In January 2019 I returned from maternity leave. Everything was feeling strange, and it was a wrench leaving my baby for the first time. I vividly remember my first meeting, which was with Robert Glick OBE, chair of our newly formed Global Malnutrition Initiative Board: a group of socially minded philanthropists seeking to raise £20 million to catalyse new approaches to dealing with a devastating issue facing children – malnutrition.
Listening to Robert and my team, I knew that, thanks to Save the Children’s deep rooted community knowledge & expertise and with Robert’s passion, this was an area for children we could make a real and lasting difference to and I remembered what a privilege it is to work for Save the Children.
Over the last year, Robert and his board, working hand in hand with Save the Children, have raised an extraordinary £2.12 million seed funding from philanthropists, foundations, and corporates. We have put the seed funding straight to work, taking malnutrition treatment into the community in Kenya, directly treating children in Yemen and combating the effects of drought in Somalia. In October, we were delighted when Sir Mo Farah became Patron of this Initiative, which strikes huge resonance for him as a father of four and his connection to his country of birth, Somalia.
The statistics on malnutrition are so stark. For the first time in decades, global hunger is on the rise, and is linked to nearly half of deaths of children under the age of 5. If a child is hungry, their little bodies are much less able to fight off an infection, and a child with acute malnutrition* is 11 times more likely to die compared to a well-nourished child. Malnutrition is also associated with nearly half of pneumonia deaths.
It is one thing to read the statistics and another to see the need first hand. In December of last year, I traveled to the Turkana region in the northwest of Kenya, an arid, dry region home to 1 million pastoralists. We traveled for over 80km before meeting communities in Kerio town, with the occasional sight of a herd of goats and camels being looked after by the men of Turkana. Acute malnutrition rates in Turkana are consistently above the critical threshold of 15%, indicating a major public health concern which needs urgent action, and the adult literacy rate is 20%, one of the lowest in Kenya.
It is in this area of Kenya that Save the Children has been piloting a new approach to preventing, diagnosing and treating malnutrition, building on our existing knowledge and expertise. As an international community, we know how to stop malnutrition; when treated with specialised therapeutic food, medicines, and regular check-ups, 80% of children recover. However, what we are encountering is a challenge of access to treatment: only 1 in 5 malnourished children globally actually get treated in the first place, because health centres are simply too far away. This is not right.
In Turkana, we have been working alongside the Ministry of Health and other partners to bring health care into communities. Government health workers are an excellent resource for communities and they are already trained to recognise, treat and refer conditions such as diarrhoea, malaria and pneumonia. However, to date, the diagnosis and treatment protocol for malnutrition has been too complex for these workers, most of whom have low levels of literacy. Through our pilot scheme, we have simplified these protocols, and the workers are now trained to also spot, treat, and refer malnutrition within communities, without children having to make the arduous journey to remote health centres.
We visited one of Save the Children’s outreach posts, which are pop up facilities moving daily to 12 different sites over a period of two weeks and then returning to complete another rotation. There were hundreds of community members gathered there with their children, waiting to weigh their children and for health workers to measure levels of malnutrition using Middle Upper Arm Circumference bands. I was shocked and saddened to meet a five-year-old girl who weighed 11.3kg, the weight of my 22-month-old son. The children then went on to a shady tent for other volunteers to check they were able to hold down food and to receive their treatment. They were also checked for other infectious diseases, such as pneumonia, diarrhoea and malaria. If the child needed urgent medical attention, we arranged transport to get them to the nearest medical facility – over 80km away.
We have worked closely with the Kenyan government and other partners** in our pilot, with the Kenyan Ministry of Health providing leadership in the development of the study. Our joint aim is to use our Turkana learnings to influence how care is delivered closer to home for other malnutrition-prone areas of the country. It is our aim that, thanks to this approach combining treatment in health facilities and in the community, we will be able to reach 70% of children in need. Our work is also informing our approach in Somalia and Yemen, and vice versa, creating a body of evidence about the value of community-level treatment. The costs are relatively low, and the potential for influence is great. We are looking forward to more lifesaving work from the Global Malnutrition Initiative Board in 2020.
* Acute malnutrition is also known as ‘wasting’, when children are thin for their height because of acute food shortages or disease. Acute malnutrition is characterised by a rapid deterioration in nutritional status over a short period of time in children under five years of age.
**Action Against Hunger, International Rescue Committee, UNICEF and the World Food Programme