Tuesday, November 15, 2016

Combatting severe acute malnutrition in Phnom Penh’s vulnerable communities

By Pharin Kiev and Arnaud Laillou

15-month-old Yin Seiha, in the arms of her mother Sok Chea, is recovering from severe acute malnutrition after undergoing a treatment regimen using ready-to-use therapeutic food in the form of nutritional wafers
©UNICEF Cambodia/2016/Kiev

October 2016, Phnom Penh
- Seiha is 15 months old. She lives with her mother Chea Sok in a single room hut that floats on Phnom Penh’s Tonle Sap River, in one of the capital city’s slum communities. Smiling and playing with her one-year-old neighbor, it’s hard to believe that this is the same child that a month ago was struggling to live and in need of urgent treatment.

Luckily, the young child caught the attention of a local village health volunteer, Sothea Teth, whose role is to identify malnourished children in the community and refer them to services, in addition to following up with women and children who are at risk of becoming malnourished and could benefit from available support.

Sothea met with Seiha’s mother and urged her to take her daughter to be checked by the nearby health centre staff during a nutrition screening session conducted by the Ministry of Health, with UNICEF support. The baby had been frequently sick, suffering from fevers and regular diarrhea. “As the volunteer, I know many families with malnourished children,” Sothea says. “Visiting families at their home enables me to refer them to outreach services when they are offered at the village or to services at the health centre and hospital.”

At the screening site, Seiha was diagnosed to be suffering from severe acute malnutrition by the trained health staff, requiring a special treatment. It was suspected that inadequate diet such as watered-down rice given as the only source of solid nutrition was the reason behind her poor nutritional status, as is the case with many other young children from poor families who live in similar unhealthy conditions.

Like many poor Cambodians, Seiha’s mom was simply unaware of her baby’s nutritional needs and what she needed to thrive. She did not realize that the food she was giving her child was preventing her child’s growth and development and threatening her life.

After her child was diagnosed with severe acute malnutrition, Chea was directed by the visiting health staff to take the baby to the National Pediatric Hospital in Phnom Penh for treatment. There, she was given take-home rations of a therapeutic food developed and tested by UNICEF and Institut de recherche pour le développement (IRD), a wafer called “num trey” (fish snack in Khmer).

Num Trey, Therapeutic fish snacks with new packaging designed based on field tests 
©UNICEF Cambodia/2016/Laillou

This therapeutic snack was designed to suit better the Cambodian diet to increase the acceptability of receiving and staying on treatment. Children who receive this new therapeutic food are seen monthly by hospital staff to monitor their development and progress. The final results from the ongoing study of the impact of this new therapeutic food product is expected to be available by the end of this year.

Seiha is among the 206 children who have been treated or are under treatment for severe acute malnutrition during the first three quarter of 2016 at the National Pediatric Hospital of Phnom Penh.

For her part, Seiha’s mother, Chea, is pleased with results. “Now my baby is much better and has gained some weight because of the num trey from the hospital,” the happy mother says. “At the hospital, they also taught me the importance of coming back for three follow-up visits to monitor Seiha’s progress and receive more of these therapeutic snacks.”

Seiha enjoys eating this energetic wafer and has shown progress after each follow-up appointment: after the first visit, she could crawl for the first time. Two weeks later, she was able to move around and play with other children. Chea is committed to completing the follow-up treatment because of these encouraging results. “I saw her getting better as she started to eat more,” says Chea. “I don’t want her to get sick again. I want her to get well. Seiha is now a healthy weight and her diet is much improved. I am very happy.”

A volunteer with UNICEF (left) conducts data collection for a field study on the acceptability
of the flavour and packaging of Num Trey (fish snack) back in May 2016 in Ratanakiri
Province by interviewing children and parents
 ©UNICEF Cambodia/2016/Morooka

With support from the National Committees for UNICEF in Australia, Canada, Hong Kong, and South Korea, targeted mass nutritional screening sessions were conducted in Phnom Penh three times during 2015 and so far twice in 2016, reaching more than 5,000 children each time.

These interventions coupled with other services have allowed more than 4,000 children to be treated in 2015, with more children expected to have been treated by the end of 2016.

Developing localized protocols and guidelines for the treatment of severe acute malnutrition is helping children complete their treatment and making a full recovery, with long-term impact on their physical and cognitive development.

Each child reached and treated brings Cambodia one step closer to eradicating the harmful effects of severe acute malnutrition and creating a healthier future for all.

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