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Oxfam is engaged in an ambitious three year program to address the underlying causes of malnutrition and tackle the tragedy which is estimated to be the cause of nearly half of all child deaths in Niger.
Hygiene ready - Clean Water and sanitation
Malnutrition is aggravated by a lack of clean water for drinking and washing, leading to sickness caused by waterborne diseases. Lack of access to clean water is a major problem in some areas even for women giving birth. Health centers, even when they are accessible, often suffer from a lack of access to clean water and sanitation facilities. By providing clean, chlorinated water at health centers and nearby villages we are dealing with malnutrition at first source - ensuring that there is clean water for mothers giving birth and sick people.
Attri Regional Health Center in Agadez Region, Niger, March 2015. Attri itself is a set of small rural villages comprising 512 families. The area will benefit from improvements made by the Oxfam program in 2015. Photo credit: Abbie Trayler-Smith/Oxfam
Lack of water a problem for Treatment Centers
Marho Boubacar (29) is a midwife at Attri Treatment Center, part of Oxfam’s program in 2015. The center is an hour by car or motorbike from the nearest town of Agadez (the ambulance has broken down). The building has only one treatment room and a great need for water.
“The provision of water is a real concern here because there’s no water point There’s a well but it's 500 meters from here, and it's difficult to keep going to fetch water all the time. The cleaner has to go to fetch the water – he carries it back four-five times a day, its hard work! 20 liters per day is the minimum I can get by with and at the moment we’re delivering up to ten babies a month.” Marho Boubacar, midwife, (29).
In 2015 Oxfam will be in Attri to rehabilitate two wells, install a hand pump for the community well and a pipeline to the center from the nearest water point, install four latrines, two hand-washing stations, an incinerator and create a laundry area, as well as training three hygienists and six community health leaders.
Benefits already delivered
Midwife: Tino Elhaji Bila at Azel Treatment Centre, Agadez Region, a small community health center, largely dealing with malnutrition cases. Azel has benefitted from OFDA funded water, sanitation, hygiene and nutrition programming (WASH / NUT) The project is one year old, and started in April 2014. Photo credit: Abbie Trayler-Smith/Oxfam
Azel, Banneberi, Tondikwindi and Dabaga Treatment centers are already seeing the benefits of the program. We installed water tanks, pumps, toilets, hand-washing stations, incinerators and laundry areas, according to need, at these centers last year. We also trained community health leaders and medical hygienists and provided aquatabs, sensitization programs, hygiene training sessions (WASH) and distributed hygiene kits.
Salama (38) and Hama, her baby boy, 9 months at their home in Azel. The father is Agalher, a gardener. Photo credit: Abbie Trayler-Smith/Oxfam
“We are completely delighted to get the water system in our health centre – before it was here we had to go to the neighboring village to fetch water for going to the treatment centre and it was difficult for the nurse to really look after us. Now, they can wash our babies when they have diarrhea. There’s a laundry system and everything is sanitary. It’s huge progress!” Salama (38) mother of Hama*, a baby boy, 9 months. (visitor to Azel Treatment Center).
Providing clean water, sanitation and training voluntary hygienists helps enable good hygiene practices both for the birthing process and treatment of the sick. But health centers are only a part of the picture. Sometimes there is a lack of education about hygiene and nutrition and this is also an underlying cause of malnutrition in Niger. We support families to keep their children healthy by enhancing their knowledge of food nutrition and good hygiene practices.
Halima and children at a hand-washing demonstration at Tondikwindi Treatment Centre, Ouallum, Niger, March 2015. Photo credit: Abbie Trayler-Smith/Oxfam
“The main cause of malnutrition is [lack of] education, if only people knew how to eat. If we intensify sensitization of the villagers we could see huge progress …” Alhassane Mahmoudane (39, lead nurse at Attri Health Center).
Sensitization programs have a waterfall effect, we teach a few ambassadors about good hygiene practices and nutrition and how to spread the knowledge not the illnesses.
“The sensitization sessions are really important - before, people didn’t know the importance of good hygiene to stay healthy. Since the sessions started, we are well informed about hygiene and sanitation. These are changes! Before the sessions people didn’t even seek medical support. Now they come straight to be seen. As soon as any child is sick, I bring them straight in.” Salama (38) mother of Hama*, a baby boy, 9 months (visitor to Azel Treatment Center).
Community health worker (‘Relay’ volunteer trained by Oxfam) Azara Mohammed using a picture book, at an Oxfam Distribution and Sensitization Session at Azel Treatment Centre, Agadez Region, Niger, March 2015. Photo credit: Abbie Trayler-Smith/Oxfam
Picture books are used in the demonstrations to teach expectant mothers about the importance of immediate breastfeeding, to demonstrate the fundamentals of hand washing, the importance of exclusive maternal breastfeeding, complementary feeding, water treatment at home and hygiene practices to prevent disease.
Local cultural practices have led in the past to mothers not giving their babies the essential nutritious and immune boosting first milk and waiting until their full milk comes in. Educating the local population about the value and purpose of immediate breastfeeding gives babies a better start and protects against disease.
Nutrition and Spotting Malnutrition
Fatima Abdou, a lady from the community who has been trained as a community health leader uses a cooking demonstration to teach the importance of having a varied diet and eating vegetables, to encourage the women to diversify from an otherwise monotonous diet of millet. Photo credit: Abbie Trayler-Smith/Oxfam
The local diet tends to be little varied; a diet of carbohydrate heavy millet. Cooking demonstrations teach the importance of having a varied diet and eating vegetables.
Binta Boukary demonstrates how she's learned to assess children for malnutrition using a Muak tape so they can be quickly diagnosed in the community and seek treatment. In Dadaga Village, Ouallum Province, Niger, March 2015. Photo credit: Abbie Trayler-Smith/Oxfam
Binta Boukary is an Oxfam trained Community Health Leader in Ouallum Province. She both teaches about nutrition and has been trained to spot malnutrition in children. She weighs the children once a month and evaluates them, this means that malnourished children receive help quickly. “I was really pleased with what I learned about hygiene and nutrition; I learned to prepare fruit as well as porridge, and to wash my child and her hands everyday. The conditions here have really improved. “ Binta Boukary, Dadaga Village, Ouallum Province, Niger.
Spreading knowledge not disease
The health leaders train people who come to the treatment centers and hold sessions for the community, but the message doesn’t stop there - the word spreads and others start to learn about and copy good practices. In this way the program’s benefits are much further reaching.
Maimouna – her daughter Lehana * (5) demonstrate the hand washing skills they’ve learned ‘second hand’ in the village, Kokosseye, Ouallum district, Niger, March, 2015. Photo credit: Abbie Trayler-Smith/Oxfam
Maimouna is an ‘indirect’ beneficiary of the program:
“It’s very simple, the program is being taught here by the women. Women who’ve had sick children and have seen the benefits of hand-washing and hygiene practice. Before, we did not do these things. We just learned it from those who’ve been to the training sessions, but we’re already seeing the benefit. It has prevented diarrhea in our children – that’s massively reduced. They are more healthy and they’re more happy! They practice themselves, whether or not adults are present. When the meal is ready, after the meal, after the toilet – they run and wash their hands! Because all the kids are friends, the neighbors copy those who’ve adopted good practice. When I started teaching it here, the kids run to their parents, and say ‘look what they’ve got next door, the kit for hand-washing!’ We only started a few months ago but we’ll definitely keep on with it. We really want it to be a permanent improvement.”
* some names have been changed.