IRC simplifies wasting treatment as child malnutrition surges

The International Rescue Committee has simplified how it treats wasting as it responds to a surge in hospital admissions for child malnutrition in East Africa. Assumpta Ndumi, IRC’s East Africa technical adviser for nutrition, told Devex that the charity had moved fast to ramp up its work in identifying and treating malnourished children in Kenya, Somalia, and Ethiopia, where it sees a huge need. But with food shortages hitting even therapeutic products, IRC has also been pushed to adapt its treatment for wasting. It is now giving just two daily sachets of ready-to-use therapeutic foods instead of adjusting the dosage to the child’s weight. That has enabled the organization to reach more children faster and without any adverse effects, Ndumi told Devex. This interview is part of a Devex Pro series on how organizations are responding to the food crisis. The conversation has been edited for length and clarity. How is the food crisis affecting IRC’s work? We are seeing an increasing number of children who are malnourished in most of our clinics. In one clinic in Somalia, we’ve seen a 265% increase in admissions compared to last year, and in one of our refugee camps in Kakuma [Kenya], we have seen a threefold increase in admission numbers needing inpatient care. This is mainly children under five [years old]. In response, we are expanding our mobile outreach services so that we are reaching as many children as possible and early before they become severely malnourished. Where are you seeing the biggest impact? We are seeing the biggest effects among rural populations in areas that rely on rain for their livelihoods. In Kenya, we have the arid and semi-arid lands in the north; in Somalia, the south west region is the most affected. In Ethiopia, we have the ongoing crisis in Tigray, where on top of the conflict there is food insecurity. For now, children under five are the ones we see with malnutrition and [who are] presenting more in our health facilities. But we are also seeing a higher number of women, especially pregnant and lactating women [because of their increased energy needs] … presenting as malnourished. For example, in Ethiopia, 70% of the women we screen are presenting as malnourished. How are you responding? The biggest part of the response right now is outreach and active case finding. We send mobile teams to villages to carry out screenings by measuring children’s mid upper-arm circumference. Those who are found to be malnourished are started on treatment immediately, given that referral clinics could be far away. Once we’ve identified the children, we map out hotspots and start providing weekly visits to these communities to make sure that they get the support they require. “In one clinic in Somalia, we’ve seen a 265% increase in admissions [of malnourished children] compared to last year.” --— Assumpta Ndumi, East Africa technical adviser for nutrition, International Rescue Committee In cases where the malnutrition is acute [but] without other complications such as malaria or diarrhea, we provide first-line antibiotics and [sachets of] ready-to-use therapeutic food (RUTF) based on their body weight. However, we are seeing shortages in these therapeutic foods and so we have simplified our protocol, whereby instead of giving the dosage by a child’s body weight, we now only give two sachets [as opposed to potentially three or four sachets]. This allows us to reach more children with less amounts of RUTF and children recover just as well. This has been shown in recent studies done by IRC [and other partners] and it worked very well during the COVID-19 pandemic when we had to reduce contact with patients. So now, with the food emergency, we use this alternative protocol in places where supplies are deficient. It is a more efficient system and can be administered by community health volunteers. We’ve had to hire more staff in Somalia, Ethiopia, and Kenya so that we can increase our outreach work and also keep existing programs running with the increased demand. In Kenya, we are supporting the Ministry of Health with logistics and training and have seconded health workers to them so that they can scale up the government response. The scale of the response is huge so it affects staff who are working extra hours to deal with bigger caseloads, but the programs are all still running, just with additional activities and staff. IRC is also doing gender-based violence response [which has also seen an uptick]. We have teams who travel alongside our [nutrition] mobile teams and screen and identify any cases of GBV and then provide support to them. This could be medical or psychosocial, for example. Finally, what do you think needs to change in the long-term to prevent this from happening again? We are facing a catastrophe. The predictions are that the next rains will also be below average and so the situation will only get worse. We need funding for the response and then as we build longer-term recovery options. We are already doing this; for example, where we are providing water. We are also rehabilitating wells and installing rain catchment in health facilities and schools, but we need funding to be able to prevent a catastrophe from happening.