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Recurring Malnutrition: a silent epidemic devastating Chad

19 Sep 2016

“It’s serious for children here,” says Bernadette Ammaji, 37, as she prepares food for malnourished children and their mothers at Médecins Sans Frontières’ therapeutic feeding centre in Bokoro town, central Chad. “Some mums don’t have the means to be able to feed their children. Others do, but they fail to take proper care of them due to a lack of education about hygiene and nutrition. You need to be strong and brave to care for a child here. It’s not easy.” 

Bernadette, who has worked with Médecins Sans Frontières since 2012, is one of more than 200 staff working to tackle malnutrition in the region. Malnutrition is endemic in Bokoro, as it is across much of Chad, with almost half of child deaths in the country associated with the condition. This year, in villages across the Bokoro region, in partnership with the Ministry of Health (MoH), we are running 15 mobile outpatient clinics for malnourished children aged between six months and five years old. In Bokoro town, we have an Inpatient Therapeutic Feeding Centre in a MoH Hospital with an intensive care unit where the sickest children are referred. Médecins Sans Frontières is also working in the area to identify and try to prevent children at risk of malnutrition from falling ill.

An ‘extreme climate’

 “Living conditions are really hard here,” says Suzanne Moher, 36, a Spanish epidemiologist. “Yes, it’s green now, but when I arrived here a couple of months ago there was no sign of life.” The population has just a couple of months to grow and harvest enough crops to last them the year. The vast majority of people in the area are subsistence farmers, so a bad harvest can be devastating. At the moment, hundreds of women bring their babies to Médecins Sans Frontières’ mobile outpatient clinics every day, as the number of children with malnutrition reaches its annual peak. Last month, Médecins Sans Frontières transferred an average of 50 babies every week from the outpatient clinics to its intensive care unit in Bokoro for emergency care. 

At the moment, hundreds of women bring their babies to Médecins Sans Frontières’ mobile outpatient clinics every day, as the number of children with malnutrition reaches its annual peak

Harmful traditions

Babies and young children in Bokoro also fall into malnutrition due to cultural practices that can unintentionally cause more harm than good. “Some mums here say that when their next child is conceived, their breastmilk is not good for their existing child,” says Benedicte La-Toumbayle, 28, a Chadian nurse at Médecins Sans Frontières’ therapeutic feeding centre in Bokoro town. “They think that by continuing to feed their baby breastmilk, they will harm the future child in their womb.”


Mothers often prefer to take their sick child to a religious leader rather than a health clinic. Marabout [Islamic religious leaders] may say Koranic prayers for the baby, give them a plant-based concoction which can be poisonous, make three cuts on a baby’s stomach or cut out their uvula, at the back of the throat. In the best cases, this can delay malnourished babies getting the treatment they need and, in the worst cases, vulnerable babies, whose immune systems have been weakened by a lack of food, can die from poison or infection. It doesn’t help that making the journey to public health clinics in Chad can be expensive , the clinics often don’t have the necessary medicines or enough trained staff, and despite a national free care policy for malnourished children there are often other hidden costs that make it impossible for people in this area to afford this essential care. 

A desperate need for prevention to tackle chronic malnutrition cases

Médecins Sans Frontières has launched an emergency response to malnutrition in Bokoro at this time of year four times in the last five years. Over that time, it has become clearer that these aren’t one-off emergencies, but part of a pattern of recurring malnutrition. As a result, this year MSF started work in Bokoro, before the malnutrition cases peaked at the start of the rainy season (May to October). Since then, Médecins Sans Frontières has treated more than 9,140 babies and children for severe malnutrition.  “The children who come to our distribution sites should be healthy, but are at risk of getting malnourished,” says Elizair Djamba, supervisor of Médecins Sans Frontières’ distribution team in Bokoro. “For the first time in Bokoro this year, we’re giving these children rations of specially formulated supplementary food and giving them a chance to stay healthy.”

The Médecins Sans Frontières teams have distributed ready-to-use supplementary food, as well as mosquito nets and soap, to more than 30,000 mothers across Bokoro, along with a short health and nutrition lesson. The work is hard but the staff feel passionately that it’s what is needed if Médecins Sans Frontières is to make an impact on recurring malnutrition.