Bangladesh – Three weeks' intensive care to cure Akitara
16 Sep 2011 Health and nutritionBangladesh
Little Akitara was admitted to Terre des hommes’ specialised nutrition unit in Kurigram. At three years and eight months old, she weighed only 8.9 kg. Her case was serious, as on top of being undernourished, she was suffering from diarrhoea and required emergency medical treatment. “<-3 Standard Deviation”, announced Dr. Tazul in a loud voice.
The diagnosis of acute severe malnutrition made only that morning at the Terre des hommes’ outpatient health centre in Kurigram was confirmed on arrival. “This means that her weight is more than 30% below the norm for a child of her age”, he added. In Bangladesh, no fewer than 12% of the children under 5 are in the same condition. Altogether, nearly one child in two suffers from moderate or serious weight insufficiency.
At 1 o’clock, hardly 20 minutes after being admitted, Akitara was given the first preparation of therapeutic milk. She was treated for the diarrhoea and fed continually: every two hours, day and night, her mother gave her a formula of powdered skimmed milk enriched with vegetable fats, maltodextrine, sugar and a mineral and vitamin complex. In this acute stage, it is essential to stabilise the child’s health to pull her out of the critical area where her life is in danger. After three days, Akitara could go on to eight meals a day, then to six daily meals given every four hours. This is the second phase during which the child’s nutritional recuperation takes place: it is about getting the child’s weight back up.
The day we visited, after 16 days of being treated, Akitara had got up to ten kilos in weight. She still could not run about everywhere like a child of her age in good health, but she was on the right track to be able to go back home in a few days without risking a setback.
Taking care of the mother to help the child
During these weeks of convalescence, the mother’s state of health was also followed up closely. Like most of the other mothers, Labli was debilitated and very thin when she arrived. Terre des hommes took care of the mother, as she should be well when the child recovers. All the mothers at the unit can rest and have balanced meals together three times a day. They do not have to worry all the time about finding food for the next meal.
When she arrived, Labli was worried because she had had to decide to leave her eldest daughter, only 6, at home. Dr. Tazul, the resident duty doctor, explains that “other siblings are not admitted to this specialised unit as they might risk of catching one of the diseases that the children have when they arrive”. During the period of hospitalisation, it was therefore Akitara’s grandmother who did the cooking and looked after the elder sister at home. The family owns a small plot of land with a kitchen garden, but this is not enough to feed the whole family, and so the father has to find work as a day labourer.
On June 26th, after 18 days’ treatment, Akitara finally reached the 10.6 kg mark and could go home again. It felt like a real victory, and her mother had done well and not interrupted the treatment before the doctor gave them the green light. The little girl’s life is no longer in danger, even though she has still not reached the ideal weight for her age, i.e. 12.6 kg. Terre des hommes will continue to check up on this family with monthly visits to the village. The health agents will be watching over the development of the little one, so she does not fall back into the danger zone.
Fighting against recurrence is a major challenge for Tdh
Terre des hommes hopes to be able to supply the mothers who can take their children back home with ready-to-use therapeutic foods, so that they can continue the treatment of moderate malnutrition at home, reducing the high rate of recurrence, which is presently 15%. It is a challenge for the Terre des hommes delegation, as the availability is restricted or yet to be sanctioned for wider use because the Bangladeshi Government is carefully studying its appropriateness as a medical treatment for severe wasting.
For the whole of her stay, Akitara’s mother also took part in daily information sessions. She will now be better able to give care and a balanced diet to her children, even though still with the same very limited financial means. The time of recovery was therefore put to good use by the nurses and medical staff, who passed on basic knowledge on child health care. Every day, before the common mealtime, a new subject was discussed in the group. For 18 days, Labli was made aware of personal hygiene, family planning, malnutrition, the use of vitamins, of childish illnesses, of respiratory infections like pneumonia, of first aid after birth and of vaccination. She also got advice about gardening and about balanced cooking, like the traditional ‘Kitchury’ dish. Kitchury is a gruel based on rice and lentils with added onions, green vegetables, marrow, garlic, ginger, and oil. The nutritive qualities of this Bangladeshi dish make it suitable for children from six months old as a complement to mother’s milk.
Thanks to this repeated advice, Labli will be changing things in the diet of her little girl when they are back home. “Now I’ve learned to feed my daughter more frequently”, she explains, “and I am careful to wash my hands before preparing food and giving it to her.”
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