Protecting and caring for children in Koutiala
In Koutiala, in southern Mali, severe acute malnutrition, malaria, diarrhoea, respiratory tract diseases and other so-called opportunistic infections are creating havoc in children aged 6 months to 5 years.
To reduce morbidity and infant mortality in a region that has very few health professionals, Médecins Sans Frontières (MSF) has been working in Koutiala in partnership with the Ministry of Health and Public Hygiene of Mali since 2009. With nearly 600,000 inhabitants Koutiala district, within the Sikasso region, is one of Mali’s most populous.
MSF has developed a simplified and cost-effective approach to protect and care for the youngest children, adapted to the needs of the population and replicable in similar contexts. The approach responds to health and nutrition needs together to combat the main causes of child mortality.
Improving the quality of care for children
The programme aims to improve the quality of individual care for children in all 42 health zones in the district (covering approximately 575,000 inhabitants, including 35,000 children aged 6-24 months and 165,000 children aged under 5 years). Five years into the programme the results are clear: thanks to vaccination, regular health monitoring, and the focus on preventing of malnutrition and malaria, mortality has been halved, and stunting reduced by one third.
MSF and the Ministry of Health have been working on several fronts, linking up each activity, to achieve these results.
First, the programme provides healthcare as close to the population as possible in the community health centres in five health zones, offering a free “package” of care for children under five years old: treatment and prevention of malnutrition, vaccination against the major infectious diseases, regular medical consultations for children aged from 1 to 24 months, and early treatment of malaria. A ready-to-use supplementary food is dispensed to healthy children aged 6-24 months to prevent malnutrition, alongside mosquito nets to prevent malaria.
Because some of the children need hospital-level care, MSF and the Ministry of Health are also partnering in the paediatric department of Koutiala Hospital (Koutiala Referral Hospital, or CSREF). Bed capacity in the paediatric wards varies from 200 beds (off-peak) to 400 beds (at the height of the malaria season). The hospital also houses an intensive nutrition unit. At the end of their treatment, the nutrition patients can return home to be followed in the nearest health centre until their full recovery.
The teams conduct year-round nutritional screening of children aged 6-59 months using the mid upper arm circumference band (MUAC), and undertake systematic assessment of nutritional oedema in the most serious cases.
If a child is acutely malnourished, he or she is referred to the URENAM or URENAS (Nutritional Rehabilitation and Education Unit for Moderate or Severe Acute Malnutrition) in a community health centre. If the child has oedema or severe acute malnutrition with complications, he or she is immediately referred to the URENI (Intensive Nutritional Rehabilitation and Education Unit) attached to Koutiala hospital.
Meanwhile, MSF and the Ministry of Health have established a Seasonal Chemoprevention (SMC) strategy against malaria, to reduce the impact of this disease on children already weakened by malnutrition or affected by other infections. This preventive campaign is conducted during the malaria peak in complement to outreach by volunteer “malaria agents”, whose role is to detect and treat uncomplicated malaria in 36 villages during the rainy season.
Research and training to strengthen quality of care
Lastly, a training and research component has been developed, bringing in Malian paramedical trainees and medical students, and implementing several epidemiological studies under the auspices of Epicentre. The bacteriological laboratory inaugurated in May 2014, coupled with reorganisation of the blood bank, has further strengthened the hospital’s services.
1 Created in 1986 by MSF doctors, Epicentre is a satellite association of MSF dedicated to clinical and epidemiological research and training.
Expanding the network of prevention and care
Building on the results to date, MSF and the Ministry of Health are working on extending the program, continuing to promote a comprehensive approach including the “paediatric package” of care and its components such as vaccination, regular medical follow-up and the prevention of malnutrition and malaria.
One objective is to better link the decentralised approach between the community health centres (currently five) and the paediatric department run by MSF within the Ministry of Health’s Koutiala Hospital. MSF and the Ministry are investigating how to gradually expand the reference network to other health centres or outpatient settings, while also expanding the network of partners to other national and international associations and organisations.
The programme will also continue to train community health workers and hospital staff, introduce improved systems including the organisation of care, to use research to monitor and evaluate, but also to innovate.
* All statistics are for 2014
Last update December 2015. This overview will be updated over time to reflect the evolution of the programme in Koutiala, but in the meantime brief updates will be shared via Live News.