Posted on 3 April, 2012

Sahel: As Likely Malnutrition Crisis Looms, MSF Prepares Short- And Long-Term Responses

A food crisis has been declared in the Sahelian Band of West Africa. UNICEF has estimated that up to 15 million people in six countries in the region are living with moderate or acute food insecurity. In a region where global acute childhood malnutrition rates regularly near the warning threshold of 10 percent, any factor that further reduces access to food can tip the situation into a full-blown nutritional crisis.

Although MSF has not yet noted a significant increase in cases in most of its current nutritional programs, the organization did have to open new malnutrition treatment programs in Biltine and Yao, in Chad, where rates of acute malnutrition of 24 percent and 20 percent, respectively, have been reported. Teams are also evaluating the nutritional situation in other areas of Chad, as well as in Mali, Niger, Mauritania, and Senegal.

“It is too soon to know the extent of the expected nutritional crisis,” says Stéphane Doyon, manager of MSF’s malnutrition campaign. “Traditionally, the most difficult period is still ahead, between May and July. However, we already project that hundreds of thousands of children will suffer from acute severe malnutrition, as they do every year in this region.”

Photo: Chad 2011 © Alfons Rodriguez
An MSF staff member measures the mid-upper arm circumference (MUAC) of a child with severe acute malnutrition in Chad.

MSF Blogs: Precious Blood

Veronica Ades is an obstetrician-gynecologist on her first Doctors Without Borders mission in Aweil, South Sudan.

“The woman was sent from the Ministry of Health (MoH) section of the hospital. MSF operates the Maternity Ward, the Pediatric wards, and the therapeutic feeding center. The rest of the hospital is under the direction of the MoH. We are not sure why she was sent, but there is a written request to check hemoglobin. The midwife has checked it, and it is extremely low at 4.4 g/dL. If I had a hemoglobin this low, I would probably be dead, but people here are generally so anemic that they are physiologically more adjusted to it, and can tolerate very low levels. Nonetheless, she is symptomatic. She is visibly tachypneic (fast breathing), tachycardic (high heart rate), and she looks weak and miserable.

There is some confusion about what to do with her. She is quite sick, but we only manage pregnant women. If she is not pregnant, then the MOH should manage her. We learn that they had already given her one unit of blood—her original hemoglobin on arrival was 2.9 g/dL. Good grief. But why did they send her to us then? She arrived with a piece of paper, ostensibly a referral, but it is in Arabic.

We decide to do a pregnancy test, and if it is negative, we will send her back. It comes back positive. We put her in a bed, and the maternity manager (who is a midwife) examines her while I see other patients. She asks me to come and look at her ultrasound. She shows me the uterus, and it looks empty. She moves the ultrasound probe to the right, and suddenly a very clear pregnancy appears—outside the uterus. The patient has an ectopic pregnancy. That may or may not explain the anemia. If the ectopic ruptured and she bled into her abdomen, that would make her very anemic, but we don’t see any free fluid in her abdomen, and she doesn’t have any abdominal pain. She did have abdominal pain two days ago, she tells us. Strange.

Now we have a problem. She needs surgery to remove her ectopic pregnancy, but she is so anemic that we are not sure she can tolerate the surgery. She needs blood before we can operate, but there are two problems. First, if we transfuse her, will she just bleed what we give her into her abdomen? And second, is there any blood for her in the blood bank?”

Read the rest of Veronica’s blog post here.

Photo:South Sudan 2011 © Q. Sakamaki/Redux
Sudanese mothers wait to see a doctor at the MSF maternity/pediatrics department in Aweil.