Monday, July 13, 2015

Turning Despair to Dreams: Meeting Malnutrition Challenges in Lao PDR

Thien (2012) in Adone Village with her 2 year-old son, Thear © 2015 UNICEF Lao PDR / S. Noorani

By Shane Powell, UNICEF C4D Specialist.

Adone village, Saravane province, Lao PDR – Thien was just 16 years old the night she felt her first labour pains radiate up through her belly and around her lower back. Three days later, Thien’s newborn first child died...

Less than a year later, her second child died immediately after birth.

“I had no idea why. At the time, I didn’t understand what was happening,” she explains, clutching her back as she recalls the pain of childbirth”

Then, three months into her third pregnancy, Thien suffered a miscarriage. Her story is emblematic of many mothers her age in Lao PDR, especially among the numerous ethnic groups, traditions, and religious beliefs comprising the majority of the country’s most rural and remote areas.

Child mortality rates in Lao PDR are among the highest in the region with nearly 89 deaths per 1,000 children (live births) dying prior to their fifth birthday.

Changing customs, cultivating health

Thien’s story didn’t end with her third pregnancy. Today she is 30 with four children ranging in age from 2 to 6 years. She is also five-months pregnant. Each of her subsequent children survived.

She admits, however, that her surviving children’s health has not always been as good as today. “Things have been difficult,” she says. “(Before) I was always tired. My children were thin and unhealthy.”

In 2012, local health centre staff, trained to screen children’s health in surrounding villages, identified Thien’s 1-year-old son, Thing, as suffering from ‘severe acute malnutrition’, a dangerous condition that can produce life-long physical and cognitive disabilities.

Malnutrition remains one of the most serious threats to children’s health in Lao PDR. Nearly half the country’s children suffer some form of nutrition-related illness. Saravane province is amongst the worst of 17 provinces with 54 per cent of children under 5 years old ‘stunted’ – a condition marked by children growing too slowly for their age as a result of poor nutrition.

Multiple paths to progress

“We know the challenges, but we are also seeing changes,” explains Mr Loth Lanaphane, Director of the Tahuak Health Centre (the health facility closest to Thien and her family). “This used to be an extremely difficult place to live, especially because of the roads … certain villages were situated in very remote locations, and accessible only by mobile doctors during the dry season … there were no local health centres like today.”

Newer roads, he says, coupled with the construction of such health centres, have literally paved the way for progress.

In 2012, Mr Loth was one of those trained to identify malnourished children in his health centre’s zone. Thien’s son, Thing, was one of 13 discovered in a first round of screenings for children under 5 years old. The health centre staff provided a treatment course of ‘eeZeePaste Nut’ – a special therapeutic food designed to quickly treat and replenish a child’s nutrient levels.

The training and the supplements are part of a three-year Government-led initiative, supported by UNICEF with funding from the European Union (EU). The effort is intended to directly benefit 30 million children and 5 million pregnant and lactating women in Lao PDR, Bangladesh, Indonesia, Nepal and the Philippines. In Lao PDR, the estimated target is approximately 730,000 children and 187,000 mothers.

However, in Lao PDR the initiative has gone beyond simply screening children and providing therapeutic treatment. In addition to micronutrient supplementation and deworming, trainings have addressed exclusive breastfeeding from birth to the first six months of a child’s life; continued breastfeeding and appropriate introduction of complementary foods after six months; good hygiene practices; and parenting techniques to inspire children’s interest in eating. This knowledge is passed on to Thien and other mothers through quarterly village visits by health-staff and reinforced by a trained, community-based volunteer.

The evidence

Today, only three of the initial 13 children identified as malnourished in 2012, remain in need of treatment and follow-up, says Mr Loth.

“With the assistance of these initiatives, the trend is definitely falling,” he explains.

Thien credits her remaining children’s survival, especially her youngest ones, primarily to better eating habits and resting and performing less physical labour while pregnant – advice from both the health staff and the local health volunteer. The latter has provided her with counseling at least twice each month during and after her pregnancies, she says.

“That’s right, I listen to what she says. I no longer work hard while I’m pregnant,” Thien says. “I don’t cut things out of my diet like I used to, and when I fall sick I go to the health centre. When the doctor makes an appointment for a health check, I go.”

This is precisely what the EU-UNICEF nutrition partnership, in support of the Lao Government, aims to achieve.

“We’re especially pleased to be hearing this type of information,” says Dr Uma Palaniappan, Nutrition Specialist at the UNICEF office in Lao PDR. “It means the trainings we’re supporting are working. Evidence shows the importance of adolescent and maternal nutrition for the health of the mother and for optimal fetal growth and development.”

Extending the impacts 

In Lao PDR, the EU-UNICEF initiative was extended in 2014 to the end of 2015. The aim is not only to carry forward and ensure ongoing successes on the ground, but also to improve the systems that secure their availability.

“It’s going to take 5-10 years, but we have an opportunity here to do something absolutely essential,” explains Michel Goffin, ChargĂ© d'Affaires of the Delegation of the European Union to Lao PDR. “We want to improve governance …basically, how to help the government to organize itself to address the issue of nutrition.”

Surviving and thriving

Regardless of decisions made by Government or donors, Thien is simply grateful for the changes she’s seen in recent years.

“In the past, there were so many difficulties,” she says. “These days, my children don’t often fall sick, and even when they do we take them to be checked in time and they receive proper treatment.”

She explains, with a glimmer of pride in her voice and eyes, her hopes that perhaps at least one of her children will grow up to be a teacher, civil servant, or even a doctor.

“As for this pregnancy, I know now how to look after myself and I know how to give all my children (what they need) to grow healthy,” she says.

Written by Shane Powell


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