According to the North East Nigeria Nutrition Sector report of July 2022, admissions of severely malnourished children with and without medical complications across the BAY states increased by 24% and 18% respectively during the first half of 2022, with Borno state accounting for and alarming trend of admission for severe acute malnutrition (SAM), that on average increased by 30% compared to the same period in 2021.
Globally, children suffering from SAM are up to 11 times more likely to die than well-nourished children. Many died at home without care but even when hospital care is provided, case fatality rate remains high because health care providers unknowingly use practices that are suitable for normal children but highly dangerous for SAM patients.
A training of trainers for a better management of severe acute malnutrition
WHO recognizes that food crisis is a health crisis and works strategically to reduce the health impacts of acute malnutrition. To address the urgent need to improving the quality of care and reduce deaths among children with wasting, WHO AFRO, in the context of the Health Emergency Project in the Sahel and in close collaboration with WCO Nigeria and Cameroon, organised a training of trainers (ToT) on the management of severe acute malnutrition with medical complications using the newly released 2022 WHO training package on inpatient management of severe malnutrition for public healthcare providers.
The training package provides guidance and is instrumental to improve the capacity of health personal working at central and district levels, including physicians, nurses and nutritionists on the current evidence and best practices in the inpatient management of SAM, for children 0-59 months that are admitted in stabilization centers. The main objective of this training was to develop a core team of high-level experts across the Sahel region, and specifically targeting Cameroon and Nigeria, who will be tasked with rolling-out the trainings on Inpatient Care Facility care of SAM at facility level, across the two countries and beyond. To this end, a total of twenty-five (25) health professional drawn from Nigeria Federal Ministry of Health in Abuja, Borno, Adamawa and Yobe state Ministries of Health and from the Ministry of Health in Cameroon successfully participated in the training .
Course Director and Facilitators were drawn across three WHO Country Offices (Sierra Leone, Cameroon and Nigeria). This is a clear manifestation of collaborative approach, experience sharing and effective use of the available limited resources both financial and human within the WHO Africa Region.
The course content was taught in eight modules; each module having specific objectives that contributed to building knowledge and skills to enable participants follow the appropriate procedures to manage severe acute malnutrition with medical complications in inpatient care settings and to fully familiarize them with the supplies and necessary equipment needed to provide this service. It is expected that participants upon return to their respective hospitals will implement the procedures learned in this course and adapt the tools to their context.
Improved inpatient management of SAM cases following the training
A week later, a WHO AFRO mission to North East Nigeria was conducted to visit the stabilization center of Molai General Hospital in Borno State, where one of the trained participants works as a doctor. Looking at the registers, it was realized that for the whole week, there were no deaths recorded, marking a virtual 0% of case fatality in that facility. This result is indicative of a clearly improved quality of care, which must be sustained to ensure the reduction of suffering and mortality in order to achieve the best possible impact on people’s health.
One of the participants, Eunice Kodak, Senior Nutrition Officer, FMOH Nigeria said: “I always look forward to a well-structured workshop like this Training of Trainers. This workshop is beyond the conventional way of just power-point presentations, it is both practical and engaging. With the knowledge I have acquired, I can now give better on-the-job training support to my colleagues and conduct a more qualitative inpatient management of SAM cases. I also look forward to being a co-facilitator in the future.”
Lessons learned
• The current increase of emergencies and humanitarian crises that affect the nutritional status of local population in Africa, in a context of limited resources to respond adequately to their needs required innovative approaches, expertise, capacity and strategic preparedness.
• The inter-country collaboration and leveraging strong and unique expertise available in countries office are the backbone of an efficient and timely response to country’s needs.
• The roles played by the three level of WHO (ensure availability of training modules, funding and bridging country experts) was an asset to the success of the story.
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