An Extension Nutrition Action training session at Wrobone Mothers' Group, Liberia. Photo: Nora LorekAn Extension Nutrition Action training session at Wrobone Mothers' Group, Liberia. Photo: Nora LorekAn Extension Nutrition Action training session at Wrobone Mothers' Group, Liberia. Photo: Nora Lorek

In pictures: how we combat malnutrition

In pictures: how we combat malnutrition

Malnutrition is 100% preventable. Yet it affects millions of people worldwide and remains responsible for more ill-health than any other cause, particularly in women and children. This is one of the reasons why so much of our work focuses on the prevention and treatment of malnutrition. This photo story illustrates what our work consists of, revealing exactly how we try to combat malnutrition in some of the world’s poorest and most vulnerable communities.

1. Home gardens

The best way to prevent malnutrition is to eat a healthy and varied diet. However, for those living in some of the world’s poorest countries who can’t grow, afford, access, or consume the right foods and nutrients, this can be a challenge.  

This is where Concern steps in.

 As part of the Graduation Programme all participants are given seeds and training on how to grow food in their gardens. Photo: Abbie Trayler-Smith
A home garden in Cibitoke, Burundi. Photo: Abbie Trayler-Smith

Home gardens are essentially vegetable patches designed to maximise the production of food throughout the year - even in difficult conditions. Concern delivers the seeds and training people need to grow their own kitchen garden and provides them with nutritious vegetables such as spinach and tomatoes. Through this, they have a healthy source of food all year round.

Cecelia and Teneh in Teneh's vegetable garden. They have received training and support from Concern to grow their own vegetables. Photo: Nora Lorek
Cecelia and Teneh in Teneh's vegetable garden. Photo: Nora Lorek
Cecelia Morris, left, and Teneh Morris, right, in Teneh's vegetable garden. Photo: Nora Lorek
Cecelia Morris, left, and Teneh Morris, right, in Teneh's vegetable garden. Photo: Nora Lorek
Chawada Aboubacar shows her vegetable garden to Concern staff member Mounkaîla Habibou. Photo: Apsatou Bagaya
Chawada Aboubacar shows her vegetable garden to Concern staff member. Photo: Apsatou Bagaya
Marie shows other women how to prepare more nutritious meals and set up a kitchen garden – in order to tackle childhood malnutrition. Photo: Darren Vaughan
Marie shows how to prepare more nutritious meals and set up a kitchen garden. Photo: Darren Vaughan
Euphemia Inina waters her home garden in Mabayi, Cibitoke. Photo: Abbie Trayler-Smith
Euphemia Inina waters her home garden in Mabayi, Cibitoke. Photo: Abbie Trayler-Smith

Zenon Ndikuriyo, who works as a Health and Nutrition Coordinator for Concern in Burundi, describes how home gardens work.

The [home garden] is a simple structure; circular and raised above the ground with an inner circular basket in the centre where compostable waste is added to nourish the soil.

Zenon Ndikuriyo
Community Health Worker Jeannette Icimanishatse. Photo: Abbie Trayler-Smith / Concern Worldwide
Community Health Worker Jeannette Icimanishatse. Photo: Abbie Trayler-Smith

The gardens produce an array of vegetables ranging from cabbages to carrots. They provide a nutritious and diversified diet to families, especially children under five for whom nutrition is so crucial.

Zenon

2. Ready to use therapeutic food (RUTF)

For decades, health and humanitarian organisations – including Concern – searched for alternatives to treating malnourished children during crises and emergencies to replace the traditional milk-based diet provided through clinical settings.

Children with malnutrition are given a supply of RUTF. Photographer: Darren Vaughan
Children with malnutrition are given a supply of RUTF. Photographer: Darren Vaughan

Many factors prevent people going to health facilities for treatment. These include:

