00Introduction01Community health centre02Triage03Emergency04Acute Care05Nutritional transition06Cooking Workshop07Discharge08Home


Seven-month-old Youssouf has been sick for a month or more. Like many rural families here his mother tried traditional treatments first, but when they didn’t work she brought Youssouf to their nearest health centre in Molobala. The nurses there want a doctor’s opinion, because complicated cases are harder for them to diagnose.
  • Name : Youssouf Traoré
  • Age : 7 months
  • Sex : Male
  • Village : Bouba
  • Preliminary diagnosis : Malnutrition and suspected pneumonia
  • Under Treatment : 7 days
Youssouf lives in Bouba village. His mother decided to take him to the Molobala health centre, where she knew she could find medical care.

Diagnosed at the health centre

Youssouf’s passed an appetite test, which augurs well for starting therapeutic nutritional care. But his lungs don’t seem to be working as they should. Instead, Youssouf’s using muscles in his chest to help him breathe, and exhausting himself in the process. This points to a severe chest infection— the doctor says severe pneumonia. With this complication, it’s time for Youssouf to be referred to a higher level of care.
Youssouf needs to be referred up through the network to Koutiala hospital, 1 hour 40 minutes away.
Youssouf - Diagnosed at the health centre
Admissions nurse Job Coulibaly explains the triage process.

An “emergency” at triage

The triage team becomes very busy processing this latest influx of cases. Youssouf is a “priority” based on his level of malnutrition (moderately acute), but with his severe respiratory distress he’s pushed into the “red” category, alongside Tiemoko and Fatoumata. For Youssouf, the next step involves a closer look at his pneumonia diagnosis, in ER.

Reviewed in Emergency

The ER doctor weighs up Youssouf’s assessments so far, to decide the course of treatment. Youssouf’s patchy immunisation history may not link directly to his pneumonia today, but it has increased his risk of getting sick overall. He’s obviously in severe respiratory distress, but there could be something other than severe pneumonia at play. Youssouf will continue the antibiotics started in Molobala, to see how he progresses.
Respiratory tract infection including pneumonia is one of the top three reasons for hospitalisation in Médecins Sans Frontières' joint project, and the leading infectious cause of death in under-fives worldwide..

Nutritional therapy in acute care

Youssouf now starts his other treatment regime, to address his moderate but acute malnutrition. He starts on a high-calorie, nutrient-dense therapeutic milk, known as F75 due to the number of kilocalories in 100ml. Youssouf is able to drink this from a cup, but weaker children are fed through a tube. A child can spend 1-3 days under this phase of care.
  • Youssouf
  • Youssouf
  • Youssouf

Progress report good on Day 4

Yesterday, Youssouf transitioned from milk to a therapeutic peanut paste. This morning the scales say he’s lost 200 grams, and it could be the effort of breathing and coughing that has held him back. But his clinical progress augurs well, and the doctor sums it up: with his fever down, and his lungs all clear, Youssouf should be able to go home in two to three days.

Cooking tips for working mothers

On Wednesday, Youssouf and his mother attend a cooking workshop, a nurse-led initiative to share nutrition tips and recipe ideas with the mothers who typically work long hours cultivating their fields, and sell much of their hard-won produce for income. The nurses hope this meal preparation advice will put a dent in the number of children readmitting to the malnutrition program. Today's recipe is meat soup.

Completing the loop in the nutrition program

It’s been seven days, and Youssouf is now recovered from the pneumonia and ready to go home. He doesn’t need any more antibiotics, but he’ll continue to receive nutrition treatment via the community-based feeding program run out of Molobala health centre, where we first met him. He takes home a week’s worth of peanut paste until his first appointments there.
“At last he isn't coughing as much as before, he has really improved. And he's maintained yesterday's weight. So I'm counting on him leaving today for the community-based feeding program.”- Dr Issa Diakite, MSF

Visiting grandmother on the way home

First stop is Youssouf’s grandmother’s house, where he’s reunited with his extended family. He and his mother will spend a few days here before going back to Bouba.