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More than 224 million children around the world last year suffered from malnutrition
by Medicins Sans Frontieres / Doctors Without Borders
More than 224 million children around the world last year suffered from malnutrition. It is the underlying contributing factor in nearly half of the deaths of children under five years of age.
Malnutrition can lead to a weakened immune system meaning children are more vulnerable to disease. These diseases can lead to further malnutrition, creating a vicious cycle of malnutrition and disease. MSF first introduced specific therapeutic foods to treat malnutrition on a large scale as long ago as 2005, which has been widely used since; but access to specific and necessary nutrition remains one of the major challenges in reducing child mortality, especially in conflict-affected countries, where they are most vulnerable.
July 2018
Tackling malnutrition in Am Timan, Chad
It’s 7.30 in the morning and the clouds in the sky are holding back the heat. Soon it will rise, forcing people under the trees to find relief in the shade. The day starts early in Am Timan, in the east of Chad. Am Timan hospital, which MSF has worked in since 2006, is already bustling with people. A chorus of babies’ wails echo out from the paediatric ward – the first sign that the little patients are all awake.
Dr Yannick Tsomkeng, an MSF doctor working at Am Timan hospital, starts his medical consultations in the therapeutic feeding unit, in the paediatric ward. "Children arrive in critical health conditions, so compromised that often it’s too late to save them and they pass away within 24 hours of being hospitalised.
Here they’re the first victims of the lack of food, poverty and dangerous nutritional habits,” Dr Yannick says. "At the beginning of the month, the therapeutic feeding centre had already exceeded its capacity. In the last week, 46 severely malnourished children, all suffering from medical complications, have been hospitalised."
By May, the nutritional feeding centre run by MSF, was already over its capacity of 60 beds, with 325 malnourished children admitted in that month alone.
It’s expected that this number will only increase over the coming months. But despite the high numbers of children requiring treatment, and the strain this puts on medical staff, the crisis is not unexpected; nor is it the first time the region has been hit by such worrying numbers of undernourished children.
From May to September each year, hundreds of thousands of people in Chad and in the entire Sahel region endure extreme food insecurity due to the lean period, a result of the dry season coupled with low food stocks. A recurrent nutritional crisis has just started in Chad’s Salamat region, and has spread to other parts of the country.
Fanna, 19 years old, sits on a bed in the nutritional centre with her baby. She struggles to feed her three children. “My boy was sick. He couldn’t eat at all. He kept on vomiting. After four days, he was so weak that he couldn’t react and I decided to bring him to the hospital. It’s hard to stay in the hospital for several days, when there’s no one who can look after the other children,” Fanna says, holding Moussa, eight months old.
Moussa doesn’t complain, despite his feeding tube, which seems so big on his gaunt face. He’s too feeble even to cry. He stares at people around him, with his big brown eyes, in visible pain. He’s been hospitalised due to severe malnutrition and complications.
“I knew there was a nutritional programme in the hospital because my oldest daughter has been hospitalised before, because she was malnourished. We eat once per day. The food is never enough, so my children often get sick. And now it’s even worse, since the harvest is over,” Fanna says.
This food emergency is the result of several factors. Inadequate nutritional practices, climate change, difficult access to land and drinking water, and the poor education and fragile health sys-tems in a country which is in the midst of a deep economic crisis.
In 2017, the nutritional situation deteriorated significantly and the lean season arrived early, throwing nearly 900,000 people into severe food insecurity, according to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Of the country’s 23 regions, 12 have now been declared as facing a ‘nutritional emergency’.
The prevalence of severe acute malnutrition has exceeded the emergency threshold by two per cent in 15 regions. In a country with the sixth highest child mortality rate in the world, the first victims of this cyclical nutritional crisis are inevitably children under the age of five, who are the most vulnerable. In Chad, malnutrition is one of the main causes of child mortality and one child in seven dies before her or his fifth birthday, also according to OCHA.
In order to combat these high mortality rates, in the nutritional feeding centre in Am Timan hospital, during their treatment patients receive special food to help them recover their appetites and responsiveness. They’re fed with therapeutic milk containing sugar, oil, minerals and vitamins, and with a high-protein peanut paste fortified with vitamins and minerals. The children admitted to this programme have a very low weight for their height and severe muscle wasting. They may also have nutritional oedema – characterised by swollen feet, face and limbs. The hope is that they can be discharged when they’re able to eat again, without medical assistance.
When their patients finally reach a stable level of health, MSF teams combine medical treatments with a daily session of cognitive stimulation. Severely malnourished children may have mental and behavioural developmental delays that, if left untreated, can become the most serious lasting consequence of malnutrition.
Emotional and physical stimulation through play can significantly reduce the risk of mental deficiencies and irreversible effects of prolonged malnutrition. For this reason, MSF teams organise ‘stimulation sessions’ every day, with various games for mothers and children undergoing nutritional treatment.
“We realise, day after day, how important play and maternal care are as part of the recovery process. During the stimulation sessions, mothers are encouraged to play with their children using toys, and to interact with them in other playful activities. The results of this are touching. We see children recovering their reactiveness. Above all, they smile and play again together. It’s so important to involve parents and to encourage the emotional care of children,” explains Aya Sonoda, MSF information and education coordinator in Am Timan.