  • The distance from and time spent going to the centre and the cost of treatment and transport.
  • The duration of the therapeutic milk treatment (up to five weeks), which prevents parents and caregivers from looking after other children or going to work, as it must be administered as an in-patient treatment.
  • The dangers surrounding needing water to administer treatment due to waterborne bacteria and disease being rife.
Khadra* and her baby girl Akon* relax in the mother and baby room at the Concern Worldwide Nutrition Clinic in a POC in Juba, South Sudan. Photo: Abbie Trayler-Smith
Khadra* and her baby Akon* relax in the mother and baby room in a POC. Photo: Abbie Trayler-Smith
Concern nutrition worker, Naima Islow, dispensing emergency therapeutic food to mother *Hani at an Outpatient Therapeutic Centre . Photo: Mohamed Abdiwahab / Concern Worldwide.
Concern dispensing emergency therapeutic food. Photo: Mohamed Abdiwahab / Concern Worldwide.
Concern staff work tirelessly at a nutrition clinic in South Sudan. Photo: Abbie Trayler-Smith
Concern staff work tirelessly at a nutrition clinic in South Sudan. Photo: Abbie Trayler-Smith
Maria Hussein and baby Kali (18 months old) in Filtu Regional Hospital, Somali Region, Ethiopia. Kali is being treated for severe acute malnutrition with the support of International NGO Concern Worldwide. Photo: Jennifer Nolan/ Concern Worldwid
Maria Hussein and baby Kali in Filtu Regional Hospital, Somali Region, Ethiopia.

The discovery of RUTF in the late 1990s, and then introduced as the main weapon against malnutrition during the early 2000s, has changed the future of treating malnourished children forever.

Baby Kali (18 months old) in Filtu Regional Hospital, Somali Region, Ethiopia. Kali is being treated for severe acute malnutrition with the support of International NGO Concern Worldwide. Photo: Jennifer Nolan/ Concern Worldwide
Baby Kali is being treated for severe acute malnutrition with the support of Concern. Ethiopia. Photo: Jennifer Nolan/ Concern Worldwide

Why?

  • It provides all the nutrients required for recovery.
  • It has a good shelf life, and does not spoil easily - even after opening.
  • Since RUTF is not water-based, the risk of bacterial growth is very limited, and consequently it is safe to use without refrigeration at household level.
  • Parents can treat babies receiving RUTF at home. This reduces cost and time away from home and consequently increases the likelihood of their mums bringing them into a clinic to receive their treatment supply in good time.
  • And, most important of all, malnutrition death rates can be cut in half.

 

3. Community Management of Acute Malnutrition (CMAM)

Khamissa, here with her daughter, is a Concern-trained Community Health Volunteer in Doroti, Chad. Photo: Lucy Bloxham
Khamissa is a Concern-trained Community Health Volunteer in Doroti, Chad. Photo: Lucy Bloxham

For almost 20 years, our CMAM approach to tackling acute malnutrition has been extremely effective - so much so that it has become the preferred approach for tackling malnutrition internationally. The central principle of CMAM is to treat malnourished children in their homes. This approach reaches more children and reduces the risks and expenses in travel for parents, guardians, malnourished children and their siblings.

Supplies of ready-to-use supplementary food used to treat children with moderate acute malnutrition. Photo: Darren Vaughan
Supplies of ready-to-use supplementary food used to treat malnourished children. Photo: Darren Vaughan
Around 40 mums with their babies and young children attend a weekly health screening at Bekadili Health Facility. Photo: Chris de Bode
Mums and their children attend a health screening at Bekadili Health Facility. Photo: Chris de Bode
After Nasibo Asuran gave birth to her eight-month-old daughter, Ramah – a Concern trained community health volunteer – was sent to ensure that her baby had a healthy start to life. Kenya. Photo: Peter Caton/Concern
After giving birth, Nasibo Asuran was sent a Concern-trained community health volunteer. Kenya. Photo: Peter Caton/Concern

Malnourished children who have been admitted to the CMAM programme are provided with weekly medical treatment and given one week's supply of therapeutic food to take home - RUTF. And, as we have seen, this micronutrient-enriched food is the key to success.

4. Ensuring access to clean safe water and good sanitation to prevent illness

So much of the world’s water is contaminated. Drinking contaminated water, which contains bacteria from human as well as animal poo, often leads to diarrhoea, meaning that any nutrients eaten are not absorbed by the human body. This poses a huge health risk, but if there is no other way to get clean water then people are forced to take the risk.

