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Field Article
Figure 1: Model of intervention for the management of acute malnutrition in Guinea
Figure 2: Map of Guinea focused on Conakry communes
Community
screening
Referal
g CS
Screening
in CS
Transfer
g CNT
cSAM CM
in CNT
SAM
cSAM
cSAM
Treated
cSAM
Stabilised
Transfer g CNA
< 5years AM
Suspected
AM
Referred
sSAM
sSAM
Treated
sSAM
Recovery
MAM
Recovery
MAM
Treated
MAM
Referral
g CNS
Transfer
g CNA
sSAM CM
in CNA
MAM CM
Activity
Child
RATOMA
MATOTO
Key to figure: AM: acute malnutrition; SAM: Severe acute malnutrition; MAM: moderate acute malnutrition;
CS: health centre; cSAM: complicated SAM; sSAM: Uncomplicated SAM; CNA: ambulatory nutrition centres;
CNS: supplementary nutrition centres; CM: case management
KALOUM
DIXIN
MATAM
cal, material and equipment support to the nutrition
units of the health facilities.
The staff of Fondation Tdh comprises two
medical doctors and a nutritionist. Technical
support includes training and on the job supervision.
Fondation Tdh also invests in quarterly
nutrition programme supervision of all the
health facilities by the higher authorities of the
Conakry City Health Directorate. Fondation
Tdh staff also assist the health facilities in
collating and analysing data generated from
their nutrition activities. Through these analyses,
weaknesses are jointly identified and
decisions are reached on corrections. Further,
on the request of the health authorities,
Fondation Tdh acts as an active interface
between the health authorities and agencies
like UNICEF and World Food Programme
(WFP) for supplies to the health facilities. This
is a temporary arrangement pending the time
the authorities study the reporting mechanisms
of these agencies and identify a liaison person
for this activity.
In addition to the technical support,
Fondation Tdh also provides material support
to the nutrition units, such as stationery, IEC
(information, education, communication)
materials, cooking materials, MUAC tapes and
weighing scales.
Urban Community Health Workers in
Ratoma commune
In six of the 20 quarters of Ratoma, Fondation
Tdh in collaboration with the communal health
authorities, recruited and trained 32 urban
community health workers (UCHW). The
UCHWs participate in the community screening
of children for acute malnutrition in their
neighbourhoods, follow up on defaulting cases
and engage in the promotion of healthy nutrition
practices through cooking demonstrations,
counselling on breastfeeding and hygiene (See
Figure 3).
Screening of children for acute
malnutrition
Screening of children for acute malnutrition
takes place at two levels – in the neighbourhoods
(active screening) and at the health
facility level (passive screening). See Figure 3.
Active screening
Each of the UCHWs is assigned an area within
their neighbourhoods. The UCHWs compile a
list of all the children within their area and visit
their homes on a monthly basis. In the course of
the visits, MUAC of children 6-59 months is
measured and recorded. Children with MUAC
of 65 cm), MUAC is also measured.
Children between 6-59 months presenting
with acute malnutrition are assigned to the
appropriate treatment as directed by the
National Guidelines.
The total case load of malnutrition for Ratoma
Comune and St Gabriel is shown in Table 2.
Management of SAM
The child with sSAM is prescribed Ready to use
therapeutic foods (RUTF) 1 and routine drugs
like Vitamin A, antibiotics and anti-helminthics.
RUTF is given on a weekly basis to the children
and at the end of each week, the child presents
at the health facility for a check-up until the
child attains and maintains the target weight
(85% of the median % weight-for-height) at two
consecutive weekly checkups (option 1) or
option 2 (discharge on reaching 85%) without
two consecutive check-ups.
Monitoring reports indicate that St Gabriel
Dispensary has had major problems with
defaulting in the treatment of sSAM. In 2010, of
a total number of 1,133 recorded exits, 35.6%
were cases of defaulting. The reason for this is
that, unlike the four other CNAs supported by
Fondation Tdh, St. Gabriel Dispensary has a
reputation for inexpensive and quality medical
treatment which extends far beyond Ratoma
commune. The dispensary charges a flat rate
which includes costs for consultation, laboratory
tests and medicines. Many people travel
great distances, sometimes up to 200 km, to
seek treatment is this dispensary. Normally,
parents do not recognise signs of acute malnutrition
in their children and come to the
healthcare centre expecting treatment for
illnesses rather than for malnutrition. The
healthcare centre staff identify malnourished
cases through routine measurement of the children.
When a child is diagnosed as suffering
from acute malnutrition and the parents are
told that treatment is necessary and that this
will involve several weekly check ups (a total of
5 to 10 visits), many of them fail to return to the
centre after one or two follow-up visits. This is
due to the distance they have to travel each
time. These cases present a problem for the
Dispensary, because there are no CNAs or CNS
in the villages of origin of these children to
which they can be referred.
All identified cases of cSAM are referred to
INSE. Fondation Tdh supports the patients
through the payment of transport costs from
the referring health facility to INSE. Further,
Fondation Tdh pays the treatment costs of
cSAM cases referred from any of its intervention
centres. cSAM cases are managed with F75
formula until stabilisation and then referred
back to referring centre for Phase 2 management
as prescribed by the National Guidelines.
Management of MAM
Breastfed children