Client: Office of U.S. Foreign Disaster Assistance (OFDA), United States Agency for International Development (USAID)

Recovering child being weighed Photo by Peggy Koniz-Booher

Niger is a Sahelien country with a long history of repeated cycles of famine due to environmental vulnerability and extreme poverty. Niger’s persistent acute malnutrition rate of 12% and chronic malnutrition rate of 50% contribute to one of the highest childhood mortality burdens in the world. The 2005 food crisis in Niger severely strained a struggling national health system with very limited capacity for integrated child nutrition services. Despite recurrent food crises, services for malnourished children in Niger are usually provided by transient relief groups working outside the public health system with little capacity building within the national health system.

In August 2005 the Nigerien Ministry of Health (MOH) and partners issued the first-ever national guidelines for prevention, screening, and recuperation of childhood malnutrition. The challenge now is to operationalize these national standards into an integrated continuum of nutrition services for Niger’s most vulnerable children.

Counseling tool demonstrating active feeding of a sick child

In the spring of 2006 the Office of U.S. Foreign Disaster Assistance (OFDA) awarded the Center for Human Services (CHS) a 12-month program grant entitled Rapid Expansion of Nutritional Recuperation Services for Malnourished Children in Nigerien Facilities. Under this project, CHS is leveraging its established countrywide Pediatric Hospital Improvement (PHI) Collaborative, run as part of the Quality Assurance Project, to rapidly expand nutritional recuperation services for acutely malnourished children in 15 district hospitals while building local capacity for improved behavior change communication, screening, referral, and recuperation at global district levels. Initiated in 2003, the PHI collaborative works in 32 of Niger’s 43 government hospitals and has made nationally recognized gains in improving the quality of pediatric first referral services for integrated management of childhood illness due to its unique improvement collaborative approach and strong partnership with regional and national MOH leadership.

The OFDA-funded program targets 15 of the 32 MOH facilities participating in the PHI Collaborative, in 7 of Niger’s 8 administrative regions. Working in close collaboration with regional MOH authorities, CHS is working to:

• Expand care for severely malnourished children at 15 district hospitals that participate in the PHI collaborative
• Collaborate with UNICEF and Helen Keller International to improve sustainability, quality, and efficiency of recuperation centers (Centre de Recuperation Nutritionnelle Intensif (CRENI’s)) established in 2005/06 in government regional and district hospitals
• Establish new CRENI’s in PHI sites at government hospitals that do not have established nutritional recuperation services for malnourished children
• Strengthen referral/counter-referral mechanisms between primary health and hospital facilities through advocacy for reduced economic barriers to access and by partnering with relief nongovernmental organizations (NGO’s) and local committees working at the community level to reduce malnutrition
• Educate health care providers and caretakers of malnourished children in prevention of, recovery from, and reduced relapse of malnutrition by using accessible, affordable local foods and promoting continuation of breastfeeding
• Reduce malnutrition case fatality rates at targeted Nigerien facilities by rapidly introducing and promoting compliance with the new national nutritional recuperation protocol

• Helen Keller International
• Islamic Relief
• UNICEF

• As of December 2006, 1,721 severely malnourished children have been admitted to program government-run nutritional recuperation centers.
• Systematic nutritional screening and behavior change communication activities are now routine in all program facilities including promotion of continued breastfeeding throughout the recuperation period for breastfeeding infants.
• Overall compliance with recuperation standards in targeted new nutrition recuperation facilities has increased from less than 10% at baseline to an average of 89% at the end of the second program quarter.
• The average recovery rate for all program sites combined has increased from an average 61% in the second program quarter to 77% during the third program quarter (Oct-Dec 2006).
• The average malnutrition case fatality rate has decreased from an average 26% during the second quarter to 16 % during the third program quarter (Oct-Dec 2006).
• Improved Referral/counter-referral (RCR) capacity for a continuum of malnutrition care is being introduced via quarterly district level RCR workshops. Proportion of children admitted to CRENI’s referred from an outside facility or community source has increased from a baseline of 43% to 67% as of December 2006.

Countrywide in 15 districts

Contact Dr. Kathleen Hill at khill@urc-chs.com (Bethesda HQ) or Dr. Maina Boucar (URC-CHS/Niger) at paqchs@intnet.ne.

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