming capital. This rapid and unplanned urbanization has created pockets of poverty that are likely to grow.  To date, the Phnom Penh municipality has identified 514 urban settlements, representing some 250,000 people (of whom, approximately 35 per cent are children under the age of 14 and almost the same proportion of women aged 15-30).

A field assessment of Phnom Penh urban poor communities in April 2014 by UNICEF and its implementing partner, the non-governmental organization People in Need (PIN), found that the levels of underweight (35.6 per cent), wasting (11.2 per cent) and stunting (29.1 per cent) in children aged 6-59 months were much higher than those recorded in the 2010 Cambodia Demographic and Health Survey for Phnom Penh.

Following the screening, Sophy and Samthida were immediately sent to the nearby health centre to receive ready-to-use therapeutic food. “Once those families arrived at the health centre, we re-screened the children to ensure they had no other infections to treat…We then explained [to their mothers] how to use the ready-to-use-therapeutic food and with what the frequency. We also gave them another appointment to follow-up on their progress and growth,” said health centre director, Srey Ratana. “Thanks to the latest two-month mass screening campaign, 45 children [were found to be] severely malnourished but we still need to find solutions for the 186 children screened as moderately malnourished, as we have no other alternative than counselling them for better nutrition.”

High poverty levels and under-nutrition

The UNICEF/PIN assessment found that, at 29 per cent, poverty levels among urban poor communities are considerably higher than the official poverty levels for Phnom Penh (12.8 per cent - using the adjusted absolute poverty rate for Phnom Penh). Among households in urban poor communities 69 per cent were reported to have debt and of these, 30 per cent reported debt of more than US$400 with the funds used for daily subsistence expenses, such as food, healthcare and home repair. Households from the lowest quintile like Samthida’s and Sophy’s families are making loan repayments averaging US$40 per month, which severely limit their chances of being able to pay for any unforeseen health expenses.

Happily, for Sophy and Samthida, after three weeks of out-patient treatment they are on their way to recovery. Sophy’s mother, Sam Phalla,is very happy that her son was admitted for treatment. “My child ate the [ready-to-use-therapeutic food] well. I encouraged him to eat by preparing it in different ways. After a few days, he was eager to eat and now he looks healthier and his skin is brighter.”

Phalla Sophy, 10 months of age, after three weeks of treatment against malnutrition with ready-to-eat therapeutic food.
© UNICEF Cambodia/2014/Arnaud Laillou

The village health support volunteer in Sangkat Deum Tkov is Mrs. Suy Sambath. She says, “Screening the children is essential to create awareness among the mothers. [They] do not realise their children are malnourished most of the time. [The screenings] allow them to realize and allow us to provide counselling. In addition, due to their socioeconomic status those are often not coming to the health centres and therefore do not receive free deworming and/or vitamin A tablets, however through the outreach screening we are able to provide them.”

According to Dr. Po Rithy, from the Health Department of Phnom Penh Municipality, “Malnutrition is also a result of ignorance, poverty and lack of food, and even after rehabilitation, those families have difficulties to correctly feed their children with quality diets.”

The Cambodia government’s Health Equity Fund enables children from identified poor households to receive free medical treatment, including the provision of therapeutic foods, antibiotics and any other required drugs or supplies. Unfortunately, some families - like those of Sophy and Samthida - do not have the ‘ID Poor’ certificate which would allow them to benefit. The UNICEF-supported nutrition screening does not require such certification, Treatment of severe acute malnutrition is free and the child’s caregiver is provided with transport and meals in order to remain with the child during hospital treatment.

Every year, UNICEF - with funding from the Czech, Danish, Lithuanian, Norwegian and Australian Committees for UNICEF - supports the treatment of more than 1,600 severely acute malnourished children in Cambodia’s 25 provinces. The screening of vulnerable children in urban settlements helps to ensure that malnourished children receive treatment as soon as possible so as not to jeopardize their future growth. Affordable and sustainable solutions to child malnutrition are essential. With this in mind, UNICEF is continuing to work with partners to develop innovative ways to supplement food with essential micronutrients to improve the diets of all Cambodian children aged 6-24 months.

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