Joanna Bogunjoko1,2, S. Kolade Ernest1,2.
1CREN Hopita de la SIM, Galmi, Nigeria Republic,
2University of Ilorin Teaching Hospital Ilorin, Nigeria. | | Abstract | Niger Republic is a land-locked resource-poor country with very low annual rainfall and poor agricultural performance. It is rated second poorest country in the world. Due to the problem of malnutrition the Canadian International Development Agency started a nutritional programme located within the premises of the only major Mission hospital in the country to focus on treating malnourished children in an effective and affordable way, train mothers on child care through "Learning by Doing" and encourage the trained mothers to train other mothers. This one-year appraisal shows that 382 children were admitted into the rehabilitation center. None was less than 6 months of age. Their stay ranged between 2 to 39 days. Most of the children gained weight appreciably after initial loss due to peripheral oedema. Mothers understood what was taught to them. No mother had to stay back after child was discharged because of knowledge gaps. It was assessed that the programme is satisfying its objectives and recommended that it should be duplicated in other parts of Niger Republic and other resource-poor nations of the West Africa.
| | | | Introduction | Niger Republic is a land-locked country straddling the Sahara desert. It has a population of 9.7 million people 1. Just over half are children under 15yrs of age and 20% of the population is under 5yrs of age and nearly 40% of this is considered malnourished 2,3,4 Galmi is a relatively wealthy town due to the employment benefit of the mission hospital. It has a dependable water supply and health care is readily available in the hospital that is located on the only east-west road spanning the country. It would therefore, be expected that the incidence of malnutrition in Galmi would be less than the Nigerian national average.
Niger Republic remains one of the most socio-economically disadvantaged nations of the world, second only to Sierra Leone due to devastating effects of war 5. A world bank report put the Infant Mortality Rate at 135.8 per thousand life birth, Under 5 Mortality Rate 302.6 per thousand life birth, stunted children at 41.1%, moderately under weight children at 49.6% and severely underweight children at 20.2% while low maternal Body Mass Index (BMI less than 8.5) at 20.7% average population figures 6. Due to this poor state of nation, the Canadian International Development Agency initiated a project called Galmi Nutrition project with the general aim of improving the health and nutritional status of under 5 children in Galmi and surrounding villages. The specific objectives include treating malnourished children who presented to the hospital in a way that is effective and affordable for the family, teaching mothers how to care for their children through "learning by doing" in a culturally appropriate setting and encouraging mothers to teach other mothers in their locality what they learnt at the unit 7. This represents a one year appraisal of the project.
Although quinine therapy has been practiced in the treatment of severe malaria for decades, its efficacy has been observed to be declining over the last few years (6-8), which is possibly due to the development of drug resistance. Although quinine resistant falciparum malaria has not been documented yet from Bangladesh , a declining quinine response in some cases of severe malaria has been observed recently. Therefore, to minimize further development of drug resistance and to improve the treatment response with minimum side effects, an alternative new drug or drugs in combination must be sought out. artemether has been introduced very recently in the treatment of falciparum malaria and its efficacy compared to quinine has been found promising. Since a major portion of severe malaria cases are pediatric patients and no intervention study has yet been done with artemether in children with severe malaria in Bangladesh, this randomized clinical trial is designed to evaluate the efficacy and safety of artemether in the pediatric patients of severe malaria. | | | | Methods & Materials | A. Admission Criteria: Patients admitted into the project center (CREN) came from various units of the hospital like the Under 5 clinics, family planning clinics, hospital in-patients and self referrals. Housemother and the unit Doctor screen children and select those that may be best treated in the nutritional center, CREN, for admission. The family must agree to support the mother and child for one month's stay and also be responsible for the cost of any hospital treatment. All children received free food throughout their stay and where finances constituted the only barrier to admission, benevolent funds were made available.
B. Material Resources: CREN, the nutrition rehabilitation unit, comprises of a family size compound containing 8 living rooms, a store and an office. There was running water all the time and VIP latrine available for sewage disposal. Shaded seating areas were available for group teaching sessions. Improved wood sparing and fuel conserving stoves were used for food preparation. Also mortar for pounding grains and other kitchen utensils were available. Funds were provided for the purchase of food, milk, oil and sugar used in the recovery phase and medications.
C. Human Resources: Housemother manages the care of children where no medical complications exist. She also does home visit to the villages every Monday. The unit Doctor visits the units 4 times weekly in the mornings to see all children at admission and consultation for intercurrent illnesses and where a child fails to thrive during their stay. She also reviews children before discharge and follow-up fortnightly after discharge
D. Procedures: Children's weight and height were taken at admission plus a regular daily programme which included charting of children's weight, issuing of materials for first porridge meal in the day, doctor's visit for consultation, distribution of food snacks and teaching sessions for mothers. During the day some patients get into the hospital for wound dressing, injections and other procedures. Further supervised meals and snacks took place at regular interval during the day and final evening meals were given by the mothers to children after the housemother's departure. At discharge, all children have their weight and duration of hospital stay recorded. Intercurrent illness treated during their stay were noted for the purpose of follow-up visits. Maternal education included nutrition, personal and family hygiene, first aids for fever and diarrhea, immunization and family planning. | | | | Results | Over a 12 months period, a total of 382 children were admitted to the unit. The age range of children admitted into the CREN was 6months to 49months (Mean = 17.3 +7.46). Infants constituted 22.2% of total. No infant less than 6months of age were admitted. Admission weight ranged between 3.3kg to 7.8kg (Mean = 5.4 +0.98) while discharge weight ranged between 3.3kg to 9.5kg (Mean = 5.9 +1.22). The length of stay at CREN ranged between 2days and 39 days (Mean = 20.5 +8.15). Several of the children developed intercurrent illnesses like acute malaria, pneumonia and diarrhea disease which were well managed. The differences between admission and discharge weight-for-height standard deviations from the means were shown on Table I.