To tackle the nutritional crisis during its peak in the lean season, MSF teams are supporting three health centres in Am Timan to screen and treat malnutrition. They’ll be present until the end of October 2018 to treat malnourished patients with medical complications.
* In more than 70 countries, Médecins Sans Frontières provides medical humanitarian assistance to save lives and ease the suffering of people in crisis situations.

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Ending violence against children: a call to action
by The Lancet, End Violence Aganst Children
Global Partnership to End Violence Against Children, agencies
Violence in all forms is ubiquitous, increasingly visible, and recognised as a public health problem worldwide. Violence against children is a human rights violation and places huge costs on individuals and society.
The magnitude and devastating burden of such violence globally is immense; violence affects more than 1 billion children every year, and occurs in every country and community.
In 2006, the UN published a report on violence against children, and in 2011 the UN Committee on the Rights of the Child published general comment 13 on the “right of the child to freedom from all forms of violence”; however, many issues related to the implementation of violence prevention programmes have not been addressed.
Data from high-income countries show that the burden and long-lasting consequences (including intergenerational effects) of violence against children are considerable both to children themselves and to society at large, and are likely to be greatly amplified in low-income and middle-income countries.
Evidence over the past 30 years—from neuroscience, developmental psychology, epigenetics, social science, and epidemiology—shows that violence against children contributes to social, emotional, physical, and cognitive impairments and high-risk behaviours leading to disease, disability, social problems, and premature mortality.
Recognising an ethical, public health, and human rights imperative to respond to this pressing issue, a coalition comprising the International Society for Social Pediatrics and Child Health (ISSOP), the International Society for the Prevention of Child Abuse and Neglect (ISPCAN), and the International Pediatric Association (IPA) produced a position statement—Violence against children of the world: burden, consequences and recommendations for action. The statement, a call to action to policy makers and practitioners, was launched in Lahore, Pakistan, in November, 2017, at the inaugural South Asia Conference on Child Rights.
The past 2 years have seen the international community align around the issue of violence against children, its scale, the immense burden in terms of pain and suffering, and the urgency for collective action.
Our main objective with this statement is to broaden the narrow perspective of violence against children. The focus of peoples understanding of violence should be shifted to make practitioners and policy makers think about the wide context of violence against children and families and to recognise and respond to the myriad forms of violence affecting children across the world.
We redefine the agenda on violence against children with a focus on child rights and highlight the need to move from evidence to policy.
We acknowledge the primary importance of structural violence and describe typologies of violence specifically pertinent to children and young people globally, including child maltreatment; bullying, cyber violence, and corporal punishment; domestic and family violence; institutional violence; child labour; armed conflict; and harmful cultural and traditional practices.
Children are disproportionately affected by widespread conflict, which is possibly the most visible form of violence globally as images of conflict frequently include images of children.
We address the intersectionality between different types of violence, for example, children exposed to armed conflict, whether directly or remotely; the intersections between violence against women and violence against children; and the gender dimensions of violence against children.
In 2016, ten major international organisations and campaigns launched INSPIRE, an evidence-based resource package of strategies to end violence against children.
The strategies include implementation and enforcement of laws; norms and values; safe environments; parent and caregiver support; income and economic strengthening; response and support services; and education and life-skills.
The Know Violence report, Ending violence in childhood, gathered the best available evidence, mostly from low-income and middle-income countries, of the burden and scale of violence against children.
The report highlighted the importance of prevention as the only feasible response on a global scale. Building on this previous work, we are calling for a child rights-based response to violence against children that requires multisectoral action and involves not only prevention, but also treatment and rehabilitation of the effects of such violence.
A rights-based response involves all children, everywhere, with their voices heard and taken seriously. A child''s right to survival, health, wellbeing, and development to the fullest potential is paramount and must be fulfilled.
Although the role of the health sector, along with those in justice, welfare, and education, are essential in achieving this goal, the sustainable development goals are explicit in calling for multisectoral policies and intersectoral collaboration. Efforts should be coordinated and prioritised effectively.
Priorities for ending violence against children
Recognise armed conflict as a major form of violence against children and address the needs of children living in humanitarian contexts
Adopt a public health model incorporating population-based studies and improved monitoring and surveillance of violence
Integrate the common concerns of violence against women and children into policy and community programmes for broader outreach and support for those affected
Train all professionals working in child protection, as part of preservice and ongoing professional development, and link such training to awarding credentials to professionals through inter-agency partnerships
Highlight the role of hospitals, health-care facilities, and schools as settings for prevention, early identification, and intervention, in programmes and systems through inter-disciplinary collaborations and outreach
Generate relevant public policies with intersectoral action and effective child and youth participation, to support large-scale interventions
The time has come to end violence against children and we are calling for action to achieve this globally and within a single generation, recognising that the benefits will continue to accrue across several generations.
All violence against children is preventable and no violence against any child is justifiable. In 2015 the global community committed to ending such violence by 2030 in Sustainable Development Goal 16. Public health approaches are crucial to address all causes and consequences of violence against children, whether the violence occurs in the home, community, or society.
The mantle of a shared agenda to end violence against children should be taken up as an imperative in promoting and protecting children''s rights and benefiting generations to come.

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