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Nutrition Interventions Securing Livelihoods in Hard-to-Reach Areas of Borno

The growing insurgency in Northeast Nigeria is negatively impacting the lives and health care of residents in the region, particularly mothers and their infants, who lack adequate care and face life-threatening food shortages. The insurgency has also worsened health issues such as malaria and malnutrition and has adversely obstructed access to clean water.

In a December 2020 report, UNICEF says that more than 400,000 children in North East Nigeria are currently at risk of severe acute malnutrition (SAM) and without treatment, and 75,000 are likely to die this year. UNICEF adds that an estimated 10.6 million people — including 6.2 million children and 1.2 million people living in inaccessible areas — need humanitarian assistance in the North East.

Image credit: Nigeria Health Watch

According to the World Health Organisation (WHO), malnutrition is the single greatest threat to the world’s public health. A recent UNDP report assessing the impact of conflict in North East Nigeria found that it had led to a food crises and as a result over 288,000 children in Borno, Adamawa and Yobe were found to be suffering from SAM.

In addition to state government efforts, non-profits and international relief organisations are providing humanitarian assistance and medical aid to individuals and communities displaced by the conflict.

The conflict in Borno State has worsened malnutrition because most people are being displaced from their communities and have lost their sources of livelihood,” said Ugochukwu Ugwu, a nutrition officer with the Justice Development and Peace Commission (JDPC), an organisation that visits communities in the state to respond to their nutrition needs. “When we meet those who are severely malnourished or moderately malnourished, we refer them to outpatient therapeutic centres where they can be given intensive treatment,” he said.
 
Médecins Sans Frontières Doctors Without Borders [MSF] is also responding to the nutritional challenges of residents despite security threats. Trained teams from MSF have been running mobile clinics to provide basic health care to children under-16 years of age suffering from malnutrition in rural communities outside Maiduguri. These include Dusuman, Musari and the Ahmed Grema Camp for displaced people in Shuwari. “Our medical teams provide emergency treatment, surgery, malnutrition treatment, maternity and antenatal services, vaccinations, and the prevention and treatment of malaria and other diseases”, Isa Ibrahim, the head of MSF’s mobile team, said.

Image credit: Nigeria Health Watch

MSF started working in Borno state in 2014 to respond to the growing needs of displaced persons as a result of the insurgency. In 2019, the MSF mobile team treated more than 10,000 patients, mostly children, for malnutrition across several mapped out communities in the state. In 2020, the team provided a total of 6,881 consultations on malnutrition for children living in villages outside Maiduguri. Of this number, 71 children have been treated for SAM and 190 children for moderate acute malnutrition.
 
According to Ibrahim, some neighbourhoods such as Zabarmari are too insecure for the team to visit. This makes it difficult to provide people in the area with humanitarian assistance and medical care. Zabarmari is the community outside Maiduguri where more than 100 rice farmers were beheaded in November 2020 by Boko Haram terrorists, which caused global condemnation and outrage.
 
In situations like these, Ibrahim says MSF employs a simple yet effective method to provide children with essential healthcare and treatment for malnutrition. The team goes to a community and ask community leaders to select three to five people who can read and write to work as focal persons for the organisation. After the selection, the individuals are trained and taught basic patient-care skills. They are also provided with tools to carry out simple tests such as malaria rapid diagnostic tests, malnutrition screening, weighing, temperature measurements and the mid-upper arm circumference (MUAC) for affected children in the community.

The MSF teamwork to help residents of the state in the face of growing attacks by insurgents and armed men. Photo source: MSF

In addition, since March this year, MSF has been engaging seven community mobilisers from the host communities and three Community Health Extension Workers (CHEWs) — a clinician, drug dispenser and supervisor as auxiliary staff who work from Monday to Friday every week and are paid incentives monthly. The mobilisers inform and educate mothers and caregivers about the activities of the MSF and how they can benefit from it.
 
However, in difficult cases where a child’s condition is serious or hard to determine, the focal persons and auxiliary health workers call the MSF team for advice or make referrals to Gwange Pediatric Hospital, the organisation’s central clinic in the city. Ibrahim says MSF provides local transportation for the guardians or caregivers of the children to bring them to the clinic for treatment and after being treated, they are taken back to their communities.
 
This health intervention is producing positive results as children suffering malnutrition have received treatment and their parents provided with nutrition advice and how to respond when cases arise, Ibrahim says. For instance, more than 1,529 consultations on malnutrition have been carried out since April 2021 out of which 160 cases were referred to the MSF-run clinic for proper treatment and management.

Image credit: Nigeria Health Watch

Ibrahim says this way, children living in hard-to-reach villages and rural communities have access to basic health care when they need it.
 
If not the use of focal person in affected communities, access to health will be difficult for them because not everyone will like to be there because of the (security) challenges,” Abdulkareem Yakubu, MSF’s field communication officer, says of the success of the technique.
 
Ibrahim added that MSF’s use of focal persons and auxiliary staff to work in communities is novel for the organisation’s work and this was devised due to heightened security issues in the area. But thrice a week, MSF staff visit the communities to deliver drug supplies, supervise their activities and assess progress.
 
Building sustainable interventions requires an end to conflict
The spike in insurgency in the region is causing a strain on the works of the nonprofit in accessing the communities. However, Ibrahim says that this challenge has been largely solved because of the experience and skills acquired by the focal persons, community mobilisers and auxiliary health workers they engage with to work in these communities. “Most of them live in the communities with their families, so it is easier to engage with their people,” he said.
 
As MSF continues its interventions in the face of growing security challenges, the sustainability of their work is also a concern for residents and experts who say the government needs to do more to complement their efforts. 
 
Dr. Laz Ude Eze, a public health expert said while ad hoc interventions by NGOs are invaluable, they are at the same time not sustainable in communities they work. He adds that the only thing that is sustainable is achieving food security in the state and across the country. “It is better to prevent malnutrition from occurring in the first place through food security and doing that involves many things because there is a high level of poverty and this drives malnutrition too,” he said, adding, “Solving the problem of insecurity in the state will also help farmers to achieve food security.”

Image credit: Nigeria Health Watch

Eze, who is also a Sustainable Development Consultant, says that raising public health awareness especially among mothers in the rural areas will help them know the combination of local foods and supplements that have high nutritional value to avoid malnutrition. “This should be driven by the local and state governments, with deliberate and intentional actions,” he said, adding, “The school feeding program of the Federal Government, for example, was targeted towards fighting malnutrition, but the implementation has been poor.
 
Most residents have lost their livelihoods and cannot go to the farm to produce what they eat as a result of the conflict, and as a result most of them depend solely on NGO interventions, which is not sufficient enough.
 
In addition to developing sustainability models that enhance continuity in the works of the NGOs such as MSF and others operating in the region, the government needs to intervene and allocate more funds to local organizations on ground as a way of reaching more vulnerable communities in the state. 
 
While questions of sustainability remain, MSF’s adaptation to providing nutrition and healthcare access to children in hard-to-reach areas by training select community members is proof that even within ongoing conflict, those who need care the most can, and should be reached.

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