Due to the severity of the drought in Kenya, Budha Tura has been forced to gather water from a muddy puddle. Photo: Jennifer Nolan
Due to the severity of the drought in Kenya, Budha has been forced to gather water from a muddy puddle. Photo: Jennifer Nolan

Likewise, when going to the toilet, many people in the countries we work in do not have any soap or water to wash their hands. Consequently, when feeding a baby, making food or eating it themselves, they end up ingesting the bacteria, which can lead to more diarrhoea, or at the very least a poorly tummy. However, some simple solutions save many people’s lives.

WASH stands for Water, Sanitation and Hygiene.

40-year-old widow Tayma* receives a dignity kit from Concern. It consists of a torch, bucket and lid, soap, flip flops, shawls, underwear and sanitary pads.
40-year-old widow Tayma* receives a dignity kit from Concern. Photo: Abir Abdullah

The “W” can mean drilling a borehole and installing a hand pump; or installing a structure to take and treat water coming from an underground spring. Where something technical like this is not possible, small water purification tablets can treat the water, killing all the bacteria and keeping it clean.

15 year old Liliana Mwenza wa llunga says the new water point and other interventions by the Concern-led WASH consortium in her village, Mulombwa, has had a very positive impact on family life. DRC. Photo: Kieran McConville/ Concern Worldwide
Liliana Mwenza wa llunga at a new water point constructed by a Concern-led WASH consortium. DRC. Photo: Kieran McConville/Concern Worldwide
15 year old Liliana Mwenza wa llunga says the new water point and other interventions by the Concern-led WASH consortium in her village, Mulombwa, has had a very positive impact on family life. DRC. Photo: Kieran McConville/ Concern Worldwide
Liliana Mwenza wa llunga says the new water point has had a very positive impact on family life. DRC. Photo: Kieran McConville/Concern Worldwide
15 year old Liliana Mwenza wa llunga says the new water point and other interventions by the Concern-led WASH consortium in her village, Mulombwa, has had a very positive impact on family life. DRC. Photo: Kieran McConville/ Concern Worldwide
Liliana Mwenza wa llunga says the new water point has had a very positive impact on family life. DRC. Photo: Kieran McConville/ Concern Worldwide

The “S” means making sure that people use a safe, clean toilet – and supporting people to build their own household latrine.

Toilet facilities in Bentiu's POC provided by Concern. Without proper sanitation, diseases can spread very quickly. Photo: Steve De Neef
Toilet facilities in a POC provided by Concern, South Sudan. Photo: Steve De Neef

And last but not least, the “H” means making sure that hygiene and specifically handwashing practices are correct – making sure that people understand why they should wash their hands, that they actually DO wash their hands, but also that they have the means to be able to do this properly with water and soap.

A tippy tap outside a woman's home in Chad. Photo: Lucy Bloxham
A tippy tap outside a woman's home in Chad. Photo: Lucy Bloxham
Marie-Chantal shows families how to improve hygiene in the house by using a tip-tap for hand washing. Photo: Darren Vaughan
Marie-Chantal shows families how to improve hygiene. Photo: Darren Vaughan
Two local men, Naaju and Rajesh are talking to each other happily while drinking water from water plant installed by Concern Worldwide. Photo: Black Box Sounds/ Concern Worldwide.
Two local men, Naaju and Rajesh are talking to each other happily while drinking water. Pakistan. Photo: Black Box Sounds/ Concern Worldwide.
Joella, 5, washes her hands using a tip-tap and soap in Burundi. Photo: Chris de Bode
Joella, 5, washes her hands using a tip-tap and soap in Burundi. Photo: Chris de Bode
Esperence washing her hands using a tip-tap with her two-year-old daughter Delphine. Photo: Chris de Bode
Esperence washing her hands using a tip-tap with her daughter Delphine. Photo: Chris de Bode

Campaigning for wider action on malnutrition

As well as our work on the ground to fight malnutrition, we are also campaigning for more action from the international community. This year, there is an important nutrition summit, which has the power to save and transform millions of lives. But we need world leaders to step up. 

Will you sign our petition asking the UK to commit to tackling global malnutrition at the summit?

The root cause; the root solution

Our goal of ending extreme poverty can only be achieved by tackling poverty’s root causes – and top among them is malnutrition. For many of the 50 years we’ve been operating, we have been leading the way with sector-defining programmes that are changing people’s lives for the better. And we will continue to do so for the next 50 years - or as long as we are needed.

 

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