Table 1. Differences between Admission and Discharge Weight-for-Height Standard Deviation from the Mean
| Quarter |
Number (%) |
Admission |
Discharge |
Difference in mean |
| April-June |
96 (25.1) |
- 3.0 |
- 1.7 |
+ 1.3 |
| July-Sept |
93 (24.4) |
- 3.2 |
- 2.6 |
+ 0.6 |
| Oct-Dec |
105 (27.5) |
- 3.2 |
- 2.2 |
+ 1.0 |
| Jan-March |
88 (23.0) |
- 3.0 |
- 1.8 |
+ 1.2 |
| | | | Discussion | Programme evaluation is a necessary part of interventional activities such as Nutritional programmes. It helps in identification of omission, faults and wrong projections so that adjustment could be made for re-planning and redirection of activities towards the objectives of the particular programme. Therefore, a one year performance evaluation of this Nutritional intervention programme was desperately needed for streamlining of the programme to achieve its main objective in a socio-economically disadvantaged nation like Niger Republic 5.
A total of 382 admissions was remarkably higher compared to admissions at CREN before the intervention programme started this may not be unexpected since public enlightenment through education and home visit were good means of advertisement that projected new hope for caring mothers of nutritionally-ill children and those at risk.
Infants constituted less than a quarter of all the admission which may be a positive effect of breast feeding 8. Breast feeding advocacy insisted on exclusive breastfeeding for 6months of life. This was demonstrated by the fact that no infants less than 6 month was admitted into CREN over the reviewed 12months period. However, the preponderance of malnutrition after infancy just shows the poor nutritional supplementation after exclusive breastfeeding. Intense promotion of continuous breastfeeding till the 2nd birthday may be necessary in addition to the public education on food mixes of the locally available staples. It is known that Nigerians in the Galmi area prefer to sell their farm produce and earn some income than to use them for family menu thereby reducing available staple food for the children.
There was fairly equal admission into CREN during the 4 quarters of the 12 months review period. This also validates the fact that food availability are no better during the harvest season since most of the harvest would be sold for an income. The prevalence of malnutrition therefore was consistently the same all seasons through the year.
The Table I shows significant difference in the standard deviations between the mean Weight-for-Height on admission and discharge. This difference might have been more since most of the children had oedema on admission which they lost just as nutritional rehabilitation resumes before they start to gain weight subsequently. The fall before a rise in the weight significantly affected the differences in the mean weight before admission and discharge while the height remained practically the same while on admission 8. It is evident that the children gained good weights during the admission in the CREN; however, their weights were still below the mean at discharge. This was because the rehabilitation has just commenced and will continue at home. The impact of this can be measured during follow-up visits. This result also showed a fairly consistent outlook indicating that the quality of care offered was sustained over the period.
The intercurrent illnesses among the children was not different from the general childhood population. It was concluded that the programme performance was good and sustainable. It is recommended that exclusive breastfeeding for 6months and continued breastfeeding well in to the 2nd year of life be promoted to reduce the nutritional health burden on the health facility. As awareness increases more children might be brought into the CREN and over stretch the facilities. Also, it would be desirable if the Canadian International Development Agency (CIDA) can duplicate the CREN facility in other parts of Niger Republic so that more children could be reached. This will reduce the growing burden on the Galmi facility so that the standard of care presently been offered can be sustained for a long period. | | | | Compliance with Ethical Standards | | Funding None | | | | Conflict of Interest None | | |
- Decalo S. Historical Dictionary of Niger. Scarecow Press 1997. [PubMed]
- UNICEF : In The State of The World's Children 2007: 138-141.
- Minister des finances et du plan recensement General de la population. Bureau Central du Recensement Niamey Niger 1988 : 1-20.
- Barermes H, Banos MT, Malnutrition de Infants (0-5am) Consultants des centers de Sante de Niamey (Niger) of conditions socio-Economiques des families. Annales pediatric 1997;44: 550-556.
- Gwatlin DR, Rutsten S. Johnson K, Pande RP, and Wagstaff A: Socio-Economic Difference in Health, Nutrition and population Niger: In World Bank publication 2000: www.worldbank.org/hnp.
- Bogunjoko J. Canadian International Development Agency (CIDA) Nutrition Project Progress Report 1999: 1-20.
- The United States Agency for International Development (USAID). International Forum for Francophone Africa-Infant feeding and child survival Lome Conference Report 1992.
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| Cite this article as: | | Bogunjoko J, Ernest S K. One Year of Canadian International Development Agency Nutritional Project Galmi, Niger Republic. Pediatr Oncall J. 2007;4: 42-44. |
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