Putting malnutrition back on the agenda in Ivory Coast

A civil war in 2002 split the country in two: a rebel-held north and government-controlled south. All the health workers, nurses and administrators abandoned the North, making access to basic health services problematic for local communities. For a number of years, the only relief was provided by humanitarian workers.

A power-sharing peace deal in 2007 was agreed and now the humanitarian situation has improved, with health workers slowly returning. However, people still do not have the basic income or work to restore their livelihoods. 

The Ivory Coast is heavily agricultural, producing lots of cocoa, hevea, palm oil and cashew nut. The North was also renowned for its cotton production which employed many people. However, this was interrupted due to the civil war, displacement and  due to  the international collapsing of the cotton prices in 2005-2006. With people not having the tools or money to resume production, and a poor harvest in 2007, child acute malnutrition rates in the North soared to 17.5%.

Due to socio-cultural aspects, one of the major challenges is to make people understand that malnutrition is a severe condition. The word malnutrition does not exist in the native language, and instead is translated into “thin child” with no reference to poor nutrition. This translation can be problematic when a child is suffering from a severe form of malnutrition called oedema, as the child is puffy and inflated, so a mother would not necessarily think her child is suffering from malnutrition.

To address this, we help train and supervise health workers in vulnerable areas of the North, thereby ingraining the concept of malnutrition into national health systems. We have partnered up with the Ministry of Health to technically advise on the detection, prevention and treatment of malnutrition. Our goal is not to create a parallel health system within the Ivorian one, but to really integrate malnutrition within existing systems and resources; this will ensure our work has lasting solutions.

Not only were we able to directly treat some 9,000 children suffering from acute malnutrition, but now five hospitals can treat in-patient malnutrition cases, and forty-six health centres can treat out-patient cases.

Instilling long-term change is a key success for us. The community health workers who volunteer for the benefit of their community were an inspiration to me; as a part of the programme, these volunteers take on the responsibility of ensuring malnourished children in their community get the treatment they need. They even refer to the children as “theirs” asking a nurse: how is “my” child? Some of the community health workers are just 18 years old.